Immunotherapy-related hepatitis: real-world experience from a tertiary centre

OBJECTIVE

Immune checkpoint inhibitors like anti-programmed cell death protein 1 (PD-1) drugs Nivolumab and Pembrolizumab and anti-cytotoxic T-lymphocyte associated (CTLA-4) drug Ipilimumab have become standard of care in many metastatic cancers. Immunotherapy-related hepatitis and cholangitis present a diagnostic and management challenge, being rare and incompletely characterised. We aim to report the incidence, features and treatments used for this in a real-world setting and to identify useful biomarkers, which can be used to predict effective use of steroids.

DESIGN

Retrospective review of 453 patients started on immunotherapy over 7 years.

SETTING

Tertiary hepatology and oncology centre.

PATIENTS

21 patients identified with immunotherapy-related hepatotoxicity.

RESULTS

Hepatitis was most common in those receiving dual therapy (incidence 20%), with 75% of Grade 4 hepatitis cases occurring with ipilimumab-containing regimens. Corticosteroid monotherapy is first line treatment, but doses above 60 mg OD prednisolone do not demonstrate any additional benefit in time to hepatitis resolution. The alanine transaminase (ALT) reduction in steroid-responsive hepatitis is typically rapid (with a halving of ALT within 11 days). The commencement of additional immunosuppression (typically mycophenolate) appears safe and prompts a more rapid fall in ALT than corticosteroid use alone. Infliximab was safely used twice as hepatitis treatment. We also describe one patient with rare immunotherapy-induced biliary disease.

CONCLUSIONS

Vigilance is required for detection of immunotherapy-associated liver disease as, other than dual immunotherapy, we can identify no predictive factors for its development. Our data suggest that corticosteroid response is not dependent on the higher dosing regimens. Early escalation of immunosuppression may be of benefit in the absence of a rapid response to corticosteroids.

P14.50 Clinicopathological spectrum of intracranial germ cell tumors: an Indian tertiary cancer center experience

BACKGROUND

Incidence of intracranial germ cell tumors (ICGCT) in Western literature is low (0.3–0.6 %) as compared to East Asia (3–4 %), & their clinicopathological features are well documented. However, there are scant studies on ICGCT from India.

MATERIAL AND METHODS

Retrospective observational study of all ICGCT histologically diagnosed in our hospital from 2007–2018. Metastasis were excluded. Clinicopathological features were retrieved from hospital’s electronic medical records.

RESULTS

We diagnosed 82 primary ICGCT, forming approx. 0.54 % of all primary brain tumors, & 3.5% of pediatric brain tumors. Age range: 2 months-32 yrs (Median age 14 yrs). M:F ratio: 1.82:1 (53M,29F). Nearly 80% patients were pediatric (<18 yrs), & 8 very young (<3 yrs, 7M1F). Majority were suprasellar & pineal (31/82, 37% each), with one bifocal presentation. Other rarer sites: posterior fossa (4), midbrain (1), corpus callosum (1) & 11 non midline (4 thalamic, 4 frontal, 2 cerebellar, 1 CP angle). Predominant histology was germinoma (G) (51/82, 62%), while non germinomatous (NGGCT) were 31/82 (38%), of which 9 were mixed. Pure teratoma were 11 (9 immature (IT), 2 mature), & 5 pure yolk sac tumor (YST). Interestingly, all very young age group patients (<3 yrs), showed only NGGCT histology (5/8 IT, 3/8 pure YST). In contrast, G histology formed nearly 70% of all patients >3 yrs. Females were associated mainly with G (21/29, 72%). NGGCT were predominantly seen in males (M:F=2.9:1). Also, pure IT (9) were seen only in males. Posterior fossa tumors were all IT (4/4). Spinal tumors were NGGCT (1 mature teratoma, 1 YST). Majority of suprasellar tumors (25/31, 80.6%), other midline locations like corpus callosal, midbrain, & all thalamic tumors were G. However, pineal tumors showed equal distribution of G (15/31) & NGGCT (16/31). Spine screening was positive in 8 patients (6 G, 2 IT)- 7 on MRI and 1 only on CSF cytology. Serum tumor markers were raised in 13/54 cases- 6/34G(17.6%), vs 7/20 NGGCT (35%). CSF tumor markers were raised in 14/34-10/23 G (43.4%), vs 4/11 NGGCT (36.3%). Follow up was available for 37 patients (Duration 3 months-10 yrs, median 2 yrs). On f/u 6/15 (40%) NGGCT showed progression/death, while only 2/32 G relapsed (6.5%). Four deaths in G group were not directly attributable to the tumor.

