Limited sun safety education in high school curricula: a pilot study and call to action

Although tanning is widespread, the use of both indoor and outdoor tanning most often begins in adolescence and young adulthood and is more prevalent in adolescents and young adults (AYA) than any other age group. Despite this, information regarding sun safety education in high school curricula is limited. In this pilot study, we sought to characterize the presence of education regarding sun safety in the curricula of US public high schools. Cross-sectional survey administered to random sample stratified by state of public high schools in the US. 31 high schools from 22 states submitted survey responses (Fig. 1). Ten high schools (32.2%) provided curricula regarding sun safety. Southern high schools were less likely to provide sun safety education (p = 0.01). The lack of an association between sociodemographic characteristics of the high school and the provision of sun safety curricula suggests that the lack of sun safety education may be widespread. These findings support a call to action regarding further research to better characterize the efficacy of implementing sun safety education in high school curricula. Educational interventions designed to inform high school students about sun safety present a unique opportunity to intervene in the rising skin cancer rates in the AYA population. As rates of skin cancer in AYA continue to rise, it is vital to develop strategies to implement education regarding sun safety and skin cancer risk factors in high school curricula.

Characteristics of State and Federal Malpractice Litigation of Medical Liability Claims for Keratinocyte Carcinoma, 1968 to 2018

Importance

The prevalence of keratinocyte carcinoma (KC) exceeds that of all other malignant neoplasms combined. Despite the steady rise of payments for medical malpractice liability claims over time, data regarding the characteristics of malpractice litigation for KC are scarce.

Objective

To identify state and federal appellate medical malpractice liability cases for KC and determine the factors associated with the verdicts.

Design, Setting, and Participants

This retrospective review of KC-related malpractice litigation under state or federal jurisdiction reviewed the LexisNexis Academic database of state and federal cases, legal reviews, and case law. All appellate medical malpractice cases at the state and federal levels involving basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) from January 1, 1968, through December 31, 2018, were identified.

Main Outcomes and Measures

Demographic characteristics of the cases and plaintiffs, verdict, health care specialty of the defendant, setting of the litigation, rationale for the lawsuit and verdict, factors associated with the case outcome, and monetary payout in cases won by the plaintiff.

Results

In total, 83 cases were included in our analysis (34 BCC cases and 49 SCC cases; 47 [57%] male plaintiffs). Sixty-two cases (75%) were decided in favor of the defendant. More KC-related malpractice cases were won by defendants in more recent years than were won by plaintiffs (mean year, 2004 [SD, 11 years] vs 1998 [SD, 14 years]; P = .03). Twenty-five cases (30%) each occurred in the Northeast and the South, and 45 (54%) involved private practices. Most cases involved KCs occurring on the face, head, and/or neck (39 [47%]), the genitalia (22 [27%]), or the extremities (15 [18%]). More than half of defendants were dermatologists (19 [23%]), family medicine physicians (15 [18%]), or oncologists (8 [10%]). Jurisprudence for KC-related malpractice cases most often occurred at the state level (49 [59%]). The most common causes of litigation were failure to diagnose (18 [22%]), misdiagnosis (18 [22%]), and delay in treatment (11 [13%]). More female than male plaintiffs won their malpractice cases (11 of 35 [31%] vs 5 of 43 [12%]; P = .03). More cases involving SCC than BCC led to a decision favoring the plaintiff (13 of 47 [28%] vs 3 of 31 [10%]; P = .05). In cases won by the plaintiff, the median monetary payout was $179 654 and the mean payout was $909 801 (range, $11 537-$5 320 161).

Conclusions and Relevance

This study sheds light on the characteristics and settings of KC malpractice litigation claims, which is vital information for discovering potential areas of quality improvement, patient safety initiatives, and education for patients and health care professionals.

United States Stock Market Response to FDA Approval of New Dermatologic Drugs

BACKGROUND

The Food and Drug Administration (FDA) has approved several new dermatologic drugs in the last decade. The public response to their approval has not yet been evaluated.

