Pleomorphic Sarcoma of the Head and Neck Region

                       http://austinpublishinggroup.com/head-neck-oncology/currentissue.php

Pleomorphic Sarcoma or Malignant Fibrous Histiocytoma is commonest soft tissue sarcoma but is rare in Head and neck. Commonest site in Head and neck being Nasal cavity and para nasal sinuses. It is more common in male. Tumor is diagnosed histologically consisting of both histiocytes and fibroblast cells. Pleomorphic Sarcoma is classified into primary and secondary types with mean age of presentation between 6th and 7th decade. The treatment of choice for this tumor is surgery with clear margins and adjuvant Radiotherapy. Prognosis remains poor even after surgery with local and distant metastasis seen commonly.

Soft Tissue Sarcoma encompasses (STS) a broad array of malignant tumors that are derived from cells of mesenchymal origin at any anatomical site. The originating tissue is diverse that includes bones, cartilage, muscular, fibrous, vascular, fatty and neural tissue. Of all the soft tissue sarcomas only 5-20% occurs in the head and neck region. The most common STS of the head and neck region are Rhabdomyosarcoma followed by Malignant fibrous Histiocytoma, Fibrosarcoma and Neuro-fibrosarcoma. The incidence of MFH seems to be the highest among various types of adult malignant soft tissue sarcomas. Pleomorphic Sarcoma or Malignant Fibrous Histiocytoma (MFH) is a rare primitive mesenchymal tumor showing both fibroblastic and histiocytic differentiation. We report a case of Pleomorphic Sarcoma/ MFH and the review of literature in relation to Pleomorphic Sarcoma.

A 40 year old male presented with the chief complaint of gradually progressive, painless, irregular swelling over the right side of the face for the past 6 months. On examination it was a 10 x 8 x 8 cm large firm mass of the right parotid region with no evidence of intra oral lesion. There were no palpable neck glands. On radiological evaluation, CT scan revealed a 98 x 113x 106 mm enhancing soft tissue lesion over the right parotid region. Lesion showed area of necrosis within. Lesion reaches up to the skin and involves the masseter muscle. Right submandibular gland is not seen separately from the lesion. Presence of few lymph nodes at level IA, II, III with the largest at IA measuring 20 x17 mm. No evidence of mandible erosion.

HLA-G 14 bp Polymorphism and Risk of Pre-Eclampsia

                    http://austinpublishinggroup.com/austin-hypertension/currentissue.php

HLA-G:Human Leukocyte Antigen G; PE: Pre-Eclampsia; IUGR: Intrauterine Growth Restriction; HELLP: Hemolytic Elevated Liver Enzymes and Low Platelets; TGF: Transforming Growth Factor; ILT: Immunoglobulin-Like Transcript Receptor; APC: Antigen- Presenting Cell; KIR: Killer-Immunoglobulin Like Receptors; NK: Natural Killer; CD: Cluster of Designation; UTR: Untranslated Region; BP: Base Pair; Snp: Single Nucleotide Polymorphism; PCR: Polymerase Chain Reaction; OR: Odds Ratio; 95%CI: Confidence Interval; Ins: Insertion; Del: Deletion; CVD: Cardiovascular Disease.

Pre-eclampsia belongs to one of very serious complication during pregnancy. It is a multisystem disorder that is manifested by hypertension, proteinuria and abnormal blood clotting. Advanced clinical symptoms include seizures, renal failure, IUGR (Intrauterine Growth Restriction) and/or HELLP (Hemolysis, Elevated Liver Enzymes and Low Platelets) syndrome. Finally the generalized damage of the maternal endothelium, kidneys and liver can develop leading to increased mortality of mother as well as foetus. The clinical symptoms of pre-eclampsia can be observed in the second or the third trimester in pregnancy and are the most common in primiparas. Clinical features of PE are studied by Doppler flowmetry not only in foetal and foetoplacental circulation as well as in maternal organs, i.e. uterine cerebral ophtalmic and renal vessels. Stiffness metabolic syndrome and risk of CVD  are other clinical research topics.

