The Olfactory System: Basic Anatomy and Physiology for General Otorhinolaryngologists

Olfaction is one of the five basic human senses, and it is known to be one of the most primitive senses. The sense of olfaction may have been critical for human survival in prehistoric society, and although many believe its importance has diminished over time, it continues to have an impact on human interaction, bonding, and propagation of the species. Even if we are unaware of it, the sense of smell greatly affects our lives and is closely related to overall quality of life and health. Nonetheless, olfaction has been neglected from a scientific perspective compared to other senses. However, olfaction has recently received substantial attention since the loss of smell and taste has been noted as a key symptom of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Studies investigating olfaction loss in association with coronavirus disease 2019 (COVID-19) have revealed that olfactory dysfunction can be both conductive and sensorineural, possibly causing structural changes in the brain. Olfactory training is an effective treatment for olfactory dysfunction, suggesting the reorganization of neural associations. A reduced ability to smell may also alert suspicion for neurodegenerative or psychiatric disorders. Here, we summarize the basic knowledge that we, as otorhinolaryngologists, should have about the sense of smell and the peripheral and central olfactory pathways for managing and helping patients with olfactory dysfunction.

A journey of neuroendocrine carcinoma of the brain from the primary to metastatic tumor

The neuroendocrine tumors most commonly originate in the lung, liver, and gastrointestinal tract. They can be graded into a three-tiered system depending on their proliferation index. These tumors frequently metastasize to the regional lymph nodes. Neuroendocrine tumors of the brain are very rare. Most of them are metastatic and a handful of cases are primary. Hereby, we present a case of brain neuroendocrine carcinoma, which was solitary with no evidence of the primary tumor in the body at the time of neurosurgery. However, treating physicians vigilantly kept him on regular follow-up and investigated further. The patient was diagnosed to have a lesion in the lung 3 months after surgery. Thus, it was considered primary neuroendocrine carcinoma of the brain; however, regular follow-up and further positron emission tomography scan showed a small mass in the lung and adrenal gland. Based on this, a final diagnosis of metastatic neuroendocrine carcinoma of the brain was made.

Hematological and biochemical reference intervals of wild‑caught and inhouse adult Indian rhesus macaques (Macaca mulatta) / 한국실험동물학회지

Background@#Nonhuman primates are used for research purposes such as studying diseases and drug discovery and development programs. Various clinical pathology parameters are used as biomarkers of disease conditions in biomedical research. Detailed reports of these parameters are not available for Indian-origin rhesus macaques. To meet the increasing need for information, we conducted this study on 121 adult Indian rhesus macaques (57 wild-sourced and 64 inhouse animals, aged 3–7 years). A total of 18 hematology and 18 biochemistry parameters were evaluated and reported in this study. Data from these parameters were statistically evaluated for significance amongst inhouse and wild-born animals and for differences amongst sexes. The reference range was calculated according to C28-A3 guidelines for reporting reference intervals of clinical laboratory parameters. @*Results@#Source of the animals and sex appeared to have statistically significant effects on reference values and range. Wild-born animals reported higher WBC, platelets, neutrophils, RBC, hemoglobin, HCT, MCV, and total protein values in comparison to inhouse monkeys. Sex-based differences were observed for parameters such as RBCs, hemoglobin, HCT, creatinine, calcium, phosphorus, albumin, and total protein amongst others. @*Conclusions@#Through this study, we have established a comprehensive data set of reference values and intervals for certain hematological and biochemical parameters which will help researchers in planning, conducting, and interpreting various aspects of biomedical research employing Indian-origin rhesus monkeys.