OBJECTIVE

To analyze the United States stock market response surrounding FDA approval of new dermatologic drugs between 2008 and 2018.

METHODS

A list of 34 FDA approved dermatologic drugs for publicly traded companies was compiled from the CenterWatch New Dermatology Drugs List and the FDA Annual Reports on New Drugs. Company and stock market data was acquired from the Center for Research in Security Prices (CRSP) United States Stock database. Cumulative abnormal returns (CAR) were calculated as the difference between raw returns and expected value-weighted returns. Data analyses were performed using SAS 9.4 (Cary, NC).

RESULTS

The average CAR for the 21-day window period surrounding FDA approval of new dermatologic drugs was +1.71%. Drugs approved for the treatment of hyperhidrosis (+17.7%), bacterial skin infections (+7.18%), and rosacea (+6.83%) added the most market value.

LIMITATIONS

The market value added to private or internationally traded companies could not be assessed.

CONCLUSION

FDA approval of dermatologic drugs generally has a positive market response. Information on market reaction may provide important insights for investors, pharmaceutical companies, and researchers. J Drugs Dermatol. 2020;19(6): doi:10.36849/JDD.2020.5033.

Racial differences in time to treatment for melanoma

Background

Longer time from diagnosis to definitive surgery (TTDS) is associated with increased melanoma-specific mortality. Although black patients present with later-stage melanoma and have worse survival than non-Hispanic white patients, the association between race and TTDS is unknown.

Objective

To investigate racial differences in time to melanoma treatment.

Methods

Retrospective review of the National Cancer Database (2004-2015). Multivariable logistic regression was used to evaluate the association of race with TTDS, controlling for sociodemographic/disease characteristics.

Results

Of the 233,982 patients with melanoma identified, 1221 (0.52%) were black. Black patients had longer TTDS for stage I to III melanoma (P < .001) and time to immunotherapy (P = .01), but not for TTDS for stage IV melanoma or time to chemotherapy (P > .05 for both). When sociodemographic characteristics were controlled for, black patients had over twice the odds of having a TTDS between 41 and 60 days, over 3 times the odds of having a TTDS between 61 and 90 days, and over 5 times the odds of having a TTDS over 90 days. Racial differences in TTDS persisted within each insurance type. Patients with Medicaid had the longest TTDS (mean, 60.4 days), and those with private insurance had the shortest TTDS (mean, 44.6 days; P < .001 for both).

Conclusions

Targeted approaches to improve TTDS for black patients are integral in reducing racial disparities in melanoma outcomes.

Incremental Health Care Expenditure of Chronic Cutaneous Ulcers in the United States

Importance

Despite the increasing incidence of chronic cutaneous ulcers (CCUs), limited information exists regarding their incremental economic burden.

Objective

To provide nationally representative estimates regarding the incremental health care cost of CCUs, controlling for comorbidities and sociodemographic characteristics.

Design, Setting, and Participants

This retrospective analysis used 9 years of longitudinal data from the Medical Expenditure Panel Survey (MEPS; January 1, 2007, through December 31, 2015). Patients with CCUs were identified using Agency for Healthcare Research and Quality-produced software that included several codes from the International Classification of Disease, 9th Revision Clinical Modification, for chronic ulcers of the skin. A cross-validated 2-part generalized linear model estimated the adjusted incremental expenditure for individuals with CCUs while controlling for comorbidities and sociodemographic covariates. Data were analyzed from July 1 through September 1, 2018.

Main Outcomes and Measures

Incremental cost of CCUs, total cost of care, and expenditures associated with inpatient care, outpatient care, prescription medications, emergency department visits, and home health care.

