Pleomorphic adenoma of minor salivary gland in the parapharyngeal space

BACKGROUND: Majority of tumours occurring in minor salivary gland are malignant. Pleomorphic adenoma is of rare occurrence in parapharangeal space. CASE PRESENTATION: A rare case of a minor salivary gland pleomorphic adenoma of the parapharyngeal space is reported. Review of literature, clinical features, pathology, radiological findings and treatment of these tumours are discussed. CONCLUSIONS: Parapharangeal salivary tumours presents as a painless progressive swelling with majority of these being malignant. Pleomorphic adenoma in parapharangeal space is of rare occurrence. Complete surgical excision is the treatment of choice

Pattern of gynecological morbidity, its factors and Health seeking behavior among reproductive age group women in a rural community of Thiruvananthapuram district, South Kerala

Introduction: Gynecological morbidities constitute an important health problem among women of reproductive age group in India. Many of them did not seek care and bare it silently. Aims and Objectives: The purpose of this study was to measure the prevalence of self-reported gynecological morbidities among women of 15 to 45 years and to find out association with certain selected socio-demographic factors. This study also tried to study the health seeking behavior of women. Methodology: A population based cross sectional survey was conducted across Vakkom Panchayat, it’s area comes under Rural Health Centre of the Department of Community Medicine, Govt. Medical College, Thiruvananthapuram. A total of 540Women of 15 to 45 years was included in the study by two stage sampling technique. Results: Of the total, 199 {(36.85%) 95% CI -31.14, 42.94} women in the study reported at least one type of gynecological morbidity. Major morbidity reported was menstrual problems (25.0%). Prevalence of overall gynecological morbidities was found to be significantly more among women who married early (<18years) Adjusted OR 1.66 (95%CI- 1.05, 2.64).On subgroup analysis the factors like age group of women (below 30yrs), age at menarche below 13 years & presence of thyroid hormone disorders were found to be significantly (p<0.05) related to menstrual diseases in the regression model. Only 110 (55.3%) women sought treatment for any one of the morbidity. Majority took treatment from private hospitals. Conclusion: Prevalence of gynecological morbidities was high in this community. The data collected are valuable & could serve as preliminary data to pilot innovative delivery of gynecologic healthcare services

Alterations in hippocampal serotonergic and INSR function in streptozotocin induced diabetic rats exposed to stress: neuroprotective role of pyridoxine and Aegle marmelose

Diabetes and stress stimulate hippocampal 5-HT synthesis, metabolism and release. The present study was carried out to find the effects of insulin, Aegle marmelose alone and in combination with pyridoxine on the hippocampal 5-HT, 5-HT2A receptor subtype, gene expression studies on 5-HT2A, 5-HTT, INSR, immunohistochemical studies and elevated plus maze in streptozotocin induced diabetic rats. 5-HT content showed a significant decrease (p < 0.001) and a significant increase (p < 0.001) in 5-HIAA in hippocampus of diabetic rats compared to control. 5-HT receptor binding parameters Bmax and Kd showed a significant decrease (p < 0.001) whereas 5-HT2A receptor binding parameters Bmax showed a significant decrease (p < 0.001) with a significant increase (p < 0.05) in Kd in hippocampus of diabetic rats compared to control. Gene expression studies of 5-HT2A, 5-HTT and INSR in hippocampus showed a significant down regulation (p < 0.001) in diabetic rats compared to control. Pyridoxine treated in combination with insulin and A. marmelose to diabetic rats reversed the 5-HT content, Bmax , Kd of 5-HT, 5-HT2A and gene expression of 5-HT2A, 5-HTT and INSR in hippocampus to near control. The gene expression of 5-HT2A and 5-HTT were confirmed by immunohistochemical studies. Behavioural studies using elevated plus maze showed that serotonin through its transporter significantly increased (p < 0.001) anxiety-related traits in diabetic rats which were corrected by combination therapy. Our results suggest that pyridoxine treated in combination with insulin and A. marmelose has a role in the regulation of insulin synthesis and release, normalising diabetic related stress and anxiety through hippocampal serotonergic function. This has clinical significance in the management of diabetes

