The efficacy of neoadjuvant chemotherapy as compared to upfront surgery for the management of oral squamous cell carcinoma: a systematic review and meta-analysis.

The efficacy of neoadjuvant chemotherapy in the field of head and neck oncology has always been debated. The aim of this study was to determine the efficacy of neoadjuvant chemotherapy followed by surgery in patients with oral squamous cell carcinoma (OSCC) by comparison to upfront surgery, in terms of overall survival, disease-free survival, response rates, positive surgical margins, loco-regional recurrence, distant metastasis, and toxicity. Prospective and retrospective studies were identified from a search of the PubMed, PubMed Central, and Cochrane Library databases (publication date between January 1, 1995 and January 1, 2022), as well as hand searches. Three randomized clinical trials and five retrospective studies reporting a total of 1373 patients were retrieved (493 treated with NACT, 880 treated with upfront surgery). All statistical analyses were done using RevMan 5.4. There was no statistically significant difference between the treatment groups for all outcomes (overall survival P = 0.41, disease-free survival P = 0.91, loco-regional recurrence P = 0.12, distant metastasis P = 0.23), except positive margins (P = 0.007); a reduced risk of positive margins was observed for neoadjuvant chemotherapy. The pooled proportion of patients with a complete pathological response (17%) was inadequate to obtain an improvement in survival. The lower margin positivity rate, leading to resectability with clear margins, may be a benefit of neoadjuvant chemotherapy in locally advanced OSCC; however, this treatment failed to provide a benefit in terms of survival and the response rate.

Role of radiological imaging and interventions in management of Budd-Chiari syndrome.

Budd-Chiari syndrome (BCS) is a clinical condition resulting from impaired hepatic venous drainage, in which there is obstruction to the hepatic venous outflow at any level from the small hepatic veins to the junction of the inferior vena cava and the right atrium leading to hepatic congestion. The diagnosis of BCS is based on imaging, which can be gathered from non-invasive investigations such as ultrasonography coupled with venous Doppler, triphasic computed tomography (CT) and magnetic resonance imaging (MRI). Apart from diagnosis, various interventional radiology procedures aid in the successful management of this syndrome. In this article, we present various imaging features of BCS along with various interventional procedures that are used to treat this diverse condition.

Cytoprotective role of the aqueous extract of Terminalia chebula on renal epithelial cells.

PURPOSE: Kidney stone is one of the most prevalent diseases worldwide. Calcium oxalate (CaOx) has been shown to be the main component of the majority of stones formed in the urinary system of the patients with urolithiasis. The present study evaluates the antilithiatic properties of Terminalia chebula commonly called as ″harad ″ which is often used in ayurveda to treat various urinary diseases including kidney stones. MATERIALS AND METHODS: The antilithiatic activity of Terminalia chebula was investigated on nucleation and growth of the calcium oxalate crystals. The protective potency of the plant extract was also tested on oxalate induced cell injury of both NRK-52E and MDCK renal epithelial cells. RESULTS: The percentage inhibition of CaOx nucleation was found 95.84 % at 25µg/mL of Terminalia chebula aqueous extract which remained almost constant with the increasing concentration of the plant extract; however, plant extract inhibited CaOx crystal growth in a dose dependent pattern. When MDCK and NRK-52E cells were injured by exposure to oxalate for 48 hours, the aqueous extract prevented the injury in a dose-dependent manner. On treatment with the different concentrations of the plant extract, the cell viability increased and lactate dehydrogenase release decreased in a concentration dependent manner. CONCLUSION: Our study indicates that Terminalia chebula is a potential candidate for phytotherapy against urolithiasis as it not only has a potential to inhibit nucleation and the growth of the CaOx crystals but also has a cytoprotective role.

UK national re-audit of sexual history-taking.

A focused repeat national audit of sexual history-taking was conducted in genitourinary (GU) medicine clinics in the UK in 2010, addressing several areas of practice under-performance identified in the baseline 2008 national audit. The case-notes of 4285 patients were audited. An increase in documentation was observed for all measures, except legibility which was unchanged. Despite the overall improvement, several measures (chaperone offer, condom usage and four of five aspects of HIV risk assessment) remained below target.

