Extracellular Vesicles and Ovarian Cancer

Extracellular vesicles (EVs) are a varied group of cell-derived, microscopic, fluid-filled pouches released from cells into neighboring microenvironments that are quickly gaining recognition as a potentially powerful tool against epithelial ovarian cancer (EOC). Recent studies show that not only do EVs play an integral part in the development of cancer through intercellular communication, cell survival, and immune modulation but also may assist with early diagnosis and improved treatments. EOC currently has few effective screening options for early detection of this disease; and, therefore, it is detected at an advanced stage where it is more likely to recur, develop chemoresistance, and ultimately become fatal. Newer research has evaluated EVs as biomarkers for early screening and diagnosis and as novel targets for treatment of EOC. Moreover, EVs are possible targets for novel immunomodulatory therapies to directly target cancer cells or make cancer cells more susceptible to other treatment modalities. Therefore, EVs present an exciting, promising approach which may improve clinical outcome for EOC patients.

Paediatric retropharyngeal abscess with potts spine — A rare case

Tubercular retropharyngeal abscess along with potts spine is very rare in children. As there is no specific sign and symptoms of tuberculosis are present and even if present can be masked by features of nretropharyngeal abscess these cases may have delay in diagnosis. Early diagnosis is important to start proper treatment and can prevent the disability and mortality. In this article we report a case where a child presented to our opd with complaint of right sided neck swelling, dysphagia and neck pain with restricted movement. Any symptoms or signs of tuberculosis were not present. Clinical examination and MRI of neck suggested this as a case of retropharyngeal abscess with cervical spine involvement. Intraoral surgical drainage of pus sent for CBNAAT examination and it revealed the diagnosis of tuberculosis. Antitubercular regimen was given for 12 months. During follow up his symptoms gradually improved and after 1 and 2 year follow up child was free from tuberculosis. So in conclusion we can say retropharyngeal abscess in child should be dealt promptly and in case of abcesses refractory to conventional medical treatment, high degree of suspicion of tuberculosis should have present especially in endemic countries in order to reduce morbidities and improve clinical outcome. Early diagnosis and treatment can improve the scenario significantly.

Nutritional Therapy in Critically Ill Patients with COVID-19: A Narrative Review

Introduction: Combating the pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), better known as Coronavirus Disease 2019 (COVID-19), in all countries of the world has been a challenge. Most patients can be treated in home isolation, however elderly patients and/or with associated comorbidities have been demonstrating more severe conditions of the disease, requiring hospitalization, or even nutritional therapy and mechanical ventilation. Objective: To review the current evidence to establish better nutritional recommendations for critically ill patients with COVID-19.Material and methods:This is a narrative review on nutritional therapy in critical patient with COVID-19. The scientific articles were searched in the databases U.S. National Library of Medicine (PubMed), as well as their respective terms in Portuguese and Spanish, and 40 articles were chosen, excluding the guidelines that were used to help better compose this article.Results: The main findings were that age and non-communicable diseases are considered risk factors for mortality, with systemic arterial hypertension and diabetes mellitus being the main ones. These patients need special care, as well as constant assessment of nutritional status, since malnourished and obese patients have shown a high association with mortality and the use of mechanical ventilation. Nutritional therapy in the affected patients can improve clinical outcome and should be considered as first-line treatment and be more valued in the hospital setting. Although there is no recommendation for supplementation of vitamin C and D and the mineral zinc, these may bring benefits to the immune system of these patients and help in a better prognosis of COVID-19, however more studies are still needed to substantiate the dosage.Conclusions: Further studies are needed, but it is important to bring these themes already exposed by some authors to stimulate discussions that might lead to improvements in the standardization of nutritional approaches.

Sinonasal Tissue Remodelling during Chronic Rhinosinusitis

The purpose of this review is to summarise contemporary knowledge of sinonasal tissue remodelling during chronic rhinosinusitis (CRS), a chronic disease involving long-term inflammation of the paranasal sinuses and nasal passage. The concept of tissue remodelling has significant clinical relevance because of its potential to cause irreversibility in chronic airway tissues. Recent studies have indicated that early surgical treatment of CRS may improve clinical outcome. Tissue remodelling has been described in the literature extensively with no consensus on how remodelling is defined. This review describes various factors implicated in establishing remodelling in sinonasal tissues with a special mention of asthma as a comorbid condition. Some of the main histological features of remodelling include basement membrane thickening and collagen modulation. This may be an avenue of research with regard to targeted therapy against remodelling in CRS.

