Amyloidosis of the skull base is a rare entity. A patient with localized amyloidosis of the sphenoid sinus presented at our institution with cerebrospinal fluid rhinorrhoea. Endoscopic excision of the lesion and multilayered obliteration of the sphenoid sinus resolved the symptoms.
Amyloidosis ; Metastatic to ; Cerebrospinal Fluid Rhinorrhea ; symptoms <1> ; Endoscopic approach

Objectives: The goal of the research was to provide local data on the varieties of posttraumatic symptomatology among survivors of Super typhoon Haiyan in a rural community in Merida, Leyte. Methodology: This is a single point non-invasive study of Filipino survivors of typhoon Yolanda who came from Merida, Leyte, involving administration of a symptom checklist i.e. Post Traumatic Stress Disorder Checklist- Civilian version (PCL-C) to assess the occurrence of posttraumatic symptoms in the selected group of volunteers with no history of psychiatric illness. The PCL-C was given as part of a community screening for symptoms of PTSD conducted three months after the typhoon. There were two ways of scoring the PTSD Checklist- Civilian version (PCL-C) - either by computing for the total severity score or by scoring each response category just like one would in the Diagnostic and Statistical Manual (DSM IV TR) criteria. The sum of all PCL-C item scores indicated the severity of Post Traumatic Stress Disorder (PTSD). A score of 30 and above represented the occurrence of PTSD. T-test was used to determine differences in the severity scores of those who met the criteria for PTSD using the total "severity scoring method" and those who did not. Results: A total of 29 respondents took part in the study where the majority were female (28/29 or 96.55%). The results showed that Filipinos suffered more re-experiencing symptoms but less avoidance symptoms compared to the DSM IV-TR criteria. Nine of 29 (31.03%) respondents were assessed as having Post Traumatic Stress Disorder (PTSD) based on the total "severity score method': However, none fulfilled the PTSD DSM IV TR criteria when the response "category scoring method" was used. Those who met the severity criteria had significantly higher scores in items 1 (Repeated, disturbing memories, thoughts, or images of a stressful experience from the past?), 3 (Suddenly acting or feeling as if a stressful experience were happening again?), 5 (Having physical reactions when something reminded you of a stressful experience from the past?), 6 (Avoid thinking about or talking about a stressful experience from the past or avoid having feelings related to it?) and 13 (Trouble falling or staying asleep?). Conclusion There seems to be a difference in how the Filipinos experience trauma compared to Western models such as described in the Diagnostic Symptom Manual (DSM IV TR) criteria though caution is warranted in interpreting the results due to the small sample size and the predominance of female respondents.
Stress Disorders, Post-Traumatic ; Natural Disasters ; Cyclonic Storms

Pneumocephalus or collection of air in the intracranial cavity can occur after trauma or surgery. However, delayed pneumocephalus occurring months after the initial injury is not common. We would like to report a case of spontaneous traumatic pneumoencephalocele presenting with transient recurrent hemiparesis 14 months after the initial trauma.
month ; Deferred ; Wounds and Injuries ; Injury inflicted to the body by an external force ; Surgical aspects

Endoscopic ultrasound (EUS) offers access to many intra-abdominal vessels that until now have only been accessible to the surgeon and interventional radiologist. In addition to assisting with diagnostics, this unique access offers the potential for therapeutic intervention for a host of indications. To date, this has had the most clinical impact in the treatment of gastroesophageal varices, with EUS-guided coil and glue application growing in use worldwide. Although randomised controlled trial data is lacking, we discuss the growing body of literature behind EUS-guided therapy in the management of varices. EUS has also been used in specialized centres to assist in non-variceal gastrointestinal bleeding. The treatment of bleeding from Dieulafoy lesions, tumours and pancreatic pseudoaneurysms has all been described. The potential applications of EUS have also extended to the placement of portal vein stents and porto-systemic shunts in animal models. As medicine continues to move to increasingly less invasive interventions, EUS-guided therapies offer substantial promise for the safe and effective delivery of targeted treatment for a widening array of vascular disorders.
Adhesives ; Aneurysm, False ; Endosonography ; Esophageal and Gastric Varices ; Hemorrhage ; Models, Animal ; Portal Pressure ; Portal Vein ; Stents ; Ultrasonography ; Varicose Veins