Results

A total of 288 698 patients (52.4% female; mean [SD] age, 38.2 [22.4] years) were included, of whom 1786 had CCUs and 286 912 did not. Patients with CCUs were more likely to be female (1078 [60.4%]), non-Hispanic (1388 [77.7%]), previously or currently married (1440 [80.6%]), and covered by Medicaid/Medicare (852 [47.7%]) and had a lower income (954 [53.4%]) when compared with patients without CCUs (P < .001 for all). The mean (SD) annual cost of care per patient with CCUs was greater than 4 times that of patients without CCUs ($17 958 [$1031.90] vs $4373.20 [$48.48]). After controlling for Charlson comorbidity index and sociodemographic factors measured in MEPS, the cost of care for patients with CCUs was 1.73 times as high as that of patients without CCUs (95% CI, 1.53-1.96; P < .001), and patients with CCUs were estimated to incur $7582.00 (95% CI, $6201.47-$8800.45) more in annual health care expenditures. When accounting for the prevalence of CCUs (0.6%), CCUs were associated with more than $16.7 billion per year in population-level US health care expenditures. Among patients with CCUs, mean annual expenditures rose from the 2010-2012 to 2013-2015 periods in association with prescription medications ($3117.26 to $6169.12), outpatient care ($3568.06 to $5920.75), and home health care ($1039.54 to $1670.56).

Conclusions and Relevance

Results of this study suggest that chronic cutaneous ulcers are associated with substantial incremental increases in annual health care expenditure. Expenses for patients with CCUs are increasing, particularly with regard to outpatient cost of care and prescription medication expenditure. As health care costs rise, investigators must identify strategies to prevent and treat CCUs.

Readability of online Spanish patient education materials in dermatology

Decreased health literacy is associated with worse outcomes for a variety of dermatologic conditions. Hispanic adults have the lowest average health literacy of any racial or ethnic group in the United Sates. Although patients are increasingly using online patient education materials (PEMs) for dermatologic care, limited information exists regarding the readability of these resources. The objective of this study is to evaluate the readability of online Spanish language PEMs in dermatology. Online Spanish language PEMs relevant to dermatology were gathered from the United States National Library of Medicine (USNLM) MedlinePlus health library and top Google, Yahoo, and Bing search results for "Spanish patient education dermatology." Spanish text was analyzed for readability using two validated programs: Spanish Lexile Analyzer and Índice Flesch-Szigriszt (INFLESZ). Pearson's correlation coefficient was used to examine the association between the two readability measures. ANOVA without post hoc correction was performed to determine variability between PEMs. A total of 254 Spanish language PEMs were collected and analyzed from nine online sources. The average article length was 601 words. The average Lexile measure was 1005 L (SD = 144 L) and the average INFLESZ score was 64.60 (SD = 7.53). Readability scores equated to an 8-10th grade reading level and was varied based on the source of information (p < 0.001). Online Spanish language PEMs related to dermatology are generally written at a reading level that exceeds national recommendations and may reduce comprehension for Hispanic patients. Targeted initiatives to address and improve online health information for Spanish-speaking patients are warranted.

National Burden of Hospitalization Due to Cutaneous Melanoma in Adolescents and Young Adults

OBJECTIVES

Although adolescents and young adults (AYA) suffer disproportionately from cutaneous melanoma (CM), little is known regarding the burden of CM leading to hospitalization in AYA. The objective of this study was to elucidate sociodemographic/hospitalization characteristics of AYA CM inpatients, determine which factors lead to the greater length of stay (LOS) and cost of care for AYA CM inpatients, and evaluate trends in the prevalence, LOS, and cost of care for AYA CM hospitalizations.

MATERIALS AND METHODS

A retrospective cohort study of nationally representative data from the 2009 to 2015 National Inpatient Sample. Multivariable survey-weighted logistic regression models were used to determine sociodemographic factors associated with AYA CM hospitalization. Multivariable survey-weighted linear regression models were used to determine characteristics associated with the greater cost of care and LOS in AYA CM inpatients.

RESULTS

A total of 8986 AYA CM inpatients were included in this study. The prevalence of AYA CM hospitalizations is decreasing over time while the cost of care is increasing. On average, AYA CM hospitalizations were 3.3 days long and cost $38,018.40. Controlling for all covariates, male sex, older age, non-Hispanic white race, higher income, private insurance, and elective admissions were associated with AYA hospitalization due to CM (P<0.0001). Male sex was associated with longer LOS (P=0.007) and cost of care (P=0.01) among AYA hospitalized for CM.

