The 10th Biennial Hatter Cardiovascular Institute workshop: cellular protection—evaluating new directions in the setting of myocardial infarction, ischaemic stroke, and cardio-oncology

Due to its poor capacity for regeneration, the heart is particularly sensitive to the loss of contractile cardiomyocytes. The onslaught of damage caused by ischaemia and reperfusion, occurring during an acute myocardial infarction and the subsequent reperfusion therapy, can wipe out upwards of a billion cardiomyocytes. A similar program of cell death can cause the irreversible loss of neurons in ischaemic stroke. Similar pathways of lethal cell injury can contribute to other pathologies such as left ventricular dysfunction and heart failure caused by cancer therapy. Consequently, strategies designed to protect the heart from lethal cell injury have the potential to be applicable across all three pathologies. The investigators meeting at the 10th Hatter Cardiovascular Institute workshop examined the parallels between ST-segment elevation myocardial infarction (STEMI), ischaemic stroke, and other pathologies that cause the loss of cardiomyocytes including cancer therapeutic cardiotoxicity. They examined the prospects for protection by remote ischaemic conditioning (RIC) in each scenario, and evaluated impasses and novel opportunities for cellular protection, with the future landscape for RIC in the clinical setting to be determined by the outcome of the large ERIC-PPCI/CONDI2 study. It was agreed that the way forward must include measures to improve experimental methodologies, such that they better reflect the clinical scenario and to judiciously select combinations of therapies targeting specific pathways of cellular death and injury

Clinicopathological spectrum of neuroendocrine neoplasms; retrospective study at a tertiary care centre

Introduction: Neuroendocrine tumors are cancers that begin in specialized cells called neuroendocrine cells. Neuroendocrine cells have traits similar to those of nerve cells and hormone-producing cells. Neuroendocrine neoplasms (NENs) belong to a group of malignancies with poorly defined, confusing histology and nomenclature to match. Neuroendocrine cells (NE) are distributed throughout the body and hence NENs have been described in the central nervous system, respiratory tract, larynx, gastrointestinal (GI) tract, thyroid, skin, breast, and urogenital system. Among which gastrointestinal tract and lungs are the most common primary tumor sites.Materials and Methods: It was a retrospective cohort study conducted at the Department of General Surgery, JSS Hospitals, Mysuru from June 2014 to June 2019 (5 years). A series of 75 patients with NENs, data was collected through the administrative database, medical records, direct interview of patients. All those patients who were diagnosed to have neuroendocrine tumors incidentally detected/detected post-operatively through histopathological examination were included. All those patients diagnosed to have neuroendocrine tumors but deemed to be medically unfit for surgery were excluded from the study.Results: There were 75 cases of NENs diagnosed in the study period which included 44 male and 31 female patients in the age range of 13 to 80 years (mean: 54 years) Majority of them (80% ) were >45 years of age. The diagnosis was made on endoscopic biopsies in 41 cases and resected surgical specimens were available in 34 patients. Biopsy diagnosis was mostly made in NENs of GI tract whereas all the pancreatic, periampullary lesions, colon, appendix, breast were diagnosed on resected specimens.Conclusion: The duodenum followed by colorectal, stomach were found to be the most common sites of NENs. The majority of tumors are NET G1 and were classified based on WHO classification and most of the G3 tumors were not amenable to surgical clearance. 87% of the NENs were completely resectable, in our study. Still, limited available studies opine differently in most of the parameters pertaining to NENs. Hence, more studies with a large number of subjects, are required in this regard

Prevalence of hysterectomy among rural and urban women with and without health insurance in Gujarat, India.

This paper presents findings on hysterectomy prevalence from a 2010 cross-sectional household survey of 2,214 rural and 1,641 urban, insured and uninsured women in low-income households in Ahmedabad city and district in Gujarat, India. The study investigated why hysterectomy was a leading reason for use of health insurance by women insured by SEWA, a women's organisation that operates a community-based health insurance scheme. Of insured women, 9.8% of rural women and 5.3% of urban women had had a hysterectomy, compared to 7.2% and 4.0%, respectively, of uninsured women. Approximately one-third of all hysterectomies were in women younger than 35 years of age. Rural women used the private sector more often for hysterectomy, while urban use was almost evenly split between the public and private sectors. SEWA's community health workers suggested that such young women underwent hysterectomies due to difficulties with menstruation and a range of gynaecological morbidities. The extent of these and of unnecessary hysterectomy, as well as providers' attitudes, require further investigation. We recommend the provision of information on hysterectomy as part of community health education for women, and better provision of basic gynaecological care as areas for advocacy and action by SEWA and the public health community in India