Prevalence and Sociodemographic Covariates of Cervical Cancer and Its Association With Menstrual Irregularities: Findings From the 2017 National Inpatient Sample Database.

Background and objective Menstrual irregularities and sociodemographic factors such as increasing age, Hispanic race, low socioeconomic strata, and low income status are known risk factors for cervical cancer. This study aimed to examine the prevalence of cervical cancer and its association with menstrual irregularities and other known risk factors based on a large nationwide inpatient sample database. Methods We used the Nationwide Inpatient Sample (NIS) database for the year 2017 and identified cases where cervical cancer and menstrual irregularities are the primary and co-occurring diagnoses using the International Classification of Diseases, Tenth Revision (ICD-10) codes. Pearson's chi-square test, independent-sample t-test, and multiple logistic regression were used to generate the analysis. Results A total of 15,800 (0.19%) female weighted admissions between the age group of 18-55 years reported a diagnosis of cervical cancer. Patients with a diagnosis of menstrual irregularity had a statistically significant higher odds of association [odds ratio (OR): 1.582] for being diagnosed with cervical cancer. The odds of association were also high for the Hispanic race [OR: 1.280, 95% confidence interval (CI): 1.128-1.453]. The odds of a diagnosis of cervical cancer increased with age, with the highest odds being reported for the age group of 46-55 years (95% CI: 12.107-21.171) and the population with lower median household income, with the highest odds being observed for the lowest interquartile range (95% CI: 1.418-1.892). Conclusion Based on our findings, a diagnosis of menstrual irregularity, the Hispanic race, increasing age, and lower household income are factors that significantly increased the odds of being diagnosed with cervical cancer.

Infection Prevalence in Adolescents and Adults With Acute Myeloid Leukemia Treated in an Indian Tertiary Care Center.

PURPOSE: Infections remain a major challenge in the treatment of acute myeloid leukemia (AML). Induction-related mortality reported in the literature is approximately < 5% in clinical trials. However, the real-world scenario is different, especially in developing countries, given the high incidence of multidrug-resistant (MDR) organisms, high incidence of fungal pneumonia at baseline, and significant delay before initiation of chemotherapy. We aimed to look at contemporary infections and infection-related mortality and analyze the patterns of infections. MATERIALS AND METHODS: This retrospective study was conducted at a large tertiary care oncology center in India. Patients with newly diagnosed AML who were older than age 15 years, considered fit for intensive therapy, and treated in the general wards of the adult hematolymphoid unit from March 1, 2014, until December 31, 2015, were included. RESULTS: One hundred twenty-one patients were treated during the study period. The most common presenting complaint was fever (85%). The focus of infection at presentation was found in 63% of patients, with respiratory infection being the most common (47%). MDR organisms were isolated in 55% of patients during induction from various foci. Klebsiella pneumoniae was the most common blood culture isolate (42.9%). Fungal pneumonia was diagnosed in 55% of patients during induction despite antifungal prophylaxis. Treatment-related mortality was 10.7% in all phases, with an induction mortality rate of 7.4%. Complete remission was attained in 69% of patients. Of all patients who received induction chemotherapy, 74% completed all three consolidation cycles. The 121 patients were followed up for a median period of 53 months. Four-year event-free survival was 35.8%, and 4-year overall survival was 41.5%. CONCLUSION: Infections and infection-related mortality are major challenges during AML induction. Gram-negative MDR and fungal infections are particularly common in our region.

Collective Conversational Peer Review of Journal Submission: A Tool to Integrate Medical Education and Practice.

BACKGROUND: In this study, we demonstrate a collective collaborative, conversational, pre-publication peer review of a randomized controlled trial. METHODS: Using Critical Appraisal Skills Programme checklist, a group of research-oriented undergraduate medical and pharmacy students and their teacher collectively on an online forum, discuss and review a randomized controlled trial submitted to the Annals of Neurosciences and the explanatory commentary from each reviewer makes a basic scaffold for critical appraisal of the manuscript. RESULTS: This method provided the opportunity for students to engage in online interactive training and allowed them to understand tools used for critical appraisal of a study. Students were incentivized by the potential publication credit and they look forward to continuing this work and perhaps providing one small step to making medical education more interactive. CONCLUSION: Open peer review involving a group of reviewers at a time produces multidirectional reviewing concepts, thus helps to improve the quality of paper and also may reduce the time between review and publication.

Bilateral Anterior Opercular Syndrome.

Opercular syndrome, also known as Foix-Chavany-Marie syndrome, is characterised by paralysis of the facial, masticatory, pharyngeal, laryngeal, brachial and tongue muscles. It is a cortical form of pseudobulbar palsyo which is commonly caused by a vascular aetiology. The clinical presentation is anarthria, weakness of voluntary muscles involving face, tongue, pharynx, larynx, and masticatory muscles. However, autonomic reflexes and emotional functions of these structures are preserved. We report a case of a 61 year old man who had difficulty in chewing, swallowing and vocalising since one and a half month, which on imaging was found to be opercular syndrome.

A rare case of lung cancer presenting as an ischioanal fossa mass.

Lung cancer metastasis commonly involves the adrenal glands, liver, bone, and brain. However, it can have some rarer forms of metastatic presentation making diagnosis difficult, especially in nonsmokers. We describe a rare case of lung cancer with metastasis to the ischioanal fossa. Overall, this case emphasizes that consideration should be given to wide range of diagnosis in atypical cases of anorectal masses. Lung cancer presenting as an ischioanal mass is not reported so far.