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BACKGROUND Above and beyond their role in cardiovascular risk reduction, statins appear to have a chemopreventive role in some gastro-intestinal cancers. In the quest for new chemopreventive agents, some existing established drugs such as statins have shown potential for re-purposing as chemoprevention. Probing existing drugs, whose pharmacodynamics are familiar, for novel beneficial effects offers a more cost-effective and less time-consuming strategy than establishing brand new drugs whose pharmacodynamic profile is unfamiliar. Observational studies show statins decrease the risk of developing colorectal cancer but there are no published studies exploring the potential impact of statins on carcinogenesis in colorectal liver metastases (CRLM). AIM To evaluate impact of statins on outcomes of CRLM resection, and secondarily to assess if statins influence CRLM histo-pathology. METHODS We conducted a retrospective cohort study of patients operated for CRLM over a 13-year period from 2005 to 2017. Patients were identified from a prospective database maintained in our Tertiary care hospital. All 586 patients included the study had undergone resection of CRLM following discussion at multidisclipinary team meeting, some patients requiring neoadjuvant chemotherapy to downstage CRLM prior to surgery. We analysed patient demographics, operative details, CRLM histopathology, Index of Deprivation, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and chemotherapy use in relation to clinical outcome. Statistics were performed using SPSS version 16.0; significance taken at 5%. RESULTS Liver resection for CRLM was undertaken in 586 patients at a median age of 68 (range 19 to 88) years. Statin therapy was used by 181 patients. Median follow-up time was 23 (range 12-96) mo and further colorectal cancer metastases developed in 267 patients. A total of 131 patients died. Multi-variate analysis identified 6 independent predictors of poorer disease-free survival: Synchronous presentation, multiple tumours, tumour size ≥ 5 cm, moderate–severe steatosis, peri-neural invasion, and R1-resection margin. Poorer overall survival was significantly associated with neo-adjuvant chemotherapy, major hepatectomy, peri-neural invasion and R1-resection margin. Neither histo-pathological nor radiological traits of CRLM were affected by statins, and, there was no demonstrable effect of statin therapy on patient outcomes. CONCLUSION Statin therapy does not affect patient survival following liver resection for CRLM. We postulate the reason for this key finding is that statins do not modulate tumour biology of CRLM.

Angiotensin-converting enzyme (ACE) inhibitors have been shown to possibly influence the survival outcomes in certain cancers. The aim of this study was to evaluate the impact of ACE inhibitors on the outcomes of patients undergoing liver resection for colorectal liver metastases (CRLM). The secondary aim was to determine whether ACE inhibitors influenced histopathological changes in CRLM. Patients treated with liver resection for CRLM over a 13-year period were identified from a prospectively maintained database. Data including demographics, primary tumour treatment, surgical data, histopathology analysis and clinical outcome were collated and analysed. A total of 586 patients underwent primary hepatic resections for CRLM during this period including 100 patients on ACE inhibitors. The median follow-up period was 23 (range: 12–96) months, in which 267 patients developed recurrent disease and 131 patients died. Independent predictors of disease-free survival on multivariate analysis included synchronous presentation, neoadjuvant chemotherapy, major liver resection, tumour size and number, extent of hepatic steatosis, R0 resection and presence of perineural invasion. Poorer overall survival was associated with neoadjuvant treatment, major liver resection, presence of multiple metastases, perineural invasion and positive resection margins on multivariate analysis. ACE inhibitors did not influence the survival outcome or histological presentation in CRLM. The use of ACE inhibitors did not affect the survival outcome or tumour biology in patients with CRLM following liver resection.

