External Laryngocoele or Anterior Jugular Vein Aneurysm (A Rare Clinical Entity): A Paradox Solved by A Few Simple Non-Invasive Radiological Tests

Introduction     The differential diagnosis of a cystic upper neck mass that becomes prominent on coughing, straining, breath holding, or Valsalva manoeuvre includes mediastinal tumours and cysts, external laryngeal diverticula, and jugular venous aneurysms. Jugular venous aneurysms, while extremely rare, must be considered. We report the fifth case of anterior jugular aneurysm in an adult patient.   Case Report   A 55 year old female patient presented with a swelling in the upper part of right side of neck near the greater cornu of hyoid bone. The swelling increased with Valsalva, straining and while stooping forward. Clinically it was thought to be an external laryngocoele. However Colour Doppler Ultra-sonography and C.T angiogram of neck established it as of anterior jugular venous aneurysm by distinguishing from external laryngocoele.   Discussion   Patient presenting with unilateral cystic swelling in upper neck at upper border of thyroid cartilage which clinically bears the common provisional diagnosis of external laryngocele must be differentiated radiologically from anterior jugular venous aneurysm, (though rare in occurrence) to avoid a catastrophic incident during surgery

Patient perceptions of co-morbidities in inflammatory arthritis

Objective: Longer life expectancy has resulted in people living with an increasing number of co-morbidities. The average individual with inflammatory arthritis has two co-morbidities, which contribute to higher mortality, poorer functional outcomes and increased health-care utilization and cost. A number of studies have investigated the prevalence of co-morbidities, whereas this study was designed to look at patient perspectives. Methods: The study comprised two parts: A patient questionnaire and an interview. Individuals with physician-verified inflammatory arthritis along with one or more Charlson co-morbidities were invited to participate. In-depth data were obtained by interviews with 12 willing participants. Results: One hundred and forty-six individuals were recruited; 50 (35%) had one co-morbidity, 69 (48%) had two and 25 (17%) had more than four co-morbidities. Seventy-seven individuals (53%) reported that co-morbidities affected their health as much as their arthritis, and 82 (56%) reported dependence on others for activities of daily living. Lack of education was highlighted by 106 (73%) participants. Qualitative data provided further support for the challenges, with participants highlighting the lack of time to discuss complex or multiple problems, with no-one coordinating their care. This, in turn, led to polypharmacy and insufficient discussion around drug and disease interactions, complications and self-help measures. Conclusion: This study highlights the challenges for individuals with inflammatory arthritis who suffer with multiple co-morbidities. The challenges result from limited resources or support within the current health-care environments. Individuals highlighted the poor quality of life, which is multifactorial, and the need for better educational strategies and coordination of care to improve outcomes

Impact of Big Data & Predictive Analytics Capability on Supply Chain Sustainability

Purpose: The purpose of this paper is to develop a theoretical model to explain the impact of big data and predictive analytics (BDPA) on sustainable business development goal of the organization. Design/methodology/approach: The authors have developed the theoretical model using resource-based view logic and contingency theory. The model was further tested using partial least squares-structural equation modeling (PLS-SEM) following Peng and Lai (2012) arguments. The authors gathered 205 responses using survey-based instrument for PLS-SEM. Findings: The statistical results suggest that out of four research hypotheses, the authors found support for three hypotheses (H1-H3) and the authors did not find support for H4. Although the authors did not find support for H4 (moderating role of supply base complexity (SBC)), however, in future the relationship between BDPA, SBC and sustainable supply chain performance measures remain interesting research questions for further studies. Originality/value: This study makes some original contribution to the operations and supply chain management literature. The authors provide theory-driven and empirically proven results which extend previous studies which have focused on single performance measures (i.e. economic or environmental). Hence, by studying the impact of BDPA on three performance measures the authors have attempted to answer some of the unresolved questions. The authors also offer numerous guidance to the practitioners and policy makers, based on empirical results

