Risk-scoring system for predicting mucositis in patients of head and neck cancer receiving concurrent chemoradiotherapy [rssm-hn]

BACKGROUND

One of the most distressing complications of head and neck cancer patients on chemoradiotherapy is mucositis. There is no proper tool to predict its occurrence in these patients.

AIM

This study was conducted to develop a risk-scoring system to predict probable incidence and severity of mucositis in head and neck cancer patients on chemoradiotherapy.

MATERIALS AND METHODS

This is a retrospective analysis conducted at a tertiary care cancer center with approximately 2,000 new cases of head and neck cancer patients annually. We Hypothesized were age, comorbid conditions, leukocyte count, nutritional status, oral hygiene, tobacco use, erythrocyte sedimentation rate (ESR); Eastern cooperative oncology group (ECOG) performance status (PS) and TNM (tumor, node, metastasis) stage as possible risk factors. Receiver operating characteristic (ROC) curves were drawn to predict the cutoff values for risk factors, and a final scoring system was developed with sensitivity and specificity data.

RESULTS

A total of 218 patients on chemoradiation receiving cisplatin 40 mg/m2 /week along with local radiation of 60-70 Gy depending on primary site were analyzed. Based on ROC analysis, the following cutoff values were selected: age > 40 years, ECOG PS > 2, WBC < 3000/μL, elevated ESR, albumin < 3 gm/dL and > stage III disease. The remaining factors were indicated as present or absent. A score of 1 was assigned for the above risk factors. For patients, the final score of 3 or less there is 17% probability of developing grade 3 or 4 mucositis, while patients having score of 6 or more have 76% probability.

CONCLUSION

The current tool is fairly accurate in predicting development of mucositis in head and neck cancer patients on chemoradiotherapy. This will further help clinicians to adopt preventive strategies as well as better counseling.

Effect of aqueous Enicostemma littorale Blume extract on key carbohydrate metabolic enzymes, lipid peroxides and antioxidants in alloxan-induced diabetic rats

The present study investigates the effect of oral administration of an aqueous Enicostemma littorale whole plant extract on some key carbohydrate metabolic enzymes and antioxidant defence in alloxan-induced diabetes in rats. Rats were rendered diabetic by alloxan (150 mg kg−1 body weight) administration. Oral administration of E. littorale extract for 45 days increased the activity of hexokinase and decreased the activities of glucose 6-phosphatase and fructose 1,6-bisphosphatase significantly in the serum, liver and kidney of diabetic rats. The extract lowered the concentration of thiobarbituric acid reactive substances and lipid hydroperoxides significantly in brain and increased it significantly in heart in diabetic rats. E. littorale administration increased the concentration of reduced glutathione and the activity of glutathione peroxidase in diabetic rats. The activities of superoxide dismutase and catalase were increased significantly by E. littorale treatment in diabetic rats. The effect of a 2 g kg−1 dose was greater than that of a 1 g kg−1 dose. Insulin (6 units kg−1) normalized all the parameters in diabetic rats. Our study has provided evidence for the antidiabetic activity of E. littorale aqueous extract. This study can also be extrapolated to clinical studies in future.

Efficacy and safety of tenecteplase in ST elevation myocardial infarction patients from the Elaxim Indian Registry

OBJECTIVE

to study the efficacy and safety of indigenously developed tenecteplase injection in the management of Indian STEMI patients in clinical practice.

METHODS

post-licensure, observational, prescription event monitoring study.

RESULTS

2100 patients received weight-adjusted tenecteplase injection. More than 90% patients received aspirin, clopidogrel, and enoxaparin/heparin. Clinically successful thrombolysis was reported in 86.71%, in-hospital mortality was 3.48%. The adverse events recorded were comparable with previously published data. Any bleeding (excluding intra-cranial hemorrhage) was seen in 4.62% patients which was reported in 0.90% patients of which 47.34% patients had also received GpIIb/IIIa inhibitors.

CONCLUSION

This study confirms the efficacy and safety of indigenous tenecteplase in Indian STEMI patients.

