Medulloblastoma: A common pediatric tumor: Prognostic factors and predictors of outcome

BACKGROUND

Medulloblastoma is a common malignancy in the pediatric population, accounting for 25% of all childhood brain tumors and relatively uncommon in adults. This review was to investigate treatment outcome and prognostic factors after treatment of medulloblastoma.

MATERIALS AND METHODS

A total of 53 patients with histological confirmed medulloblastoma cases treated at our institute between 2006 and 2012 were included in the study. Demographic variables, clinical variables, radiological findings and treatment details with respect to age, sex, signs and symptoms, location of tumor, extent of surgical resection, histopathology type, radiotherapy dose, follow-up period and outcomes were recorded. Survival was analyzed by using these parameters.

RESULTS

Thirty-one (58.5%) patients were pediatric (<14 years), and 22 (41.5%) patients were adults (≥14 years). Duration of symptoms were <3 months in 19 (36%) and more than 3 months in 34 (64%) patients. Tumor resection was performed in all patients with gross total resection in 8 (15%) patients, near total resection in 34 (64%) patients and subtotal resection in 11 (21%) patients. All patients underwent postoperative craniospinal irradiation (CSI) delivering a median craniospinal dose of 36 Gy with additional boosts to the posterior fossa up to 54 Gy. Median overall survival was 50 months for the total group whereas 36 months for pediatric age group and 70 months for adult group. Desmoplastic histology showed an improved outcome compared with other histologies with a median survival of 71 months compared with that of classical medulloblastoma histology being 36 months and other histologies shown a median survival of 34 only.

CONCLUSIONS

Treatment of medulloblastoma with surgery and CSI yields long survival rates in both children and adults. Adult age group and desmoplastic histology were associated with a favorable outcome.

Acute intravascular hemolysis and methemoglobinemia following naphthalene ball poisoning

Naphthalene (C10H8) is a natural component of fossil fuels such as petroleum, diesel and coal. The common consumer products made from naphthalene are moth repellents, in the form of mothballs or crystals, and toilet deodorant blocks. Major toxic effects of naphthalene are due to precipitation of acute intravascular hemolysis. Very few cases of naphthalene poisoning and its effects have been reported from India. We report a case of accidental naphthalene poisoning, who presented with intravascular hemolysis and methemoglobinemia.

Epidemiological and clinical profile of triple negative breast cancer at a cancer hospital in North India

Background:

Triple negative breast cancer (TNBC) is a recent concept and the burning topic of research today. Various studies have been reported in western literature on TNBCs or the similar group of basal like cancers, all highlighting the poor prognostic features of this molecular subtype in comparison to the other types of breast cancers. However extensive data from India is lacking. The aim of this study was to analyze the epidemiological and clinical profile of TNBcs at our institute.

Materials and Methods:

Data on 171 patients of TNBCs registered at this hospital between 2005 and 2008 and followed up until December 2010 was collected and reviewed for epidemiological and clinical features.

Results:

The median age at presentation was 49 years (22-75 years). Sixty eight patients (40%) had lump in the breast of less than 1 month duration. Fourteen (8%) were nulliparous and 10 (7%) patients had crossed the age of 30 years at first full-term pregnancy, 89 (52%) were pre or peri-menopausal at presentation. Only 8 (5%) patients had a family history of breast or ovarian cancer. One hundred and six (62%) patients were stage II, 26 (15%) stage III, 21 (12%) stage I and 18 (10%) stage IV at presentation. One hundred and twenty eight patients (75%) had early breast cancer eligible for surgery at presentation, 25 (15%) were locally advanced and received neoadjuvant chemotherapy (NACT) and 18 (10%) were found to be metastatic. Modified radical mastectomy was the preferred surgical option by most patients (76%) who underwent upfront surgery in our study. The pathological overall response rates (complete and partial response) after NACT was 75% with complete response rate of 25% and there were no relapses in the complete responders. The median follow-up was 30 months (9-70 months). One hundred and twenty two patients (71%) were alive at last follow-up, 34 (22%) had relapsed, 18 (11%) had died due to progressive disease. Thirty one patients (18%) were lost to follow-up. Most of the relapses were systemic and rarely preceded by local relapses.

Conclusions:

TNBCs are aggressive cancers with high rates of systemic relapses within the first 3 years of presentation. Longer follow-up of these patients is required for more mature data on these cancers.

Impact of protein supplementation and care and support on body composition and CD4 count among HIV-infected women living in rural India: results from a randomized pilot clinical trial

Body composition in HIV-infected individuals is subject to many influences. We conducted a pilot 6-month randomized trial of 68 women living with AIDS (WLA) from rural India. High protein intervention combined with education and supportive care delivered by HIV-trained village women (activated social health activist [Asha] life [AL]) was compared to standard protein with usual care delivered by village community assistants (usual care [UC]). Measurements included CD4 counts, ART adherence, socio-demographics, disease characteristics (questionnaires); and anthropometry (bioimpedance analyzer). Repeated measures analysis of variance modeled associations. AL significantly gained in BMI, muscle mass, fat mass, ART adherence, and CD4 counts compared to UC, with higher weight and muscle mass gains among ART adherent (≥66%) participants who had healthier immunity (CD4 ≥450). BMI of WLA improved through high protein supplementation combined with education and supportive care. Future research is needed to determine which intervention aspect was most responsible.

Pre-clinical toxicity & immunobiological evaluation of DNA rabies vaccine & combination rabies vaccine in rhesus monkeys (Macaca mulatta)

BACKGROUND & OBJECTIVES

Pre-clinical toxicology evaluation of biotechnology products is a challenge to the toxicologist. The present investigation is an attempt to evaluate the safety profile of the first indigenously developed recombinant DNA anti-rabies vaccine [DRV (100 μg)] and combination rabies vaccine [CRV (100 μg DRV and 1.25 IU of cell culture-derived inactivated rabies virus vaccine)], which are intended for clinical use by intramuscular route in Rhesus monkeys.

METHODS

As per the regulatory requirements, the study was designed for acute (single dose - 14 days), sub-chronic (repeat dose - 28 days) and chronic (intended clinical dose - 120 days) toxicity tests using three dose levels, viz. therapeutic, average (2x therapeutic dose) and highest dose (10 x therapeutic dose) exposure in monkeys. The selection of the model i.e. monkey was based on affinity and rapid higher antibody response during the efficacy studies. An attempt was made to evaluate all parameters which included physical, physiological, clinical, haematological and histopathological profiles of all target organs, as well as Tiers I, II, III immunotoxicity parameters.

RESULTS

In acute toxicity there was no mortality in spite of exposing the monkeys to 10XDRV. In sub chronic and chronic toxicity studies there were no abnormalities in physical, physiological, neurological, clinical parameters, after administration of test compound in intended and 10 times of clinical dosage schedule of DRV and CRV under the experimental conditions. Clinical chemistry, haematology, organ weights and histopathology studies were essentially unremarkable except the presence of residual DNA in femtogram level at site of injection in animal which received 10X DRV in chronic toxicity study. No Observational Adverse Effects Level (NOAEL) of DRV is 1000 ug/dose (10 times of therapeutic dose) if administered on 0, 4, 7, 14, 28 th day.

INTERPRETATION & CONCLUSIONS

The information generated by this study not only draws attention to the need for national and international regulatory agencies in formulating guidelines for pre-clinical safety evaluation of biotech products but also facilitates the development of biopharmaceuticals as safe potential therapeutic agents.

Fabrication of hexagonal ZnO nanorods on porous carbon matrix by microwave irradiation

The hexagonal ZnO nanorods supported activated carbon (ZSAC) was successfully prepared using zinc nitrate hexahydrate and urea through microwave irradiation. The method of preparation is simple and cost effective. The activated carbon (AC) with high surface area (446.44 m2/g), pore volume (00.21 cm3/g) and average pore diameter (01.89 nm) was employed as a matrix support for the growth of ZnO nanorods. The XRD results affirm the formation of wurtzite ZnO nanostructures. The FT-IR studies disclose the presence of varied functional groups present in ZSAC. The HR-SEM images reveal the pore morphology of AC and hexagonal shape of ZnO nanorods formed. The E(g) value obtained from Kubelka-Munk transformed reflectance spectra is about 3.43 eV. The photoluminescence emissions reveal the defects in the crystal lattice. The ZSAC thus prepared would perform substantial role in the area of catalysis.

Growth of N-Glycyl-L-Valine (GV) single crystal and its spectral, thermal and optical characterization

A nonlinear optical crystal of N-Glycyl-L-Valine (GV) single crystals was grown by slow evaporation solution growth technique from an aqueous solution. The unit cell parameters and the crystal structure were determined by single crystal X-ray diffraction study. The Fourier transform infrared (FTIR) and proton nuclear magnetic resonance ((1)H NMR) spectral studies were carried out to identify the functional groups of the grown crystals. The ultraviolet visible near infrared (UV-Vis-NIR) spectrum was recorded to study the optical transparency of the grown crystal. The thermogravimetric (TG) and differential thermal (DTA) analyses revealed the thermal stability of the sample. The presence of second harmonic generation (SHG) for the grown crystal was confirmed by Kurtz-Perry powder technique.

Generation of a strong uniform transversely polarized nondiffracting beam using a high-numerical-aperture lens axicon with a binary phase mask

We present a theoretical approach to generate a nondiffracting beam with extended depth of focus (DOF) and a smaller focal spot along the optical axis, by tight focusing of an azimuthally polarized beam with a circular symmetrical binary phase mask and an interference effect over a high-numerical-aperture (NA) lens axicon system. We find a general azimuthal diffraction integral for the circularly symmetric binary phase mask and examine it in two special cases: a high-NA lens and a high-NA lens axicon. The azimuthally polarized beam remains well behaved in both cases. We verify that the longitudinal component generated by azimuthally polarized illumination produces the narrowest spot size for a wide range of geometries. Finally, we discuss the effects of tight focusing on a dielectric interface and provide some ideas for circumventing the effects of the binary phase mask interface and even utilize them for spot size reduction.

Correlates of stigma among rural Indian women living with HIV/AIDS

AIDS-related stigma has received increasing attention in the literature; however, little is known about the devastating impact it has on rural women living with AIDS (WLA) in India. This cross-sectional study (N = 68), analyzed from complete baseline data, identified a number of correlates of stigma among rural WLA in South India. Structured instruments were used to capture sociodemographic history, stigma, knowledge of HIV, depressive symptoms along with the recording of CD4 data. A higher level of felt stigma and more AIDS symptoms were related to avoidant coping, while fewer adherence strategies and lower support for antiretroviral therapy (ART) adherence were also associated with avoidant coping. These findings promote the need for support and resources for rural Indian WLA.

Eight year follow-up dental treatment in a patient with Treacher Collins syndrome

Treacher Collins syndrome (TCS) is an autosomal dominant disorder of craniofacial development characterized by variable involvement of the craniofacial structures derived from the first and second branchial arches. Occurrence of this syndrome is relatively rare with wide variations in the clinical expression. Aspects of speech, appearance, and social well-being along with psychological issues are hampered in these patients. Treating such disabled children poses a great challenge not only in the medical field but also in the dental meadow. We report a case of a 5-year-old boy who presented with this syndrome and the dental treatment was carried out with a noteworthy outcome for a period of 8 years. A brief review of etiology, dental anomalies along with prognosis is documented.

Carbon footprint optimization

We discuss four problems that we have identified under the umbrella of carbon economics problems: carbon credit allocation (CCA), carbon credit buying (CCB), carbon credit selling (CCS), and carbon credit exchange (CCE). Because of the strategic nature of the players involved in these problems, game theory and mechanism design provides a natural way of formulating and solving these problems. We then focus on a particular CCA problem, the carbon emission reduction problem, where the countries or global industries are trying to reduce their carbon footprint at minimum cost. We briefly describe solutions to the above problem.

Physical and mental health of rural southern Indian women living with AIDS

The purpose of this descriptive study is to highlight the physical and mental health symptoms of 68 rural women living with AIDS (WLA) in India, their compliance to antiretroviral therapy (ART) medication, and barriers to accessing health care within the past 6 months. Physical and mental health status was obtained by self-report, administered by questionnaire and physician-determined clinical assessment, as well as selected objective parameters. Findings revealed that while rural WLA had been on antiretroviral therapy for just under 2 years, they self-reported a high prevalence of physical symptoms, and more than half reported high levels of depressive symptoms and major barriers to accessing health care. CD4 levels, body weight, and basal metabolic rate were also low. While the rural and urban WLA faced similar health care challenges, the demographic characteristics of the rural women may make them more vulnerable, as they are less adherent to ART and slimmer than their urban counterparts.

Generation of sub wavelength super-long dark channel using high NA lens axicon

We investigate the focusing properties of a double-ring-shaped azimuthally polarized beam by a high numerical aperture (NA) lens axicon based on vector diffraction theory. We observe that our proposed system generates a sub wavelength focal hole of 0.5λ having large uniform focal depth of 48λ without any annular aperture. We also observed that the distribution of the total intensity near the focus has little variation with the degree of truncation β of the incident beam by the pupil. The authors expect such a super-long dark channel may find applications in optical, biological, and atmospheric sciences.

Correlates of Adherence among Rural Indian Women Living with HIV/AIDS

In this prospective, randomized clinical trial, correlates of adherence to antiretroviral therapy (ART) were assessed using a baseline questionnaire among 68 rural women living with AIDS (WLA) in India. Unadjusted analyses revealed positive relationships of ART adherence with Hindu religion, and support from spouses and parents, whereas negative associations were found with depression, poor quality of life, and having ten or more HIV symptoms. Multiple linear regression analysis also revealed that WLA who were Hindu, not depressed, had ART support from spouses and parents, and perceived some benefit from ART were more adherent to ART than their respective counterparts. This study reveals the unique challenges which rural WLA experience and the need to mitigate these challenges early in ART treatment. Further, the findings enable the refinement of an intervention program which will focus on strengthening ART adherence among rural WLA.