Adenoid Cystic Carcinoma of Larynx

Salivary gland tumours are rare tumours of larynx, hypopharynx and parapharyngeal space. Adenoid cystic carcinoma (AdCC) is the most common malignant salivary gland tumour of larynx. Subglottic region is the most common site followed by supraglottic region. AdCC usually involves elderly patients. Etiology of AdCC is mostly unknown. Clinically patient presents with dysphagia, cough, dyspnoea, hoarseness and rarely haemoptysis. Indirect laryngoscopy shows submucosal laryngeal mass. On CT scan, there is a submucosal mass, which may show extra-laryngeal extension. Histopathological examination shows epithelial and myoepithelial cells arranged in cribriform pattern, which may present with perineural invasion in the periphery of the lesion. Patients usually present in a later course of the disease. Tumour may present with pulmonary metastasis. The surgical approach depends on the tumour stage

Disseminated herpes zoster as a result of immunomodulation by Adalimumab

"The patient is a 75-year-old Caucasian male who was admitted in May for management of a penile ulceration and a generalized rash. He has a medical history of Type II Diabetes Mellitus, tobacco abuse, and Rheumatoid Arthritis (RA) on adalimumab. One week prior to his presentation, the patient noted an ulcer proximal to the glans penis (Figure 1). Upon further questioning, he reported noticing a small tick attached to his thigh one week prior. He has no history of sexually transmitted illnesses, incarceration, animal exposures, or meningeal signs. Two days prior to admission, the patient developed a large, dark, vesicular lesion on the anterior scalp, followed by smaller lesions over the rest of his body including the hard palate (Figures 2-6). Laboratory studies demonstrated a mildly elevated Erythrocyte Sedimentary Rate, C-Reactive Protein, and transaminitis. The patient was started on empiric doxycycline and intravenous acyclovir. Infectious work-up was negative for gonorrhea, chlamydia, syphilis, HIV, Ehrlichia, and Rocky Mountain Spotted Fever. Shave biopsies were obtained of the penile lesion and a lesion from the patient's upper back. Dermatopathology evaluation demonstrated herpetic dermatitis in both sites, and a penile swab polymerase chain reaction for Varicella Zoster Virus was positive. Treatment for disseminated Herpes Zoster was initiated with marked improvement of the lesions noted at follow-up."Tarang Patel (1), Ethan Karle (1), Taylor Nelson (2), Dima Dandachi (2); 1. Department of Medicine, University of Missouri. 2. Department of Medicine, Division of Infectious Diseases, University of Missouri.Includes bibliographical reference

Method Development, Validation and Forced Degradation Studies of Dapagliflozin and Pioglitazone Hydrochlorides in Synthetic Mixtures by RP-HPLC

A simple, sensitive, robust, precise, and efficient RP-HPLC approach for the simultaneous determination of Dapagliflozin and Pioglitazone Hydrochloride in Synthetic Mixture. As per ICH Q2 (R1) guidelines, the final chromatographic conditions were Optimized with a mobile phase ratio of (25:75% v/v) in ACN: Potassium Dihydrogen Phosphate Buffer (pH 4) was adjusted by adding OPA at a flow rate of 1 mL/min, column temperature of 30 °C, injection volume of 20 µL, Kromstar Vertex C18 analytical column, and UV detection at 228 nm wavelength. Dapagliflozin and Pioglitazone Hydrochloride reported retention times of 3 min and 6.5 min, respectively. Validation of a method was found to be linear in the range of 2-10 µg/ml for Dapagliflozin and 3–15 µg/mL for Pioglitazone Hydrochloride. The % Recovery for Dapagliflozin was discovered to be 98.52 - 99.90 %, while for Pioglitazone Hydrochloride, it was found to be 99.67- 99.94 %. The Precision results for both drugs were within the limits while expressed Intraday and Interday. For Dapagliflozin, the LOD and LOQ were reported to be 0.041 µg/mL and 0.13 µg/mL, respectively, and for Pioglitazone Hydrochloride, 0.105 µg/mL and 0.32 µg/mL. As per ICH Q1A (R2) guidelines, the synthetic mixture was subjected to acid, base, oxidation, thermal, and photolysis stress conditions

Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026

Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings In 2019, at the onset of the COVID-19 pandemic, US$9·2 trillion (95$7·3 trillion (95% UI 7·2–7·4) in 2019; 293·7 times the $24·8 billion (95$43·1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, $1·8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and$37·8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12·2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the health-related COVID-19 response is 252·2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11–21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP. Interpretation There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained

Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021

This online publication has been corrected. The corrected version first appeared at thelancet.com on September 28, 2023BACKGROUND : Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. METHODS : Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively. FINDINGS : In 2021, there were 529 million (95% uncertainty interval [UI] 500–564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8–6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7–9·9]) and, at the regional level, in Oceania (12·3% [11·5–13·0]). Nationally, Qatar had the world’s highest age-specific prevalence of diabetes, at 76·1% (73·1–79·5) in individuals aged 75–79 years. Total diabetes prevalence—especially among older adults—primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1–96·8) of diabetes cases and 95·4% (94·9–95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5–71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5–30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22–1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1–17·6) in north Africa and the Middle East and 11·3% (10·8–11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%. INTERPRETATION : Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers.Bill & Melinda Gates Foundation.http://www.thelancet.comam2024School of Health Systems and Public Health (SHSPH)SDG-03:Good heatlh and well-bein

Experimental Investigation and Performance Analysis of an Automobile Air Conditioning System

