Level I nodal positivity as a factor for involvement of the submandibular gland in oral cavity carcinoma: A case series report

Introduction: The routine practice of neck dissection in the surgical management of oral carcinoma has evolved into a more functionally conservative approach. Over time, the rationale for removal of the submandibular gland has been questioned. Routine extirpation of the submandibular gland can aggravate the xerostomia experienced by many patients, significantly affecting their quality of life. Objective: The objective of the present study was to determine the incidence of submandibular gland metastases in oral cavity carcinoma and to identify possible factors that may affect their involvement. Methods: A total of 149 cases of oral carcinoma presenting at a private tertiary care hospital in Karachi, Pakistan, over the course of 1 year were reviewed retrospectively. Results: Histopathological data showed that the submandibular gland was involved in 7 (4.7%) cases. Involvement of level I lymph nodes was found in all of the cases. Direct extension of primary tumor was noted in two cases when the primary tumor was in the floor of the mouth. Conclusion: The results suggest that preservation of the submandibular gland during neck dissection for oral carcinoma can be practiced safely when there is no evidence of direct extension of the primary tumor toward the submandibular gland or when there is no clinical or radiological evidence of neck disease in level I. Presence of pathological lymph nodes in level I requires caution when contemplating preservation of the submandibular gland

Current state of knowledge of basic life support in health professionals of the largest city in Pakistan: A cross-sectional study

Background: Basic Life Support (BLS) is the recognition of sudden cardiac arrest and activation of the emergency response system, followed by resuscitation, and rapid defibrillation. According to WHO, Pakistan has one of the highest mortality rates from accidental deaths therefore assessment and comparison of BLS knowledge in health professionals is crucial. We thereby aim to assess and compare the knowledge of BLS in doctors, dentists and nurses. Methods: A multi-centric cross-sectional survey was conducted in Karachi at different institutions belonging to the private as well as government sector from January to March 2018. We used a structured questionnaire which was adapted from pretested questionnaires that have been used previously in similar studies. Descriptive statistics were analyzed using SPSS v22.0, where adequate knowledge was taken as a score of at least 50%. P \u3c 0.05 was considered as significant. Logistic regression was used to identify the factors affecting the knowledge regarding BLS in health care professionals. Results: The responders consisted of 140 doctors, nurses and dentists each. Only one individual (dentist) received a full score of 100%. In total, 58.3% of the population had inadequate knowledge. Average scores of doctors, dentists and nurses were 53.5, 43.3 and 38.4% respectively. Doctors, participants with prior training in BLS and those with 6 to 10 years after graduation were found to be a significant predictor of adequate knowledge, on multivariate analysis. Conclusion: Even though knowledge of BLS in doctors is better than that of dentists and nurses, overall knowledge of health care professionals is extremely poor. Present study highlights the need for a structured training of BLS for health care workers

Comparison of different cephalometric variables in patients with and without history of snoring

Background: Obstructive sleep apnea syndrome has a high prevalence among adults. Cephalometric variables can be a valuable method for evaluating patients with this syndrome. The objective of this study is to evaluate and compare the craniofacial variables in subjects with and without snoring by cephalometric analysis.Methods: 40 patients were included in the study who were divided into two groups; group 1 of 20 snoring patients and group 2 control group of 20 non-snoring patients and were evaluated and compared for various cephalometric variables.Results: The distance from the hyoid bone to the mandibular plane (MP-H) was the only variable that showed a statistically significant correlation between two groups.Conclusions: Cephalometric variables are useful tools for evaluating the patients with snoring who are predisposed to obstructive sleep apnoea. The distance from the hyoid bone to the mandibular plane showed a statistically significant correlation between two groups

Aflatoxins and Hepatitis B, C Viral Associated Hepatocarcinogenesis

Hepatocellular carcinoma is a serious human disease with fatal consequences. The most distressing aspect of hepatocellular carcinoma is the limited improvement in mortality (mortality rate of more than 90%). At present, the underlying molecular mechanisms are not well understood and treatment options are often of limited efficacy. This review presents our current understanding of the burden of hepatocellular carcinoma on human health, pathogenesis and pathophysiology, and molecular mechanisms associated with the disease, as well as our knowledge of the physical barriers, cellular mechanisms and molecular elements that may be targets for therapeutic interventions and/ or the development of preventative measures. As the proposed findings present a major risk to public health, it is hoped that robust intervention measures will be introduced for aflatoxins monitoring and reduction in diet

Proprotein convertase subtilisin/Kexin type-9 (PCSK-9) inhibitors induced liver injury - a retrospective analysis.

Background: Proprotein convertase subtilisin/Kexin type 9 (PCSK-9) inhibitors induced liver dysfunction in patients with or without previous liver injury, and this is not well discussed in the previous literature. Methods: A total sample of 202 patients were retrospectively reviewed at the University of Missouri, Kansas City, from the year 2015 to 2018 based on predefined selection criteria. Inclusion criteria involved patients with dyslipidemia, with or without PCSK-9 inhibitors, liver function tests and lipid profile at baseline and at a mean of 6-month follow-up. The variables, including age, gender, and confounding factors like other medications (statin, oral antidiabetic, and antihypertensive) induced, or chronic secondary liver diseases causing liver injury were taken into consideration. Exclusion criteria included patients without dyslipidemia. Results: The mean age of the study population was 64 ± 11 years (63% males and 37% females). The lipid profile including triglyceride and cholesterol levels during 6-month followup visit showed a mean of 184 ± 260 and 163 ± 50 mg/dL as compared to that at baseline of 227 ± 603 and 181 ± 70 mg/dL, respectively. In terms of clinical efficacy, a 6-month follows-up showed a drop in triglyceride and cholesterol levels by 38 and 15 mg/dL, respectively. A liver function test at 6 months in patients taking PCSK-9 inhibitors showed an increase in alanine transaminase (ALT) and aspartate transaminase (AST) by 5.8 mg/dL (p = 0.037) and 6.2 mg/dL (p = 0.008), respectively, from baseline values. Conclusion: PCSK-9 inhibitors should be used cautiously with a follow-up liver function test

