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BackgroundThe coronavirus disease 2019 pandemic led to increased pressure on health services, which, combined with variable social restrictions, led to decreased referrals for head and neck cancer. This study assessed whether there were lasting changes to head and neck cancer referrals during different stages of the pandemic response in 2020 and 2021.MethodsA retrospective review was conducted of all cases referred for suspected head and neck cancer to our institution in January 2020, April 2020, April 2021 and June 2021.ResultsThere was a rebound 91 per cent increase in referrals between April 2020 and April 2021 following the 59 per cent decrease in referrals between January 2020 and April 2020. Males made up 47.1 per cent of referrals in January 2020, 40 per cent in April 2020 and 37.82 per cent in April 2021.ConclusionFurther research is recommended to investigate the reasons why there is a continued decline in male referrals and the effect this has on their outcomes.

ObjectiveCone beam computed tomography is an imaging technique that can be used for the paranasal sinuses. This study assessed how widely it is used and the impact it has on chronic rhinosinusitis management in the ENT department of one hospital.MethodA nationwide survey was conducted to assess the use of cone beam computed tomography throughout ENT UK members. A retrospective analysis of four-year rhinology clinic data for patients presenting with chronic rhinosinusitis symptoms was subsequently performed to assess how many scans were achieved the same day and the subsequent patient management.ResultsThe survey results indicated that a majority of staff do not use cone beam computed tomography to image sinuses (86.5 per cent), and this was largely because of lack of access (92 per cent). This study assessed 355 cone beam computed tomography requests. Overall, 306 cases had a cone beam computed tomography scan on the same day as their clinic appointment with the majority seen back in clinic during the same hospital attendance for the results. Overall, 97 patients were discharged on the same day.ConclusionThis study suggested a lack of awareness and understanding of cone beam computed tomography in managing rhinosinusitis. The ‘one-stop’ rhinology clinic model offers benefits including reduced patient hospital attendance.

Background: The knowledge of the incidence of blood Transfusion Transmissible Infections (TTIs) such as Hepatitis B, Hepatitis C, Human Immunodeficiency Virus infection, malaria and syphilis is essential for monitoring the safety of blood supply. Objective: To describe the prevalence of TTIs for monitoring blood supply safety and evaluating the efficacy of screening procedures. Methods: A five-year retrospective study spanning January 2016 to December 2020 was carried out on voluntary blood donors at blood donation camps organised by Adesh Medical College and Hospital, Kurukshetra, Haryana, India, and from donors at the hospital’s blood bank. The donated blood was tested for Hepatitis-B, Hepatitis-C, Human Immunodeficiency Virus (HIV), malaria and syphilis. Results: There were a total of 10,468 voluntary blood donors during the period of study. Out of all the donors, 0.4% tested positive for at least one of the TTIs, including 0.06% testing positive for HIV, 0.21% for Hepatitis-B virus (HBV) infection (Hepatitis-B Surface Antigen) and 0.13% for Hepatitis-C virus (HCV) infection (Anti HCV Antibodies). None of the voluntary donors was positive for malaria or syphilis. There were no co-infections. Conclusions: The prevalence of TTIs among voluntary blood donors was low hence the advocation for blood from this group of donors. Donated blood specimens should be more effectively screened, and blood should be rationally used.

ObjectivesTo report the clinical outcomes of patients with chronic parotid sialadenitis treated with superficial parotidectomy, and to review the literature.MethodsA retrospective case series was conducted of all patients undergoing parotidectomy for chronic parotid sialadenitis at our institution between 2009 and 2018.ResultsEighteen superficial parotidectomies were performed, resulting in complete symptom resolution in 17 patients. There was only one recurrence, of a milder form of the disease, requiring no specific treatment. Eight temporary post-operative facial nerve palsies and one permanent palsy occurred. Further complications included post-operative wound haematoma, seroma, Frey's syndrome, neuropathic pain and wound infection.ConclusionSuperficial parotidectomy is sufficient to control patient symptoms, avoiding the increased morbidity associated with near-total parotidectomy. The literature does not point to a clear difference in either the incidence of recurrence or the risk of a facial nerve palsy between the two procedures. Furthermore, the symptoms attributed to recurrence are often not severe enough to warrant salvage near-total parotidectomy.

