Bilateral Brenner tumor of ovary with associated unilateral mucinous cystadenoma: a case report

Brenner tumors are rare ovarian tumors, which are a subgroup of transitional cell tumors of ovary. Most of these tumors are benign presenting as incidental unilateral masses in postmenopausal age group. Only 5-7% cases are bilateral. These tumors are mostly small, solid and asymptomatic, seen commonly in association with mucinous cystadenomas of ovary. In such cases they may attain a massive size. Specific diagnosis of Brenner tumor is difficult using imaging studies and can be definitely diagnosed only on pathological examination. Surgical removal is usually curative for benign tumors. We present a rare case of bilateral Brenner tumor of ovary with associated unilateral mucinous cystadenoma in which bilateral Brenner tumor was a rare incidental finding on pathological examinati

Comparative study of dry eye after Phacoemulsification in senile cataract

Background:Corneal surgery has been identified as one of the risk factors for the development of dry eye disease by decreasing corneal sensation and changing the contour of the ocular surface as a result of the inflammation caused by surgical trauma. Clear cornea phacoemulsification may also alter the ocular surface and disrupts normal tear function in eyes.  The  purpose  of  study  to  compare  dry eye  caused  by phacoemulsification   in  different  age  groups  in senile cataract  patient with no pre-existing  dry eye.Methods: After  taking  informed  consent  50  eyes  of  50 patient  of  senile  cataract  with  no preoperative  dry eye  had  under gone   2.75 mm  superior clear corneal phacoemulsification  with  IOL implantation.  After ruling out  pre-existing  ocular disease, surgery ,trauma and systemic diseases, Dry  Eye  evaluation by  schirmer1test , FTBUT and  lissamine  conjunctival  staining was done pre and  postoperatively at 1st ,4th and  12th week .Data was collected and analysed on IBM SPSS version 23 by paired T test.Results: In all age group, S1T and FTBUT, conjunctival staining showed   lowest   values at 1stweek (p <0.05) and by 12th week values has come near to base line value (p <0.05). Results showed only 38% of cases in 45-55 age group, 50% in 56-65 age group and all the cases showed dry eye in 66-75 age group at 12th week.Conclusions: We  have concluded that  phacoemulsification  surgery  affects  the  tear  film  stability and the  production of tears postoperatively and causes  dry  eye  more  in  the  older  age  group.

Thoracopagus conjoined twin: an unusual presentation

Conjoined twins are among rare clinical conditions observed by obstetricians. Due to rare incidence of this condition there is general lack of knowledge among obstetricians, especially at primary care level which leads to missed diagnosis during antenatal period. The management of this condition is complex especially in cases where the diagnosis is not known before onset of labour. A 30 - year old Hindu lady was referred to us from other hospital with diagnosis of twin pregnancy and prolonged second stage of labour. Clinical examination revealed findings of ruptured uterus and foetal head of one baby and feet of second baby were outside the introitus. Emergency laparotomy was done which revealed conjoined twins. This article report clinical course of a thoracopagus conjoined twin. The relevant literature is also reviewed.

Physico-chemical properties based differential toxicity of graphene oxide/reduced graphene oxide in human lung cells mediated through oxidative stress

Goraphene derivatives (GD) are currently being evaluated for technological and biomedical applications owing to their unique physico-chemical properties over other carbon allotrope such as carbon nanotubes (CNTs). But, the possible association of their properties with underlying in vitro effects have not fully examined. Here, we assessed the comparative interaction of three GD - graphene oxide (GO), thermally reduced GO (TRGO) and chemically reduced GO (CRGO), which significantly differ in their lateral size and functional groups density, with phenotypically different human lung cells; bronchial epithelial cells (BEAS-2B) and alveolar epithelial cells (A549). The cellular studies demonstrate that GD significantly ineternalize and induce oxidative stress mediated cytotoxicity in both cells. The toxicity intensity was in line with the reduced lateral size and increased functional groups revealed more toxicity potential of TRGO and GO respectively. Further, A549 cells showed more susceptibility than BEAS-2B which reflected cell type dependent differential cellular response. Molecular studies revealed that GD induced differential cell death mechanism which was efficiently prevented by their respective inhibitors. This is prior study to the best of our knowledge involving TRGO for its safety evaluation which provided invaluable information and new opportunities for GD based biomedical applications

A rare case of primary mesenteric gastrointestinal stromal tumor with metastasis to the cervix uteri

<p>Abstract</p> <p>Background</p> <p>Gastrointestinal stromal tumors are CD117 (C Kit) positive mesenchymal neoplasms, that may arise anywhere in the gastrointestinal tract. Their current therapy is imatinib mesylate before or after surgery.</p> <p>Case presentation</p> <p>We describe a case of 17-year-old female with metastasis to the cervix uteri of a primary mesenteric gastrointestinal tumor.</p> <p>Conclusion</p> <p>Surgery remains the mainstay of known curative treatment. The manifestations of GIST are not restricted to the typical locations within the bowel; may have very unusual metastatic sites or infiltrations per continuitatem.</p

Dengue Virus Serotypes 1 and 2 Responsible for Major Dengue Outbreaks in Nepal: Clinical, Laboratory, and Epidemiological Features