Cytoprotective role of the aqueous extract of Terminalia chebula on renal epithelial cells

PURPOSE: Kidney stone is one of the most prevalent diseases worldwide. Calcium oxalate (CaOx) has been shown to be the main component of the majority of stones formed in the urinary system of the patients with urolithiasis. The present study evaluates the antilithiatic properties of Terminalia chebula commonly called as "harad" which is often used in ayurveda to treat various urinary diseases including kidney stones. MATERIALS AND METHODS: The antilithiatic activity of Terminalia chebula was investigated on nucleation and growth of the calcium oxalate crystals. The protective potency of the plant extract was also tested on oxalate induced cell injury of both NRK-52E and MDCK renal epithelial cells. RESULTS: The percentage inhibition of CaOx nucleation was found 95.84% at 25µg/mL of Terminalia chebula aqueous extract which remained almost constant with the increasing concentration of the plant extract; however, plant extract inhibited CaOx crystal growth in a dose dependent pattern. When MDCK and NRK-52E cells were injured by exposure to oxalate for 48 hours, the aqueous extract prevented the injury in a dose-dependent manner. On treatment with the different concentrations of the plant extract, the cell viability increased and lactate dehydrogenase release decreased in a concentration dependent manner. CONCLUSION: Our study indicates that Terminalia chebula is a potential candidate for phytotherapy against urolithiasis as it not only has a potential to inhibit nucleation and the growth of the CaOx crystals but also has a cytoprotective role.

An ongoing outbreak of heterosexually-acquired syphilis across Teesside, UK.

Prior to 2006, diagnoses of heterosexually acquired syphilis were rare in Teesside (an area in the north east of England, UK). Since 2006, there has been an increase in such cases, with 24 cases diagnosed in 2006 and 22 in 2007. There was a marked reduction in cases in 2008 with six cases reported, but a large increase in diagnoses in 2009 (34 cases). There have been 14 cases to date in 2010. Of concern is the increase noted in women and younger age groups. Geographical mapping of cases shows a wide dispersion across Teesside although some clusters were identified, mostly in areas of high deprivation. Little detailed information is available to help identify social and sexual networks widely and target intervention. A multiagency outbreak control team is addressing this problem, based on the principles of partner notification, increased awareness, increased screening and health promotion activities. A range of measures, including a detailed communications plan, have been implemented.

Audit of partner notification for chlamydia infection in the genitourinary medicine clinic at the University Hospital of Hartlepool: 2004-2008.

Partner notification is essential for the control of chlamydia infection, which is on the rise. The aim of this study was to assess the performance of partner notification for chlamydia infection in the genitourinary medicine clinic at the University Hospital of Hartlepool, UK from 2004 to 2008. Overall 1.37 partners were declared per index patient, with male patients declaring 1.59 partners and female patients declaring 1.19 partners. For each chlamydia index patient 0.52 partners were screened (38 per cent of declared partners). Fifty-seven percent of the screened patients were positive for chlamydia and this increased from 33% in 2004 to 66% in 2008. The number of index cases needed to interview to get a new positive chlamydia was 3.37 over the study period and varied from 6.74 in 2004 to 2.74 in 2008. This audit highlights the need to improve partner notification for chlamydia infection.

Paromomycin treatment of recalcitrant Trichomonas vaginalis.

We report a 49-year-old woman with a five-year history of persistent Trichomonas vaginalis infection. Treatment with several courses of metronidazole and tinidazole failed to resolve her symptoms. A single course of intravaginal paromomycin was effective in clearing the infection.

Preliminary HIV test result disclosure: lessons we can learn.

Result disclosure following routine HIV testing can be challenging. We present an interesting real life scenario regarding a young heterosexual Caucasian male patient, who was diagnosed as having a positive HIV antibody result following a routine HIV screening test, his confirmatory test result was HIV negative. This article covers important lessons learnt from the case.

Audit of early syphilis: Teesside experience 2005-2007.

A retrospective audit of all cases of early syphilis seen in genitourinary (GU) medicine clinics in Teesside was undertaken between 2005 and 2007. In all 80 patients early syphilis was identified. Data on patient sexuality, treatment, and serological follow-up and partner notification were collected and analysed. There were 48 heterosexual cases. There were 21 heterosexual males, and of the 27 females, 12 (44%) were diagnosed during antenatal care. Intramuscular injections of benzathine penicillin were used to treat 75 out of the 80 patients at the clinics. The remaining five patients received oral therapy for two weeks: four had a course of doxycycline and one received amoxicillin plus probenecid. The treatment rate of the population was 100%. In total, there were 115 contactable partners, of whom 87 (75.7%) were screened and/or treated. Successful treatment was defined as a four-fold or greater titre decrease in the Venereal Disease Reference Laboratory test within 3-6 months after treatment. Twenty-one patients were excluded when assessing this due to incomplete serological follow-up. Satisfactory titre declines occurred in 56 (94.9%) of the 59 patients. Overall, the clinics were shown to have adhered well with national standards. The rise in heterosexual and antenatal incidence is of concern.

Reducing waiting times for GU medicine appointments: the impact of a new appointment system.