Background: Pathology is a key subject at the pre-clinical stage of medical training. Objectives: To determine the perception of second-year MBBS (preclinical) students regarding Pathology as a subject and the effectiveness of various teaching, learning and assessment methods. Methods: This cross-sectional study was carried out on 145 randomly selected, second-year MBBS students, appearing for their Phase II final university exams. A predesigned questionnaire with questions about students’ perception of pathology was administered to the students. The questionnaire also assessed the various teaching-learning methods currently used by the faculty. The students were also requested to make suggestions regarding the modifications needed in the teaching methods. Results: A total of 145 out of 150 regular-batch students participated in the study. One hundred (68.9%) regarded pathology as an interesting subject; 131 (90.3%) felt pathology acts as a bridge between paraclinical and clinical branches while 107 (73.8%) found blackboard teaching more effective. Conclusion: The study revealed that the preclinical medical students showed a favourable predisposition towards pathology as a subject while highlighting areas that need to be addressed for more effective teaching and improved learning towards producing better medical professionals.

Introduction Parapharyngeal Space (PPS) tumours are responsible for 0.5% of head and neck cancers. Presenting features can mimic peritonsillar abscess. A differential diagnosis of PPS tumour should therefore be considered in young, systemically well patients with resistant peritonsillar masses. Aim To report a rare case of parapharyngeal schwannoma in a fit and well adult female with a focus on investigations and optimal management. Method A 29-year-old, Caucasian female presented with a three-week history of a right sided oropharyngeal mass, odynophagia, and dysphonia. A stagnant clinical picture prompted further investigation with Magnetic Resonance Imaging (MRI). This demonstrated a 7cm right sided PPS mass arising from the deep lobe of the right parotid gland. Mass excision and partial, ipsilateral parotidectomy confirmed Schwannoma (neurilemoma). Results & Discussion Schwannomas account for a third of PPS tumours. Arising from neurological Schwann cells, they are often encapsulated, benign tumours which are characterised by slow and asymptomatic growth. Presentation often follows mass effects leading to dysphagia, odynophagia, and dysphonia. MRI and FNAC remain the gold standard in confirmation of diagnosis. Insensitivity to radiotherapy ensures that surgical resection is the mainstay of treatment and may utilise the transcervical, transparotid or transmandibular approach. Conclusion There is a significant degree of overlap in the epidemiology and presenting features of peritonsillar abscess and PPS tumours. In cases of treatment resistant, chronic peritonsillar masses a differential diagnosis of PPS tumour must therefore be excluded.

In this article, Mughal understandings of their own past are reconstructed from the standpoint of Mughal paramountcy in around 1700. That was the moment of the empire's greatest territorial reach, when it knew no peer nor threat. To reconstruct contemporary understandings of how this situation came about, histories of the Mughal empire composed by governing officials of the time are analysed using a novel approach rooted in a particular distinction between constants and contingencies. These understandings allow us to recapture the political sociology of empire as apprehended by the Mughal elites. The article's findings are of value for two reasons. Narrowly construed, they help fill a lacuna in mainstream views on Mughal historiography, traditionally dominated by Akbar and his reign, and imbued with the logic of decline (and of its corollary, the transition to colonialism). More broadly, because of the weight accorded to knowledge of the past in the formation of Mughal ruling elites, the findings provide fresh insights into the cognitive framework within which these elites operated at a moment recognized as highly significant then, and in retrospect.

BackgroundThere is increasing concern regarding efficacy of organ preservation protocol in laryngeal and hypopharyngeal cancers.MethodThis study retrospectively assessed disease-related and functional outcomes of 191 patients with non-metastatic laryngeal or hypopharyngeal squamous cell carcinoma treated with curative intent (radiotherapy with or without chemotherapy).ResultsSeventy-six patients (39.8 per cent) had a primary cancer in the larynx, and 115 patients (60.2 per cent) had a primary cancer in the hypopharynx. The median follow up was 39 months. The 3-year time to progression, overall survival, local control and laryngectomy free survival was 56.2 per cent, 76.3 per cent, 73.2 per cent and 67.2 per cent, respectively. At the time of analysis, 83 patients (43.5 per cent) were alive and disease free at their last follow up and did not require tube feeding or tracheostomy. The laryngo-oesophageal dysfunction-free survival was 61 per cent at 3 years.ConclusionOrgan conservation protocols remain the standard of treatment in appropriately selected patients with laryngeal and hypopharyngeal cancers.