Algorithms ; Antineoplastic Agents ; therapeutic use ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; Humans ; Lung Neoplasms ; drug therapy

AIMTo investigate the activity of RRR-alpha-tocopheryloxybutyric acid (TOB), an ether analog of RRR-alpha-tocopheryl succinate (VES), in prostate cancer cells.

METHODSVES and TOB were used to treat prostate cancer LNCaP, PC3, and 22Rv1 cells and primary-cultured prostate fibroblasts. The proliferation rates were determined by MTT assay, the cell viabilities were determined by trypan blue exclusion assay, and the cell deaths were evaluated by using Cell Death Detection ELISA kit. The protein expression levels were determined by Western blot analysis.

RESULTSThe MTT growth assay demonstrated that TOB could effectively suppress the proliferation of prostate cancer cells, but not normal prostate fibroblasts. Mechanism dissections revealed that TOB reduced cell viability and induced apoptosis in prostate cancer cells similar to VES. In addition, both TOB and VES suppressed prostate-specific antigen (PSA) at the transcriptional level leading to reduced PSA protein expression. Furthermore, vitamin D receptor (VDR) expression increased after the addition of TOB.

CONCLUSIONOur data suggests that the VES derivative, TOB, is effective in inhibiting prostate cancer cell proliferation, suggesting that TOB could be used for both chemopreventive and chemotherapeutic purposes in the future.

Antineoplastic Agents ; pharmacology ; Apoptosis ; drug effects ; Cell Division ; drug effects ; Cell Line, Tumor ; Cell Survival ; drug effects ; Cells, Cultured ; Fibroblasts ; cytology ; drug effects ; Humans ; Kinetics ; Male ; Prostate ; cytology ; Prostatic Neoplasms ; pathology ; Vitamin E ; analogs & derivatives ; pharmacology

Objective: To describe the prevalence, onset, associated symptoms, and clinical characteristics of COVID-19 in-patients with olfactory and gustatory dysfunction at the Philippine General Hospital from March 2021 to January 2022 and determine the number of patients with olfactory dysfunction/dysgeusia who recovered or expired. : Methods Design: Prospective Cohort Study Setting: COVID-19 Referral Hospital (Tertiary National University Hospital) Participants: COVID-19 RT-PCR positive in-patients, ages 19 and older Results: A total of 207 patients were included. Sixty-four (64) patients reported olfactory dysfunction and 79 reported dysgeusia. Olfactory and gustatory dysfunction were observed early in the course of infection, before day 6 of illness. The average length of hospital stay was 20.36 days; those with olfactory dysfunction stayed for 17.53 days, dysgeusia for 19.92 days, and 21.09 days for those who noted neither. For those subsequently intubated, 0 had olfactory dysfunction, three reported dysgeusia, three had both and six had neither. Thirteen (13) patients in the study expired. Among them, none reported olfactory dysfunction and two had dysgeusia. Conclusions Our results corroborate existing literature that olfactory and gustatory dysfunction as key indicators of COVID-19 with 42.5% of participants reporting these symptoms early, often before day 6 of illness. Ninety-two percent (92%) of those affected recovered and had shorter hospital stays, emphasizing the importance of recognizing these dysfunctions for improved disease detection and outcomes.
Anosmia ; Dysgeusia ; COVID-19 ; Coronavirus