CONCLUSIONS

Despite a decreasing prevalence of CM hospitalizations in AYA inpatients, the economic burden of these hospitalizations is increasing. Substantial sex-based differences exist in the inpatient burden of AYA CM. Further research is required to elucidate the causes of these differences and prevent AYA hospitalization due to CM.

Association of Demographic and Socioeconomic Characteristics With Differences in Use of Outpatient Dermatology Services in the United States

Importance

Knowledge regarding differences in dermatologic care for patients with a broad range of dermatologic conditions is limited.

Objective

To elucidate nationwide differences in use of outpatient dermatologic care.

Design, Setting, and Participants

Retrospective analysis of nationally representative data from the 2007 to 2015 Medical Expenditure Panel Survey (MEPS) provided by the Agency for Healthcare Research and Quality. Health care use outcomes for dermatologic conditions (skin cancers, infections, dermatologic inflammatory conditions/ulcers, and other skin disorders) were examined via multivariable logistic regression analyses of outpatient and office-based dermatologist visit rates accounting for sex, age, race/ethnicity, educational level, income, insurance status, region, self-reported condition, and self-reported health status. Participants were 183 054 MEPS respondents who visited a dermatologist from 2007 to 2015.

Main Outcomes and Measures

The primary outcome measure was whether the patient received outpatient care for any dermatologic condition (by payment). The secondary outcomes were annual health care use by individuals with dermatologic conditions (including per capita expenditure for the visit).

Results

Of 183 054 MEPS respondents (mean [SD] age, 34 [23] years; 52.1% female), 19 561 (10.7%) self-reported a dermatologic condition; 9645 patients had a total of 11 761 outpatient visits to dermatologists. Hispanic (adjusted odds ratio [aOR], 0.55; 95% CI, 0.49-0.61) and black (aOR, 0.42; 95% CI, 0.38-0.46) patients were both less likely to receive outpatient care for their dermatologic condition relative to non-Hispanic white patients. Male patients were less likely to receive outpatient dermatologic care than female patients (aOR, 0.66; 95% CI, 0.62-0.70), and Midwestern patients were less likely to receive outpatient dermatologic care than Northeastern patients (aOR, 0.80; 95% CI, 0.70-0.91). Patients with Medicaid or Medicare coverage (aOR, 0.75; 95% CI, 0.68-0.83) and uninsured patients (aOR, 0.39; 95% CI, 0.33-0.47) were both less likely to receive outpatient dermatologic care than privately insured patients. Increasing educational level and income were associated with increased odds of receiving outpatient care for the dermatologic condition.

Conclusions and Relevance

These findings highlight wide-ranging differences in use of dermatologic care in the United States across various demographic and socioeconomic lines. Results of this study suggest an urgent need to further characterize potential dermatologic health care differences and improve use of outpatient dermatologic care among disadvantaged populations.

An Analysis of Marketing Trends for the Approval of Cryolipolysis Devices by the United States Food and Drug Administration

Introduction: Cryolipolysis is a noninvasive technique that involves the application of cooling for localized fat reduction. In recent years, cryolipolysis has been increasingly favored for its limited side effects compared to more invasive methods. Methods: Records from a public United States Food and Drug Administration (FDA) database for premarket approval of cryolipolysis devices approved between January 1, 2000 and July 15, 2018 were reviewed. Results: Eleven devices received 510(k) premarket approval, with an increasing number of devices available since 2012. In addition, product indications have recently been expanded for use in patients with body mass index (BMI) values of up to 43kg/m². Conclusion: The number of approved cryolipolysis devices has increased, with more companies exploring the technology's growth potential in the market. Furthermore, use in patients with higher body mass index values is now permitted and expanding; however, indications are not well studied, and these marketed devices might misinform consumers and distort clinical expectations. Additional research to delineate specific practice guidelines for cryolipolysis is necessary.

