Ectopic colloid goiter in mediastinum with normal thyroid gland.

Ectopic thyroid tissue is a rare developmental abnormality involving aberrant embryogenesis of the thyroid gland during passage from the primitive foregut to the pretracheal position. The most frequent position is the base of the tongue (lingual thyroid); however, it has been described in other sites, such as the submandibular region, trachea, mediastinum, and subdiaphragmatic regions.Here, we report a case of an adenomatous goiter that developed in mediastinal thyroid tissue without any connection to the pretracheal thyroid gland.

Administering drugs to an individual in a non-pathological situation: The Caster Semenya case.

The International Association of Athletics Federations (IAAF) has barred individuals whose circulating testosterone levels are higher than 5 nmol/L from competing in women's competitions in middle-distance track events. To become eligible, they must take anti-testosterone treatment to achieve the appropriate testosterone levels. The 2019 decision of the Court of Arbitration for Sport has brought the spotlight back on Caster Semenya's case and on the ethics of testing the testosterone levels of sports persons with or without consent, imposing anti-testosterone treatment in order to qualify to participate in sports competitions for females. This article debates all the issues concerned from various perspectives.

Public, patient and carers' views on palliative and end-of-life care in India.

AIM: To systematically review the existing evidence on the Indian public, patient and carers' perspectives on palliative and end-of-life care. BACKGROUND: With a growing population of terminally ill people across the world, there is also an increasing awareness among international health policy makers of the need to improve the quality of life for terminally ill patients. Understanding service users' (patients, family and public) perspectives is crucial in developing and sustaining successful community-centred palliative nursing policies and service models especially in countries like India with diverse population. METHODS: An integrative review was performed on five databases, using hand searches of key journals and reference citation tracking for empirical studies published in English from 1990 to 2015. A thematic analysis framework was used to analyse and identify key themes. RESULTS: Analysis of the six eligible studies revealed five themes. Themes describe how social, economic, cultural, religious, spiritual and traditional factors influenced the palliative and end-of-life care perspectives and experiences among Indians. They also illustrated preferences relating to place of care, as well as benefits and challenges of family caregiving during the last days of life. CONCLUSIONS: Although we found minimal evidence on user perspectives, nurses need to aware of those unique components of context-specific palliative and end-of-life care practices in India - socioeconomic, cultural and religious factors - on their nursing encounters. Nurses need to advocate same in policy development to enable accessibility and utility of palliative and end-of-life care services, which are scant in India. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nurses can be central in gathering the contextual evidence that advocate users' perspectives to inform further studies and national palliative care policies in India. Emerging policies in nursing education need to focus on integrating family-centred palliative and end-of-life care within curricula, whereas nursing practice may promote nurse-led community models to address the patchy palliative and end-of-life service provision in India.

Synthesis and Bioevaluation of Quaternary Centered 3-hydroxy-3 (alkynyl)indolin-2-one Derivatives as Potential Cytotoxic Agents and Akt Kinase Inhibitors.

BACKGROUND: Alkynes are fundamental building blocks in synthetic chemistry with high pharmaceutical applications. Among the bioactive acetylenic molecules, propargylic alcohol is most important as almost all the marketed drugs contains quaternary centered propargylic alcohol functionality. OBJECTIVE: In this study we have synthesised and evaluated 3-hydroxy-3-ethynylindolin-2-one derivatives for in vitro cytotoxic activity. METHOD: An expeditious method for direct alkynylation of isatins (ketones) has been developed using tetrabutylammonium fluoride (TBAF) as a catalyst in THF solvent at room temperature under metal-free conditions. Furthermore, this method is an economically viable process that also compliments green aspects like being a ligand/metal free process under ambient conditions. This reaction tolerated a wide range of substrates with good to excellent yields (80-94%). RESULTS: The results showed that the synthesized compounds (4m, 4n and 4p) has the ability to inhibit Akt kinase activity with IC50 values ranging from 7.7 to 9.8 µM. CONCLUSION: All the 3-hydroxy-3-ethynylindolin-2-one derivatives were subjected for in vitro cytotoxic activity on five different cancer cell lines. Further, the synthesized compounds (4m, 4n and 4p) were evaluated for their ability to inhibit Akt kinase activity and exhibited good inhibition with IC50 values ranging from 7.7 to 9.8 µM..

Does the internal inguinal ring need closure during laparoscopic orchiopexy with Prentiss manoeuvre?