Manufacturing considerations for the development of lipid nanoparticles using microfluidics

In the recent of years, the use of lipid nanoparticles (LNPs) for RNA delivery has gained considerable attention, with a large number in the clinical pipeline as vaccine candidates or to treat a wide range of diseases. Microfluidics offers considerable advantages for their manufacture due to its scalability, reproducibility and fast preparation. Thus, in this study, we have evaluated operating and formulation parameters to be considered when developing LNPs. Among them, the flow rate ratio (FRR) and the total flow rate (TFR) have been shown to significantly influence the physicochemical characteristics of the produced particles. In particular, increasing the TFR or increasing the FRR decreased the particle size. The amino lipid choice (cationic—DOTAP and DDAB; ionisable—MC3), buffer choice (citrate buffer pH 6 or TRIS pH 7.4) and type of nucleic acid payload (PolyA, ssDNA or mRNA) have also been shown to have an impact on the characteristics of these LNPs. LNPs were shown to have a high (>90%) loading in all cases and were below 100 nm with a low polydispersity index (≤0.25). The results within this paper could be used as a guide for the development and scalable manufacture of LNP systems using microfluidics

Recurrence of borderline ovarian tumors: a survival analysis

Background: Borderline ovarian tumors are non-invasive tumors that display greater epithelial proliferation and cytological atypia than benign tumors, but less than carcinomas. They may be treated conservatively in young women, however there is a concern for recurrence and progression to frank malignancy. We aimed to study the clinicopathological features of borderline ovarian tumors and their risk of recurrence.Methods: We reviewed the electronic and paper charts of all borderline ovarian tumors operated between January 1, 2001 and December 31, 2019 at a tertiary level teaching hospital in India. Descriptive statistics such as proportions and means were used. A survival analysis was done for recurrence and death.Results: A total of 93 borderline ovarian tumor patients were identified. The most common histology in our study was mucinous 60 (63%) followed by serous 28 (29%). Ninety two (99%) of them were stage I at diagnosis. Microinvasion was present in 27 (26%) of the cases. Out of the 30 fertility sparing operations performed (unilateral salpingo-oophorectomy/cytectomy), 4 (13%) had recurrences and progressed to malignancy. The overall malignancy rate was 4%. There was one mortality secondary to septic shock.Conclusions: Borderline ovarian tumors account for 10-20% of ovarian epithelial tumors and have extremely good prognosis affecting majorly the reproductive aged women. The low recurrence rate and good five year survival rate, at all the stages of the disease enables to incorporate fertility sparing surgeries as part of the staging

Role of Sirtuins in Modulating Neurodegeneration of the Enteric Nervous System and Central Nervous System.

Neurodegeneration of the central and enteric nervous systems is a common feature of aging and aging-related diseases, and is accelerated in individuals with metabolic dysfunction including obesity and diabetes. The molecular mechanisms of neurodegeneration in both the CNS and ENS are overlapping. Sirtuins are an important family of histone deacetylases that are important for genome stability, cellular response to stress, and nutrient and hormone sensing. They are activated by calorie restriction (CR) and by the coenzyme, nicotinamide adenine dinucleotide (NAD+). Sirtuins, specifically the nuclear SIRT1 and mitochondrial SIRT3, have been shown to have predominantly neuroprotective roles in the CNS while the cytoplasmic sirtuin, SIRT2 is largely associated with neurodegeneration. A systematic study of sirtuins in the ENS and their effect on enteric neuronal growth and survival has not been conducted. Recent studies, however, also link sirtuins with important hormones such as leptin, ghrelin, melatonin, and serotonin which influence many important processes including satiety, mood, circadian rhythm, and gut homeostasis. In this review, we address emerging roles of sirtuins in modulating the metabolic challenges from aging, obesity, and diabetes that lead to neurodegeneration in the ENS and CNS. We also highlight a novel role for sirtuins along the microbiota-gut-brain axis in modulating neurodegeneration

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme