Primary Upper Urinary Tract Small Cell Carcinoma: A Case Series and Literature Review

Background: Primary upper urinary tract small cell carcinoma (SCC) is exceedingly rare with \u3c 30 cases reported in the literature. Little is known about the incidence, diagnosis, treatment, and outcomes in these patients. We present a series of three patients with primary upper tract SCC. Case Presentation: Patient 1 is an 89-year-old Caucasian male who presented with hydroureteronephrosis and a mass in the proximal right ureter. Biopsy revealed SCC. Without further intervention, the patient died 2 months after his diagnosis. Patient 2 is a 67-year-old Caucasian female who underwent left laparoscopic nephroureterectomy for primary distal ureteral SCC, pT4N1M0. She developed lymphadenopathy and completed external beam radiation to the pelvis and four courses of cisplatin-based chemotherapy. She died from metastatic disease 7 months after diagnosis. Patient 3 is a 45-year-old female who underwent open right radical nephrectomy, retroperitoneal lymph node dissection, and hepatic metastasectomy for metastatic primary upper tract SCC, pT3N1M1. She underwent two subsequent retroperitoneal debulking procedures for recurrence followed by treatment with octreotide. She developed widespread metastasis and was treated with temozolomide and capecitabine before her death 80 months after diagnosis. Conclusion: This series contributes to the limited knowledge of the management and natural course of primary upper tract SCC. Patient 1 represents the first disease-specific mortality reported in a patient who received no therapy. Patient 3 represents the longest reported survival with metastatic disease, and the first treated with octreotide. The patient was managed with aggressive repeat surgical resection and exhibited 2 years of progression-free survival on octreotide. Emphasis should be placed on aggressive resection of all visible disease combined with the use of multimodal adjuvant chemoradiation for selected patients in this rare disease

Outpatient Management of Chronic Pain

In this chapter, we provide an overview of the most current techniques in the evaluation, diagnosis, and treatment of pain in the outpatient setting. We performed a targeted literature review by searching for the terms such as “chronic pain” and “pain management.” Relevant articles were cited, and findings were described in the chapter text. Additionally, we supplemented our review with images from the Spine and Pain Associates’ offices at St. Luke’s University Health Network (SLUHN) in Bethlehem, PA, as well as medical illustrations by our authors. We begin the review with a description of pain—its definition, components, complexity, and classifications and then provide a stepwise outline of the pharmacologic approach beyond nonsteroidal anti-inflammatory drugs before delving into newer interventional pain management procedures. Subsequently, this chapter is not comprehensive as it does not provide extensive discussion on older, more established procedures such as epidural steroid injections as well as practices falling out of favor such as discograms and neurolysis. Instead, we focus on newer subacute to chronic nonmalignant pain interventions. Finally, we attempt to highlight future directions of the growing field. Overall, we provide an overview of the management of chronic by providing insights into updates to chronic pain management

A 10-Year Experience of Therapeutic Drug Monitoring (TDM) of Linezolid in a Hospital-wide Population of Patients Receiving Conventional Dosing: Is there Enough Evidence for Suggesting TDM in the Majority of Patients?

A retrospective study was conducted to assess our 10-year experience of therapeutic drug monitoring (TDM) of linezolid in a large patient population to establish whether conventional dosing may result in adequate drug exposure in the majority of patients. Patients included in this study underwent TDM of linezolid trough concentration (Cmin ) during treatment with conventional doses of 600 mg every 12 hr in the period between January 2007 and June 2016. The desired range of Cmin was set between 2 and 7 mg/L (under-exposure, Cmin 7 mg/L). Multivariate logistic regression analysis investigated variables potentially correlated with linezolid Cmin . One thousand forty-nine patients had 2484 linezolid Cmin assessed during treatment with conventional doses. Median (IQR) linezolid Cmin was 5.08 mg/L (2.78 - 8.52 mg/L). Linezolid Cmin were within the desired range in 50.8% of cases (1262/2484). Over-exposure (n=821; 33%) occurred much more frequently than under-exposure (n=401;16.2%), and was severe (> 20 mg/L) in 3.9% of cases (98/2484). Linezolid over-exposure was significantly associated with CrCLC-G estimates 64 40 mL/min (OR 1.463; 95% CI 1.124 - 1.904, P = 0.005). Linezolid under-exposure resulted significantly associated with CrCLC-G estimates > 100 mL/min (OR 3.046; 95% CI 2.234 - 4.152, P < 0.001. Linezolid Cmin was not correlated linearly to CrCLC-G (R(2) = 0.061). Variability in renal function explained only partially the very wide interindividual linezolid Cmin variability. Our study suggests that TDM could represent a valuable approach in optimizing linezolid exposure in the majority of patients. This article is protected by copyright. All rights reserved