Current and emerging methodologies for estimating carbon sequestration in agricultural soils: A review

This review covers the current and emerging analytical methods used in laboratory, field, landscape and regional contexts for measuring soil organic carbon (SOC) sequestration in agricultural soil. Soil depth plays an important role in estimating SOC sequestration. Selecting appropriate sampling design, depth of soil, use of proper analytical methods and base line selection are prerequisites for estimating accurately the soil carbon stocks. Traditional methods of wet digestion and dry combustion (DC) are extensively used for routine laboratory analysis; the latter is considered to be the "gold standard" and superior to the former for routine laboratory analysis. Recent spectroscopic techniques can measure SOC stocks in laboratory and in-situ even up to a deeper depth. Aerial spectroscopy using multispectral and/or hyperspectral sensors located on aircraft, unmanned aerial vehicles (UAVs) or satellite platforms can measure surface soil organic carbon. Although these techniques' current precision is low, the next generation hyperspectral sensor with improved signal noise ratio will further improve the accuracy of prediction. At the ecosystem level, carbon balance can be estimated directly using the eddy-covariance approach and indirectly by employing agricultural life cycle analysis (LCA). These methods have tremendous potential for estimating SOC. Irrespective of old or new approaches, depending on the resources and research needed, they occupy a unique place in soil carbon and climate research. This paper highlights the overview, potential limitations of various scale-dependent techniques for measuring SOC sequestration in agricultural soil.

Utilization and Cost of Inpatient Dermatologic Procedures: A Cross-sectional Analysis

Knowledge surrounding inpatient dermatologic procedure costs is limited; therefore to learn more, we performed a cross-sectional analysis of dermatologic procedures contained in a publicly available Washington State Comprehensive Hospital Abstract Reporting System database from 2014. Dermatologic procedure utilization and cost were evaluated based on several parameters including demographics, length of hospital stay, payments, and payers. SAS 9.4 was used for the analysis. A total of 14,768 patients underwent dermatologic procedures in 2014 and 81.0% were white. The average age was 53 years (SD = 0.17), and the average payment for all patients who underwent dermatologic procedures was $85,059.48 (SD = $1,284.34). The average hospital length of stay was 8.91 days (SD = 0.07). The most common admission type was elective (66.2%), the most common admit source was a non-healthcare facility point of origin (78.2%), the most common primary payer was Medicare (36.2%), and the most common procedure was incision and drainage of skin and subcutaneous tissue (26.5%), followed by closure of skin and subcutaneous tissue of other sites (20%). This analysis demonstrated that inpatient dermatologic procedures are a significant driver of inpatient health care costs, and it is critical to determine factors that increase inpatient costs related to dermatologic procedures in order to develop strategies for reducing healthcare costs.

Emergency Department Visits due to Scabies in the United States: A Retrospective Analysis of a Nationally Representative Emergency Department Sample

Background

Limited information exists regarding the burden of emergency department (ED) visits due to scabies in the United States. The goal of this study was to provide population-level estimates regarding scabies visits to American EDs.

Methods

This study was a retrospective analysis of the nationally representative National Emergency Department Sample from 2013 to 2015. Outcomes included adjusted odds for scabies ED visits, adjusted odds for inpatient admission due to scabies in the ED scabies population, predictors for cost of care, and seasonal/regional variation in cost and prevalence of scabies ED visits.

Results

Our patient population included 416 017 218 ED visits from 2013 to 2015, of which 356 267 were due to scabies (prevalence = 85.7 per 100 000 ED visits). The average annual expenditure for scabies ED visits was $67 125 780.36. The average cost of care for a scabies ED visit was $750.91 (±17.41). Patients visiting the ED for scabies were most likely to be male children from lower income quartiles and were most likely to present to the ED on weekdays in the fall, controlling for all other factors. Scabies ED patients that were male, older, insured by Medicare, from the highest income quartile, and from the Midwest/West were most likely to be admitted as inpatients. Older, higher income, Medicare patients in large Northeastern metropolitan cities had the greatest cost of care.

Conclusion

This study provides comprehensive nationally representative estimates of the burden of scabies ED visits on the American healthcare system. These findings are important for developing targeted interventions to decrease the incidence and burden of scabies in American EDs.

Inter-relationship between intercepted radiation and rice yield influenced by transplanting time, method, and variety

Photosynthetically active radiation (PAR) is one of the most important environmental factors that determine the productivity and grain quality of the crops. Continuous rainy days or cloudy weather throughout crop growth especially at critical stages often resulted in great loss of grain quality and yield in rice. Low light stress has rigorously constrained the rice production in various rice-growing regions, especially in Southeast Asia. Method and time of planting are the major management factors contributing to the higher yield potential of rice by influencing light harvesting and use efficiency. Present study was executed consecutively for 5 years (kharif seasons of 2012-2016) to determine whether planting time improves the radiation absorption and use efficiency in different duration rice cultivars. We evaluated the difference in plant growth and development leading to yield formation under different planting time which related to radiation incidence and interception. The results of the study revealed that PAR interception depends on morphological characters of cultivars and also with agronomic management such as transplanting time and method. Long duration cultivar intercepted more PAR but interception decreased due to late planting (3rd week of July), whereas short duration cultivars (Naveen) when planted earlier (1st week of June) could not effectively utilize intercepted PAR constraining the biomass accumulation and yield formation. Effect of planting density and crop architecture on PAR absorption was apparent among establishment methods as light interception at crop canopy was highest in the system of rice intensification and lowest in that of wet direct seeding. In general, Pooja as a long duration cultivar intercepted more PAR per day but when compared on same date of planting, the comparative absorption of radiation was 30.6% higher in Naveen. The lower yields in the wet season are attributed mostly to reduction in grain number per panicle or per unit land area, which is a consequence of high spikelet sterility. Grain yield of rice planted in July third week was reduced by 3.8, 12.3, and 6.9% over June first and third week and July first week, respectively, mainly due to spikelet sterility (26%) and lower grains per panicle (18%). Our results indicated that agronomic management like optimum time of sowing, cultivar duration, and establishment methods should be followed for yield improvement in tropical lowlands where light intensity is limiting due to prevailing weather situations.

Alternate Splicing in Head and Neck Cancer: An Update

Background: Alternate splicing (AS) is a regulatory process during gene expression that allows a single gene to code multiple proteins. Sequencing of RNA (RNA-Seq) is a high throughput technology, which has been used in various studies to identify AS mechanisms in head and neck cancer (HNC). Until date, there is no available review that could update us with the major outcomes from these studies. Aim: To perform a comprehensive literature search for AS studies on HNC via RNA-Seq. Methods: A systematic literature search was performed following PRISMA guidelines to give a complete picture of AS in HNC identified through RNA-Seq. In addition, comprehensive search was also performed to identify the bioinformatics softwares that analyses RNA-Seq data for finding AS in cancer. Results: Six studies were found that used RNA-Seq data for identifying AS events in HNC. Five softwares were used by these studies to identify AS events, of which Suppa and AltAnalyze can also categorize all four AS events to subtypes, i.e., cassette exon skipping (ES), intron retention (IR), mutually exclusive exon (MXE), and alternative 5′ and 3′ splice site (ASS). Additionally, SplAdder, ASprofile, JuncBASE, and MATS softwares have been used to identify and categorize AS events in cancers other than HNC. Conclusion: Alternate splicing in HNC is a complex regulatory process of gene expression. It can be studied through RNA-Seq using various bioinformatics softwares. SplAdder, ASprofile, JuncBASE, and MATS have been used to identify and characterize other cancers, but not implemented in HNC, and hence could be used for studying AS in HNC.