Acinetobacter species have important role in modern medicine due to their increasing presence in health-care facilities and antibiotic resistance. They are non-fermentative, aerobic, Gram-negative coccobacilli and are important bacteria causing peritonitis in patients on peritoneal dialysis. Acinetobacter johnsonii is widely found in the aquatic environment and animals. Peritonitis caused by A. johnsonii is rarely encountered and reported. Here we report a case of A. johnsonii peritonitis in a patient on peritoneal dialysis. To the best of our knowledge, this is the first case of peritoneal dialysis-associated peritonitis by A. johnsonii reported from India.

BackgroundThe coronavirus disease 2019 pandemic has necessitated almost exclusive National Health Service focus on emergency work and cancer care. There are concerns that increased hospital and community pressures will lead to decreased referrals and worse outcomes for head and neck cancer patients.MethodThis is a retrospective review of all cases referred for suspected head and neck cancer to our institution in January and April 2020.ResultsThere was a 55 per cent decrease in referrals but diagnostic yield rose from 2.9 per cent in January to 8.06 per cent in April. In both months, 100 per cent of patients met the 31- and 62-day targets, with similar 14-day wait time success (97.83 per cent for January vs 98.33 per cent for April). Referrals for laryngopharyngeal reflux rose from 27.5 per cent to 41.9 per cent. Referrals for those aged over 60 years fell from 42 per cent to 26 per cent.ConclusionIt is suggested that further research be conducted into the reasons why fewer patients were referred, particularly elderly patients, and why laryngopharyngeal reflux is so prevalent in fast-track referrals.

Little is known regarding the epidemiology and outcomes of patients with primary sclerosing cholangitis (PSC) in Australia. We, therefore, evaluated the epidemiology and clinical outcomes of PSC in a large cohort of Australian patients and compared these to the general population.We conducted a multicentre, retrospective cohort study of PSC patients at nine tertiary liver centers across three Australian states, including two liver transplant centers.A total of 413 PSC patients with 3,285 person-years of follow-up were included. Three hundred and seventy-one (90%) patients had large duct PSC and 294 (71%) had associated inflammatory bowel disease. A total of 168 (41%) patients developed cirrhosis (including 34 at the time of PSC diagnosis) after a median of 15.8 (95% CI 12.4, NA) years. The composite endpoint of death or liver transplantation occurred in 49 (12%) and 78 (19%) patients, respectively, with a median transplant-free survival of 13.4 (95% CI 12.2-15) years. Compared to the general population, PSC accounted for a 240-fold increased risk of development of cholangiocarcinoma (CCA) and CCA-related death. CCA risk was increased with older age of PSC diagnosis, presence of dominant stricture and colectomy. Compared to same-aged counterparts in the general population, PSC patients who were diagnosed at an older age or with longer disease duration had reduced relative survival.In this large retrospective cohort study of PSC patients in Australia, increased age and time from diagnosis was associated with increased mortality and morbidity particularly from CCA and development of cirrhosis, necessitating need for liver transplant.

ObjectiveTo describe the utility of sleep nasendoscopy in determining the level of upper airway obstruction compared to microlaryngotracheobronchoscopy.MethodsA retrospective observational study was conducted at a tertiary level paediatric hospital. Patients clinically diagnosed with upper airway obstruction warranting surgical intervention (i.e. with obstructive sleep apnoea or laryngomalacia) were included. These patients underwent sleep nasendoscopy in the anaesthetic room; microlaryngotracheobronchoscopy was subsequently performed and findings were compared.ResultsTwenty-seven patients were included in the study. Sleep nasendoscopy was able to induce stridor or stertor, and to detect obstruction at the level of palate and pharynx, including tongue base collapse, that was not observed with microlaryngotracheobronchoscopy. Only 47 per cent of patients who had prolapse or indrawing of arytenoids on sleep nasendoscopy had similar findings on microlaryngotracheobronchoscopy. However, microlaryngotracheobronchoscopy was better in diagnosing shortened aryepiglottic folds.ConclusionThis study demonstrates the utility of sleep nasendoscopy in determining the level and severity of obstruction by mimicking physiological sleep dynamics of the upper airway.

