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Metastases to the nose and paranasal sinuses are unusual. These tumors are commonly seen in the 4th to 6th decades of life. The clinical presentation may be analogous to that of primary sino-nasal tumors. They usually present with common nasal and ocular symptoms due to which diagnosis may be missed and delayed. Hence, high level of suspicion is necessary for patients with known malignancies presenting with inconsistent or repeated nasal and ocular symptoms. Otorhinolaryngologists should be familiar with these metastases to paranasal sinuses from unusual primary elsewhere in the body, to evaluate and manage these tumors. Retrospective data was collected from the hospital records from 2020-2023. A total 14 cases of sino-nasal malignancies were identified. On further analysis three cases were found to be having distant metastases from primary sites such as kidney, breast and lymph nodes. We are reporting three metastatic malignancies. Each was systematically evaluated, confirming their origin as metastases from other primary sites. They were then managed appropriately.

Pott’s puffy tumour is most frequently associated with bacterial infection but fungus causing Pott’s puffy tumour is very rare. A case series of three patients with Pott’s puffy tumour caused by fungi of different species like candida, aspergillus, mucor along with the clinical findings and management is presented here.

Eddie J Gibson,1 Najida Begum,1 Ian Koblbauer,1 George Dranitsaris,2 Danny Liew,3 Phil McEwan,4 Yong Yuan,5 Ariadna Juarez-Garcia,6 David Tyas,6 Clive Pritchard1 1Wickenstones Ltd, Abingdon, UK; 2Augmentium Pharma Consulting Inc., Toronto, ON, Canada; 3School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; 4Health Economics and Outcomes Research Ltd, Cardiff, UK; 5Bristol-Myers Squibb, Lawrenceville, NJ, USA; 6Bristol-Myers Squibb, Uxbridge, UKCorrespondence: Clive PritchardWickenstones Ltd., Units 24-26, 127 Olympic Avenue, Milton Park, Abingdon, Oxfordshire OX14 4SA, UKTel + 441865 959735Email Clive@wickenstones.comBackground: Existing economic model frameworks may not adequately capture the atypical treatment response patterns in immuno-oncology (I-O) compared with conventional therapies and thus may fail to represent the full clinical value associated with disease dynamics and improved survival.Objective: A cost-effectiveness analysis (CEA) of the I-O Regimen (nivolumab/ipilimumab) versus ipilimumab alone in advanced melanoma was carried out by applying a 5-state partitioned survival model (PSM) as a case study, to explore the I-O treatment response and clinical outcomes. The findings were compared with those of a conventional 3-state PSM.Materials and Methods: The case study extends the conventional 3-state PSM, by separating the pre-progression state into non-responders and responders, and the post-progression state into normal and I-O progression to account for delayed treatment effects preceding clinical response. Model states were populated using patient-level data (where possible), mapping from the best overall response (BOR), and survival analysis with flexible and traditional parametric methods. Survival functions were applied to progression-free survival (PFS) and overall survival (OS) endpoints across treatment arms using the 4-year follow-up data (data available at the time of the research; since then 5-year follow-up data have been published) from the CheckMate 067 trial. Information on BOR was used as a means of differentiating the I-O treatment response in addition to the outcomes of progression-free and progressed disease. A UK National Health Service and personal social services (NHS/PSS) perspective over a lifetime horizon was used with outcomes discounted at 3.5% annually.Results: The 5-state PSM generated an increase in quality adjusted life years (QALYs) in both treatment arms and gave a more granular description of patients’ health profiles compared with the traditional 3-state PSM. The incremental QALY increased by 13% (from 2.62 to 2.95 QALYs) and the incremental cost decreased by 12% (£ 29,125 to £ 25,678) with the 5-state model. In both models, the Regimen had an incremental cost-effectiveness ratio (ICER) relative to ipilimumab alone within the lower bound of the National Institute for Health and Care Excellence (NICE) reference range (£ 20,000 per QALY gained).Conclusion: A 5-state economic model, incorporating relevant I-O health states, can be more informative to gain insight into treatment response and progression differences that are not commonly captured in existing economic models. Clinical trial endpoints, including those relating to treatment response, which are not directly reported in ongoing I-O trials, can be mapped on to the proposed modelled health states (although assumptions are required to do so). Improvements in reporting treatment response in future I-O clinical trials could help to further validate and improve the proposed model framework.Keywords: immunotherapy, cost-effectiveness, melanoma, CheckMate 067