Our objective was to reduce the 'did not attend' (DNA) rates and waiting times by introducing a new confirmatory appointment system prior to their attendance at both Hartlepool and Middlesbrough genitourinary (GU) medicine departments. In Middlesbrough it was previous day appointment confirmation, whereas at Hartlepool it was 10 days. Both systems achieved significant attendance rates of 83.4% and 79.1% at Hartlepool and Middlesbrough, in comparison to 68.7% and 75.0% prior to the new system. The new system will improve the departmental capacity.

Asymptomatic HIV patient with cardiomyopathy and nephropathy: case report and literature review.

We report a previously asymptomatic HIV patient with high CD4 lymphocyte count and low HIV1 viral load who developed cardiac and renal disease. Management with ACE inhibitor, diuretics and triple antiretroviral combination therapy yielded a rapid clinical response. An understanding of the spectrum of renal and cardiac derangements is essential for clinicians in managing patients with HIV disease.

Neisseria gonorrhoeae in Newcastle upon Tyne 1995-1997: increase in ciprofloxacin resistance.

Fluoroquinolones and third generation cephalosporins are the most effective antimicrobial agents for the treatment of gonorrhoea. However, clinically significant resistance to fluoroquinolones in Neisseria gonorrhoeae has been reported worldwide including Britain. The aim of this analysis was to study the factors relating to ciprofloxacin resistance and treatment failure. A total of 201 patients attending the Newcastle Genitourinary Medicine (GUM) clinic from 1995-1997 who were diagnosed with culture positive gonorrhoea was analysed. Treatment failure rates for ciprofloxacin were determined and the minimum inhibitory concentration (MIC) was measured for all cases of treatment failure. The case notes of all patients who had strains with MICs of ciprofloxacin in the resistant range (>0.05 microg/ml) were reviewed to determine the clinical outcome. The ciprofloxacin resistance with treatment failure was seen in 5% (8/160). All the 8 cases of treatment failure were heterosexual and had isolates resistant to penicillin and 4 cases (50%) were also resistant to tetracycline. All were sensitive to spectinomycin and ceftriaxone. Most of the cases probably acquired their infection from the Far East. As ciprofloxacin resistance seems to be associated with overseas exposure, changes in the standard treatment of gonorrhoea are not justified but consideration should be given to appropriate alternatives when the infection may have arisen from where such resistant strains are endemic. Monitoring fluoroquinolone resistance is now essential for ensuring adequate treatment of infections with resistant strains and for maximizing the time of usage of fluoroquinolones to treat gonorrhoea.

An indolent penile herpetic ulcer in a patient with previously undiagnosed human immunodeficiency virus infection.

We report a case of an atypical penile herpetic ulcer in a man with previously undiagnosed human immunodeficiency virus (HIV) infection. Swabs of the lesion were negative for herpes simplex virus (HSV) by culture and electron microscopy. However, histopathology of biopsy material showed characteristic herpetic multinucleate giant cells. Immunochemistry using polyclonal antibodies was positive for HSV1 and HSV2. The lesion completely resolved after treatment with aciclovir and the patient subsequently tested positively for HIV antibodies.

Meningococcal carriage: prevalence and sex-related risk factors.

A retrospective analysis was done to examine whether sexual behaviour was associated with meningococcal carriage. Over the 4 month period from January to April 1994, 136 (27.4%) of the 496 consecutive new/re-registered genito-urinary medicine clinic attenders showed meningococcal carriage. Two (15.4%) of 13 homosexual men compared with 134 (27.7%) of 484 heterosexual men and women had evidence of meningococcal carriage. Relative risk (RR) of meningococcal carriage was 1.8 with > 10 lifetime partners and 1.2 with 3-10 partners (P < 0.007). RR with age group of 16-25 was 4.2 and for 26-35 it was 3.5. There was no relationship with meningococcal carriage and pharyngeal symptoms, sexual orientation, intravenous drug use, number of partners per month and orogenital sex. Further longitudinal studies may be of value in order to determine whether a high number of sexual partners is a marker for meningococcal carriage. In addition, further study may show whether there is an increased risk of meningococcal carriage and disease in those who live with meningococcal carriers.

Musculoskeletal disorders: genitourinary medicine perspective.

The association of musculoskeletal disorders and genitourinary symptoms is reviewed. Reactive arthritis, Sjögren's syndrome and rheumatoid arthritis can present with a variety of genitourinary symptoms. Similarly sexually transmitted diseases including gonorrhoea, syphilis, HIV and other viral infections can affect the musculoskeletal system. Reiter's syndrome may be a consequence of a sexually transmitted infection although its presentation can suggest that also in post-dysenteric cases. The fact that conditions may present to various medical specialties requires doctors outside departments of GUM to allow their patients an opportunity and the time to discuss sexual matters.