Role of Total Laryngopharyngoesophagectomy with Gastric Pull Up in the Management of Locally Advanced Hypopharyngeal Cancers.

The current consensus in the management of hypopharyngeal cancers favors the non-surgical management. However, many studies have reported relatively better oncological and functional outcomes with the surgical approach in locally advanced hypopharyngeal cancers. In here, we report a tertiary care center's experience with total laryngopharyngoesophagectomy with gastric pull-up done for such cases. We also describe a slight modification of the procedure that has been followed at our institute, and discuss its advantages. It is a retrospective study of patients who have undergone the surgical procedure between the September 2016 and the March 2019. The primary objective was to analyze the surgical complications and the benefits in terms of disease clearance, survival duration, and functional outcomes. Study consisted of 15 patients, mostly men, with mean age of 56 years. 12/15 had stage IV disease and 7/15 were failed chemoradiotherapy. Most common complication of surgery was anastomotic failure (33%). Perioperative mortality rate was 13.3%. Higher complications could probably be attributed to poor nutrition and tension over the anastomosis. Mean survival duration and disease free interval were 12.1 and 11 months, respectively. Oral feeds was restored in 77%, and the average time to restore oral feeds was 17 days. Most of our results were comparable with the literature, which supports the surgical excision of larynx-pharynx-esophagus and reconstruction by pull-up, in all those medically fit cases of radio-recurrent/residual tumors, and also in primary cases of locally advanced hypopharyngeal cancers with non-functional larynx. In these scenarios, the radical surgical treatment would atleast serve as palliative if not curative.

Microbial Community Distribution and Core Microbiome in Successive Wound Grades of Individuals with Diabetic Foot Ulcers.

Diabetic foot ulcer (DFU) is a major complication of diabetes with high morbidity and mortality rates. The pathogenesis of DFUs is governed by a complex milieu of environmental and host factors. The empirical treatment is initially based on wound severity since culturing and profiling the antibiotic sensitivity of wound-associated microbes is time-consuming. Hence, a thorough and rapid analysis of the microbial landscape is a major requirement toward devising evidence-based interventions. Toward this, 122 wound (100 diabetic and 22 nondiabetic) samples were sampled for their bacterial community structure using both culture-based and next-generation 16S rRNA-based metagenomics approach. Both the approaches showed that the Gram-negative microbes were more abundant in the wound microbiome. The core microbiome consisted of bacterial genera, including Alcaligenes, Pseudomonas, Burkholderia, and Corynebacterium in decreasing order of average relative abundance. Despite the heterogenous nature and extensive sharing of microbes, an inherent community structure was apparent, as revealed by a cluster analysis based on Euclidean distances. Facultative anaerobes (26.5%) were predominant in Wagner grade 5, while strict anaerobes were abundant in Wagner grade 1 (26%). A nonmetric dimensional scaling analysis could not clearly discriminate samples based on HbA1c levels. Sequencing approach revealed the presence of major culturable species even in samples with no bacterial growth in culture-based approach. Our study indicates that (i) the composition of core microbial community varies with wound severity, (ii) polymicrobial species distribution is individual specific, and (iii) antibiotic susceptibility varies with individuals. Our study suggests the need to evolve better-personalized care for better wound management therapies.IMPORTANCE Chronic nonhealing diabetic foot ulcers (DFUs) are a serious complication of diabetes and are further exacerbated by bacterial colonization. The microbial burden in the wound of each individual displays diverse morphological and physiological characteristics with unique patterns of host-pathogen interactions, antibiotic resistance, and virulence. Treatment involves empirical decisions until definitive results on the causative wound pathogens and their antibiotic susceptibility profiles are available. Hence, there is a need for rapid and accurate detection of these polymicrobial communities for effective wound management. Deciphering microbial communities will aid clinicians to tailor their treatment specifically to the microbes prevalent in the DFU at the time of assessment. This may reduce DFUs associated morbidity and mortality while impeding the rise of multidrug-resistant microbes.

Ischemia-Modified Albumin, Creatinine, And Paraoxonase-1 Levels in Serum of Patients Undergoing Intravenous Contrast-Enhanced Computed Tomography and Its Association with Contrast-Induced Nephropathy.

BACKGROUND: Following contrast-enhanced computed tomography (CECT) contrast-induced nephropathy (CIN) may occur in patients with renal insufficiency or diabetes. Creatinine, the most common marker of CIN, may not be an accurate measure of damage and is affected by many non-renal factors. Our aim was to evaluate ischemia-modified albumin (IMA) as an early CIN marker and correlate it with paraoxonase-1 (PON-1) and creatinine before and after CECT. METHODS: Forty-eight adult patients scheduled for intravenous CECT, regardless of indication or body region for CECT, were included in this prospective study. Venous blood samples were obtained 12-24 hours before and after contrast media (CM) administration. Ischemia-modified albumin and PON-1 were estimated using methods described by Bar-Or et al. and Dantoine et.al., respectively. Creatinine was estimated on an automated analyzer. RESULTS: Significant differences in IMA (P < 0.001) and PON-1 (P < 0.001) levels were found between pre- and post-CECT samples, while the difference for creatinine was not significant (p = 0.073). No correlation was found between IMA and PON-1 or IMA and creatinine in either the pre- or post-CECT samples. CONCLUSION: After CM administration patients are subjected to oxidative stress and/or ischemia, as revealed by elevated IMA and decreased PON-1 levels; however, creatinine levels, most commonly estimated to assess reduced renal function, did not reflect the condition accurately. IMA may be a sensitive marker for CIN but further studies are required to confirm its usefulness.

Indicators of oxidative stress in thyroid cancer.

Ferric reducing antioxidant power (FRAP), myeloperoxidase (MPO) activity and the levels of protein thiols and carbonyls were estimated in the blood samples of thyroid cancer patients (n = 20) before and after thyroidectomy, as well as in healthy controls (n = 10) to study the extent of damage caused by tumor tissue proliferation-induced oxidative stress and to ascertain that oxidative stress levels drop, when there was no proliferation. A significant decrease (p<0.001) in the levels of serum protein thiols and FRAP as well as a significant increase (p<0.001) in the levels of protein carbonyls and MPO activity in the blood of thyroid cancer patients before surgery was observed as compared to healthy controls. All the parameters studied also showed a significant difference (p<0.001) in their respective levels in thyroid cancer patients, pre- and post-thyroidectomy. These findings present the role of oxidative stress as a pathological implication of thyroid cancer.