CONCLUSION

Frequency of ICGCT in our hospital similar to western data rather than Asian, albeit with less striking male preponderance. ICGCT were tumors of 2nd decade & majority occurred in pineal/suprasellar areas. About 2/3rd were pure G on histology, and showed good prognosis. NGGCT were common in infants, males and in posterior fossa. IT were seen exclusively in males and pure YST mainly in males. Although majority of ICGCT are in midline, rarely non midline involvement also occurs, and it’s essential to exclude metastasis before considering primary ICGCT. Expectedly, NGGCT showed poorer prognosis, compared to pure germinomas.

Randomized controlled study of the prediction of diminutive/small colorectal polyp histology using didactic versus computer-based self-learning module in gastroenterology trainees

BACKGROUND AND AIM

The aim of this randomized trial was to evaluate the performance of self-training versus didactic training in order to increase the diagnostic accuracy of diminutive/small colonic polyp histological prediction by trainees.

METHODS

Sixteen trainees reviewed 78 videos (48 iSCAN-OE and 30 NBI) of diminutive/small polyps in a pretraining assessment. Trainees were randomized to receive computer-based self-learning (n = 8) or didactic training (n = 8) using identical teaching materials and videos. The same 78 videos, in a different randomized order, were assessed. The NICE (NBI International Colorectal Endoscopic) and SIMPLE (Simplified Identification Method for Polyp Labeling during Endoscopy) classification systems were used to classify diminutive/small polyps.

RESULTS

A higher proportion of high-confidence predictions of polyps was made by the self-training group versus the didactic group using both the SIMPLE classification (77.1% [95% CI 73.4-80.3] vs 69.9% [95% CI 66.1-73.5%] [P = 0.005]) and the NICE classification (77% [95% CI 73.2-80.4%] vs 69.8% [95% CI 66-73.4%] [P = 0.006]). When using NICE, sensitivity of the self-training group compared with the didactic group was 72% versus 83% (P = 0.0005), and the accuracy was 66.1% versus 69.1%. The training improved the confidence of participants and SIMPLE was preferred over NICE.

CONCLUSION

Self-learning for the prediction of diminutive/small polyp histology is a method of training that can achieve results similar to didactic training. Availability of adequate self-learning teaching modules could enable widespread implementation of optical diagnosis in clinical practice.

Comparison of Epidemiology and Outcomes in Neuro-Oncology Between the East and the West: Challenges and Opportunities

Although neoplasms of the brain and central nervous system (CNS) are relatively uncommon, comprising only 1-2% of the overall cancer burden, they represent a substantial source of morbidity and mortality worldwide. The age-adjusted annual incidence of CNS tumours is reportedly low; however, there is substantial global variability in its incidence, with nearly a five-fold difference between regions with the highest rates in developed countries in the West and those with the lowest rates in developing countries in South-East Asia, including India, possibly attributable to key differences in environmental factors, genetic susceptibilities and cultural practices, as well as resource constraints in low-middle income countries precluding precise ascertainment and accurate diagnosis. The burden of CNS tumours is further compounded by the fact that they require highly specialised and skilled multidisciplinary care, including access to modern neuroimaging, neurosurgery, neuropathology and molecular biology, radiotherapy, chemotherapy and rehabilitation services, which may not be widely available in an integrated manner in large parts of the world with a large variation in clinical pathways, non-uniformity of care and resultant heterogeneity in clinical outcomes. CNS tumours encompass a heterogeneous spectrum of histopathological entities with differences in presentation, distinct molecular/genetic alterations, diverse biological behaviour and varying clinical outcomes. Survival is highly dependent on histology, grade and molecular biology, but varies widely across continents, even for the same tumour type and grade. In general, survival is higher in children with primary brain tumours than in adults, largely due to the differences in histological distribution across age groups. However, there is widespread variability, with 5-year survival for paediatric brain tumours being <40% in some low-middle income countries compared with 70-80% in the developed world. This review compares the descriptive epidemiology and clinical outcomes of primary brain tumours between the East and the West that pose unique challenges but also provide new opportunities in contemporary neuro-oncological practice.