Clinical characteristics and prognostic analysis of triple-negative breast cancer: single institute experience

Background: Triple-negative breast cancer [TNBC] is a poor prognostic subset of breast cancer that lacks the benefit of specific targeted therapy

Materials and Methods: A prospective study of the clinical profile of triple negative breast cancer cases at a tertiary referral centre. The duration of the study period was 26 months and the median follow up period was ten months. A total of 111 invasive breast cancer patients were evaluated from 1st August 2009 to 31st October 2011. We examined TNBC patients with respect to clinicopathological parameters, adjuvant chemotherapy regimens and relapse free survival

Results: In our study, patients were young [median age at presentation, 47 yrs], premenopausal [54%], tumour size was discordant with lymph node positivity, the histology was predominantly intraductal carcinoma [90%], histological grade higher than two [90%]. Relapses were early and preferential visceral [32%] and CNS metastasises [11.7%]. 91% of patients were eligible for adjuvant therapy but only 80% of the patients could complete full course of adjuvant chemotherapy. Anthracycline-based regimens [43%], sequential anthracycline and taxane-based regimen [24%] and other regimes like CMF [13%] were used as adjuvant chemotherapy in eligible TNBC patients. Median relapse free survival in patients following adjuvant chemotherapy was around 10 months at last follow-up

Conclusions: Patients with TNBC have aggressive clinicopathological characteristics with early and higher rate of disease relapse and therefore derive inadequate benefit from current adjuvant chemotherapy. So, new treatment strategies in adjuvant chemotherapy for TNBC are needed

Saphenous vein graft perforation during percutaneous coronary intervention - a nightmare to be avoided

Percutaneous coronary interventions [PCIs] of saphenous vein grafts [SVGs] is challenging and is associated with adverse short- and long-term clinical outcome as compared to native coronary arteries. SVG perforation is rare but catastrophic and needs immediate attention. Various factors predisposing for SVG perforation are old degenerated graft, ulcerated plaque, severe fibrotic, or calcified lesion necessitating high pressure balloon or stent inflation, use of intravascular ultrasound [IVUS] or other atheroablative devices. Management includes prolonged balloon occlusion, reversal of anticoagulation, use of covered stent, and emergency pericadiocentesis if required

Platinum-based chemotherapy in metastatic triple negative breast cancer: experience of a tertiary referral centre in India

Experimental data suggest that triple-negative breast cancer [TNBC] may have increased sensitivity to platinum-based chemotherapy but there is lack of relevant clinical data. Clinical outcomes in patients with metastatic TNBC treated with Platinum-based chemotherapy were evaluated in this prospective study. 21 selected patients with metastatic TNBC presenting at GCRI during the study period from 1[st] August 2009 to 31[st] October 2011 formed the study group with median follow up period of 10 months. They were given palliative chemotherapy based upon prior adjuvant chemotherapy along with an additional platinum compound. Response rates, response duration and toxicities of platinum-based chemotherapy were recorded and analyzed. In evaluable TNBC patients, overall response rate and complete clinical response were 72% and 38% with median response duration of four months. Response could not be assessed in three patients due to patient refusal for evaluation, lost to follow up and toxicities. In three TNBC patients after completion of platinum based chemotherapy have early isolated CNS relapse with systemic disease in remission. Haematological adverse effects were febrile neutropenia in 19% of patients, and grade 3-4 neutropenia [9%] thrombocytopenia and anaemia [7%]. The main non-hematological adverse effects reported in the present study were peripheral neuropathy [14%] and severe emesis [9%]. The most common Platinum-based chemotherapy combination was carboplatin and paclitaxel in 11 patients [52%] of evaluable patients. Patients who received this regime have complete response rate, overall response rate and toxicity was 45%, 65% and 10%. TNBC patients with platinum-based chemotherapy have better overall response rates, higher complete clinical response rates, prolonged response duration and acceptable safety profile. The results of the present study need to be confirmed with a larger randomized study with a longer follow up

Delayed versus Delayed-Immediate Autologous Breast Reconstruction: A Blinded Evaluation of Aesthetic Outcomes