Despite many research studies, the pathology of pre-eclampsia is not fully understood. One cause may originate in an insufficiently developed placenta, referred to as poor placentation. It is characterized by impaired remodeling of spiral arteries of the uterus (endothelial dysfunction) caused by an imbalance of circulating angiogenic factors. High circulating levels of soluble Fms like tyrosine kinase 1 (sFlt1) and soluble endoglin (sEng), a circulating receptor or TGFbeta, (both anti-angiogenic factors) and low levels of circulating Vascular Endothelial Growth Factor (VEGF) and Placental Growth Factor (PlGF) (both pro-angiogenic factors) have been described.

Gender Disparity in Hepatitis: A New Task in the Challenge Against Viral Infection

                                               http://austinpublishinggroup.com/hepatitis/

Gender/sex-specific medicine is still a neglected field of investigation, which is devoted to the analysis of the disparity between men and women in disease pathogenesis and prevention, in the detection of clinical signs or symptoms, in the prognosis and response to therapy as well as in psychological and social determinants of morbidity. For instance, it is well documented that incidence and outcome of several human diseases, such as cardiovascular diseases, tumors, degenerative diseases, or some respiratory and neurological disorders display a significant disparity between males and females. In addition, it is now emerging that men and women also experience a different susceptibility to some virus infections, often with a different outcome. In addition, even the prevention or the response to antiviral treatments can display significant differences between male and female patients.

Hepatitis B (HBV) and C viruses (HCV) are responsible of chronic liver disease and are the major risk factors for development of hepatocellular carcinoma (HCC). It is estimated that 240 million people worldwide are chronically infected with HBV and at risk of serious illness, like cirrhosis and HCC. One hundred seventy million people are estimated to be chronically infected with HCV, whose infection prevalence is about 3% in the developed countries whereas, only in Europe, about 4 million people are HCV carriers. Beside these epidemiological data, sex disparity in the natural history of HBV and HCV infections and in the evolution and progression of the associated liver disease in different geographic areas of the world have been reported since many.

A number of studies are available regarding gender differences in HBV infection, whereas HCV infection appears studied in less detail. After the initial knowledge that men are more likely than women to become chronic carriers for HBV, it has been recognized that the serum prevalence of HBV surface antigen (HBsAg) and the DNA virus titers are higher in serum of men than women. Both these viral factors probably contribute to the increased risk to develop HCC in male with respect to female. In fact, the male/female ratio for HCC prevalence has been reported to be from 2:1 to 4:1. Due to the close interaction between virus and host, both host and viral mechanisms could be responsible of this gender disparity in HBV infection and disease progression.

Acute Lymphoblastic Leukaemia Presenting with Bone Marrow Necrosis

      http://austinpublishinggroup.com/hematology/fulltext/hematology-v5-id1186.php

A previously healthy15-year-oldfemale presented to the emergency department (ED) in June 2013 with a two month history of fever and pain in her right thigh and buttock. On examination, she was febrile at 39°C. She had tenderness at the right sacroiliac joint but full range of hip and knee joint movements. The remainder of her examination was unremarkable, in particular, no evidence of hepatosplenomegaly, petechiae or lymphadenopathy.

Her initial blood tests showed mild hypochromic, microcytic anaemia with a haemoglobin of 105 g/L (normal range: 110-145 g/L), normal white cell count 6.8 X 109/L (normal range: 5-17 X 109/L) and platelets 224 X 109/L (normal range: 150-400 X 109/L). Her inflammatory markers were markedly elevated, erythrocyte sedimentation rate (ESR) 82 mm/hr (normal <15 mm/hr) and C-reactive protein (CRP) 68 mg/L (normal <10 mg/L). Her liver function tests and lactate dehydrogenase (LDH) were normal. She also had a pelvic X- ray which did not reveal any abnormalities.