Comparison of modified Alvarado and RIPASA scoring systems correlated with intra-operative findings in predicting acute appendicitis

Background: Imaging techniques such as ultrasound and CT (computerised tomography) offer to improve clinical outcome by increasing the accuracy of diagnosis. Ultrasound has the great advantage of being radiation free, however it is operator dependant. In comparison, CT can overcome these limitations and greater sensitivity in the diagnosis of acute appendicitis, with reported accuracies of 93-98% but it is expensive and not available at all centre, particularly in countries, like India. Hence we need a scoring system such as MASS (modified Alvarado scoring system) and RIPASA (Raja Isteri Pengiran Anak Saleha appendicitis) scoring system with good sensitivity and specificity. Aim of the present study was to explore the disease on clinical presentation and to compare both scoring systems in diagnosis of acute appendicitis and correlating both the scoring systems with the intra-operative findings.Methods: This was a prospective study done between October 2019 and October 2020 on hundred patients who underwent appendicectomy at Kempegowda institute of medical sciences and research centre, Bengaluru, Karnataka, India.Results: In the study among subjects with appendicitis, there was significant association between combined MASS and RIPASA score and intra-operative findings.Conclusions: In the study combined MASS and RIPASA score with correlated intra-operative findings had diagnostic accuracy in prediction of acute appendicitis.

Co-infection of COVID-19 and dengue: a case report

COVID-19 has now spread to most countries, causing a global pandemic. As the COVID-19 pandemic is still ongoing, some part of the world region with tropical climate is facing a dual burden of infection with the presence of concurrent endemic infectious disease. This endemic dengue infection and the COVID-19 pandemic may turn out into a fatal and hazardous combination. In addition, dengue and COVID-19 possess clinical and laboratory features that are sometimes difficult to differentiate. The possibility of COVID-19 and dengue co-infection has also been a noticeable issue. We present a case of 19-year-old male with COVID-19 and dengue co-infection admitted at Wangaya Regional Hospital Denpasar, Bali. Co-infection of COVID-19 and dengue requires special attention from all health care workers in dengue-endemic countries in order to avoid diagnostic delays and improve clinical outcome. It is also necessary to conduct further research which explores the potential of co-infection between coronavirus and arbovirus.

Comorbidities and clinical features related to severe outcomes among COVID-19 cases in Selangor, Malaysia

Background: Pre-existing comorbidities are predictive of severe COVID-19 infection requiring intubation and mechanical ventilation. This study determined comorbidity and additional predictive factors for invasive ventilatory support among Malaysian COVID-19 patients. Method: Field data collected during COVID-19 outbreak in Selangor, Malaysia up to 13th April 2020 were used. It contained sociodemographic characteristics, comorbidities, and presenting symptoms of COVID-19 cases. Their medical records were traced for information on intensive care unit admission requiring intubation and mechanical ventilation. Results: A total of 1,287 COVID-19 positive cases were included in the analysis. The most common comorbidities among COVID-19 patients were hypertension (15.5%) and diabetes (11.0%). More than one third of symptomatic patients presented with fever (43.8) and cough (37.1%). Among all 25 intubated cases, 68.0% had hypertension, 88.0% had fever, 40.0% had dyspnoea and 44.0% was lethargic. Multivariable regression model showed that the odds of being intubated among COVID-19 patients were significantly higher among older person (aged ?60 years) [adjusted odd ratio (aOR=3.9)], those who had hypertension (aOR =5.7), presented with fever (aOR=9.8), dyspnoea (aOR=9.6), and lethargy (aOR = 7.9). Conclusion: Old age, hypertension, and several presenting symptoms were strong risk factors for invasive ventilatory support among COVID-19 patients. They must be diagnosed early and monitored closely to improve clinical outcome.

Host-Directed Therapies for Cutaneous Leishmaniasis

Cutaneous leishmaniasis exhibits a wide spectrum of clinical presentations from self-resolving infections to severe chronic disease. Anti-parasitic drugs are often ineffective in the most severe forms of the disease, and in some cases the magnitude of the disease can result from an uncontrolled inflammatory response rather than unrestrained parasite replication. In these patients, host-directed therapies offer a novel approach to improve clinical outcome. Importantly, there are many anti-inflammatory drugs with known safety and efficacy profiles that are currently used for other inflammatory diseases and are readily available to be used for leishmaniasis. However, since leishmaniasis consists of a wide range of clinical entities, mediated by a diverse group of leishmanial species, host-directed therapies will need to be tailored for specific types of leishmaniasis. There is now substantial evidence that host-directed therapies are likely to be beneficial beyond autoimmune diseases and cancer and thus should be an important component in the armamentarium to modulate the severity of cutaneous leishmaniasis.

Urinary Extracellular Vesicles as Potential Biomarkers for Urologic Cancers: An Overview of Current Methods and Advances

Urologic cancers are a heterogeneous group of tumors, some of which have poor prognosis. This is partly due to the unavailability of specific and sensitive diagnostic techniques and monitoring tests, ideally non- or minimally invasive. Hence, liquid biopsies are promising tools that have been gaining significant attention over the last decade. Among the different classes of biomarkers that can be isolated from biofluids, urinary extracellular vesicles (uEVs) are a promising low-invasive source of biomarkers, with the potential to improve cancer diagnosis and disease management. Different techniques have been developed to isolate and characterize the cargo of these vesicles; however, no consensus has been reached, challenging the comparison among studies. This results in a vast number of studies portraying an extensive list of uEV-derived candidate biomarkers for urologic cancers, with the potential to improve clinical outcome; however, without significant validation. Herein, we review the current published research on miRNA and protein-derived uEV for prostate, bladder and kidney cancers, focusing on different uEV isolation methods, and its implications for biomarker studies.