Anesthetic Concerns in Psychiatric Disease

As the prevalence of mental health illnesses rises worldwide, the use of psychotropic medications follows. Undoubtedly, many patients using psychotropic medications will undergo procedures requiring anesthesia both in the operating room and outside of it. This chapter focuses on psychotropic medications that may complicate the surgical and postoperative course of patients undergoing anesthesia. Toward this aim, we performed a literature review using targeted key terms. Relevant articles were cited, and findings are summarized in this narrative review. We begin with discussing psychotropic medication pharmacology, drug-drug interactions, and side effects, emphasizing their interaction with anesthetic agents. We summarize the current recommendations for managing these medications in the perioperative period. In the discussion section, we focus on highlighting future directions for the intersection between psychotropic medications and anesthesia. Overall, we provide insight into the perioperative management of patients taking psychotropic medications, the point of intersection between the fields of psychiatry and anesthesia

3D Object Recognition in Real Time Using Machine Learning

Object recognition, a small branch of computer vision, deals with making computers detect and analyze objects in either a picture, a saved video, or a real time video feed. The major challenge in the task of object recognition is obtaining efficiency. There are several object recognition algorithms currently in place which provide astonishing results with varying efficiency. There are several libraries in the world today that provide implemented solutions to help with applications concerning object recognition; two of the most popular of these libraries are OpenCV and TensorFlow. This research focuses on two broad aspects – understanding the working of neural networks, more specifically, convolutional neural networks by experimenting with different models for object classification that use them and implementing real time object detection using pre-trained models and machine learning libraries

Comparative Analysis of the Indian and Canadian Real Estate Markets

Financial and real estate crises have been the most prevalent forms of economic catastrophe over the past three decades. In 2008, India endured a financial crisis unprecedented in its history. Canada seems to be creating a real estate bubble recently; Bloomberg Economics puts Canada as the OECD’s second greatest housing bubble in 2019 and 2021. In the case of the Indian real estate bubble, the capital and large cities saw the largest increase in house prices initially, then comparable increase spread gradually to smaller towns and provinces. Thus, this paper conducts a comparative study of the real estate markets in India and Canada and presents a basic analysis of the Canadian real estate market based on the Indian experience with the real estate crisis. Specifically, the article explores the recent economic history and deduces the elements that contributed to the real estate catastrophe. After collecting data and gaining a thorough knowledge of both nations’ real estate markets, the article performs a comparison study employing indices such as the housing index, the corruption rate, and the Business Survey Index (BSI). The research indicates that property prices in Canada are projected to rise because of a significant association between corruption and house prices and a decline in the BSI index. The research provides some recommendations to avert a full-fledged real estate meltdown

A practicable approach for periodontal classification

The Diagnosis and classification of periodontal diseases has remained a dilemma since long. Two distinct concepts have been used to define diseases: Essentialism and Nominalism. Essentialistic concept implies the real existence of disease whereas; nominalistic concept states that the names of diseases are the convenient way of stating concisely the endpoint of a diagnostic process. It generally advances from assessment of symptoms and signs toward knowledge of causation and gives a feasible option to name the disease for which etiology is either unknown or it is too complex to access in routine clinical practice. Various classifications have been proposed by the American Academy of Periodontology (AAP) in 1986, 1989 and 1999. The AAP 1999 classification is among the most widely used classification. But this classification also has demerits which provide impediment for its use in day to day practice. Hence a classification and diagnostic system is required which can help the clinician to access the patient′s need and provide a suitable treatment which is in harmony with the diagnosis for that particular case. Here is an attempt to propose a practicable classification and diagnostic system of periodontal diseases for better treatment outcome