Aggression and discrimination among closely versus distantly related species of Drosophila

Fighting between different species is widespread in the animal kingdom, yet this phenomenon has been relatively understudied in the field of aggression research. Particularly lacking are studies that test the effect of genetic distance, or relatedness, on aggressive behaviour between species. Here we characterized male-male aggression within and between species of fruit flies across the Drosophila phylogeny. We show that male Drosophila discriminate between conspecifics and heterospecifics and show a bias for the target of aggression that depends on the genetic relatedness of opponent males. Specifically, males of closely related species treated conspecifics and heterospecifics equally, whereas males of distantly related species were overwhelmingly aggressive towards conspecifics. To our knowledge, this is the first study to quantify aggression between Drosophila species and to establish a behavioural bias for aggression against conspecifics versus heterospecifics. Our results suggest that future study of heterospecific aggression behaviour in Drosophila is warranted to investigate the degree to which these trends in aggression among species extend to broader behavioural, ecological and evolutionary contexts.

Shaping Ability of Two-shape and ProTaper Gold Files by using Cone-beam Computed Tomography

AIM

T-Wire and rotating motion of two-shape (2S), M-wire and rotating motion of ProTaper Gold (PG) are the recent innovations of Nickle Titanium (NiTi) rotary file system by means of thermal treatment. Therefore, a study was planned to assess the shaping ability of 2 Shape and ProTaper Gold using cone beam computed tomography (CBCT) Materials and methods: Thirty freshly extracted mandibular first molars were selected, and Pre-instrumentation CBCT imaging was performed to attain mesial and distal dentin wall measurements followed by chemo-mechanical preparation using the following NiTi files: 2S and ProTaper Gold. Post instrumentation CBCT imaging was performed for evaluation of the volume of removed dentin, apical transportation, and centering ratio. Statistical analysis was confirmed by a suitable analysis test with significance set at 0.05r.

RESULTS

In terms of the total volume of removed dentin, apical transportation, and centering ratio there was a significant difference noted between the tow-shape and ProTaper Gold. 2Shape performed better in all aspects compared to ProTaper Gold.

CONCLUSION

Two-shape (2S) maintained better original canal anatomy and volume of removed dentin was also less during chemo-mechanical preparation when compared to ProTaper Gold.

CLINICAL SIGNIFICANCE

Two-shape (2S) system when used clinically in patients may perform better and produce less canal transportation and canal preparation will be more centered as compared to the ProTaper Gold system.

The impact of air pollution on deaths, disease burden, and life expectancy across the states of India: the Global Burden of Disease Study 2017

BACKGROUND

Air pollution is a major planetary health risk, with India estimated to have some of the worst levels globally. To inform action at subnational levels in India, we estimated the exposure to air pollution and its impact on deaths, disease burden, and life expectancy in every state of India in 2017.

METHODS

We estimated exposure to air pollution, including ambient particulate matter pollution, defined as the annual average gridded concentration of PM2.5, and household air pollution, defined as percentage of households using solid cooking fuels and the corresponding exposure to PM2.5, across the states of India using accessible data from multiple sources as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. The states were categorised into three Socio-demographic Index (SDI) levels as calculated by GBD 2017 on the basis of lag-distributed per-capita income, mean education in people aged 15 years or older, and total fertility rate in people younger than 25 years. We estimated deaths and disability-adjusted life-years (DALYs) attributable to air pollution exposure, on the basis of exposure-response relationships from the published literature, as assessed in GBD 2017; the proportion of total global air pollution DALYs in India; and what the life expectancy would have been in each state of India if air pollution levels had been less than the minimum level causing health loss.

