Pancreatic Pseudocyst of Gastrohepatic Ligament: A Case Report and Review of Management

Context Pancreatic pseudocyst of gastrohepatic or hepatoduodenal ligament and of liver is rare entity. Probably, pancreatic pseudocyst ascends via these ligaments to liver due to complex attachment of peritoneum. Very few cases have been reported in literature. Case report Hereby, we report a case of pancreatic pseudocyst of hepatoduodenal ligament in patient who presented with pain and lump in epigastric region. Conclusion This is an extrapancreatic extension of pancreatic pseudocyst and a high suspicion of this cyst (gastrohepatic ligament cyst) should be kept in mind as differential diagnosis of epigastric mass.Image: Excised pancreatic pseudocyst of gastrohepatic ligament

Feto-maternal outcome of pregnancies diagnosed as hypothyroidism after 28 weeks of gestation, at a tertiary hospital

Background: The most frequent thyroid alteration observed in pregnancy is hypothyroidism with subclinical hypothyroidism being more common than overt hypothyroidism. Women with thyroid dysfunction both overt and subclinical are at increased risk of pregnancy-related complications. In present study we assessed feto-maternal outcome of pregnancies in whom hypothyroidism was diagnosed after 28 weeks of gestation.Methods: This study was conducted in the department of obstetrics and gynaecology, Adesh institute of medical sciences and research Medical College, Bathinda. The present study was of prospective, observational design, conducted in pregnant women with more than 28 weeks pregnancy, first time diagnosed as hypothyroid (TSH>3.0 mIU/l).Results: In present study total 37 patients completed study protocol, 6 patients were delivered at other hospital. Most patients were less than 20 years (32%), nulliparous (68%). 19% patients delivered preterm either due to spontaneous labour or labour induction for obstetric reason. 62% patients delivered vaginally, 35% underwent LSCS. In present study maternal complications such as preterm labour (24%), hypertensive disorders of pregnancy (22%), oligohydramnios (16%), overt/gestational diabetes mellitus (8%) and post-partum haemorrhage (5%) were noted. 2.5-3.4 kg birth weight was most common group (65%). Total 16 % babies required neonatal resuscitation. Babies requiring neonatal resuscitation were admitted in NICU for observation and for any further management. Neonatal jaundice was noted in 30% babies. Total 22% babies needed NICU admission. We noted early neonatal death in one baby. No maternal mortality was noted.Conclusions: Treatment of maternal hypothyroidism is essential, because adverse outcomes for both mother and baby are greatly reduced, if not eliminated, when patients are treated

Angiomatous nasal polyp: Clinical diagnostic dilemma

Angiomatous polyp (Angiectatic nasal polyps) is rare and its incidence is 4-5% of all nasal polyps. As it occurs with variable clinical features and there is no confirmatory preoperative investigation, clinical diagnosis can be a dilemma. Clinical picture of angiofibroma, simple antrochoanal polyp and inverted papilloma may resemble with each other. As polyps invade surrounding bone, these should be distinguished from a malignant mass. We present an interesting case of an infarcted angiectatic nasal polyp with extensive surrounding bony destruction. Correct preoperative radiological diagnosis is important to avoid unnecessary extensive surgery. Histopathological evaluation of polyps is mandatory since they require different treatment due to difference in the prognosis

A case report on nasolabial cyst

The nasolabial cyst (NLC) is an uncommon clinical entity and is generally unilateral. It is benign in nature and is embryonic in origin and only one case with malignancy has been reported. It is located in the nasolabial folds. Most of time it is an asymptomatic deformity of face and rarely can result in nasal obstruction if it is bilateral. Its diagnosis is clinical and treatment is surgical excision. A 16 years brown female patient presented with bulging in left nasolabial region. She was treated with surgery...........................................................Cite this article as:Goyal S, Sharma J, Sharma N. A case report on nasolabial cyst. Int J Cancer Ther Oncol 2014; 2(3):020311. DOI: 10.14319/ijcto.0203.1

Giant fibroadenoma of the breast in a pre-pubertal girl: a case report

Juvenile fibroadenoma comprises about 4% of the total fibroadenomas. The incidence of giant juvenile fibroadenomas is merely 0.5% of all the fibroadenomas. Bilateral giant juvenile fibroadenomas are extremely rare. We are presenting a case of giant juvenile fibroadenomas in an 11-year-old pre-pubertal girl. The diagnosis was made on fine-needle aspiration cytology which was confirmed on histopathology. As these tumors are mostly benign, breast-conserving surgery is done so that patient can lead a normal life without psychological trauma.-----------------------------------Cite this article as: Goyal S, Garg G, Narang S. Giant fibroadenoma of the breast in a pre-pubertal girl: a case report. Int J Cancer Ther Oncol 2014; 2(1):020113.DOI: http://dx.doi.org/10.14319/ijcto.0201.1

Gall stones size, number, biochemical analysis and lipidogram- an association with gall bladder cancer: a study of 200 cases

Purpose: Objective of the study was to find out if there is any relation of number, size and type of gall stones and patient’s lipid profile with the occurrence of gall bladder carcinoma (GBC) as presence of gall stones is considered to be the most important risk factor for gall bladder cancer.Methods: 200 specimens of post-cholecystectomy gallbladder were studied. The number, size and type of stones and lipid profile were compared in all these cases. Gross as well as histopathological examination of gall bladders specimens was done.Results: 185 (92.5%) gall bladders were associated with gall stones. On histopathological examination, malignancy was found in 6 cases (3%) only and rest 194 cases (97%) revealed inflammatory/ non-neoplastic pathology. A statistically significant difference was observed in the number of stones in gall bladders with malignancy than those with benign lesions (P < 0.001). Similarly, a statistically significant difference was seen in terms of stone size between gallbladder cancer (GBC) cases and those with benign pathology (P < 0.005). Benign lesions of gall bladders were mostly associated with mixed type of stones whereas malignant cases were associated with pure cholesterol type of stones. No significant relation was found between the patient’s lipid profile and occurrence of gallbladder carcinoma (GBC) (p > 0.005). Conclusion: Thus we concluded that as the number, size and cholesterol gall stone increase the risk of gall bladder cancer also increases without any relation with lipid profile................................................Cite this article as:Narang S, Goyal P, Bal MS, Bandlish U, Goyal S. Gall stones size, number, biochemical analysis and lipidogram- an association with gall bladder cancer: a study of 200 cases. Int J Cancer Ther Oncol 2014; 2(3):020310. DOI: 10.14319/ijcto.0203.1

Sebaceous carcinoma of right upper eyelid: case report and literature review

Sebaceous gland carcinoma is a rare fast growing cutaneous cancer. It is derived from the adenxal epithelium of sebaceous glands. Sebaceous carcinomas are generally divided into those occurring in periocular or extraocular locations. Ocular sebaceous carcinomas occur most commonly in upper eye lid, in the elderly with a predilection for females and Asian populations. Due to its clinical resemblance with chalazion or other chronic inflammatory conditions, there is a delay in diagnosis. Due to its rarity, we present a case of sebaceous carcinoma of right upper eyelid in a 65-year-old female.----------------------------------------------Cite this article as:Singh S, Kaur S, Mohan A, Goyal S. Sebaceous carcinoma of right upper eyelid: case report and literature review. Int J Cancer Ther Oncol 2013; 1(2):01022.DOI: http://dx.doi.org/10.14319/ijcto.0102.

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions