A multicentre parallel-group randomised trial assessing multiparametric MRI characterisation and image-guided biopsy of prostate in men suspected of having prostate cancer:MULTIPROS study protocol

Background: There is growing evidence suggesting that multiparametric magnetic resonance imaging (mpMRI) is a marker for prostate cancer (PCa) aggressiveness and could be used to plan treatment. Improving early detection of clinically significant PCa with pre-biopsy mpMRI would very likely have advantages including optimising the diagnosis and treatment of diseases and diminishing patient anxiety.Methods and materials: This is a prospective multicentre study of pre-biopsy mpMRI diagnostic test accuracy with subgroup randomisation at a 1:1 ratio with respect to transrectal ultrasound (TRUS) and MRI/US fusion-guided biopsy or TRUS-only biopsy. It is designed as a single-gate study with a single set of inclusion criteria. The total duration of the recruitment phase was 48 months; however, this has now been extended to 66 months. A sample size of 600 participants is required.Discussion: The primary objective is to determine whether mpMRI can improve PCa detection and characterisation. The key secondary objective is to determine whether MRI/US fusion-guided biopsy can reduce the number of false-negative biopsies. Ethical approval was obtained from the East of Scotland Research Ethics Committee 1 (14/ES/1070) on 20 November 2014. The results of this study will be used for publication and presentation in national and international journals and at scientific conferences.Trial registration: ClinicalTrials.gov, NCT02745496. Retrospectively registered on 20 April 2016.</p

Furuncular Myiasis Affecting the Lower Lip of a Young Patient

Abstract Furuncular myiasis is a parasitic infection caused by the larvae of Dipteran insects after penetrating healthy skin, causing an erythematous nodule with a central pore. Additionally, the patient may feel a sensation of movement and intermittent pain. Furuncular myiasis affecting the oral and perioral region is rare, usually leading to misdiagnosis. This paper describes a rare case of furuncular myiasis in a 20-year-old healthy male patient who presented an erythematous nodule in the lower lip. An exploratory surgery was indicated for both diagnostic and curative purposes, with successful healing observed in the following appointment. After 3 years of follow-up, the patient is recovered, with no clinical signs or symptoms of the disease

Salivary Markers for Oral Cancer Detection

Oral cancer refers to all malignancies that arise in the oral cavity, lips and pharynx, with 90% of all oral cancers being oral squamous cell carcinoma. Despite the recent treatment advances, oral cancer is reported as having one of the highest mortality ratios amongst other malignancies and this can much be attributed to the late diagnosis of the disease. Saliva has long been tested as a valuable tool for drug monitoring and the diagnosis systemic diseases among which oral cancer. The new emerging technologies in molecular biology have enabled the discovery of new molecular markers (DNA, RNA and protein markers) for oral cancer diagnosis and surveillance which are discussed in the current review

Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes.

Abstract BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups. CONCLUSIONS: Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those who received placebo. (Funded by Amylin Pharmaceuticals; EXSCEL ClinicalTrials.gov number, NCT01144338 .)

Perforated Retroperitoneal Appendicitis Presenting as Extensive Subcutaneous Emphysema of Abdominal and Chest Wall: An Unusual Presentation

Acute appendicitis is a commonly encountered disease in surgical practice. Timely diagnosis and management prevents morbidity and mortality from this disease. Acute appendicitis may occasionally become extraordinarily complicated and life threatening yet difficult to diagnose. This atypical presentation is rare and required high index of suspicion. We present a case report of perforated retroperitoneal appendicitis, which presented to us with extensive subcutaneous emphysema of back and chest wall with no abdominal signs

Clinico-Bacteriological profile & Effect of Home remedies on Acute Abscess

Acute abscess are very common in tropical countries like India. We have conducted this study to evaluate clinical &amp; etiological profile of abscess. Design: Prospective study. Methodology: All patients with soft tissue abscesses either admitted in Surgery Department or attended Surgical OPD during the study period. Cases of small superficial abscesses managed in Out Patient Department. Data regarding the age, sex, hemoglobin, location of the abscess and cause if any, was tabulated. Results: Total 1065 cases were included in this study, 63.57% were male and 36.43% were female. Most common age groups were between 6-20 years (22.25% male and 10.89% female, total 33.15%) and 21-40 years (20.66% male and 14.02% females, total 35.31%). 81.78% patients belonged to lower socio-economic status. Pain and swelling were the most common presenting symptoms (99.06% and 99.15% respectively). Lower limb was the commonest site with 33.34% followed by upper limbs (23.66%). There was high percentage (40.46%) of pre-hospitalization home based interventions that increased the complication rate. Staphylococcus aureus was most common culprit organism in 72% cases (80 out of 111 cultures done). Causes were not known in 79.53% cases, but 7.32% cases developed abscesses after intramuscular injections. Conclusion: Soft tissue abscesses are more prevalent in lower socio-economic group and rainy season. In most of the cases, the cause is unknown; trauma and intramuscular injection are the leading underlying known causes of these abscesses. Use of home remedies had increased the complication rate