Accuracy of Multi-Detector Computed Tomography in Detection of Esophageal Varices in Chronic Liver Disease

Background: Patients with chronic liver disease should undergo screening endoscopy, but this approach places a heavy burden upon endoscopy units along with other limitations. The aim of this study was to determine the diagnostic accuracy of multi-detector computed tomography scan in detecting esophageal varices taking endoscopy as gold standard.Material and Methods: This cross-sectional study was done from 1st Jan 2018 to 31st Dec 2018 at Department of Radiology, PIMS Hospital Islamabad. A total of 180 patients of both gender with chronic liver disease for at least 12 months were included in this study with an age range of 25-65 years. Patients with active gastrointestinal hemorrhage, hypersensitivity to iodinated contrast agent, chronic renal failure, claustrophobic and pregnant females were excluded. All the patients underwent endoscopy and computed tomography of lower chest and the upper abdomen before and after intravenous contrast administration. Multi detector computed tomography (MDCT) scan findings for esophageal varices were compared with endoscopy findings.Results: In MDCT positive patients (n=102), 98 were true positive and 04 were false positive. Among 78 MDCT negative patients, 07 were false negative, whereas 71 were true negative. Overall sensitivity and specificity were 93.33%, and 94.67% respectively. The positive and negative predictive values were 96.08% and 91.03% respectively, while diagnostic accuracy of MDCT in detecting esophageal varices in chronic liver disease patients was 93.89%, taking endoscopy as gold standard.Conclusions: Multi-detector computed tomography scan is a highly sensitive and accurate non-invasive modality for detecting esophageal varices in chronic liver disease patients.Key words: Accuracy, Chronic liver disease, Esophageal varices, Multi-detector computed tomograph

Ectopic thyroid mass separately present in mediastinum and not a retrosternal extension: A report of two cases

Retrosternal extension of goiter is one of the most common types of masses in the superior mediastinum. These types of goiters classically present with compressive symptoms such as dyspnea, dysphonia, dysphagia, or sleep apnea. Surgical treatment with a total thyroidectomy and complete removal of the intrathoracic portion of thyroid is the gold standard treatment. These cervicomediastinal lesions at times may not be continuous, and a sternotomy may be required for complete and safe excision of the mediastinal mass to achieve decompression of the surrounding structures and preventing the hemorrhagic complications if attempted from cervical incision. We present a summary of two cases that gave an initial impression of retrosternal extension of thyroid gland, however intraoperatively were found to be separately encapsulated and required sternotomy for its safe and complete excision

Redo coronary artery surgery; early and intermediate outcomes from a tertiary care hospital in a developing country

OBJECTIVE: To evaluate outcomes of re-operative coronary artery surgery in a tertiary care hospital in a developing country. METHOD: Preoperative, intra-operative and postoperative variables were analyzed in 82 consecutive patients who underwent re-operative coronary surgery on cardiopulmonary bypass. RESULTS: The mean age was 63.3 +/- 7.7 years, 91.2% were male and 9.8% female. Coronary artery disease risk factors were present in more than 50% of the patients. History of preoperative myocardial infarction was positive in 56% patients. There was strong clinical and angiographic indication for surgery with unstable angina in 50% patients and \u3e 80% had multivessel disease. Only 5% patients were in functional class I. The risk stratification showed a mean Euro score of 8. The IABP was used in 20% patients. A mean of 3.1 grafts per patient were applied. The median cardiopulmonary bypass (CPB) and aortic cross clamp time was 144 minutes respectively. Postoperative mortality was 7.3%. Short-term follow up revealed 74% of the patients in NYHA functional class I. CONCLUSION: Reoperative coronary artery bypass grafting is challenging but with expertise, team effort can be performed with good functional outcome

Coronary artery bypass surgery in the elderly: experience of tertiary care hospital

In the subcontinent, improving life expectancy may increase the number of elderly patients requiring coronary artery bypass. The elderly have a higher risk of mortality, and cost vs benefit is presumed to be unrewarding, leading to a disinclination to operate on such patients. We reviewed the records of patients \u3eor= 70 years old undergoing coronary revascularization in a 10-year period. Between 1995 and 2004, 3,312 coronary bypass operations were performed, including 242 (7.3%) in patients \u3eor= 70 years. Of these, 207 (86%) were male, 73 (30%) had non-elective surgery, and 177 (73%) had a high-risk EuroSCORE. Early postoperative mortality was 8.7% (21/242), and 33 (13.6%) patients experienced morbidity. One-year follow-up of 106 (44%) patients was possible. There were 4 (1.7%) late deaths from noncardiac causes. Death, morbidity, and postoperative functional class were significantly associated with preoperative functional class. Meticulous selection of elderly patients for coronary artery bypass may help maximize the benefits of this surgery