BACKGROUND: The technique of delayed-immediate breast reconstruction includes immediate insertion of a tissue expander, post-mastectomy radiation, followed by reconstruction. The aesthetic benefits of delayed-immediate reconstruction compared to delayed reconstruction are postulated but remain unproven. The purpose of this study was to compare aesthetic outcomes in patients following delayed and delayed-immediate autologous breast reconstruction. METHODS: A retrospective analysis was performed of all patients who underwent delayed or delayed-immediate autologous breast reconstruction by the senior author from 2005 to 2011. Postoperative photographs were used to evaluate aesthetic outcomes: skin quality, scar formation, superior pole contour, inferior pole contour, and overall aesthetic outcome. Ten non-biased reviewers assessed outcomes using a 5-point Likert scale. Fisher's Exact and Wilcoxon-Mann-Whitney tests were used for comparative analysis. RESULTS: Patient age and body mass index were similar between delayed (n=20) and delayed-immediate (n=20) cohorts (P>0.05). Skin and scar quality was rated significantly higher in the delayed-immediate cohort (3.74 vs. 3.05, P<0.001 and 3.41 vs. 2.79, P<0.001; respectively). Assessment of contour-related parameters, superior pole and inferior pole, found significantly improved outcomes in the delayed-immediate cohort (3.67 vs. 2.96, P<0.001 and 3.84 vs. 3.06, P<0.001; respectively). Delayed-immediate breast reconstruction had a significantly higher overall score compared to delayed breast reconstructions (3.84 vs. 2.94, P<0.001). Smoking and the time interval from radiation to reconstruction were found to affect aesthetic outcomes (P<0.05). CONCLUSIONS: Preservation of native mastectomy skin may allow for improved skin/scar quality, breast contour, and overall aesthetic outcomes following a delayed-immediate reconstructive algorithm as compared to delayed breast reconstruction.

Antibiotic susceptibility pattern in urinary isolates of gram negative bacilli with special reference to AMPC beta-lactamase in a tertiary care hospital

Resistance to higher antimicrobial agent is commonly seen in gram negative bacilli. This issue is a challenging problem to the medical practitioners in addition to it is financial impact on the health care system. To document the prevalence of multi drug resistant gram negative bacilli isolated from urine of patients attending the Urology Department of Tertiary care Hospital of western India in year 2008. Out of total 328 isolates, 118 [35.98%] E.coli, 72 [21.95%] Klebsiella, 64 [19.51%] Pseudomonas aeruginosa, 30 [9.15%] Acinetobacter, 18 [5.49%] Proteus vulgaris, 18 [5.49%] Proteus mirabilis, 6 [1.83%] Providencia rettgerii, 2 [0.61%] Citrobacter freundii. Out of these isolates, 228 [69.51%] were b-lactamase positive, while 100 [30.51%] were beta-lactamase negative. Out of 228 beta-lactamase positive, 104 [45.61%] were AmpC beta-lactamase positive. Stringent protocol such as Antibiotic policy and Hospital infection control program are mandatory to curb these microbes in a tertiary care hospital

Clinical study of cutaneous drug eruptions in 200 patients.

Two hundred patients (112 males and 88 females) with cutaneous drug eruption were studied. The aim was to recognize the offending drug, to evaluate mortality and morbidity, educate the patient and avoid self-administration and readministration of drugs. Fixed drug eruption was the commonest reaction, seen in 61 patients; other reactions being urticaria and angioedema,morbilliform rash in 37, pruritus in 25, Stevens Johnson Syndrome (SJS) in 6, purpura in 6, exfoliative dermatitis in 5,photosensitivity in 5, toxic epidermal necrolysis in 2, acneiform eruption in 3, erythema multiforme in 2. Maximum patients belonged to the age group 41-50, followed by 21-30 and 31-40 years. The youngest was 1 year old and the oldest was 80 years old. Period of development of lesion after intake of drug varied from 1 day to 45 days. Cotrimoxazole was the commonest drug, in 26 cases; followed by Ibuprofen in 20 cases.

Current nutritional status of mothers and children in Al Ain, United Arab Emirates

Forty-six mothers and children from the United Arab Emirates participated in a pilot study to determine possible micronutrient deficiencies in the country. Thirty-five per cent [35%] of the children and 21% of the mothers had low serum ferritin levels, while 30% of the mothers had low serum 25-hydroxyvitamin D with 28% of mothers having a low serum folate status. These deficiencies are widespread in the nationals of the United Arab Emirates. In view of the increasing importance of intrauterine and early infant nutrition, further investigation and a national study seem warranted