Reconstruction of Head and Neck Defects with Lower Trapezius Myocutaneus Flap

Introduction  High lateral and posteriorly based defects are challenging to reconstruct as mobilization of conventional pedicled flaps is difficult. This study was done to evaluate the usefulness of lower trapezius myocutaneous flap (LTMC) in selected cases as a reconstructive alternative to other pedicled flaps which have positional and technical disadvantages and/or in cases where free flap is not possible. Materials and Methods Ten cases of locally advanced (T3 and T4) high and laterally placed head and neck carcinoma (8 cases of SCC involving posterior scalp, ear lobule, skin anterior to tragus and 2 cases of locally advanced salivary gland malignancies involving parotid glands) irrespective of sex had been selected. Due to non-availability of plastic surgeon in the institute none of the patient could be subjected to free flap reconstruction. All the patients received post operative adjuvant radiotherapy and were followed up on a monthly basis for six months at least. Results                      Out of total 10 cases 5 underwent wound infection and dehiscence at recipient site. In 3 cases there were donor site seroma. In 2 cases healing was uneventful.  However in all cases the flap was healthy and flap survival was 100%. There was no flap contracture in long term follow up. Conclusion                       The LTMC flap is ideal for mentioned defects because of its anatomical location, abundant blood flow, minor donor-site morbidity, and long pedicle. The LTMC flap, though less commonly used, is a precious option in situations where free flaps and other pedicled flaps are not feasible

Four-factor risk score for the prediction of interstitial lung disease in rheumatoid arthritis

Objective Interstitial lung disease (ILD) is one of the commonest systemic complications in patients with rheumatoid arthritis (RA) and carries a signifcant morbidity and mortality burden. We aimed to identify key variables to risk-stratify RA patients in order to identify those at increased risk of developing ILD. We propose a probability score based on the identifcation of these variables. Methods A retrospective, multicentre study using clinical data collected between 2010 and 2020, across 20 centres. Results A total of 430 RA (210 with ILD confrmed on high-resolution computed tomography (HRCT)) patients were evaluated. We explored several independent variables for the risk of developing ILD in RA and found that the key signifcant variables were smoking (past or present), older age and positive rheumatoid factor/anti-cyclic citrullinated peptide. Multivariate logistic regression models were used to form a scoring system for categorising patients into high and low risk on a scale of 0–9 points and a cut-of score of 5, based on the area under the receiver operating characteristic curve of 0.76 (CI 95% 0.71–0.82). This yielded a sensitivity of 86% and a specifcity of 58%. High-risk patients should be considered for investigation with HRCT and monitored closely. Conclusion We have proposed a new model for identifying RA patients at risk of developing ILD. This approach identifed four simple clinical variables: age, anti-cyclic citrullinated peptide antibodies, Rheumatoid factor and smoking, which allowed development of a predictive scoring system for the presence of ILD in patients with RA

Reliability of digital ulcer definitions as proposed by the UK Scleroderma Study Group:A challenge for clinical trial design

INTRODUCTION: The reliability of clinician grading of systemic sclerosis–related digital ulcers has been reported to be poor to moderate at best, which has important implications for clinical trial design. The aim of this study was to examine the reliability of new proposed UK Scleroderma Study Group digital ulcer definitions among UK clinicians with an interest in systemic sclerosis. METHODS: Raters graded (through a custom-built interface) 90 images (80 unique and 10 repeat) of a range of digital lesions collected from patients with systemic sclerosis. Lesions were graded on an ordinal scale of severity: ‘no ulcer’, ‘healed ulcer’ or ‘digital ulcer’. RESULTS: A total of 23 clinicians – 18 rheumatologists, 3 dermatologists, 1 hand surgeon and 1 specialist rheumatology nurse – completed the study. A total of 2070 (1840 unique + 230 repeat) image gradings were obtained. For intra-rater reliability, across all images, the overall weighted kappa coefficient was high (0.71) and was moderate (0.55) when averaged across individual raters. Overall inter-rater reliability was poor (0.15). CONCLUSION: Although our proposed digital ulcer definitions had high intra-rater reliability, the overall inter-rater reliability was poor. Our study highlights the challenges of digital ulcer assessment by clinicians with an interest in systemic sclerosis and provides a number of useful insights for future clinical trial design. Further research is warranted to improve the reliability of digital ulcer definition/rating as an outcome measure in clinical trials, including examining the role for objective measurement techniques, and the development of digital ulcer patient–reported outcome measures