Autologous vein graft repair of mycotic innominate artery aneurysm: A case report

Introduction: Innominate artery aneurysm (IAA) is an extremely rare fatal condition with an overall prevalence of less than 3 % of all supra-aortic artery aneurysms. These infrequent lesions usually present as an emergency and require challenging surgical procedures. Case presentation: We report an interesting case of mycotic IAA in a 25 years old male patient. He was a known intravenous drug abuser having mycotic aneurysm arising from brachiocephalic artery with eccentric thrombus causing adjacent mass effect over the trachea. He underwent successful emergent surgical management of aneurysm with autologous vein graft using superficial femoral vein. Unfortunately, he died due to massive upper gastrointestinal bleeding leading to multi-organ failure after a prolonged post-operative course. Clinical discussion: Mycotic aneurysms of the IA are extremely rare with an overall incidence of 1-2.7 % cases of all IAA. Presentation of the IAA can be quite variable from asymptomatic to symptoms exhibiting mass effect over surrounding structures. Rupture of IAA can be fatal and can occur if not treated promptly. There are no current recommendations or guidelines for treatment and interventions in IAA. Surgical management involves complete excision of the aneurysm and then revascularization. Conclusion: Infected Innominate artery aneurysm is a rare surgical entity requiring early diagnosis, detailed investigation and prompt surgical management involving multidisciplinary team approach. Our case describes a relatively innovative approach to this scarce conditio

Polyaniline-Conjugated Boron Nitride Nanoparticles Exhibiting Potent Effects against Pathogenic Brain-Eating Amoebae

Free-living amoebae include Acanthamoeba castellanii and Naegleria fowleri that are opportunistic protozoa responsible for life-threatening central nervous system infections with mortality rates over 90%. The rising number of cases and high mortality rates are indicative of the critical unmet need for the development of efficient drugs in order to avert future deaths. In this study, we assess the anti-amoebic capacity of a conducting polymer nanocomposite comprising polyaniline (PANI) and hexagonal boron nitride (hBN) against A. castellanii and N. fowleri. We observed significant amoebicidal and cysticidal effects using 100 μg/mL PANI/hBN (P < 0.05). Further, the nanocomposite demonstrated negligible cytotoxicity toward HaCaT and primary human corneal epithelial cells (pHCECs). In evaluating the mode of inhibition of A. castellanii due to treatment with PANI/hBN, increased intracellular reactive oxygen species (ROS) was measured and scanning microscopy visualized the formation of pores in the amoebae. Overall, this study is suggestive of the potential of the PANI/hBN nanocomposite as a promising therapy for amoeba infections

Polyaniline-Conjugated Boron Nitride Nanoparticles Exhibiting Potent Effects against Pathogenic Brain-Eating Amoebae

Free-living amoebae include Acanthamoeba castellanii and Naegleria fowleri that are opportunistic protozoa responsible for life-threatening central nervous system infections with mortality rates over 90%. The rising number of cases and high mortality rates are indicative of the critical unmet need for the development of efficient drugs in order to avert future deaths. In this study, we assess the anti-amoebic capacity of a conducting polymer nanocomposite comprising polyaniline (PANI) and hexagonal boron nitride (hBN) against A. castellanii and N. fowleri. We observed significant amoebicidal and cysticidal effects using 100 μg/mL PANI/hBN (P < 0.05). Further, the nanocomposite demonstrated negligible cytotoxicity toward HaCaT and primary human corneal epithelial cells (pHCECs). In evaluating the mode of inhibition of A. castellanii due to treatment with PANI/hBN, increased intracellular reactive oxygen species (ROS) was measured and scanning microscopy visualized the formation of pores in the amoebae. Overall, this study is suggestive of the potential of the PANI/hBN nanocomposite as a promising therapy for amoeba infections

Polyaniline (PANI)-conjugated tungsten disulphide (WS2) nanoparticles as potential therapeutics against brain-eating amoebae