An urgent neck lump service was introduced at the Freeman Hospital (Newcastle-Upon-Tyne) in 2017. All 2-week-wait urgent head and neck referrals were triaged into this service. The clinic involves clinical examination by a head and neck specialist and if appropriate an urgent ultrasound scan (USS) in clinic +/- a fine needle aspiration for cytology (FNAC). This centralised system means patients can be diagnosed earlier and thus receive treatment swiftly. This audit aimed to primarily identify: The prevalence/pick-up rate of cancer diagnosed through the clinic The utilisation of USS/FNAC The time-to-treatment initiation Data was collated retrospectively through the electronic record system. The initial evaluation was conducted between June-November 2018 (n = 191). The subsequent re-evaluation was performed between September-November 2019 (n = 159), following increased clinic capacity, implementation of methods to increase awareness and a formal triage process. In the initial evaluation over 6 months (n = 191), 9.9% underwent an USS in the clinic and 9.95% at a later date. 18% of patients underwent a FNAC. 6.8% patients were diagnosed with cancer. The mean time-to-treatment initiation was 36 days. In the re-evaluation over 3 months (n = 159), 23.2% had an USS in the clinic and 30.2% at a later date. 13% of patients underwent a FNAC. 9.4% of patients were diagnosed with cancer. The mean time-to-treatment initiation was 44 days. This affirms the benefits of a swift ‘one-stop clinic’. On average, patients diagnosed with cancer had treatment initiation 40-days post-review. Furthermore, even with a triage process only 1 in 10 patients had cancer.

Recently, a downward trend is seen in undergraduates wishing to pursue a career in cardiothoracic surgery(CTS). This is partly due to lack of clinical exposure and limited teaching during the undergraduate years; the focus being on cardiac ad vascular pathology. Aim Assess if WETLAB workshop encourages the engagement of medical students in CTS surgery Method We hosted a cardiac WETLAB workshop, led by a consultant cardiothoracic surgeon. Attendees were taught how to carry out an end-to-side anastomosis on animal tissue. We used pre-and -post exposure questionnaires composed of 10 items to assess the ability of the workshop to improve undergraduate interest in cardiothoracic surgery. The questionnaire included questions around students’ interest in the speciality, previous exposure to the speciality and whether students want to pursue a career in the speciality. Results Out of the 12 attendees, 10 completed both questionnaires. The workshop was well received with the overall satisfaction of 9.64 out of 10. It significantly increased respondents’ interest in CTS(z=-0.06, p = 0.01) but did not show any significant difference in encouraging them to pursue surgery. 100% of respondents agreed that specialised practical workshops should be incorporated within the medical school curriculum and that if the opportunity arises, they will attend another in the future. Conclusions Specialised practical workshops have the potential to play a significant role in the medical school curriculum in order to enhance exposure to the field of cardiothoracic surgery. This may lead to a positive impact on the number of doctors wishing to pursue this speciality in the future.

Summary: Reactive oxygen species (ROS) play critical roles in metabolism and disease, yet a comprehensive analysis of the cellular response to oxidative stress is lacking. To systematically identify regulators of oxidative stress, we conducted genome-wide Cas9/CRISPR and shRNA screens. This revealed a detailed picture of diverse pathways that control oxidative stress response, ranging from the TCA cycle and DNA repair machineries to iron transport, trafficking, and metabolism. Paradoxically, disrupting the pentose phosphate pathway (PPP) at the level of phosphogluconate dehydrogenase (PGD) protects cells against ROS. This dramatically alters metabolites in the PPP, consistent with rewiring of upper glycolysis to promote antioxidant production. In addition, disruption of peroxisomal import unexpectedly increases resistance to oxidative stress by altering the localization of catalase. Together, these studies provide insights into the roles of peroxisomal matrix import and the PPP in redox biology and represent a rich resource for understanding the cellular response to oxidative stress. : Despite its importance in metabolism and disease, a comprehensive analysis of the cellular response to oxidative stress is lacking. Here, Dubreuil et al. use genome-wide screens to identify cellular regulators of oxidative stress. They investigate paradoxical mechanisms by which disruption of the pentose phosphate and peroxisomal import pathways protect cells. Keywords: CRISPR, genome-wide screen, shRNA, pentose phosphate pathway, peroxisomal import pathway, catalase, phosphogluconate dehydrogenase, oxidative stress, reactive oxygen species