Characterization of demographics and NS5A genetic diversity for hepatitis C virus genotype 4-infected patients with or without cirrhosis treated with ombitasvir/paritaprevir/ritonavir

Hepatitis C virus (HCV) genotype 4 (GT4) is genetically diverse with 17 confirmed and 4 provisional subtypes. In this report, HCV GT4-infected patient samples from Phase 2/3 clinical studies were analysed to characterize global demographics and genetic diversity of GT4 infection among patients treated with ombitasvir (OBV, NS5A inhibitor) plus paritaprevir/r (NS3/4A inhibitor codosed with ritonavir). Among 17 subtypes isolated from GT4-infected patients in the PEARL-I and AGATE-I studies, subtype prevalence by country of enrolment and country of origin suggested that subtypes 4a and 4d were likely circulating in Europe, while heterogeneous GT4 subtypes and a portion of GT4a detected in European and North American countries were likely due to immigration of HCV-infected patients from Africa. The distributions of birth cohort and race were also significantly different across GT4 subtypes 4a, 4d, and non-4a/4d. In addition, phylogenetic analyses of NS5A sequences revealed clustering within subtype 4a which segregated by the patient-reported country of origin and the presence of the L30R/S polymorphism. HCV NS5A sequences derived from GT4a-infected patients who originated from Europe and the United States clustered separately from sequences derived from patients who originated from Egypt, suggesting that genetically distinct strains of subtype 4a may be circulating globally. Finally, NS5A baseline polymorphisms were frequently detected at amino acid positions of interest for the inhibitor-class and OBV retained activity against 37 of 39 NS5A GT4 clinical isolates, with no impact on treatment outcome in the PEARL-I and AGATE-I studies.

Regional cortical thickness changes accompanying generalized tonic-clonic seizures

Objective

Generalized tonic-clonic seizures are accompanied by cardiovascular and respiratory sequelae that threaten survival. The frequency of these seizures is a major risk factor for sudden unexpected death in epilepsy (SUDEP), a leading cause of untimely death in epilepsy. The circumstances accompanying such fatal events suggest a cardiovascular or respiratory failure induced by unknown neural processes rather than an inherent cardiac or lung deficiency. Certain cortical regions, especially the insular, cingulate, and orbitofrontal cortices, are key structures that integrate sensory input and influence diencephalic and brainstem regions regulating blood pressure, cardiac rhythm, and respiration; output from those cortical regions compromised by epilepsy-associated injury may lead to cardiorespiratory dysregulation. The aim here was to assess changes in cortical integrity, reflected as cortical thickness, relative to healthy controls. Cortical alterations in areas that influence cardiorespiratory action could contribute to SUDEP mechanisms.

Methods

High-resolution T1-weighted images were collected with a 3.0-Tesla MRI scanner from 53 patients with generalized tonic-clonic seizures (Mean age ± SD: 37.1 ± 12.6 years, 22 male) at Case Western Reserve University, University College London, and the University of California at Los Angeles. Control data included 530 healthy individuals (37.1 ± 12.6 years; 220 male) from UCLA and two open access databases (OASIS and IXI). Cortical thickness group differences were assessed at all non-cerebellar brain surface locations (P < 0.05 corrected).

Results

Increased cortical thickness appeared in post-central gyri, insula, and subgenual, anterior, posterior, and isthmus cingulate cortices. Post-central gyri increases were greater in females, while males showed more extensive cingulate increases. Frontal and temporal cortex, lateral orbitofrontal, frontal pole, and lateral parietal and occipital cortices showed thinning. The extents of thickness changes were sex- and hemisphere-dependent, with only males exhibiting right-sided and posterior cingulate thickening, while females showed only left lateral orbitofrontal thinning. Regional cortical thickness showed modest correlations with seizure frequency, but not epilepsy duration.

Significance

Cortical thickening and thinning occur in patients with generalized tonic-clonic seizures, in cardiovascular and somatosensory areas, with extent of changes sex- and hemisphere-dependent. The data show injury in key autonomic and respiratory cortical areas, which may contribute to dysfunctional cardiorespiratory patterns during seizures, as well as to longer-term SUDEP risk.