BACKGROUND: Undescended testis is a common problem, which is prevalent in 3 % of male infants. This study aimed to determine the effect of leaving the deep inguinal ring (DIR) without closure during laparoscopic orchiopexy (LO), with regard to post-operative hernia formation and other outcomes. METHODS: From 2012 to 2014, 63 testicular units were managed with laparoscopy for non-palpable testis (NPT). Diagnostic laparoscopy was performed for all NPTs, and when they were intra-abdominal (42 testicular units), the DIR was left open after mobilization of the testis into the scrotum medial to the inferior epigastric vessels (Prentiss manoeuvre). We followed up these cases to check for hernia formation. RESULTS: The ages ranged from 10 months to 11 years with mean age at 3.7 years. Clinically, no cases presented with hernia, hydrocele or any other complications during a mean follow-up period of 34.4 months. CONCLUSION: Closing the peritoneum over the DIR might be omitted in LO with Prentiss manoeuvre, saving operative time and effort. By doing so, there is no risk of hernia formation.

Emergency cardiac double valve surgery in active infective endocarditis due to Acinetobacter baumannii with aortic root abscess in a patient with dialysis-dependent end-stage renal failure: a rare case report.

We report an end-stage renal disease (ESRD) patient on regular haemodialysis awaiting renal transplant having native aortic valve endocarditis due to Acinetobacter baumannii complicated with aortic root abscess and severe mitral valve regurgitation with NYHA class IV symptoms. He underwent emergency aortic root abscess debridement, reconstruction with autologous pericardial patch and bioprosthetic aortic valve replacement along with mitral valve repair. This emergency intervention in active infective endocarditis due to A. baumannii and associated ESRD is very rare. We could not trace any case report for such combination of clinical scenario in the literature.

A case of primary intracardiac yolk sac tumour with extracardiac extension.

Primary cardiac tumour is a rare entity as secondaries in the heart are more common. A 2-year-old child was having repeated respiratory tract infection with poor oral intake and poor activity for 3 months. His symptoms progressed from New York Heart Association (NYHA) Class II to IV. On evaluation he had an intracardiac mass with extracardiac extension. Emergency tumour excision under deep hypothermic circulatory arrest was performed with provisional diagnosis of sarcoma. But Serum markers, histopathological examination and immunohistochemistry confirmed diagnosis of yolk sac tumour. Postoperative recovery was uneventful and the child was receiving adjuvant chemotherapy. Extensive literature review revealed only four cases of primary intracardiac yolk sac tumour published till date. Our case report is unique, in that intracardiac tumour had extracardiac extension by infiltration through right atrial wall. Previous four reports mention purely intracardiac mass.

Echocardiographic detection of free-floating thrombus in left ventricle during coronary artery bypass grafting.

We report an incident of detection of a free-floating thrombus in the left ventricle (LV) using intraoperative two-dimensional (2D) and three-dimensional (3D) transesophageal echocardiography (TEE) during proximal coronary artery bypass graft anastomosis. A 58-year-old man presented to us with a 6-month history of chest pain without any history suggestive of myocardial infarction or transient ischemic attacks. His preoperative echocardiography revealed the systolic dysfunction of LV, mild hypokinesia of basal and mid-anterior wall, and the absence of an aneurysm. He was scheduled for on-pump coronary artery bypass surgery. On intraoperative TEE before establishing cardiopulmonary bypass (CPB), a small immobile mass was found attached to LV apical area. After completion of distal coronary artery grafting, when the aortic cross-clamp was removed, the heart was filled partially and beating spontaneously. TEE examination using 2D mode revealed a free-floating mass in the LV, which was suspected to be a thrombus. Additional navigation using biplane and 3D modes confirmed the presence of the thrombus and distinguished it from papillary muscles and artifact. The surgeon opened the left atrium after re-establishing electromechanical quiescence and removed a thrombus measuring 1.5 cm Χ 1 cm from the LV. The LV mass in the apical region was no longer seen after discontinuation of CPB. Accurate TEE-detection and timely removal of the thrombus averted disastrous embolic complications. Intraoperative 2D and recent biplane and 3D echocardiography modes are useful monitoring tools during the conduct of CPB.

Legal changes towards justice for sexual assault victims.

The crime of rape is a major problem in India, evident from the reports in the press as well as official statistics. The accused has often gone free, because the victim did not file a complaint, or because of poor evidence gathering and well as lacunae in the law. This paper presents an overview of the laws applicable to sexual assault cases and amendments in these laws, specifically in terms of the roles and responsibilities of healthcare providers to bridge the gap in providing medical evidence to the courts.

Differences in the transactivation domains of p53 family members: a computational study.

The N terminal transactivation domain of p53 is regulated by ligases and coactivator proteins. The functional conformation of this region appears to be an alpha helix which is necessary for its appropriate interactions with several proteins including MDM2 and p300. Folding simulation studies have been carried out to examine the propensity and stability of this region and are used to understand the differences between the family members with the ease of helix formation following the order p53 > p73 > p63. It is clear that hydrophobic clusters control the kinetics of helix formation, while electrostatic interactions control the thermodynamic stability of the helix. Differences in these interactions between the family members may partially account for the differential binding to, and regulation by, MDM2 (and MDMX). Phosphorylations of the peptides further modulate the stability of the helix and control associations with partner proteins.