Galectins are a class of animal lectins that bind to β-galactoside residues through a conserved carbohydrate recognition domain of about 130 amino acids. The carbohydrate-binding specificity of mammalian galectins revealed its affinity toward lactose, related beta-galactosides, and any glycoconjugates with a nonreducing galactoside terminus. Recent studies have indicated that galectin-1 upregulation impacts progression of tumor through its pleiotropic roles such as cell transformation and proliferation, angiogenesis, adhesion, and invasiveness and immunosuppression. Several galectin-1 inhibitors such as thiodigalactoside, Anginex GM-CT-01 and GR-MD-02 have been designed for applications in cancer therapy. GM-CT-01 (DAVANAT), a modified polysaccharide, composed of mannose and galactose (galactomannan) and a variant of DAVANAT, GR-MD-02, which is a polysaccharide with a backbone of rhamnogalacturonate and branches that terminate with galactose and arabinose residues are produced from chemically processed and modified industrial-grade apple pectin are also found to be beneficial in therapy toward cancer as well as nonalcoholic steatohepatitis. Various reports have also presented evidence that galectin-1-targeted therapy will play a major role to reduce the distribution of tumor cells, inhibit angiogenesis, and restrict tumor growth, thus seeing the importance of pectins and pectin polysaccharides in cancer therapy, we purified and characterized pectins from okra pods (Abelmoschusesculentus) and citrus peels (Citruslimetta) and studied the residual protein content, total carbohydrate content, characteristic properties using Fourier-transform infrared, galacturonic acid content, equivalent weight, and methoxyl content and methyl esterification of extracted okra and citrus pectins. We further performed insilico binding study of pectin and pectic polysaccharides with Galectin-1.

ObjectiveThis study compared post-tonsillectomy pain scores and recovery using the coblation-only technique, comparing extracapsular versus intracapsular approaches.MethodsA prospective study was performed in our paediatric ENT department. Pain scores were recorded on days 0, 2, 4 and 8, using a visual analogue scale ranging from 0 (no pain) to 10 (extreme pain). Information was also collected on: return to normal fluid and solid intake, and any post-operative visits to primary care.ResultsIn total, 101 patients were included in the analysis. Average pain scores were statistically lower on days 2, 4 and 8 in the intracapsular group compared to the extracapsular cohort. The intracapsular cohort also returned sooner to normal fluid and solids intake. The extracapsular group were more likely to visit the general practitioner post-operatively.ConclusionIntracapsular tonsillectomy appears to result in reduced morbidity overall and should be considered as a viable alternative in relevant cases.

Introduction Sleep disordered breathing (SDB) is highly prevalent in tetraplegia, yet most remain undiagnosed and untreated for the disorder. We have described the care models of three international SCI rehabilitation centres that are independently diagnosing and treating SDB, and distilled their common pathways into the SCISTAR (SCI Sleep disordered breathing Treatment & Assessment in Rehabilitation) model. The aim of this project was to adapt the SCISTAR model to suit the Royal Rehab Spinal Injuries Unit, and to prepare for the implementation of this new model of care. Methods A clinical advisory group, consisting of researchers, rehabilitation and respiratory health professionals, met six times over eight months to: • identify the multidisciplinary SDB clinical team, • adapt the SCISTAR model, • develop parameters for safe clinical practice, • identify education needs, • identify and acquire the necessary equipment. Results The SDB clinical team consists of two rehabilitation consultants, two physiotherapists and four nurses. All patients with SCI will be assessed for SDB following admission. Assessments will include symptoms, spirometry and sniff nasal inspiratory pressure, and a Level 3 overnight sleep study (ResMed ApneaLink). Patients diagnosed with un-complicated SDB will be prescribed CPAP, which will be initiated and progressed on the ward. Screening for hypoventilation and predominant central sleep apnoea will occur throughout the pathway and if identified, patients will be referred to a specialist respiratory service. Comprehensive education and equipment has been provided. Conclusions The new care model is currently being piloted for 12 months. A comprehensive evaluation has been developed.