Metabolic programming: Role of nutrition in the immediate postnatal life

Although genes and dietary habits are generally implicated in the aetiology of the prevailing obesity epidemic, the steep increase in the incidence of obesity within a relatively short span of time suggests that other contributing factors may be at play. The role of nutritional experience during the very early periods of life is increasingly being recognized as contributing to growth and metabolic changes in later life. Epidemiological data and studies from animal models have established a strong correlation between an aberrant intrauterine environment and adult-onset disorders in offspring. The nutritional experience in the immediate postnatal life is another independent factor contributing to the development of metabolic diseases in adulthood. Although studies on the small-litter rat model have shown that overnourishment during the suckling period results in adult-onset metabolic disorders, our studies have shown that a change in the quality of calories-specifically, increased carbohydrate intake by newborn rat pups in the immediate postnatal period-results in chronic hyperinsulinaemia and adult-onset obesity. Several functional alterations in islets and in the hypothalamic energy homeostatic mechanism appear to support this phenotype. Remarkably, female rats that underwent the high-carbohydrate dietary modification as neonates spontaneously transmitted the obesity phenotype to their offspring, thus establishing a vicious generational effect. The high-carbohydrate diet-fed rat model has particular relevance in the context of the current human infant feeding practices: reduction in breast feeding and increase in formula feeding for infants, accompanied by early introduction of carbohydrate-enriched baby foods.

Investigation of the radioprotective efficacy of hesperidin against gamma-radiation induced cellular damage in cultured human peripheral blood lymphocytes

The present study was aimed to evaluate the radioprotective efficacy of hesperidin (HN), a flavonone glycoside against gamma-radiation-induced cellular damage in cultured human peripheral blood lymphocytes. Different concentrations of HN (3.27, 6.55, 9.83, 13.10, 16.38 and 19.65 microM) were pre-incubated with lymphocytes for 30 min prior to gamma-irradiation [4 Gy] and the micronuclei (MN) scoring, dicentric aberration and comet assay were performed to fix the effective dose of HN against gamma-irradiation induced cellular damage. The results indicated that among all the concentrations, 16.38 microM concentration of HN showed optimum protection by effectively decreasing the MN frequencies, dicentric aberrations and comet attributes. Based on the above results, 16.38 microM concentration of HN was fixed as the effective dose to further investigate its radioprotective efficacy which was then carried out by pre-incubating lymphocytes with 16.38 microM concentration of HN, exposing the lymphocytes to different doses (1, 2, 3 and 4 Gy) of radiation and investigating radiation induced genetic damage (MN, dicentric aberration, comet assay, DNA fragmentation assay) and biochemical changes (changes in the level of enzymic and non-enzymic antioxidants, lipid peroxidation). The results indicated a dose dependent increase in both genetic damage and thiobarbituric acid reactive substances (TBARS), accompanied by a significant decrease in the antioxidant status compared to HN treated groups which modulated the toxic effects through its antioxidant potential. Thus the current study shows HN to be an effective radioprotector against gamma-radiation induced in-vitro cellular damage in lymphocytes.

Soluble forms of Toll-like receptor 4 are present in human saliva and modulate tumour necrosis factor-alpha secretion by macrophage-like cells

In health, mucosal inflammation is prevented by tightly regulated responses via Toll-like receptors (TLR) that interact with specific microbe associated molecular patterns. Currently, 13 TLRs have been identified. Based on the specificity of ligand recognition, TLR-2 and TLR-4 can recognize most oral commensal microorganisms. Recent identification of some soluble TLRs (sTLRs) suggests additional regulatory roles for these receptors. We report here the presence of sTLR-4 polypeptides in adult human saliva. Functionally, the salivary sTLR-4 suppressed cytokine secretion by activated macrophages. The sTLR-4 levels were elevated significantly in oral lichen planus (OLP), a chronic inflammatory condition of the oral mucosa characterized by clinical persistence. In contrast, the epithelial cells in the saliva of OLP subjects expressed significantly reduced TLR-2 and TLR-4 mRNA that correlated with fewer bacteria/salivary epithelial cells. Investigating the soluble and cellular components of saliva is useful in identifying potential biomarkers for oral mucosal lesions.

Coral reef fish smell leaves to find island homes

Recent studies have shown that some coral reef fish larvae return to natal reefs, while others disperse to distant reefs. However, the sensory mechanisms used to find settlement sites are poorly understood. One hypothesis is that larvae use olfactory cues to navigate home or find other suitable reef habitats. Here we show a strong association between the clownfish Amphiprion percula and coral reefs surrounding offshore islands in Papua New Guinea. Host anemones and A. percula are particularly abundant in shallow water beneath overhanging rainforest vegetation. A series of experiments were carried out using paired-choice flumes to evaluate the potential role of water-borne olfactory cues in finding islands. Recently settled A. percula exhibited strong preferences for: (i) water from reefs with islands over water from reefs without islands; (ii) water collected near islands over water collected offshore; and (iii) water treated with either anemones or leaves from rainforest vegetation. Laboratory reared-juveniles exhibited the same positive response to anemones and rainforest vegetation, suggesting that olfactory preferences are innate rather than learned. We hypothesize that A. percula use a suite of olfactory stimuli to locate vegetated islands, which may explain the high levels of self-recruitment on island reefs. This previously unrecognized link between coral reefs and island vegetation argues for the integrated management of these pristine tropical habitats.

