Midface Resection And Reconstruction In Head And Neck Oncology: A 20 Years Single Institution Experience

Background: Midface tumors are relatively uncommon as midface comprises less than 1% of all malignant tumors and incorporate a distinct group of lesions, with a high variety of histological types and biological behavior. The purpose of the study is to present our experience in managing patients with advanced midface tumors for a 20-year period.Materials & Methods: From January 2000 to May 2020, we performed 72 excisions and reconstructions in 36 patients where their medical records were reviewed by the head and neck oncology clinic. The commonest anatomical site of the primary was the maxilla in 19 patients and bilaterally in 5 patients. In 15 patients there was an orbital and anterior fossa extension. In 6 patients there was a parotid and middle ear extension and in 1 patient there was a lip involvement.Results: Surgical resection included maxillectomy in the majority of the cases in combination with orbital exenteration or orbitectomy and anterior fossa resection. In 8 cases parotidectomy and mastoidectomy/ core petrosectomy was performed. One patient was subjected to total petrosectomy. Reconstruction was performed with radial forearm osteocutaneous free flap in 4 cases, latissimus with scapular bone flap in one case, lengthening temporalis myoplasty in 19 cases, rectus femoris in one case and anterolateral thigh flap in 5 cases in combination with temporalis and vastus lateralis in one case respectively and bilateral karapandzic flap in 1 case. The patients were followed-up from 2005 to 2020. To date, 23 patients (63.8%) are disease free with no recurrences of the disease and 4.4% of all patients presented disease recurrence during the follow-up period.Conclusions: In conclusion midface resections are safely performed with a combination of microvascular and dynamic reconstruction of the face offering our patients quality of life improvement.Level of Evidence: Level V, therapeutic study

Genome-wide association study identifies tumor anatomical site-specific risk variants for colorectal cancer survival

Identification of new genetic markers may improve the prediction of colorectal cancer prognosis. Our objective was to examine genome-wide associations of germline genetic variants with disease-specific survival in an analysis of 16,964 cases of colorectal cancer. We analyzed genotype and colorectal cancer-specific survival data from a consortium of 15 studies. Approximately 7.5 million SNPs were examined under the log-additive model using Cox proportional hazards models, adjusting for clinical factors and principal components. Additionally, we ran secondary analyses stratifying by tumor site and disease stage. We used a genome-wide p-value threshold of 5 × 10–8 to assess statistical significance. No variants were statistically significantly associated with disease-specific survival in the full case analysis or in the stage-stratified analyses. Three SNPs were statistically significantly associated with disease-specific survival for cases with tumors located in the distal colon (rs698022, HR = 1.48, CI 1.30–1.69, p = 8.47 × 10–9) and the proximal colon (rs189655236, HR = 2.14, 95% CI 1.65–2.77, p = 9.19 × 10–9 and rs144717887, HR = 2.01, 95% CI 1.57–2.58, p = 3.14 × 10–8), whereas no associations were detected for rectal tumors. Findings from this large genome-wide association study highlight the potential for anatomical-site-stratified genome-wide studies to identify germline genetic risk variants associated with colorectal cancer-specific survival. Larger sample sizes and further replication efforts are needed to more fully interpret these findings.

Evaluation of Pressure Ulcer Among the Critically Ill Patients Admitted in a Tertiary Hospital

Background: All over the world pressure ulcer is a significant health care problem due to high morbidity and mortality rates and also high health care cost. This study was carried out with the objectives to identify the characteristics and associated factors of pressure ulcer among the critically ill patients admitted in a tertiary military hospital. Few studies have been conducted on pressure ulcer in Bangladesh and very few in military hospitals. Methodology: This was a cross sectional study conducted among purposively selected 53 critically ill admitted pressure ulcer patients in CMH Dhaka from 01 July 2018 to 31 December 2018 and data were collected by face to face interview and checklist. Results: Among the study population half (50.9%) were aged between 61-80 years with the mean age 69.13 years. The most common anatomical site of pressure ulcer were buttock (51.9%) followed by sacrum (38.5%) and 30.2% had multiple pressure ulcer. Among the critically ill patients, 81.1% had developed pressure ulcer after admission into hospital. The most common place of pressure ulcer was geriatric HDU (30.2%) and officers ward (18.9%). Among the pressure ulcer patients 79.2% were male. Most common stage of pressure ulcer were stage II (66.0%) followed by stage I (18.9%), stage III (13.2%) and stage IV (1.9%). All of them were bedridden and half (50.9%) were completely immobile. According to Braden Scale, about half (50.9%) had high risk for development of pressure ulcer followed by moderate risk (26.4%) and there were none beyond risk. About three fourth (73.6%) of pressure ulcer patients had hypertension & cerebrovascular diseases. Age group of 60-90 years, SSC & above educational group, male sex, immobility, low Braden score group patients are statistically significant (p < 0.05), and hypertensive and cerebrovascular diseased patients are not statically significant (p > 0.05) but having clear trends to be associate factors of pressure ulcer. Conclusion: The number of pressure ulcer were increasing with the increase of age. The higher age, male sex, immobilization, low Braden score, hypertension, and cerebrovascular diseased patients were more prone for development of pressure ulcer among the critically ill patients. J Bangladesh Coll Phys Surg 2022; 40: 23-30