EJ Gibson,1 N Begum,1 I Koblbauer,1 G Dranitsaris,2 D Liew,3 P McEwan,4 AA Tahami Monfared,5,6 Y Yuan,7 A Juarez-Garcia,7 D Tyas,8 M Lees9 1Wickenstones Ltd, Didcot, UK; 2Augmentium Pharma Consulting Inc, Toronto, ON, Canada; 3Department of Epidemiology and Preventive Medicine, Alfred Hospital, Monash University, Melbourne, VIC, Australia; 4Health Economics and Outcomes Research Ltd, Cardiff, UK; 5Bristol-Myers Squibb Canada, Saint-Laurent, QC Canada; 6Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada; 7Bristol-Myers Squibb, Princeton, NJ, USA; 8Bristol-Myers Squibb, Uxbridge, UK; 9Bristol-Myers Squibb, Rueil-Malmaison, France Background: Economic models in oncology are commonly based on the three-state partitioned survival model (PSM) distinguishing between progression-free and progressive states. However, the heterogeneity of responses observed in immuno-oncology (I-O) suggests that new approaches may be appropriate to reflect disease dynamics meaningfully. Materials and methods: This study explored the impact of incorporating immune-specific health states into economic models of I-O therapy. Two variants of the PSM and a Markov model were populated with data from one clinical trial in metastatic melanoma patients. Short-term modeled outcomes were benchmarked to the clinical trial data and a lifetime model horizon provided estimates of life years and quality adjusted life years (QALYs). Results: The PSM-based models produced short-term outcomes closely matching the trial outcomes. Adding health states generated increased QALYs while providing a more granular representation of outcomes for decision making. The Markov model gave the greatest level of detail on outcomes but gave short-term results which diverged from those of the trial (overstating year 1 progression-free survival by around 60%). Conclusion: Increased sophistication in the representation of disease dynamics in economic models is desirable when attempting to model treatment response in I-O. However, the assumptions underlying different model structures and the availability of data for health state mapping may be important limiting factors. Keywords: immuno therapy, metastatic melanoma, nivolumab, dacarbazine, Markov, partitioned survival

Aminur Rahman,1,2 Sadika Akhter,1 Monjura Khatun Nisha,3 Syed Shariful Islam,4 Fatema Ashraf,5 Monjur Rahman,1 Nazneen Begum,6 Mahbub Elahi Chowdhury,1 Anne Austin,7 Iqbal Anwar1 1International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; 2College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand; 3Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; 4Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, 5Department of Gyenaecology and Obstetric, Shaheed Suhrawardi Medical College and Hospital, 6Department of Gyenaecology and Obstetric, Dhaka Medical College and Hospital, Dhaka, Bangladesh; 7JSI Research & Training Institute, Inc., Boston, MA, USA Purpose: Of the 99% maternal deaths that take place in developing countries, one-fourth is due to postpartum hemorrhage (PPH). PPH accounts for one-third of all blood transfusions in Bangladesh where the transfusion process is lengthy as most facilities do not have in-house blood bank facilities. In this context, the location where blood is obtained and the processes of obtaining blood products are not standardized, leading to preventable delays in collecting blood, when it is needed. This study evaluated the effectiveness of an online Blood Information Management Application (BIMA) system for reducing lag time in the blood transfusion process.Patients and methods: The study was conducted in a public medical college hospital in Dhaka, Bangladesh, and in two proximate, licensed blood banks between January 2014 and March 2015, using a before after design. A total of 310 women (143 before and 177 after), who needed emergency blood transfusion during their perinatal period, as determined by a medical professional, were included in the study. A median linear regression model was employed to assess the adjusted effect of BIMA on transfusion time.Results: After the introduction of BIMA, the median duration between the identified need for blood and blood transfusion reduced from 152 to 122 minutes (P

OBJECTIVE: The multi-country evaluation of Integrated Management of Childhood Illness (IMCI) effectiveness, cost and impact (MCE) is a global evaluation to determine the impact of IMCI on health outcomes and its cost-effectiveness. MCE studies are under way in Bangladesh, Brazil, Peru, Uganda and the United Republic of Tanzania. The objective of this analysis from the Bangladesh MCE study was to describe the quality of care delivered to sick children under 5 years old in first-level government health facilities, to inform government planning of child health programmes. METHODS: Generic MCE Health Facility Survey tools were adapted, translated and pre-tested. Medical doctors trained in IMCI and these tools conducted the survey in all 19 health facilities in the study areas. The data were collected using observations, exit interviews, inventories and interviews with facility providers. FINDINGS: Few of the sick children seeking care at these facilities were fully assessed or correctly treated, and almost none of their caregivers were advised on how to continue the care of the child at home. Over one-third of the sick children whose care was observed were managed by lower-level workers who were significantly more likely than higher-level workers to classify the sick child correctly and to provide correct information on home care to the caregiver. CONCLUSION: These results demonstrate an urgent need for interventions to improve the quality of care provided for sick children in first-level facilities in Bangladesh, and suggest that including lower-level workers as targets for IMCI case-management training may be beneficial. The findings suggest that the IMCI strategy offers a promising set of interventions to address the child health service problems in Bangladesh.