Uterine leiomyoma is the most common benign gynecological tumor. Rarely, it has benign extra-uterine growth patterns, including benign metastasizing leiomyoma (BML), with lungs being the most common metastatic site.We present a case of a 47-year-old female who, 3 years prior to presentation, underwent abdominal supra-cervical hysterectomy for benign leiomyoma. Approximately 6 months prior to presentation, she was seen for shortness of breath and chest pain. A CT of the chest revealed multiple new non-calcified pulmonary nodules bilaterally. PET/CT demonstrated mild FDG uptake in multiple lung nodules, with no significant extra-thoracic sites of abnormal FDG uptake. A CT guided lung biopsy showed a low grade, smooth muscle tumor. Immunohistochemical staining was positive for smooth-muscle actin and desmin, estrogen and progesterone receptor and was negative for CD117, HMB-45, CD34, pan cytokeratin and EMA. She underwent wedge resection of one of the nodules which confirmed the above findings. A cytogenetic analysis was also performed, which was consistent with pulmonary BML. She ultimately underwent left lower lobe resection and was started on a daily aromatase inhibitor.BML is a rare disease usually seen in women of reproductive age. The pathogenesis and treatment remain controversial. BML mostly tends to have an indolent course and a favorable outcome. Keywords: Benign metastasizing leiomyoma, Pulmonary metastasis, Aromatase inhibitors

Background: The nasal obstruction is one of the causes that affect the middle ear function, but the physiological mechanism of this effect is not well understood. This study aims at 1st; evaluation of the middle ear function among adults with chronic nasal obstruction due to sinonasal pathology using tympanometry, and 2nd, at comparison between the anatomical and mucosal inflammatory causes of nasal obstruction and its impact on the middle ear function.Patients and methods: A prospective case study of (310) adult patients with chronic nasal obstruction were subjected to tympanometry for study of middle ear pressure in the private ENT clinic for a period of two years in the Salah Al-Deen governorate.Results: this study found that (13%) of adults with chronic nasal obstruction had abnormal tympanogram (type B or C), (17.2%) was due to mucosal inflammation and (7%) due to anatomical and structural cause. Commonly one ear affected (unilateral) was (67.5%). Myringotomy and aspiration of middle ear found that (64%) had OME and VT was inserted.Conclusion: The study statistically proved that adults with chronic nasal obstruction due to mucosal inflammation differs from others due to anatomical and structural causes in the followings; 1.The incidence of abnormal tympanogram (type B and C) is more. 2.The type B (OME) was more than type C (Eustachian tube dysfunction). 3.In the treatment ,it was found that the need to VT insertion was more.

Percutaneous coronary intervention (PCI) is often needed in patients with stable ischemic heart disease (SIHD). After PCI, patients need dual antiplatelet therapy which puts them at an increased risk of major bleeding especially in the GI tract. We aimed to evaluate the incidence of upper

Dyspnea accounts for more than one-fourth of the hospital admissions from Emergency Department. Chronic conditions such as Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, and Asthma are being common etiologies. Less common etiologies include conditions such as valvular heart disease, pulmonary embolism, and right-to-left shunt (RLS) from patent foramen ovale (PFO). PFO is present in estimated 20–30% of the population, mostly a benign condition. RLS via PFO usually occurs when right atrium pressure exceeds left atrium pressure. RLS can also occur in absence of higher right atrium pressure. We report one such case that highlights the importance of high clinical suspicion, thorough evaluation, and percutaneous closure of the PFO leading to significant improvement in the symptoms.

Radiofrequency catheter ablation (RFA) has become a mainstay for treatment of cardiac arrhythmias. Skin burns at the site of an indifferent electrode patch have been a rare, serious, and likely an underreported complication of RFA. The purpose of this study was to determine the incidence of skin burns in cardiac RFA procedures performed at one institution. Also, we wanted to determine the factors predicting skin burns after cardiac RFA procedures at the indifferent electrode skin pad site.Methods.A retrospective case control study was performed to compare the characteristics in patients who developed skin burns in a 2-year period.Results.Incidence of significant skin burns after RFA was 0.28% (6/2167). Four of the six patients were female and all were Caucasians. Four controls for every case were age and sex matched. Burn patients had significantly higher BMI, procedure time, and postprocedure pain, relative to control subjects (p< 0.05, one-tailed testing). No one in either group had evidence of dispersive pad malattachment.Conclusions.Our results indicate that burn patients had higher BMI and longer procedure times compared to control subjects. These findings warrant further larger studies on this topic.