She was admitted under the orthopaedic team with a presumed chronic skeletal infection. Her bone scan showed irregular increased uptake at multiple sites including the right sacroiliac joint, right femur, multiple ribs and multiple areas within the thoracic spine. Chronic recurrent multifocal osteomyelitis (CRMO) was added to the differential diagnosis. Magnetic Resonance Imaging (MRI) showed multifocal areas of T2 hyperintensity in the right ilium, right ischial tuberosity, right intertrochanteric region, right and left sacral alae and left posterior acetabulum suggestive of osteonecrosis or infection. Diffuse abnormal marrow signal with symmetric areas of sparing in the proximal femoral regions were in keeping with extensive red marrow conversion on the MRI.

Macroscopic Balance Equations for Spatial or Temporal Scales of Porous Media Hydrodynamic Modeling

                                  http://austinpublishinggroup.com/hydrology/currentissue.php

We focus on thefirst author’s previous work addressing macroscopic balance equations developed for different spatial and temporal scales. We elaborate on previous findings so as to orient the reader to fundamental concepts with which the mathematical formulations are developed. The macroscopic balance Partial Differential Equations (PDE’s) are obtained from their microscopic counterparts by volume averaging over a Representative Elementary Volume (REV), considering a non-Brownian motion. The macroscopic quantity of phase/component intensive quantities product, is the premise of two concurrent decomposed macroscopic balance PDE’s of the corresponding extensive quantity. These are concurrently valid at the primary REV order of length and at a significantly smaller secondary length. The hydrodynamic characteristic at the smaller spatial scale was found to always be described by pure hyperbolic PDE’s, the solution of which presents displacement of sharp fronts. Reported field observations of condensed colloidal parcels motion, validate the suggestion of hyperbolic PDE’s describing fluid momentum and components mass balance at the smaller spatial scale. Controlled experiments supplemented by numerical predication can yield the hydrodynamic interrelation between the two adjacent spatial scales.

Further, we focus on the first author past developments concerning dominant macroscopic balance PDE’s of a phase mass and momentum and a component mass following an onset of abrupt pressure change. These account for the primary REV order of length and for evolving temporal scales. Numerical simulations were found to be consistent in excellent agreement with experimental observations. During the second time increment and in view of the aforementioned developments, we presently elaborate on new findings addressing theoretically the efficiency of expansion wave for extracting solute from a saturated matrix. Simulations comparing between pumping using an approximate analytical form based on Darcy’s equation and numerical prediction addressing the emitting of an expansion wave, suggest that the latter extracts by far more solute mass for a spectrum of different porous media.

Application of spatial averaging rules, referring to a REV, leads to the formulation of the macroscopic balance equations addressing phase interactions such as fluids carrying components and a deformable porous matrix. Further elaborations by Sorek et al. Sorek and Ronen  and Sorek et al.  prove that the phases and components macroscopic balance PDE’s can be decomposed into a primary part that refers to the REV length scale and, concurrently, a secondary part valid at a length scale smaller than that of the corresponding REV length. The secondary macroscopic balance equation always conforms to a hyperbolic PDE. Geometrical patterns of different spatial scales that prevail in various porous media are exemplified. Such patterns support the notion of the need to implement macroscopic balance equations addressing different spatial scales. Observations verify that the hydrodynamic characterization of colloidal transport comply with the developed fluid and component macroscopic balance equations for the smaller spatial scale.

Local Understanding and Responses to Deliberate Transmission of HIV: Experiences from Persons Receiving Antiretroviral Treatment in Rural Northeastern Tanzania

                    http://austinpublishinggroup.com/hiv-aids-research/currentissue.php

As access to Antiretroviral Therapy (ART) in Tanzania has been steadily improving in recent years, there has been concern that availability of Antiretroviral Drugs (ARV) could fuel HIV transmission due to deliberate unprotected sexual practices of persons receiving antiretroviral treatment. There has been a debate about the need to enforce some institutional measures to help manage and control what has been described as the deliberate spread of HIV. However, there is no widespread consensus about what constitutes ‘deliberate transmission’.