FINDINGS

The annual population-weighted mean exposure to ambient particulate matter PM2·5 in India was 89·9 μg/m3 (95% uncertainty interval [UI] 67·0-112·0) in 2017. Most states, and 76·8% of the population of India, were exposed to annual population-weighted mean PM2·5 greater than 40 μg/m3, which is the limit recommended by the National Ambient Air Quality Standards in India. Delhi had the highest annual population-weighted mean PM2·5 in 2017, followed by Uttar Pradesh, Bihar, and Haryana in north India, all with mean values greater than 125 μg/m3. The proportion of population using solid fuels in India was 55·5% (54·8-56·2) in 2017, which exceeded 75% in the low SDI states of Bihar, Jharkhand, and Odisha. 1·24 million (1·09-1·39) deaths in India in 2017, which were 12·5% of the total deaths, were attributable to air pollution, including 0·67 million (0·55-0·79) from ambient particulate matter pollution and 0·48 million (0·39-0·58) from household air pollution. Of these deaths attributable to air pollution, 51·4% were in people younger than 70 years. India contributed 18·1% of the global population but had 26·2% of the global air pollution DALYs in 2017. The ambient particulate matter pollution DALY rate was highest in the north Indian states of Uttar Pradesh, Haryana, Delhi, Punjab, and Rajasthan, spread across the three SDI state groups, and the household air pollution DALY rate was highest in the low SDI states of Chhattisgarh, Rajasthan, Madhya Pradesh, and Assam in north and northeast India. We estimated that if the air pollution level in India were less than the minimum causing health loss, the average life expectancy in 2017 would have been higher by 1·7 years (1·6-1·9), with this increase exceeding 2 years in the north Indian states of Rajasthan, Uttar Pradesh, and Haryana.

INTERPRETATION

India has disproportionately high mortality and disease burden due to air pollution. This burden is generally highest in the low SDI states of north India. Reducing the substantial avoidable deaths and disease burden from this major environmental risk is dependent on rapid deployment of effective multisectoral policies throughout India that are commensurate with the magnitude of air pollution in each state.

FUNDING

Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Mutagenicity and Cytotoxicity of Particulate Matter Emitted from Biodiesel-Fueled Engines

Biodiesel engines produce several intermediate species, which can potentially harm the human health. The concentration of these species and their health risk potential varies depending on engine technology, fuel, and engine operating condition. In this study, experiments were performed on a large number of engines having different configurations (emissions norms/fuel used), which were operated at part load/full load using B20 (20% v/v biodiesel blended with mineral diesel) and mineral diesel. Experiments included measurement of gaseous emissions, and physical, chemical, and biological characterization of exhaust particulate matter (PM). Chemical characterization of PM was carried out for detecting polycyclic aromatic hydrocarbons (PAH's) and PM bound trace metals. The biological toxicity associated with PM was assessed using human embryonic kidney 293T cells (HEK 293T). The mutagenic potential of the PM was tested at three different concentrations (500, 100, and 50 μg/mL) using two different  Salmonella strains, TA98 and TA100, with and without liver S9 metabolic enzyme fraction. PM samples exhibited cytotoxic effect on HEK 293T cells (IC₅₀ < 100 μg/mL) and there was significant potential for reactive oxygen species (ROS) generation. Comparison of different engines showed that modern engines (Euro-III and Euro-IV compliant) produced relatively cleaner exhaust compared to older engines (Euro-II compliant). Biodiesel-fueled engines emitted lower number of particles compared to diesel-fueled engines. However, chemical characterization revealed that biodiesel-fueled engines exhaust PM contained several harmful PAHs and trace metals, which affected the biological activity of these PM, as reflected in the biological investigations. Mutagenicity and cytotoxicity of PM from biodiesel-fueled engines were relatively higher compared to their diesel counterparts, indicating the need for exhaust gas after-treatment.

Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND

Lower respiratory infections are a leading cause of morbidity and mortality around the world. The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016, provides an up-to-date analysis of the burden of lower respiratory infections in 195 countries. This study assesses cases, deaths, and aetiologies spanning the past 26 years and shows how the burden of lower respiratory infection has changed in people of all ages.