Item does not contain fulltext BACKGROUND:: Candida species are the third most common cause of pediatric healthcareassociated bloodstream infection in the United States and Europe. To our knowledge, this report from the International Pediatric Fungal Network is the largest prospective, multi-center observational study dedicated to pediatric and neonatal invasive candidiasis. METHODS:: From 2007-2011, we enrolled 196 pediatric and 25 neonatal patients with invasive candidiasis. RESULTS:: Non-albicans Candida species predominated in pediatric (56%) and neonatal (52%) age groups, yet C. albicans was the most common in both groups. Successful treatment responses were observed in pediatric (76%) and neonatal patients (92%). Infection with C. parapsilosis led to successful responses in pediatric (92%) and neonatal (100%) patients, while infection with C. glabrata was associated a lower successful outcome in pediatric patients (55%). The most commonly used primary antifungal therapies for pediatric invasive candidiasis were fluconazole (21%), liposomal amphotericin B (20%), and micafungin (18%). Outcome of pediatric invasive candidiasis was similar in response to polyenes (73%), triazoles (67%) and echinocandins (73%). The most commonly used primary antifungal therapies for neonatal invasive candidiasis were fluconazole (32%), caspofungin (24%), and liposomal amphotericin B (16%) and micafungin (8%). Outcomes of neonatal candidiasis by antifungal class again revealed similar response rates amongst the classes. CONCLUSIONS:: We found a predominance of non-albicans Candida infection in children and similar outcomes based on antifungal class used. This international collaborative study sets the foundation for large epidemiologic studies focusing on the unique features of neonatal and pediatric candidiasis and comparative studies of therapeutic interventions in these populations.

Fractional flow reserve (FFR) is the gold standard for determining hemodynamic significance and thus the ischemic potential of an intermediate grade coronary stenosis (ICS). Current literature supports deferring percutaneous coronary intervention (PCI) in stable ischemic heart disease (SIHD)

Fractional flow reserve (FFR) based deferral or performance of revascularization has been a standard practice with data showing positive outcomes in stable ischemic heart disease patients. Data regarding use of FFR for intermediate grade coronary stenosis (ICS) in the setting of Acute coronary

Embolic events are a well-documented complication of bacterial endocarditis. Coronary artery septic emboli are a much less common manifestation of endocarditis, and can very rarely present as a myocardial infarction (MI) [1]. Though no consensus exists on the best management for these patients, conventional reperfusion strategies often prevail in light of the time constraints surrounding an acute MI [2]. Here we present the case of a septic coronary embolism in a patient with undiagnosed endocarditis who presented with an acute ST-segment elevation myocardial infarction (STEMI) and the subsequent management.

Cobalt, copper and nickel complexes with tris(3,5-dimethyl-1H-pyrazol-1-yl)hydroborate (Tp*) were synthesized by the reaction of potassium tris(3,5-dimethyl-1H-pyrazol-1-yl)hydroborate (KTp*) with the corresponding metal(II) chloride by using conventional reflux methods and microwave methods. The two methods were compared and the microwave method was found to be less time consuming and gave higher yields.

Extreme Coumadin Resistance in a patient with atrial fibrillation and End Stage Renal Disease Warfarin resistance is a rare condition and its prevalence is less than 0.1%. It is defined as a daily Coumadin requirement of more than 15mg or a weekly requirement of more than 70mg in order to maintain a therapeutic INR.

Deferral of percutaneous coronary intervention (PCI) for intermediate grade coronary stenosis (ICS) based on non-ischemic fractional flow reserve (FFR) value is a safe strategy. Data regarding deferral of PCI in multi-vessel disease when more than one ICS lesions are present and FFR is non-ischemic