Rhizosphere Bacterial Signalling: A Love Parade Beneath Our Feet

Plant roots support the growth and activities of a wide variety of microorganisms that may have a profound effect on the growth and/or health of plants. Among these microorganisms, a high diversity of bacteria have been identified and categorized as deleterious, beneficial, or neutral with respect to the plant. The beneficial bacteria, termed plant growth-promoting rhizobacteria (PGPR), are widely studied by microbiologists and agronomists because of their potential in plant production. Azospirillum, a genus of versatile PGPR, is able to enhance the plant growth and yield of a wide range of economically important crops in different soils and climatic regions. Plant beneficial effects of Azospirillum have mainly been attributed to the production of phytohormones, nitrate reduction, and nitrogen fixation, which have been subject of extensive research throughout the years. These elaborate studies made Azospirillum one of the best-characterized genera of PGPR. However, the genetic and molecular determinants involved in the initial interaction between Azospirillum and plant roots are not yet fully understood. This review will mainly highlight the current knowledge on Azospirillum plant root interactions, in the context of preceding and ongoing research on the association between plants and plant growth-promoting rhizobacteria.

Meta-analysis of 5-year outcomes of CABG vs PCI with stenting in patients with multivessel disease

AIM

The purpose of this meta-analysis was to systematically review and synthesize existing data on long term outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with multiple stenting in patients with multivessel coronary artery disease.

METHODS

Three randomized control trials of CABG versus stenting with a 5-year follow-up and a total number of 2 063 patients were included in the meta-analysis. The primary end-point of the study was freedom from major adverse cardiovascular events at 5 years.

RESULTS

After 5 years of follow-up, 42.81% of patients randomized to PCI with stenting versus 20.81% of patients randomized to CABG reached the primary clinical end-point(relative risk [RR] 2.16, 95% confidence interval [CI] 1.38-3.38). Repeat revascularization procedures occurred more frequently in patients allocated to PCI with multiple stenting compared with CABG (30.29% versus 7.45%, RR 4.47 and 95% CI 2.75-7.29). Non fatal myocardial infarction (MI) (6.6% versus 6.2%, RR 1.00 and 95% CI 0.58-1.70) was nearly equal in the two groups while deaths (9.3% versus 7.4%, RR 1.50 and 95% CI 0.61-3.66) were slightly higher in patients treated by PCI as compared to CABG.

CONCLUSION

Five years after the initial procedure, there is no survival benefit for CABG over PCI, but major adverse cardiovascular events and repeat revascularization procedures are high after PCI.

Corticosteroids for bacterial corneal ulcers

AIMS

The aim of the study was to conduct a preliminary clinical trial to assess whether adjunctive topical corticosteroids improve outcomes in bacterial keratitis and, if no difference was found, to determine the feasibility and sample size necessary for conducting a larger trial to answer this question.

METHODS

In this single centre, double-masked clinical trial, 42 patients with culture-confirmed bacterial keratitis at Aravind Eye Hospital in India were randomised to receive either topical prednisolone phosphate or placebo. All patients received topical moxifloxacin. The primary outcome was best spectacle-corrected visual acuity (BSCVA) at 3 months, adjusting for enrolment BSCVA and arm. Other pre-specified outcomes included re-epithelialisation time, infiltrate/scar size and adverse events.

RESULTS

Compared with placebo, patients in the steroid group re-epithelialised more slowly (hazard ratio 0.47, 95% CI 0.23 to 0.94). There was no significant difference in BSCVA or infiltrate/scar size at 3 weeks or 3 months. To have 80% power to detect a two-line difference in acuity, 360 cases would be required.

CONCLUSIONS

Although corticosteroid treatment resulted in a statistically significant delay in re-epithelialisation, this did not translate to a significant difference in visual acuity, infiltrate/scar size or adverse events. To assess the effect of steroids on acuity, a larger trial is warranted and feasible.

Distinguishing infective versus noninfective keratitis

For the purpose of this symposium, the term ″keratitis″ implies suppurative nonviral and viral keratitis. Corneal ulcers have been described in ancient literature. But even today, despite the availability of a wide range of newer antimicrobials and new diagnostic techniques, infective keratitis continues to pose a diagnostic and therapeutic challenge. This article focuses on the key diagnostic clinical features of the most common organisms causing infective keratitis - bacteria, fungi, viruses, nocardia and acanthamoeba - in India. While the clinical features in some cases are fairly straightforward, most cases challenge the clinician. We describe the salient clinical features which can help arrive at a diagnosis to begin appropriate treatment immediately, prior to the laboratory report.