Post-Endoscopy Parotid Swelling: A Rare Complication.

Parotid gland swelling, or parotitis, typically associated with infectious causes, can uncommonly result from non-infectious factors such as mechanical trauma following endoscopic procedures. We present a case of a 46-year-old female with liver cirrhosis who developed right parotid swelling shortly after undergoing endoscopy for evaluation of gastrointestinal symptoms. The patient's clinical course, imaging findings, and successful resolution with conservative measures are detailed. The etiology of post-endoscopy parotid swelling is multifactorial, involving potential mechanisms such as mechanical trauma, salivary gland dysfunction, infection, ductal obstruction, or allergic reactions to medications. Diagnosing this rare complication requires a comprehensive clinical evaluation, including a detailed history, symptom assessment, and imaging studies such as ultrasound. Management involves a combination of symptomatic relief, identification, and treatment of the underlying cause, emphasizing the importance of early recognition to prevent complications. In our case, warm compression provided pain relief, and the swelling subsided without the need for medical or surgical intervention. Regular follow-up evaluations and imaging studies are crucial to assess treatment response and ensure the resolution of the swelling. This case contributes to the limited literature on post-endoscopy parotid swelling, emphasizing the significance of recognizing and managing this rare complication promptly. Healthcare professionals should be vigilant, and further research is encouraged to better understand its pathophysiology and optimize management strategies in order to improve patient outcomes.

An Uncommon Encounter: A Comprehensive Case Report of an Advanced Esophageal Neuroendocrine Carcinoma.

Esophageal neuroendocrine carcinomas (E-NECs) are rare malignant tumors with unknown etiology and pathogenesis. The aggressive nature of E-NECs coupled with a tendency to metastasize and no available treatment guidelines lead to poor prognosis. Here, we report a case of a 65-year-old, previously healthy female who presented with difficulty in swallowing solids, burning sensation over the epigastric region, weight loss (>10%), and altered bowel habits for the last three months. Contrast-enhanced CT (CECT) thorax revealed asymmetric mid-esophageal wall thickening with lymphadenopathy and metastasis in both hepatic lobes. Esophageal endoscopy revealed a large circumferential ulcero-proliferative mass and umbilicated lesions. A histopathological examination revealed small cells with scant cytoplasm and pleomorphic, hyperchromatic nuclei with prominent nuclear molding, and extensive necrosis. Immunohistochemistry revealed positivity for synaptophysin, chromogranin A, and CD56. Ki-67 index was 53%. These findings suggested poorly differentiated, small cell type, high-grade E-NEC. Chemotherapy with cisplatin (30mg/m2) + irinotecan (60mg/m2) was initiated. However, following two chemotherapy cycles, the patient succumbed.

Early virus clearance of SARS-CoV-2 among co-infection with malaria.

BACKGROUND AND OBJECTIVES: India has witnessed significant number of cases of co-infection of malaria or dengue with COVID-19, especially during the monsoon season. It has been speculated that anti-malarial immunity might have a protective role in co-infection. Retrospective analysis of co-infection of vector-borne diseases with COVID-19 was done for comparing their remission with matched controls with COVID-19 by means of epidemiological data. METHODS: Medical case records of patients with co-infection of malaria or dengue with COVID-19 admitted at TNMC and BYL Nair Charitable Hospital from 1 March 2020 to 31 October 2020 were analyzed retrospectively. Out of 91 cases of co-infection of SARS-CoV-2 infection with vector-borne diseases, virus clearance (VC) analysis was done for 61 co-infections with malaria. RESULTS: Median duration of VC for co-infection with malaria was 8 days whereas, it was 12 days for controls with COVID-19 (p=0.056). Young patients (≤50 years) with co-infection recovered faster than controls age (p=0.018). INTERPRETATION & CONCLUSION: Co-infection with malaria is associated with less severe disease and early recovery in the form of early VC. Genetic and immunological studies are necessary to confirm malaria protection against SARS-CoV-2 infection.

Spectrum of viral hepatitis in hospitalized children in western India.

Viral hepatitis is a major public health problem affecting children globally. Clinical presentation varies from asymptomatic illness to hepatitis, and liver failure. Data on clinical features and laboratory parameters were collected and analysed on 300 children, aged 1-12 years, admitted with confirmed viral hepatitis. A small majority (52%) were boys. The mean age of presentation was 6.9 ± 2.8 years with the commonest symptoms being anorexia or vomiting (in 98%), fever (in 89%) and jaundice (in 71.3%). Tender hepatomegaly was seen in 31.7%. Almost all (97.6%) had hepatitis A, though mixed infection (A & E) was seen in 1.7%. Only 8% had serum bilirubin levels >200 µmol/L. Significantly elevated (>20 µkat/L) levels of aspartate transaminase and alanine transaminase were seen in 19% and 25.3% of cases respectively. Coagulopathy (PT >15 s) was present in 11.0% cases. HAV remains the most common cause of viral hepatitis in children in our environment. Public awareness and universal vaccination should be the focus to prevent morbidity and mortality due to these pathogens.