Assessment of apparent diffusion coefficient values as predictor of aggressiveness in peripheral zone prostate cancer: comparison with Gleason score

Purpose. To determine association between apparent diffusion coefficient value on diffusion-weighted imaging and Gleason score in patients with prostate cancer. Methods. This retrospective case series was conducted at Radiology Department of Aga Khan University between June 2009 and June 2011. 28 patients with biopsy-proven prostate cancer were included who underwent ultrasound guided sextant prostate biopsy and MRI. MRI images were analyzed on diagnostic console and regions of interest were drawn. Data were entered and analyzed on SPSS 20.0. ADC values were compared with Gleason score using one-way ANOVA test. Results. In 28 patients, 168 quadrants were biopsied and 106 quadrants were positive for malignancy. 89 lesions with proven malignancy showed diffusion restriction. The mean ADC value for disease with a Gleason score of 6 was 935mm(2)/s (SD = 248.4mm(2)/s); Gleason score of 7 was 837mm(2)/s (SD = 208.5mm(2)/s); Gleason score of 8 was 614mm(2)/s (SD = 108mm(2)/s); and Gleason score of 9 was 571mm(2)/s (SD = 82mm(2)/s). Inverse relationship was observed between Gleason score and mean ADC values. Conclusion. DWI and specifically quantitative ADC values may help differentiate between low-risk (Gleason score, 6), intermediate-risk (Gleason score, 7), and high-risk (Gleason score 8 and 9) prostate cancers, indirectly determining the aggressiveness of the disease

Farmers’ social networks’ effects on the sustainable production of fresh apples in China’s Shaanxi province

Introduction: Recently, the public and policymakers have acquired knowledge of the detrimental effects of pesticide use in agriculture. These include the threat to the health of chemical applicators and the threat that pesticide residues pose to the safety of food. The present study focuses on the farmers’ social networks from a new perspective, along with the farmers’ concurrent agricultural business and their impact on the farmer’s safe production behavior.Methodology: The Endogenous Switching Probit Regression model and Binary Probit Group Regression model were employed for the empirical analysis of survey data collected from 585 households in the Xianyang, Yan’an, and Weinan districts of Shaanxi province, China.Results and Discussion: The results revealed that farmers’ social networks can greatly affect farmers’ safe production behavior. Additionally, we noted that the farmers’ social networks may play a positive role in promoting the farmers’ safe production behaviors of both concurrent agricultural business and non-concurrent agricultural business farmers. Moreover, their correlation coefficients were found significant at a confidence level of 5%. Our findings suggest that the government needs to construct social networks among farmers by setting up a communication platform and promoting the acquaintance of safe production through reciprocal culture

Dipyridamole-Induced Stemi: Case Report and Review of the Literature

Dipyridamole nuclear myocardial perfusion imaging is a safe and useful modality to assess for myocardial ischemia. It is the modality of choice for cardiac risk stratification in patients unable to exercise. Intravenous dipyridamole causes coronary vasodilation and may yield heterogeneity of coronary blood flow in significant coronary artery disease. Ischemic electrocardiographic changes following pharmacologic stress testing are less likely compared to exercise stress tests. Ischemia more likely presents in the form of ST depression, with ST-elevation being exceedingly rare. We present a case of a 73-year-old patient who developed ST-elevation myocardial infarction following pharmacologic stress testing

Thin-film carbon nitride (C2N)-based solar cell optimization considering Zn1−xMgxO as a buffer layer

Carbon nitride (C2N), a two-dimensional material, is rapidly gaining popularity in the photovoltaic (PV) research community owing to its excellent properties, such as high thermal and chemical stability, non-toxic composition, and low fabrication cost over other thin-film solar cells. This study uses a detailed numerical investigation to explore the influence of C2N-based solar cells with zinc magnesium oxide (Zn1−xMgxO) as a buffer layer. The SCAPS-1D simulator is utilized to examine the performance of four Mg-doped buffer layers (x = 0.0625, 0.125, 0.1875, and 0.25) coupled with the C2N-based absorber layer. The influence of the absorber and buffer layers’ band alignment, quantum efficiency, thickness, doping density, defect density, and operating temperature are analyzed to improve the cell performance. Based on the simulations, increasing the buffer layer Mg concentration above x = 0.1875 reduces the device performance. Furthermore, it is found that increasing the absorber layer thickness is desirable for good device efficiency, whereas a doping density above 1015 cm−3 can degrade the cell performance. After optimization of the buffer layer thickness and doping density at 40 nm and 1018 cm−3 , the cell displayed its maximum performance. Among the four structures, C2N/Zn0.8125Mg0.1875O demonstrated the highest PCE of 19.01% with a significant improvement in open circuit voltage (Voc), short circuit density (Jsc), and fill factor (FF). The recorded results are in good agreement with the standard theoretical studies.Web of Science111art. no. 9