Refrigerating effect is the amount of heat that each pound of refrigerant retains from the refrigerated space to deliver helpful cooling. This effect is known as Refrigeration. Refrigeration systems are also widely used to provide thermal comfort to humans via air conditioning. The “Steam Compression Cooling System” is used by the current Automotive Air conditioning system, which absorbs and removes heat from inside the vehicle. To drive the Compressor of the refrigeration system, the system uses the power of the motor shaft as the input power, but because of this, there is some loss of engine power also. The loss of engine power for VCR operation may be neglected by using another refrigeration system, namely a "vapor absorption refrigeration system". For that, launch of a new Hybrid Air conditioning system for cars is required. Experimental work is done by using the change of energy source to drive the compressor. In this system, An Internal Combustion Engine shaft drives the compressor, when the engine is running. And as a hybrid, DC electric motor which is powered by a lead-acid battery also drives the Compressor. An electric motor supplies the DC power, which generates electrical energy to charge the battery. Experimental work is done by using the change of energy source to drive the compressor. In this system, An Internal Combustion Engine shaft drives the compressor, when the engine is running. And as a hybrid, DC electric motor which is powered by a lead-acid battery also drives the Compressor. An electric motor supplies the DC power, which generates electrical energy to charge the battery. With this system, fuel consumption is much lower when using air conditioning and reduces carbon dioxide emissions. The concept of the air conditioning system in presented in this document

Method Development, Validation and Forced Degradation Studies of Dapagliflozin and Pioglitazone Hydrochlorides in Synthetic Mixtures by RP-HPLC

A simple, sensitive, robust, precise, and efficient RP-HPLC approach for the simultaneous determination of Dapagliflozin and Pioglitazone Hydrochloride in Synthetic Mixture. As per ICH Q2 (R1) guidelines, the final chromatographic conditions were Optimized with a mobile phase ratio of (25:75% v/v) in ACN: Potassium Dihydrogen Phosphate Buffer (pH 4) was adjusted by adding OPA at a flow rate of 1 mL/min, column temperature of 30 °C, injection volume of 20 μL, Kromstar Vertex C18 analytical column, and UV detection at 228 nm wavelength. Dapagliflozin and Pioglitazone Hydrochloride reported retention times of 3 min and 6.5 min, respectively. Validation of a method was found to be linear in the range of 2-10 μg/ml for Dapagliflozin and 3–15 μg/mL for Pioglitazone Hydrochloride. The % Recovery for Dapagliflozin was dis- covered to be 98.52 - 99.90 %, while for Pioglitazone Hydrochloride, it was found to be 99.67- 99.94 %. The Precision results for both drugs were within the limits while expressed Intraday and Interday. For Dapagliflozin, the LOD and LOQ were reported to be 0.041 μg/mL and 0.13 μg/mL, respectively, and for Pioglitazone Hydrochloride, 0.105 μg/ mL and 0.32 μg/mL. As per ICH Q1A (R2) guidelines, the synthetic mixture was subjected to acid, base, oxidation, thermal, and photolysis stress conditions

Ehrlichiosis Presenting as Hemophagocytic Lymphohistiocytosis in an Immunocompetent Adult

Hemophagocytic Lymphohistiocytosis (HLH) is a fatal, immunologic syndrome characterized by dysregulated tissue inflammation. HLH can be either primary or secondary; with the latter typically resulting from an infection. Diagnosis requires five or more of the following: fever, splenomegaly, cytopenia, hypertriglyceridemia, hemophagocytosis via biopsy, low natural killer (NK) cell activity, elevated ferritin and soluble CD25 level (sCD25). We present a case of HLH related to ehrlichiosis.In order to mount an effective immune response against microbes such as Ehrlichia chaffeensis, the host must have preserved NK cell function. Being that HLH Is characterized as a state of depleted NK cell function, It is crucial to investigate the role NK cell function has in the setting of HLH on the infectivity of Ehrlichia species

Malignant Mesothelioma Manifesting in an Elderly Female without Occupational Asbestos Exposure

Case Presentation: A 71-year-old Caucasian female with a history of SARS-CoV-2 pneumonia, chronic obstructive pulmonary disease (COPD) and 50 pack-years smoking presented with dyspnea, cough, fever, anorexia, and 12-pound weight loss over two weeks. She had three recent hospitalizations for COPD exacerbation and pneumonia. She was noted to be hypoxic despite five liters/minute of supplemental oxygen. Laboratory studies revealed leukocytosis, hypernatremia, and elevated brain natriuretic peptide. Urine streptococcal and legionella antigens, and respiratory viral panel were negative. Chest radiograph [Figure 1] revealed lobulated left-sided pleural masses, which were confirmed on computed tomography (CT) scan of the chest [Figure 2]. CT-guided pleural biopsy was performed, and the diagnosis of malignant mesothelioma (MM) was established. Positron emission tomography revealed avidity of the pleural masses [Figure 3]. The patient denied occupational asbestos exposure, however she reported routinely laundering her husband's clothing who worked extensively with asbestos. She elected to pursue hospice care.Sarah Steenson (1), Tarang Pankaj Patel (1), Satish Kalanjeri (2), Jeremy Carl Johnson (2) ; 1. Division of Pulmonary, Critical Care and Environmental Medicine, University of Missouri School of Medicine. 2. Division of Pulmonary, Critical Care and Environmental Medicine, Harry S Truman Veterans Affairs Hospital, University of Missouri School of Medicine.Includes bibliographical reference