Bridging the age gap in breast cancer: cluster randomized trial of two decision support interventions for older women with operable breast cancer on quality of life, survival, decision quality, and treatment choices.

BACKGROUND: Rates of surgery and adjuvant therapy for breast cancer vary widely between breast units. This may contribute to differences in survival. This cluster RCT evaluated the impact of decision support interventions (DESIs) for older women with breast cancer, to ascertain whether DESIs influenced quality of life, survival, decision quality, and treatment choice. METHODS: A multicentre cluster RCT compared the use of two DESIs against usual care in treatment decision-making in older women (aged at least ≥70 years) with breast cancer. Each DESI comprised an online algorithm, booklet, and brief decision aid to inform choices between surgery plus adjuvant endocrine therapy versus primary endocrine therapy, and adjuvant chemotherapy versus no chemotherapy. The primary outcome was quality of life. Secondary outcomes included decision quality measures, survival, and treatment choice. RESULTS: A total of 46 breast units were randomized (21 intervention, 25 usual care), recruiting 1339 women (670 intervention, 669 usual care). There was no significant difference in global quality of life at 6 months after the baseline assessment on intention-to-treat analysis (difference -0.20, 95 per cent confidence interval (C.I.) -2.69 to 2.29; P = 0.900). In women offered a choice of primary endocrine therapy versus surgery plus endocrine therapy, knowledge about treatments was greater in the intervention arm (94 versus 74 per cent; P = 0.003). Treatment choice was altered, with a primary endocrine therapy rate among women with oestrogen receptor-positive disease of 21.0 per cent in the intervention versus 15.4 per cent in usual-care sites (difference 5.5 (95 per cent C.I. 1.1 to 10.0) per cent; P = 0.029). The chemotherapy rate was 10.3 per cent at intervention versus 14.8 per cent at usual-care sites (difference -4.5 (C.I. -8.0 to 0) per cent; P = 0.013). Survival was similar in both arms. CONCLUSION: The use of DESIs in older women increases knowledge of breast cancer treatment options, facilitates shared decision-making, and alters treatment selection. Trial registration numbers: EudraCT 2015-004220-61 (https://eudract.ema.europa.eu/), ISRCTN46099296 (http://www.controlled-trials.com).

An improved metric for quantifying the stiffnesses of intact human vertebrae.

Accurately quantifying the compressive stiffnesses of whole human vertebrae is important in the development of new treatment regimes for fractures due to osteoporosis or metastatic involvement. Two methods are commonly used to quantify compressive stiffnesses of whole vertebrae: first, the maximum slope of the force-deformation curve over a 0.2 per cent strain window; second, the slope of the best-fit line to the load-deflection curve over a specified loading range. Because the whole bone load-displacement response is non-linear, these two measurement systems yield different stiffness values for the same set of experimental data. Thus, the goal of this study was to develop and validate a standard method for deriving the whole bone stiffnesses of human vertebrae. Data from uniaxial compression tests on isolated human thoracic vertebrae (N=30 from 24 donors; T7-T10; age, 84 +/- 10, seven male, and 17 female) were analysed using the two aforementioned stiffness measurement techniques. A sensitivity analysis was also conducted whereby stiffness values were calculated for strain windows ranging from 0.05 per cent to 10 per cent. The results showed that the whole vertebra stiffness was sensitive to the calculation method. Using strain window approaches, the calculated stiffness was erratic at small strain ranges (less than 0.75 per cent), but it began to stabilize at 1 per cent strain. Comparing the historical measurement techniques versus the new standard, it was found that the 1 per cent and 0.2 per cent strain window techniques were well correlated (R2 = 0.91; p < 0.01); however, compared with the 1 per cent strain window method, the 0.2 per cent technique consistently overestimated stiffness and had five times the sensitivity to small changes in strain window magnitude. In conclusion, it is recommended that the 1 per cent strain window technique is adopted as a new standard for measuring the whole bone compressive stiffnesses of human vertebrae based on this method's superior level of accuracy and repeatability when compared with current techniques. The adoption of such a standard in the biomechanics field is important because it allows for inter-study comparisons of new orthopaedic treatments, such as vertebroplasty products.