To evaluate the role of sonography as an adjunct to mammography in women with dense breasts

OBJECTIVE: To assess the role of sonography as an adjunct to mammography in women with dense breast tissue by determining yield and validity of sonography using histopathology/follow-up mammography as gold standard. METHODS: It was a descriptive analytical study conducted at the Radiology Department of Aga Khan University Hospital, from September 2005 to April 2007. A total of 76, mammographically dense breasts were evaluated with ultrasound. Of these 32 had palpable lumps on mammography, and were excluded from the study. A total of 44 patients had either symptoms of vague nodularity, nipple discharge, mastalgia or had no symptoms and the mammograms showed dense breast parenchyma without any focal abnormality. All these patients underwent whole breast ultrasound. The findings on ultrasound and subsequent histopathology and follow-up mammography were used to calculate the sensitivity, specificity, positive and negative predictive value of whole breast ultrasound as an adjunct to mammography. RESULTS: The age range of patients was 35 to 56 years, mean age was 42 +/- 7.33 years. Of the 44 patients included, 37 had normal ultrasound examinations and had the same findings on one year follow-up mammograms and ultrasound examinations. The remaining, seven patients were categorized as BI RADS category 4 due to presence of suspicious findings on ultrasound examination. They underwent ultrasound guided biopsy of the detected lesions. Out of seven solid lesions biopsied six were benign and one was reported malignant on histopathological examination. The sensitivity, specificity, positive and negative predictive values were 100%, 85%, 14% and 86% respectively. CONCLUSION: Breast ultrasound can be a useful adjunct to mammography in women with dense breast by detecting small cancers not identified on mammography or clinical breast examination. Larger studies will be required to suggest that ultrasound could be used as an adjunct

Organ preservation for advanced laryngeal cancer: Experience with concurrent chemoradiation therapy

Introduction: The larynx is a part of the upper respiratory tract that performs many essential functions including breathing, speaking, and swallowing. For this reason, the quality of life is significantly affected by laryngeal cancer and its treatment. Therefore, the focus of management for the last few decades has been on preserving the function of a larynx without compromising survival. This study was done with the purpose of reviewing our experience of organ preservation approach with concurrent chemoradiation therapy (CCRT) for locally advanced cancers of larynx.Methods: A retrospective chart review was carried out for the data of pathology reports and clinical notes of the patients who were diagnosed with laryngeal squamous cell carcinoma and primarily treated with CCRT at our tertiary care institute from November 2010 to June 2015.Results: Of 25 patients included in the study, there were 19 males and six females. The mean age was 56 years. On comparison of post-treatment CT scan following eight weeks of completion of therapy, 21 patients showed complete resolution of the disease and four patients had persistent disease who were later treated with salvage laryngectomy. The speech was understandable in 18 patients and poor or not understandable in seven patients. Three patients had chronic aspiration and breathing difficulties necessitating permanent tracheostomy. Three patients required permanent gastrostomy due to chronic dysphagia, one of them belonged to those who were also tracheostomized.Conclusions: Our experience with CCRT as an organ preservation approach for advanced laryngeal cancers was promising. When considering the functional organ preservation, the proportion of success is remarkably less; however, the overall impression is worthy enough to uphold the sentiment in favor of non-surgical organ preservation. The debate is ongoing in the quest of finding a balanced approach with acceptable toxicity and decent functional outcome with adequate speech, breathing, and swallowing

Developmental Changes of Axonal Excitability: Refractory Period Measurement in Normal Children.

Background: “The absolute refractory” period is the time interval during which the nerve fiber is in capable of conducting another impulse after a conditioning stimulus and the determination of the refractory period distribution in a nerve can give a good idea about the characteristics of the conducting fibers constituting that nerve as it reflects their excitability and could be used as a sensitive  indicator for the ability of the nerve fiber to conduct pairs of closely spaced impulses. Methods: The new collision test was used to measure precisely the absolute motor refractory period and the paired shock technique to measure the absolute sensory refractory period in the ulnar nerves of 167 normal infants and children to identify age related changes in the excitability of the nerve fiber membrane. Results: These tests showed that changes in the membrane properties of the fastest and the slowest motor and sensory fibers differ with age. Fastest fibers have more prominent and rapid reduction in their absolute refractory periods (increased excitability) at the successive age groups during the period between 6 months to 6years of life, while the slowest ones have more gradual and prolonged membrane changes (as assessed by the dispersion of the refractory periods) Conclusion: These electrophysological findings point to a period of rapid increment in the nerve fiber diameter, myelin thickness and the possibility of addition of new functioning nerve fibers during the process of growth and development, since each fiber has its characteristic absolute refractory period from birth

Isolated tuberculous thyroiditis as solitary thyroid nodule

Isolated involvement of the thyroid by tuberculosis is very rare as reported in literature. We are presenting a case of isolated tuberculous thyroiditis presented as a solitary thyroid nodule. The patient was treated with anti-tuberculous regimen and he responded well with disappearance of the nodule and normalization of the thyroid scan