Introduction Epistaxis is one of the most common ENT conditions leading to unplanned hospital admission. This closed loop quality improvement project looked at epistaxis admissions, and whether patients could be safely managed on an ambulatory basis with unilateral intranasal packing, through the implementation of a new epistaxis pathway. Method Two prospective cycles at a District General Hospital. First cycle: three-month period (October-December 2018); recorded all patients admitted with epistaxis and the percentage with intranasal packing; criteria for discharge with unilateral intranasal packing created (including normal observations, normal clotting/haemoglobin, only on aspirin, safe home environment). Second cycle (after implementation of new pathway): two months (December 2019 and January 2020); recorded all patients admitted with epistaxis or discharged with unilateral intranasal packing; patient feedback obtained. Results First cycle: 31 epistaxis admissions; 12 patients met discharge criteria; average length of stay was 1.4 days. Second cycle: 22 epistaxis admissions; 4 admissions were avoided; 2 admissions were unnecessary according to new pathway; no patient-reported issues with pack at home. Conclusions Successful creation and initial implementation of pathway with no adverse outcomes. Approximately £1380 of savings through avoided admissions. Pathway expanded and successfully used during COVID-19 to include patients on anticoagulation as suitable for discharge with intranasal packing.

Introduction Face of healthcare, patient safety and protection of healthcare providers has been completely transformed with global health pandemic. However, emergency surgical procedures must still be performed, with the commonest being appendicectomy. It is common practice across National Health Service trusts to collect a group and save (G&S) sample pre-operatively which increases healthcare staff exposure to the patient and increased use of personal protective equipment in this pandemic. Method Prospective study of adult patients undergoing emergency appendicectomy since the transformation of emergency care with COVID-19 induced restrictions compared with patients undergoing the same operation before the pandemic. Results 179 adult patients underwent emergency appendicectomy over 6-months in 2019–2020, 60 patients in the 12 weeks period from the start of the transformed emergency services due to the pandemic. Pre-operative G&S samples were taken for 60(33.5%) patients in the pre COVID-19 period, whereas 7(11.6%) were taken for patients undergoing appendicectomy during the pandemic. None of the patients in either group had intra-operative blood loss of more than 500 millilitres and none of them required peri-operative blood transfusion Conclusions Our study demonstrates that the routine pre-operative G&S can safely be abandoned as a routine practice for all patients undergoing emergency appendicectomy.

© 2020 The Authors. The Plant Genome published by Wiley Periodicals, Inc. on behalf of Crop Science Society of America Using genomic information to predict phenotypes can improve the accuracy of estimated breeding values and can potentially increase genetic gain over conventional breeding. In this study, we investigated the prediction accuracies achieved by best linear unbiased prediction (BLUP) for nine potato phenotypic traits using three types of relationship matrices pedigree ABLUP, genomic GBLUP, and a hybrid matrix (H) combining pedigree and genomic information (HBLUP). Deep pedigree information was available for >3000 different potato breeding clones evaluated over four years. Genomic relationships were estimated from >180,000 informative SNPs generated using a genotyping-by-sequencing transcriptome (GBS-t) protocol for 168 cultivars, many of which were parents of clones. Two validation scenarios were implemented, namely “Genotyped Cultivars Validation” (a subset of genotyped lines as validation set) and “Non-genotyped 2009 Progenies Validation”. Most of the traits showed moderate to high narrow sense heritabilities (range 0.22–0.72). In the Genotyped Cultivars Validation, HBLUP outperformed ABLUP on prediction accuracies for all traits except early blight, and outperformed GBLUP for most of the traits except tuber shape, tuber eye depth and boil after-cooking darkening. This is evidence that the in-depth relationship within the H matrix could potentially result in better prediction accuracy in comparison to using A or G matrix individually. The prediction accuracies of the Non-genotyped 2009 Progenies Validation were comparable between ABLUP and HBLUP, varying from 0.17–0.70 and 0.18–0.69, respectively. Better prediction accuracy and less bias in prediction using HBLUP is of practical utility to breeders as all breeding material is ranked on the same scale leading to improved selection decisions. In addition, our approach provides an economical alternative to utilize historic breeding data with current genotyped individuals in implementing genomic selection.