Asymptomatic reproductive tract infections/sexually transmitted infections among HIV positive women

This study aims to highlight the importance of screening all HIV positive women for various reproductive tract infections/sexually transmitted infections (RTIs/STIs) irrespective of symptoms and to determine its occurrence in asymptomatic HIV positive women. Relevant specimens were collected for diagnosis of various RTIs/STIs. STIs were diagnosed in nearly one-third of the HIV positive asymptomatic patients which is quite high. The national strategy for STIs/RTIs control misses out large number of asymptomatic RTIs/STIs in HIV positive women which is responsible for silently transmitting these infections in the community. So this strategy should be modified to include screening of all HIV positives women irrespective of symptoms of STIs/RTIs.

Detection of rifampicin resistance in tuberculosis by molecular methods: A report from Eastern Uttar Pradesh, India

Diagnosis of drug resistance tuberculosis (TB) by the gold standard method is labour intensive and time consuming. Hence, there is an urgent need for introduction of rapid diagnostic techniques. Line probe assay (LPA) and cartridge-based nucleic acid amplification test (CBNAAT) have been introduced in India under Revised National Tuberculosis Control Program. Spot and morning sputum samples of previously treated patients by anti-TB drugs were subjected to LPA or CBNAAT. Total 682/1253 (54.4%) were diagnosed as rifampicin-resistant. The patients could be diagnosed early by molecular methods and put on second line treatment.

Impairment of soil health due to fly ash-fugitive dust deposition from coal-fired thermal power plants

Thermal power stations apart from being source of energy supply are causing soil pollution leading to its degradation in fertility and contamination. Fine particle and trace element emissions from energy production in coal-fired thermal power plants are associated with significant adverse effects on human, animal, and soil health. Contamination of soil with cadmium, nickel, copper, lead, arsenic, chromium, and zinc can be a primary route of human exposure to these potentially toxic elements. The environmental evaluation of surrounding soil of thermal power plants in Odisha may serve a model study to get the insight into hazards they are causing. The study investigates the impact of fly ash-fugitive dust (FAFD) deposition from coal-fired thermal power plant emissions on soil properties including trace element concentration, pH, and soil enzymatic activities. Higher FAFD deposition was found in the close proximity of power plants, which led to high pH and greater accumulation of heavy metals. Among the three power plants, in the vicinity of NALCO, higher concentrations of soil organic carbon and nitrogen was observed whereas, higher phosphorus content was recorded in the proximity of NTPC. Multivariate statistical analysis of different variables and their association indicated that FAFD deposition and soil properties were influenced by the source of emissions and distance from source of emission. Pollution in soil profiles and high risk areas were detected and visualized using surface maps based on Kriging interpolation. The concentrations of chromium and arsenic were higher in the soil where FAFD deposition was more. Observance of relatively high concentration of heavy metals like cadmium, lead, nickel, and arsenic and a low concentration of enzymatic activity in proximity to the emission source indicated a possible link with anthropogenic emissions.

Classic Tower of Hanoi, Planning Skills, and the Indian Elderly

OBJECTIVE

Elderly populations are vulnerable to age-related cognitive decline. Planning, a frontal lobe function, is reported to be affected in the elderly population. There is a paucity of studies which assessed planning skills in the elderly Indian population. The present study aimed to examine the utility of the classic Tower of Hanoi in the assessment of planning skills of elderly Indian subjects.

METHODS

A total of 215 (60 of whom were females, all aged 55-80 years) cognitively normal elders and 24 patients with mild Alzheimer's disease were recruited. All subjects provided informed consent and their planning skills were assessed using the classic Tower of Hanoi. Performance at each level was measured by the total time taken to solve, number of moves to solve, and the number of rule violations. Receiver operating characteristic curve analysis was exploratively performed to test the utility of the Tower of Hanoi in differentiating patients with mild Alzheimer's disease from those who were cognitively normal.

RESULTS

Performance measures of cognitively normal group steeply worsened with increasing complexity. With receiver operating characteristic curve analysis, patients with mild Alzheimer's disease were poorly differentiated from cognitively normal group according to their Tower of Hanoi performance.

CONCLUSION

The Tower of Hanoi test is of limited value for the assessment of planning skills in the Indian elderly population. There is a need to modify and develop a suitable neuropsychology tool to assess the planning skills of elderly Indian subjects and further validate it.