Dengue virus (DENV) is expanding toward previously nonendemic areas. DENV has recently been introduced in Nepal with limited information. We report the clinical features and serotype distribution of DENV in Nepal during the 2010 outbreaks. A total of 1,215 clinical dengue cases at two major hospitals of central and western Nepal were investigated. Demographic, clinical, and laboratory parameters were recorded. Serum specimens were tested for DENV by IgM/IgG enzyme-linked immunosorbent assays (ELISAs) and reverse transcription polymerase chain reaction (RT-PCR). We confirmed DENV infection in 403 (33%) patients from 12 districts with an estimated case fatality rate of 1.5%. DENV infection was more common in adults (87%) and urban settings (74%). We detected all four serotypes but DENV-1 and -2 were mainly responsible for major outbreaks (92%). Overall, 60% of all DENV infections were secondary and 17% were severe dengue; both being more frequent among the DENV-2 infections. Rash, bleeding, abdominal pain, hepatomegaly, elevated liver enzymes, and thrombocytopenia were significantly more common in severe dengue compared with nonsevere infections. We also confirmed the expansion of dengue to hill urban areas (DENV-1 and -2), including the capital Kathmandu (altitude, 1,300 m) though > 90% cases were from southern plains. Differential clinical and laboratory features probably help in clinical decisions. Multiple serotypes circulation and elevated secondary infections pose potential risk of severe outbreaks and deaths in the future. Therefore, a country with recent dengue introduction, like Nepal, urgently requires a systematic surveillance and appropriate control measures in place to respond to any disastrous outbreaks

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Delay of gratification in 2- and 3-year-olds: Associations with attachment, classroom behavior, personality, and temperament

The study investigated the relationship between 2- and 3-year-old children\u27s ability to delay immediate gratification in an experimental situation and attachment, classroom behavior, personality, and temperament. The study was unique as it studied delay in younger children than is the norm in the field and it studied dimensions of attachment and parental caregiving. The sample comprised of fifty preschoolers and their primary caregivers. Data were collected at preschools at the University of Connecticut and Montclair State University (New Jersey). Each child and parent participated in two laboratory tasks. The Gift Task was used to determine the child\u27s ability or inability to wait for a preferred reward. The Preschool Strange Situation was used to assess the child\u27s attachment and the parent\u27s caregiving. Both tasks included a series of episodes with the child, parent, and a stranger. The tasks were videotaped and coded by independent, reliable teams of coders. Parents and the teachers also completed questionnaires regarding children\u27s temperament and personality. Videotaped classroom behaviors of children during a group time setting in the regular classroom were coded for children\u27s activity, attention, and affect. On the basis of children\u27s behaviors in the Gift Task, three delay categories were identified: the Delay group (n = 10), the Touch & Go group (n = 23), and the Non Delay group (n = 17). Delayers did not touch the gift in the room and waited through the entire 12-minute period. Touch & Go children touched the gift initially but, when given a second chance, revised their strategy and waited for the preferred gift. Non Delayers took the gift in the room, and did not respond to additional opportunities to wait. A series of oneway ANOVAs were computed to determine the relationship between several predictor variables and children\u27s delay ability. Type of attachment-caregiving insecurity was related to delay. Insecure-Avoidant children were more likely to be represented in the Touch & Go group, whereas more Insecure-Ambivalent children were in the Non Delay group. Surprisingly, parents\u27 reports of children\u27s personality were not associated with delay, but various aspects of teachers\u27 personality reports were. Some temperamental traits, as reported by parents and teachers, were associated with delay. As a partial validation of the Gift Task procedure, delay classifications were compared to group time classroom behaviors. There were some significant differences among the three delay groups in terms of classroom behavior, especially in terms of coded affect. Overall, the three delay groups were found to be different from each other in some of the hypothesized domains. Further investigations will be necessary to replicate and extend the individual and relationship factors that may have an impact on children\u27s delay ability.

Can Reflective Writing Reconcile ACGME Core Competencies with Daily Encounters in Medical Education? A Prospective, Randomized, Cross-over Pilot Study

Introduction Residency program directors are still exploring means to teach and evaluate ACGME core competencies. Finding simple means to reconcile ACGME core competencies with daily encounters offers a unique opportunity. Reflective writing through narratives may be the answer to simple and affordable means to achieve such goals. Methods To investigate the educational value of reflective writing, we conducted a prospective, randomized, cross-over pilot study among family practice residency program residents. The intervention group was introduced to the educational intervention. During the intervention, each narrative was analyzed by the authors, sentence by sentence, helping the learners spot ACGME core competencies. A week later, both groups were given five preselected narratives (test narratives) to analyze and identify what ACGME core competencies were reflected. A week later, the control group was subjected to the same intervention to comply with the cross-over design of the study. Data were then collected and a statistical analysis was completed. Results Nine learners were randomized into the control group and ten were randomized into the intervention group. Each learner analyzed ten sentences within the five test-narratives. The mean score for each learner across the ten sentences was calculated. The grand mean score for each group was calculated. The grand mean score for the control group was 58.75 (SD 13.4). The grand mean score for the intervention group was 69.90 (SD 15.8). Our one-tailed t test analysis showed no significant difference between the two groups (t = 1.647, df = 17, p = 0.057). Conclusion Our pilot study failed to show any statically significant improvement in the learners ability to reconcile the ACGME core competencies with their daily encounters using reflective writing. We identified several possibilities for the negative outcome. Sample size seems to be a major contributor. Further prospective randomized studies using larger sample sizes would be worthwhile to answer our research question