Oral mucosal and salivary lipids exhibit potent antimicrobial activity for a variety of Gram-positive and Gram-negative bacteria; however, little is known about their spectrum of antimicrobial activity or mechanisms of action against oral bacteria. In this study, we examine the activity of two fatty acids and three sphingoid bases against Porphyromonas gingivalis, an important colonizer of the oral cavity implicated in periodontitis. Minimal inhibitory concentrations, minimal bactericidal concentrations, and kill kinetics revealed variable, but potent, activity of oral mucosal and salivary lipids against P. gingivalis, indicating that lipid structure may be an important determinant in lipid mechanisms of activity against bacteria, although specific components of bacterial membranes are also likely important. Electron micrographs showed ultrastructural damage induced by sapienic acid and phytosphingosine and confirmed disruption of the bacterial plasma membrane. This information, coupled with the association of treatment lipids with P. gingivalis lipids revealed via thin layer chromatography, suggests that the plasma membrane is a likely target of lipid antibacterial activity. Utilizing a combination of two-dimensional in-gel electrophoresis and Western blot followed by mass spectroscopy and N-terminus degradation sequencing we also show that treatment with sapienic acid induces upregulation of a set of proteins comprising a unique P. gingivalis stress response, including proteins important in fatty acid biosynthesis, metabolism and energy production, protein processing, cell adhesion and virulence. Prophylactic or therapeutic lipid treatments may be beneficial for intervention of infection by supplementing the natural immune function of endogenous lipids on mucosal surfaces.
Anti-Bacterial Agents ; pharmacology ; Bacterial Proteins ; drug effects ; Colony Count, Microbial ; Fatty Acids ; pharmacology ; Humans ; Lipids ; pharmacology ; Microscopy, Electron ; Mouth Mucosa ; chemistry ; immunology ; microbiology ; Porphyromonas gingivalis ; chemistry ; drug effects ; ultrastructure ; Saliva ; chemistry ; microbiology ; Sphingolipids ; pharmacology ; Virulence ; drug effects

The utility of intravenous tissue plasminogen activator (IV t-PA) in improving the clinical outcomes after acute ischemic stroke has been well demonstrated in past clinical trials. Though multiple initial small series of endovascular stroke therapy had shown good outcomes as compared to IV t-PA, a similar beneficial effect had not been translated in multiple randomized clinical trials of endovascular stroke therapy. Over the same time, there have been parallel advances in imaging technology and better understanding and utility of the imaging in therapy of acute stroke. In this review, we will discuss the evolution of endovascular stroke therapy followed by a discussion of the key factors that have to be considered during endovascular stroke therapy and directions for future endovascular stroke trials.
Stroke* ; Tissue Plasminogen Activator

Purpose: Postoperative pancreatic fistula (POPF) remains a devastating complication of pancreatoduodenectomy (PD). Minimally invasive PD (MIPD), including laparoscopic (LPD) and robotic (RPD) approaches, have comparable POPF rates to open PD (OPD). However, we hypothesize that the likelihood of having a more severe POPF, as defined as clinically relevant POPF (CR-POPF), would be higher in an MIPD relative to OPD. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) targeted pancreatectomy dataset (2014–2020) was reviewed for any POPF after OPD. Propensity score matching (PSM) compared MIPD to OPD, and then RPD to LPD. Results: Among 3,083 patients who developed a POPF, 2,843 (92.2%) underwent OPD and 240 (7.8%) MIPD; of these, 25.0% were LPD (n = 60) and 75.0% RPD (n = 180). Grade B POPF was observed in 45.4% (n = 1,400), and grade C in 6.0% (n = 185). After PSM, MIPD patients had higher rates of CR-POPF (47.3% OPD vs. 54.4% MIPD, p = 0.037), as well as higher reoperation (9.1% vs. 15.3%, p = 0.006), delayed gastric emptying (29.2% vs. 35.8%, p = 0.041), and readmission rates (28.2% vs. 35.1%, p = 0.032). However, CR-POPF rates were comparable between LPD and RPD (56.8% vs. 49.3%, p = 0.408). Conclusion The impact of POPF is more clinically pronounced after MIPD than OPD with a more complex postoperative course. The difference appears to be attributed to the minimally invasive environment itself as no difference was noted between LPD and RPD. A clear biological explanation of this clinical observation remains missing. Further studies are warranted.