Primary fallopian tube cancer in the setting of endometriosis

We report the first case of PFTC arising in the setting of pelvic endometriosis. A 45 year old nulliparous lady, menopausal lady presented with pelvic mass. She had history of pelvic endometriosis. MRI findings were suggestive of ovarian malignancy. Histological analysis of specimen obtained following staging laparotomy proved it to be a case of bilateral PFTC. She received 6 cycles of adjuvant chemotherapy. This case opens a new door to think or investigate if fallopian tube endometrioma behaves as a more aggressive premalignant lesion. This case also poses questions whether it is important to differentiate an endometrioma arising from the ovary to one which is arising from a fallopian tube. Once identified can fallopian tube endometrioma also be managed medically or should it be always removed surgically

Validation of a noninvasive aMMP-8 point-of-care diagnostic methodology in COVID-19 patients with periodontal disease

Objectives: The aim of this study was to validate an active matrix metalloproteinase (MMP-8) point-of-care diagnostic tool in COVID-19 patients with periodontal disease. Subjects, Materials, and Methods: Seventy-two COVID-19-positive and 30 COVID-19-negative subjects were enrolled in the study. Demographic data were recorded, periodontal examination carried out, and chairside tests run for evaluating the expression of active MMP-8 (aMMP-8) in the site with maximum periodontal breakdown via gingival crevicular fluid sampling as well as via a mouth rinse-based kit for general disease activity. In COVID-19-positive patients, the kits were run again once the patients turned COVID-19 negative. Results: The overall (n = 102) sensitivity/specificity of the mouthrinse-based kits to detect periodontal disease was 79.41%136.76% and that of site-specific kits was 64.71%/55.88% while adjusting for age, gender, and smoking status increased the sensitivity and specificity (82.35%/76.47% and 73.53%/88.24, respectively). Receiver operating characteristic (ROC) analysis for the adjusted model revealed very good area under the ROC curve 0.746-0.869 (p < .001) and 0.740-0.872 (p < .001) (the aMMP-8 mouth rinse and site-specific kits, respectively). No statistically significant difference was observed in the distribution of results of aMMP-8 mouth rinse test (p = .302) and aMMP-8 site-specific test (p = .189) once the subjects recovered from COVID-19. Conclusions: The findings of the present study support the aMMP-8 point-of-care testing (PoCT) kits as screening tools for periodontitis in COVID-19 patients. The overall screening accuracy can be further increased by utilizing adjunctively risk factors of periodontitis. The reported noninvasive, user-friendly, and objective PoCT diagnostic methodology may provide a way of stratifying risk groups, deciding upon referrals, and in the institution of diligent oral hygiene regimens.Peer reviewe

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Resident Case Conference Medicine Grand Rounds

Case Presentation, Dr. Varun Bhalla Empyema Necessitans, Dr. Frank Genese Surgical Management of Benign and Malignant Empyema, Dr. Shuyin Lian

Sarcoidosis presenting as a solitary pulmonary mass

Sarcoidosis has a wide varying presentation. Pulmonary sarcoidosis typically presents with bilateral hilar adenopathy and reticulonodular opacities. Very rarely it can present as a single solitary mass. Here we present a case of a 39 year old African-American male who presented with cough and pleuritic chest pain. Initial imaging revealed a right lower lobe airspace opacity, concerning for pneumonia. Despite treatment with antibiotics, symptoms and radiological findings persisted. A PET scan revealed a FDG positive right lower lobe pulmonary mass. Biopsy of the mass and lymph nodes revealed non-caseating granulomas suggestive of sarcoidosis. This case showcases a rare presentation of pulmonary nodular sarcoidosis

Hexaarylbenzene: Evolution of properties and applications of multitalented scaffold

The easily rotatable peripheral aromatic rings around central benzene in hexaarylbenzene (HAB) derivatives create a very intriguing nonplanar, propeller-shaped geometry. Because of the very low susceptibility toward self-aggregation, HAB derivatives are much stronger candidates among various polyphenylenes/hetero-oligophenylenes when poor molecular cohesion and inefficient packing is required. However, the native properties of hexaphenylbenzene (HPB) can be varied by proper tailoring and substitution of the HAB core. The cohesion and packing in the structures of HAB aggregates induce effective structural variations so as to modify the fundamental features. Recently, HAB derivatives attracted a lot of research interest because of their significant role as liquid crystalline materials, organic light-emitting diodes, photochemical switches, redox materials, and molecular receptors. Herein, detailed attention is given to the pioneering work based on synthetic optimization of different HAB cores, elaborated study of their crystal engineering, various interesting applications of HAB derivatives, and future possibilities and capabilities of this still underexplored scaffold

Attogram detection of picric acid by hexa-peri-hexabenzocoronene-based chemosensors by controlled aggregation-induced emission enhancement

Hexa-peri-hexabenzocoronene (HBC) based molecules 5 and 6 have been designed and synthesized. These planar coronenes are appended with rotors to invoke aggregation induced emission enhancement (AIEE) phenomenon by controlling the ratio of H2O in solutions of aggregates. These aggregates of HBC derivatives serve as highly selective chemosensors for picric acid (PA) in mixed aqueous solution. These aggregates are also able to detect PA in vapor phase. In addition, fluorescent test strips have been prepared by dip-coating the Whatman paper with aggregates of both compounds for trace detection of PA in contact mode with detection limits in attograms

Vapor-phase detection of trinitrotoluene by AIEE-active hetero-oligophenylene-based carbazole derivatives

New AIEE-active hetero-oligophenylene carbazole derivatives 3 and 4 have been synthesized and serve as fluorescent probes for the selective detection of 2,4,6-trinitrotoluene (TNT) in the vapor phase, the solid phase, and aqueous media. In addition, paper strips prepared by dip-coating a solution of aggregates of derivatives 3 and 4 can provide a simple, portable, sensitive, selective, low-cost method for the detection of TNT on the picogram level

A Diagnostic Dilemma of Secondary Hemophagocytosis Lymphohistiocytosis in an Elderly Patient

Hemophagocytic lymphohistiocytosis (HLH) is a rapidly progressive fatal condition. Although well described in the pediatric population, cases of secondary HLH are seen in adolescents and young adults. In the elderly, HLH has been shown to have a poor prognosis. Owing to its varied presentation and multisystemic involvement, diagnosis is often delayed. Due to its high mortality, prompt diagnosis and treatment are crucial. Here we present a case of secondary HLH in a 69-year-old male, who presented with fever for one week. Initial laboratory workup revealed a bicytopenia and elevated creatinine. He was initially treated with broad-spectrum antibiotics; however, a comprehensive infectious workup was negative. CT scan of the abdomen revealed splenomegaly. Further investigations revealed an elevated ferritin and triglycerides. Due to the constellation of findings, he was started on corticosteroids for concerns of HLH. Bone marrow biopsy was obtained, which revealed dysplastic changes and hemophagocytosis, consistent with HLH. This case highlights the diagnostic challenge and prognosis of HLH in the elderly population, suggesting that diagnosis and treatment should not be delayed for histological confirmation