Introduction: Decalcification is a technique used to remove calcium salts from hard tissue specimens, such as bone or teeth, to make them suitable for sectioning. X-rays, physical methods, and chemical methods are commonly used to determine the endpoint of decalcification. However, these procedures can be cumbersome, may deteriorate the specimen, and are often subjective. Aim: To determine the endpoint of decalcification of hard tissue specimens using a colour palette. Materials and Methods: A cross-sectional study was conducted in the Department of Oral Pathology at Saveetha Dental College and Hospitals in Chennai, Tamil Nadu, India, over a period of 5 months. A total of 25 hard tissue specimens (10 bone and 15 teeth) were subjected to decalcification in 20% formic acid. To evaluate the endpoint of decalcification, silver nitrate solution was added to the formic acid, and the colour change was noted. The resulting colour was compared with a previously patented colour palette (Patent number: 202241047215). Once a lighter colour was obtained, the specimen was processed, sectioned, and stained using Haematoxylin and Eosin (H&E). The slides were then evaluated by two pathologists. Results: A total of 8 (80%) bone samples exhibited excellent staining, while 2 (20%) samples showed a good staining score. Regarding the tooth samples, 14 (93.3%) showed excellent staining, and one (6.66%) tooth displayed a good staining score. Conclusion: The present method is a simple and safe way to determine the endpoint of decalcification for a specimen. It does not damage the tissue, thus preserving the integrity of the hard tissue specimen. [ABSTRACT FROM AUTHOR]

The innovations in information and communication technology have made it convenient for the government to deliver services to the people in a time-bound manner, besides causing inconvenience to many, including the government, due to their ill-effects. The countries of the world are plagued with cyber threats that are proving to be detrimental to carrying out administration and discouraging the common man from going digital. India is not an exception. This article focuses on the cyber-safety consciousness of students pursuing higher education. It highlights the initiatives introduced by the government and the role of University Grants Commission (UGC) and the All India Council of Technical Education (AICTE) in confronting cyber threats among students. To comprehend the cyber safety awareness among the students, a questionnaire was circulated among the selected colleges and universities in Bengaluru—the capital city of Karnataka. This article suggests measures to make the virtual environment safe and secure for students. [ABSTRACT FROM AUTHOR]

This ENETS guidance paper aims to provide practical advice to clinicians for the diagnosis, treatment and follow‐up of functioning syndromes in pancreatic neuroendocrine tumours (NET). A NET‐associated functioning syndrome is defined by the presence of a clinical syndrome combined with biochemical evidence of inappropriately elevated hormonal levels. Different hormonal syndromes can be encountered in pancreatic NET patients, including insulinoma, gastrinoma as well as the rare glucagonoma, VIPoma, ACTHoma, PTHrPoma, carcinoid syndrome, calcitoninoma, GHRHoma and somatostatinoma. The recommendations provided in this paper focus on the biochemical, genetic and imaging work‐up as well as therapeutic management of the individual hormonal syndromes in well‐differentiated, grade 1‐3, functioning NET with the primary tumour originating in the pancreas, and for specific subtypes also in the duodenum. [ABSTRACT FROM AUTHOR]

Background: Despite improvements in burn management, infection is still the biggest challenge in major burn cases globally. Burn causes extensive tissue destruction, immune dysfunction, increases the risk of infection and septicemia with high morbidity and mortality. The aim of this study was to observe the levels of serum fibrin degradation product (FDP), D-dimer and procalcitonin in patients with burn sepsis treated in intensive care unit (ICU). Methods: This observational study was carried out in Department of Burn and Plastic Surgery, Dhaka Medical College Hospital, Dhaka from February 2018 to January 2019. Forty (40) patients with major burns, from (15% to 50% total body surface area burn) with burn sepsis, were recruited for the study. In all cases, plasma level of fibrin degradation product (FDP), D-dimer and procalcitonin were measured and recorded. Result: Male predominance (57.5%) was observed in our study. Eighty five percent (85%) patients had total body surface area burn (TBSA) 20% to 50%. Sixteen patients (40%) suffered from flame burn, 13 (32.5%) patients from scalds and 11 (27.5%) patients had high voltage electric burn. The value of FDP was raised in 62.5% patients, Ddimer in 67.5% patients. Serum procalcitonin level was high (> 2ng/ml), indicating burn sepsis in 47.5% cases but it was not significant (2 sample t - test reveals no significant relationship between rise of serum level of procalcitonin and presence of burn sepsis) Conclusion: Fibrin degradation product (FDP) and D-dimer were raised in two-thirds of burn cases while procalcitonin in two-fifths cases. Measurement of serum level of FDP, Ddimer and procalcitonin may give an idea regarding early onset of bacterial infection and burn sepsis and can serve as an indicator for burn sepsis. [ABSTRACT FROM AUTHOR]