The impact of trust and cabin crew performance on customers’ satisfaction

In this research, the case of AIRBLUE has been taken to examine what people think about its performance, whether they trust this airline or not, and are they satisfied or not? Further, this study measures the impact of cabin crew performance and trust on customer satisfaction. The data was collected by distributing questionnaires to the domestic travelers of AIRBLUE. The sample size of the research was of 180 people. The result shows that majority of people are satisfied with the performance of AIRBLUE and they trust on its service, but at the same time they have positive expectation that AIRBLUE would improve its services. The results of this further explain there is positive correlation among the satisfaction, trust and cabin crew performance

The impact of trust and cabin crew performance on customers’ satisfaction

In this research, the case of AIRBLUE has been taken to examine what people think about its performance, whether they trust this airline or not, and are they satisfied or not? Further, this study measures the impact of cabin crew performance and trust on customer satisfaction. The data was collected by distributing questionnaires to the domestic travelers of AIRBLUE. The sample size of the research was of 180 people. The result shows that majority of people are satisfied with the performance of AIRBLUE and they trust on its service, but at the same time they have positive expectation that AIRBLUE would improve its services. The results of this further explain there is positive correlation among the satisfaction, trust and cabin crew performance

Glioblastoma multiforme involving conus medullaris in a child

Primary spinal cord glioblastoma multiforme involving the conus medullaris is an uncommon entity with poor outcomes. An aggressive multimodality treatment approach has been used, but prognosis remains same. There are no guidelines for the treatment of patients with spinal glioblastoma multiforme (GBM). We highlight the case of a child diagnosed with conal GBM. He was treated with definitive surgery followed by adjuvant concurrent chemoradiation. After completion of treatment, he showed a temporary symptomatic improvement, but later on his condition deteriorated. We elaborate the stepwise treatment approach employed in this patient

Sustainable green nanoadsorbents for remediation of pharmaceuticals from water and wastewater: A critical review

In the last three decades, pharmaceutical research has increased tremendously to offer safe and healthy life. However, the high consumption of these harmful drugs has risen devastating impact on ecosystems. Therefore, it is worldwide paramount concern to effectively clean pharmaceuticals contaminated water streams to ensure safer environment and healthier life. Nanotechnology enables to produce new, high-technical material, such as membranes, adsorbent, nano-catalysts, functional surfaces, coverages and reagents for more effective water and wastewater cleanup processes. Nevertheless, nano-sorbent materials are regarded the most appropriate treatment technology for water and wastewater because of their facile application and a large number of adsorbents. Several conventional techniques have been operational for domestic wastewater treatment but are inefficient for pharmaceuticals removal. Alternatively, adsorption techniques have played a pivotal role in water and wastewater treatment for a long, but their rise in attraction is proportional with the continuous emergence of new micropollutants in the aquatic environment and new discoveries of sustainable and low-cost adsorbents. Recently, advancements in adsorption technique for wastewater treatment through nanoadsorbents has greatly increased due to its low production cost, sustainability, better physicochemical properties and high removal performance for pharmaceuticals. Herein, this review critically evaluates the performance of sustainable green nanoadsorbent for the remediation of pharmaceutical pollutants from water. The influential sorption parameters and interaction mechanism are also discussed. Moreover, the future prospects of nanoadsorbents for the remediation of pharmaceuticals are also presented

Magnetic resonance-guided laser interstitial thermal therapy in the management of hypothalamic hamartomas: a systematic review and meta-analysis

Introduction Magnetic resonance-guided laser interstitial thermal therapy (MRg-LITT) is a promising new technique to ablate epileptic foci in patients with hypothalamic hamartoma (HH). We aim to systematically synthesize all available evidence and determine the effectiveness of MRg-LITT in reducing seizures in patients with HH. Methods We systematically searched MEDLINE (PubMed), Embase (Ovid), Scopus, and Google Scholar for all relevant articles. We used Open[Meta]Analyst to pool the number of seizure free patients after MRg-LITT treatment in a Random Effects model. Risk ratios (RRs) were calculated, and subgroups were analyzed. Comprehensive Meta Analysis was used to assess publication bias via funnel plots, Egger’s regression test and Begg’s correlation test. This review complies with the PRISMA guidelines. Results After screening the titles, abstracts, and full texts, we included seventeen articles in our meta-analysis, which revealed a 77.1% rate of seizure freedom (95% CI 0.696 to 0.837, p < 0.001), with moderate heterogeneity (I2 = 49.46%). Subgroup analysis by study design and sensitivity analyses excluding one study at a time did not impact the results substantially, and we found no evidence of publication bias. Adverse effects included electrolyte imbalances, weight gain, and transient neurologic disturbances. Conclusion Magnetic resonance-guided laser interstitial thermal therapy might be a feasible and effective technique for ablation of epileptic foci, leading to seizure freedom in a large proportion of patients with hypothalamic hamartoma. However, there is a paucity of literature on the topic, and prospective clinical trials with larger number of participants, comparing MRg-LITT to open surgery, are needed