Metaverse beyond the hype: Multidisciplinary perspectives on emerging challenges, opportunities, and agenda for research, practice and policy

The metaverse has the potential to extend the physical world using augmented and virtual reality technologies allowing users to seamlessly interact within real and simulated environments using avatars and holograms. Virtual environments and immersive games (such as, Second Life, Fortnite, Roblox and VRChat) have been described as antecedents of the metaverse and offer some insight to the potential socio-economic impact of a fully functional persistent cross platform metaverse. Separating the hype and “meta…” rebranding from current reality is difficult, as “big tech” paints a picture of the transformative nature of the metaverse and how it will positively impact people in their work, leisure, and social interaction. The potential impact on the way we conduct business, interact with brands and others, and develop shared experiences is likely to be transformational as the distinct lines between physical and digital are likely to be somewhat blurred from current perceptions. However, although the technology and infrastructure does not yet exist to allow the development of new immersive virtual worlds at scale - one that our avatars could transcend across platforms, researchers are increasingly examining the transformative impact of the metaverse. Impacted sectors include marketing, education, healthcare as well as societal effects relating to social interaction factors from widespread adoption, and issues relating to trust, privacy, bias, disinformation, application of law as well as psychological aspects linked to addiction and impact on vulnerable people. This study examines these topics in detail by combining the informed narrative and multi-perspective approach from experts with varied disciplinary backgrounds on many aspects of the metaverse and its transformational impact. The paper concludes by proposing a future research agenda that is valuable for researchers, professionals and policy makers alike

Short-term efficacy and safety of rituximab therapy in refractory systemic lupus erythematosus: results from the British Isles Lupus Assessment Group Biologics Register.

OBJECTIVES: To describe the baseline characteristics of SLE patients requiring biologic therapy in the UK and to explore short term efficacy and infection rates associated with rituximab (RTX) use. METHODS: Patients commencing biologic therapy for refractory SLE and who consented to join BILAG-BR were analysed. Baseline characteristics, disease activity (BILAG 2004/SLEDAI-2K) and rates of infection over follow-up were analysed. Response was defined as loss of all A and B BILAG scores to ⩽ 1 B score with no new A/B scores in other organ systems at 6 months. RESULTS: Two hundred and seventy SLE patients commenced biologic therapy from September 2010 to September 2015, most commonly RTX (n = 261). Two hundred and fifty (93%) patients were taking glucocorticoids at baseline at a median [interquartile range (IQR)] oral dose of 10 mg (5-20 mg) daily. Response rates at 6 months were available for 68% of patients. The median (IQR) BILAG score was 15 (10-23) at baseline and 3 (2-12) at 6 months (P < 0.0001). The median (IQR) SLEDAI-2K reduced from 8 (5-12) to 4 (0-7) (P < 0.001). Response was achieved in 49% of patients. There was also a reduction in glucocorticoid use to a median (IQR) dose of 7.5 mg (5-12 mg) at 6 months (P < 0.001). Serious infections occurred in 26 (10%) patients, being more frequent in the first 3 months post-RTX therapy. A higher proportion of early infections were non-respiratory (odds ratio = 1.98, 95% CI: 0.99, 3.9; P = 0.049). CONCLUSION: RTX is safe and is associated with improvement in disease activity in refractory SLE patients with concomitant reductions in glucocorticoid use. Early vigilance for infection post-infusion is important to further improve treatment risks and benefits