Cancer Scenario in Kashmir—A Study Conducted in a Tertiary Care Center, Srinagar, Kashmir, India

Background Cancer can have profound social and economic consequences for the people in India, often leading to family impoverishment and societal inequity. Reported age-adjusted incidence rates for cancer are still quite low in the demographically young country. Slightly more than 1 million new cases of cancer are diagnosed every year in a population of 1.2 billion. It accounts for about 23 and 7% deaths in United States and India, respectively. The world's population is expected to be 7.5 billion by 2020 and approximations predict that about 15.0 million new cancer cases will be diagnosed, with deaths of about 12.0 million cancer patients. Early detection of cancers is a challenging task because clinical symptoms develop slowly. Objective The aim of the present study was to analyze the cancer scenario in the Kashmir valley. Materials and Methods This was a retrospective study. So, all patients were included who had histopathologically confirmed neoplasm registered at Regional Cancer Centre of Government Medical College Srinagar, Kashmir between 2015 and 2018. All the patient characteristics including age, sex, and anatomical site of the disease were studied in detail. Results The number of cancer patients in 2015, 2016, 2017, and 2018 were 230, 239, 391, and 511, respectively, with a combined total of 1,371. Thus, it is clear from these figures that the number of cancer cases has increased gradually with time. Stomach cancer is the most common cancer in the Kashmir territory. In males the most common cancer is stomach cancer with 175 (12.8%) reported cases and in females the most common cancer is breast cancer with 151 (11%) reported cases. The male to female ratio was 1.4:1. Conclusion A careful reading the reported cancer cases indicates an increased number of cancer patients every year in Indian-occupied Kashmir. Kashmir is a growing state in India playing a crucial role in the development of India and, hence, it needs special attention on this issue. A multidisciplinary approach to cancer treatment is essential and this has to be made available at all regional cancer centers. Cancer control is an area in which we need participation from all sectors of the society.

Clinico-Epidemiological Profile of Patients with Psoriasis in a Tertiary Care Hospital of Western Nepal

INTRODUCTION: Psoriasis is a common, chronic, inflammatory and proliferative condition of the skin which poses a significant health problem in general population. It is clinically characterized by erythematous plaques covered by silvery white scales, associated with systemic manifestations in many organ systems. MATERIAL AND METHODS: This is a descriptive study conducted at the Department of Dermatology, Universal College of Medical Sciences, Bhairahawa, Nepal. All psoriasis patients who gave consent were clinically examined and proforma documentation including patient’s clinical and demographic details was studied. RESULTS: Fifty two psoriasis patients were studied. The median age was 40 years and male: female ratio was 1.7:1 with 33 (63.5%) male and 19 (36.5%) female psoriasis patients. The most common clinical type of psoriasis observed according to morphology was chronic plaque psoriasis 45 (86.54%) and according to involvement of anatomical site was nail psoriasis 33 (63.5%). This study showed that 30 (57.7%) had no symptoms of pruritus and pain and 29 (55.8%) of psoriatic cases had seasonal variation. The commonest treatment modality was a combination of oral and topical medication 29 (55.8%). CONCLUSION: Psoriasis is a common skin disorder associated with systemic manifestations seen by dermatologists. This study outlines the clinico-epidemiological profile of patients with psoriasis which can provide further guidance for taking appropriate measures in diagnosing, providing adequate treatment, and undertaking various preventive measures among psoriasis patients.

The Role of Genital Tract Microbiome in Fertility: A Systematic Review

The human microbiome plays a crucial role in determining the health status of every human being, and the microbiome of the genital tract can affect the fertility potential before and during assisted reproductive treatments (ARTs). This review aims to identify and appraise studies investigating the correlation of genital microbiome to infertility. Publications up to February 2021 were identified by searching the electronic databases PubMed/MEDLINE, Scopus and Embase and bibliographies. Only full-text original research articles written in English were considered eligible for analysis, whereas reviews, editorials, opinions or letters, case studies, conference papers, and abstracts were excluded. Twenty-six articles were identified. The oldest studies adopted the exclusive culture-based technique, while in recent years PCR and RNA sequencing based on 16S rRNA were the most used technique. Regardless of the anatomical site under investigation, the Lactobacillus-dominated flora seems to play a pivotal role in determining fertility, and in particular Lactobacillus crispatus showed a central role. Nonetheless, the presence of pathogens in the genital tract, such as Chlamydia trachomatis, Gardnerella vaginalis, Ureaplasma species, and Gram-negative stains microorganism, affected fertility also in case of asymptomatic bacterial vaginosis (BV). We failed to identify descriptive or comparative studies regarding tubal microbiome. The microbiome of the genital tract plays a pivotal role in fertility, also in case of ARTs. The standardization of the sampling methods and investigations approaches is warranted to stratify the fertility potential and its subsequent treatment. Prospective tubal microbiome studies are warranted.