Brain-eating amoebae, including Acanthamoeba castellanii and Naegleria fowleri, are the causative agents of devastating central nervous system infections with extreme mortality rates. There is an indisputable urgency for the development of effective chemotherapeutic agents for the control of these diseases that are increasing in incidence. Here, we evaluated the anti-amoebic potential of polyaniline:tungsten disulphide (PANI:WS2) nanocomposite against the infective trophozoite and cyst stages of N. fowleri and A. castellanii. Throughout these evaluations, significant viability inhibition was noted when 100 µg/mL of PANI:WS2 was employed at its 1:5 formulation. These effects were studied to be due to increased levels of reactive oxygen species (ROS) as visualised through fluorescence microscopy. Furthermore, field emission scanning electron microscopy (FE-SEM) analysis pictured disruption to amoeba morphology. The host-cell cytotoxicity of the nanocomposite (PANI:WS2) was studied to be negligible, making it an attractive avenue in the pursuit for effective treatments for brain-eating amoeba infections. KEY POINTS: • Synthesis of polyaniline:tungsten disulphide (PANI:WS2) nanocomposite. • Anti-amoebic potential of PANI:WS2 nanocomposite. • PANI:WS2 nanocomposites are promising anti-amoebic agents in vitro

Over-expression of FoxM1 offers a promising therapeutic target in diffuse large B-cell lymphoma

Background: FoxM1 has been shown to play a critical role in the pathogenesis of various epithelial malignancies. However, its role in lymphoid malignancies has not been fully clarified. We, therefore, investigated the role of FoxM1 expression in a large cohort of diffuse large B-cell lymphoma samples and panel of cell lines.Design and Methods: FoxM1 expression was investigated in a large series of diffuse large B-cell lymphoma tissues in a tissue microarray format by immunohistochemistry. Apoptosis was measured by flow cytometry and protein expression was detected by immunoblotting using diffuse large B-cell lymphoma cell lines following treatment with either pharmacological inhibitor of FoxM1 or small interference RNA knockdown strategy. Invasion/migration and soft agar colony assays were also performed following treatment with FoxM1 inhibitor.Results: FoxM1 expression was detected in 84.6% of diffuse large B-cell lymphoma tumors and found to be significantly associated with proliferative tumor marker Ki67 Conclusions: Altogether, these results suggest that FoxM1 is over-expressed in the majority of diffuse large B-cell lymphoma samples. These data also indicate that targeting FoxM1 signaling can serve as a potential therapeutic modality in the management of diffuse large B-cell lymphoma

Antibacterial Effects of Quinazolin-4(3H)-One Functionalized-Conjugated Silver Nanoparticles

Infections due to multi-drug resistant bacteria are on the rise and there is an urgent need to develop new antibacterials. In this regard, a series of six functionally diverse new quinazolinone compounds were synthesized by a facile one-pot reaction of benzoic acid derivatives, trimethoxymethane and aniline derivatives. Three compounds of 3-aryl-8-methylquinazolin-4(3H)-one, and 3-aryl-6,7-dimethoxyquinazolin4(3H)-one were prepared and tested against multi-drug resistant bacteria. Furthermore, we determined whether conjugation with silver nanoparticles improved the antibacterial efficacy of these quinazolinone derivatives. The newly synthesized compounds were characterized by ultraviolet visible spectrophotometry (UV-vis), Zetasizer analysis, Fourier transform infrared spectroscopic methods (FT-IR), and scanning electron microscopy (SEM). Using bactericidal evaluation, effects were determined against selected Gram-negative and Gram-positive bacteria. Furthermore, cytotoxicity of nanoconjugates on human cells were determined. The UV-vis spectrum of silver nanoparticles conjugated quinazolinone displayed surface plasmon resonance band in the range of 400–470 nm, and the size of nanoparticles was detected to be in the range of 100–250 nm by dynamic light scattering (DLS). FT-IR study confirmed the stabilization of silver nanoparticles by the presence of diverse functional arayl on each compound. SEM further revealed the construction of spherical nanoparticles. Among the quinazolinone derivative tested, two compounds (QNZ 4, QNZ 6) conjugated with silver nanoparticles showed enhanced antibacterial activity against Escherichia coli K1, Streptococcus pyogenes, Klebsiella pneumoniae, B. cereus and P. aeruginosa as compared to the compounds