Drawing on in-depth interviews with a sample of people receiving ART and health workers providing care in a rural setting, this article examines the context in which deliberate HIV transmission is defined and the ways through which it can be controlled. The article demonstrates that people on ART face the dilemma of reducing risk of spreading HIV and a desire to maintain socially acceptable sexual and reproductive lives. Although many participants reportedly remained sexually abstinent, they also revealed that some people on treatment from within and beyond the study area were engaging in sexual behaviours perceived to amount to deliberate spread of HIV.

Despite some reservations, formal sanctions to control deliberate HIV transmission were generally highly approved by participants. The article strongly recommends for a careful examination of needs of persons on treatment and strengthened prevention in order to manage unintended consequences of ART for individuals living with HIV/AIDS and uninfected population.

Looking Beyond Liver! Cirrhotic Cardiomyopathy: Pathophysiology, Clinical Presentation and Management Strategies

                                    http://austinpublishinggroup.com/glpd/currentissue.php

Cardiac dysfunction in cirrhosis of liver remains dormant due to hyperdynamic circulatory state even with the severe stage of cirrhosis. This in actuality is worsening of the cardiac functions. The decline in diastolic functions, inotropic and chronotropic functions and cardiac hypertrophy all occur simultaneously in the setting of an absent organic cardiac disease. The Cirrhotic cardiomyopathy has pertinent findings in its loop comprising of impaired contractile reaction to stress stimuli and electrophysiological abnormalities along with prolonged QT interval. The disruption in β-adrenergic receptor signalling, altered composition of cardiomyocyte membrane lipids plus biophysical properties, ion channel defects and enhanced cardiodepressant factors attributed to hormones are the pathogenic assailants. The hindrance to diagnose cirrhotic cardiomyopathy mainly lies in unavailability of a stark specific diagnostic test nevertheless; an echocardiogram is favourably used to follow deteriorating diastolic functions and the E/e′ ratio thus giving insight to the progression of disease. The severity of cirrhosis is linked in parallel with ensuing cirrhotic cardiomyopathy which substantially impairs arterial blood volume. So, in case of any hemodynamic stress, a heart bearing cirrhotic cardiomyopathy retorts with diminished cardiac response which may cause renal hypoperfusion leading to renal failure. The management is mainly symptomatic where only the liver transplantation could play an imperative role in correction of the cardiac functions.

CCM: Cirrhotic Cardiomyopathy; QTc: Corrected QT interval; SNS: Sympathetic Nervous System; RAAS: Renin Angiotensin Aldosterone System; CAIDS: Cirrhosis-Associated Immune Dysfunction Syndrome; NO: Nitric Oxide; CO: Carbon monoxide; LV: Left Ventricle; SVR: Systemic Vascular Resistance; BDL: Bile Duct Ligation; PWCP: Pulmonary Wedge Capillary Pressure; PRAL: Plasma Renin Activity; TGF β: Transforming Growth Factor Β; IVRT: Increased Isovolumic Relaxation Time; DT: Deceleration Times; TDI: Tissue Doppler Imaging; CAMP: Cyclic Adenosine Monophosphate; PKA: Protein Kinase; ECS: Endocanabinoid System; iNOS: inducible Nitric Oxide Synthase; L-NMMA: N Omegamonomethyl-larginine; NGL: Nitro-arginine Methyl Ester; HO: Haem Oxygenase; CGMP: Cyclic Guanosine Monophosphate; MAPKs: Mitogen-Activated Protein Kinase; HRS: Hepatorenal Syndrome; ANP: Atrial Natriuretic Peptide; BNP: B Type Natriuretic Peptide; GLS: Global Longitudinal Strains.

Cirrhosis is a chronic state of liver caused by various aetiologies characterized by altered parenchyma and distorted hepatic vascular architecture consequent to chronic tissue fibrosis and regenerative nodules. Globally, cirrhosis has become an emergent cause of mortality. Apart from the known complications of cirrhosis like ascites, hepatic encephalopathy, upper GI bleeding and Coagulopathy, cardiac involvement in the form of Cirrhotic Cardiomyopathy (CCM) has recently gained attention as the commonest cause of post liver transplant mortality.