Bacterial Signatures of Paediatric Respiratory Disease: An Individual Participant Data Meta-Analysis

Introduction: The airway microbiota has been linked to specific paediatric respiratory diseases, but studies are often small. It remains unclear whether particular bacteria are associated with a given disease, or if a more general, non-specific microbiota association with disease exists, as suggested for the gut. We investigated overarching patterns of bacterial association with acute and chronic paediatric respiratory disease in an individual participant data (IPD) meta-analysis of 16S rRNA gene sequences from published respiratory microbiota studies.Methods: We obtained raw microbiota data from public repositories or via communication with corresponding authors. Cross-sectional analyses of the paediatric (&lt;18 years) microbiota in acute and chronic respiratory conditions, with &gt;10 case subjects were included. Sequence data were processed using a uniform bioinformatics pipeline, removing a potentially substantial source of variation. Microbiota differences across diagnoses were assessed using alpha- and beta-diversity approaches, machine learning, and biomarker analyses.Results: We ultimately included 20 studies containing individual data from 2624 children. Disease was associated with lower bacterial diversity in nasal and lower airway samples and higher relative abundances of specific nasal taxa including Streptococcus and Haemophilus. Machine learning success in assigning samples to diagnostic groupings varied with anatomical site, with positive predictive value and sensitivity ranging from 43 to 100 and 8 to 99%, respectively.Conclusion: IPD meta-analysis of the respiratory microbiota across multiple diseases allowed identification of a non-specific disease association which cannot be recognised by studying a single disease. Whilst imperfect, machine learning offers promise as a potential additional tool to aid clinical diagnosis.

Adrenal incidentaloma: prevalence and referral patterns from routine practice in a large UK university teaching hospital

Context Adrenal incidentalomas are increasingly being identified during unrelated imaging. Unlike AI clinical management, data on referral patterns in routine practice are lacking. Objective To identify factors associated with AI referral Design We linked data from imaging reports and outpatient bookings from a large UK teaching hospital. We examined; (i) AI prevalence and (ii) pattern of referral to endocrinology, stratified by age, imaging modality, scan anatomical site, requesting clinical specialty and temporal trends. Patients Utilising key radiology phrases to identify scans reporting potential AI, we identified 4,097 individuals from 479,945 scan reports (2015-19). Main Outcome Measures Prevalence of AI and referral rates Results Overall, AI lesions were identified in 1.2% of scans. They were more prevalent in abdomen CT and MRI scans (3.0% and 0.6%, respectively). Scans performed increased 7.7% year-on-year from 2015-19, with a more pronounced rise in the number with AI lesions (14.7% pa). Only 394/4097 patients (9.6%) had a documented endocrinology referral code within 90 days, with medical (11.8%) more likely to refer than surgical (7.2%) specialties (p&lt;0.001). Despite prevalence increasing with age, older patients were less likely to be referred (p&lt;0.001). Conclusions While overall AI prevalence appeared low, scan numbers are large and rising; the number with identified AI are increasing still further. The poor AI referral rates, even in centres such as ours where dedicated AI multi-disciplinary team meetings and digital management systems are used, highlights the need for new streamlined, clinically-effective systems and processes to appropriately manage the AI workload.

Melanoma Detection by AFM Indentation of Histological Specimens

Melanoma is visible unlike other types of cancer, but it is still challenging to diagnose correctly because of the difficulty in distinguishing between benign nevus and melanoma. We conducted a robust investigation of melanoma, identifying considerable differences in local elastic properties between nevus and melanoma tissues by using atomic force microscopy (AFM) indentation of histological specimens. Specifically, the histograms of the elasticity of melanoma displayed multimodal Gaussian distributions, exhibiting the heterogeneous mechanical properties, in contrast with the unimodal distributions of elasticity in the benign nevus. We identified this notable signature was consistent regardless of blotch incidence by sex, age, anatomical site (e.g., thigh, calf, arm, eyelid, and cheek), or cancer stage (I, IV, and V). In addition, we found that the non-linearity of the force-distance curves for melanoma is increased compared to benign nevus. We believe that AFM indentation of histological specimens may technically complement conventional histopathological analysis for earlier and more precise melanoma detection.