METHODS

We used three separate modelling strategies for lower respiratory infections in GBD 2016: a Bayesian hierarchical ensemble modelling platform (Cause of Death Ensemble model), which uses vital registration, verbal autopsy data, and surveillance system data to predict mortality due to lower respiratory infections; a compartmental meta-regression tool (DisMod-MR), which uses scientific literature, population representative surveys, and health-care data to predict incidence, prevalence, and mortality; and modelling of counterfactual estimates of the population attributable fraction of lower respiratory infection episodes due to Streptococcus pneumoniae, Haemophilus influenzae type b, influenza, and respiratory syncytial virus. We calculated each modelled estimate for each age, sex, year, and location. We modelled the exposure level in a population for a given risk factor using DisMod-MR and a spatio-temporal Gaussian process regression, and assessed the effectiveness of targeted interventions for each risk factor in children younger than 5 years. We also did a decomposition analysis of the change in LRI deaths from 2000-16 using the risk factors associated with LRI in GBD 2016.

FINDINGS

In 2016, lower respiratory infections caused 652 572 deaths (95% uncertainty interval [UI] 586 475-720 612) in children younger than 5 years (under-5s), 1 080 958 deaths (943 749-1 170 638) in adults older than 70 years, and 2 377 697 deaths (2 145 584-2 512 809) in people of all ages, worldwide. Streptococcus pneumoniae was the leading cause of lower respiratory infection morbidity and mortality globally, contributing to more deaths than all other aetiologies combined in 2016 (1 189 937 deaths, 95% UI 690 445-1 770 660). Childhood wasting remains the leading risk factor for lower respiratory infection mortality among children younger than 5 years, responsible for 61·4% of lower respiratory infection deaths in 2016 (95% UI 45·7-69·6). Interventions to improve wasting, household air pollution, ambient particulate matter pollution, and expanded antibiotic use could avert one under-5 death due to lower respiratory infection for every 4000 children treated in the countries with the highest lower respiratory infection burden.

INTERPRETATION

Our findings show substantial progress in the reduction of lower respiratory infection burden, but this progress has not been equal across locations, has been driven by decreases in several primary risk factors, and might require more effort among elderly adults. By highlighting regions and populations with the highest burden, and the risk factors that could have the greatest effect, funders, policy makers, and programme implementers can more effectively reduce lower respiratory infections among the world's most susceptible populations.

FUNDING

Bill & Melinda Gates Foundation.

Clinicopathological profile of paroxysmal nocturnal haemoglobinuria clone-positive aplastic anaemia paediatric patients-A single centre study from North India

INTRODUCTION

There is a paucity of literature related to the prevalence of Paroxysmal Nocturnal haemoglobinuria (PNH) clones in paediatric aplastic anaemia (AA) patients.

METHODS

We performed a retrospective analysis over a period of 42 months to study the prevalence of PNH clones in paediatric (age less than 18 years) AA cases, using Fluorescein-labelled proaerolysin-based flow cytometric screening and analysed their clinico-pathological features.

RESULTS

PNH clone was identified in 100 (33.2%) of the 301 patients screened. These were comprised of 51 cases of non-severe AA, 33 cases of severe AA and 16 cases of very severe AA. The median age was 13 years with an M:F ratio of 2.5:1. The median clone size (taken as the proportion of PNH-positive neutrophils) was 2.15% (range: 0.05%-93.1%). Although a majority of patients (n = 77) had a clone size of less than 10%, a significant proportion (n = 23) did harbour a clone size of more than 10%. Evidence of haemolysis was observed in 3 patients, all of them having a clone size of more than 10%. Interestingly, 1 patient with dural sinus thrombosis harboured a clone size of 1.25% only. Chromosomal breakage analysis was performed in 61 patients, none of which was positive. Complete and partial response to immunosuppressive therapy was found in 55.1% patients (16/29).

CONCLUSION

There is a high prevalence of PNH clones in paediatric AA patients, which in a majority of cases are of small clone sizes. The use of immunosuppressive therapy does not show a better outcome as compared to PNH-negative cases.

Comparative Study of the Effect on Apical Sealability with Different Levels of Remaining Gutta-Percha in Teeth Prepared to Receive Posts: An in vitro Study

OBJECTIVE

The objective of this study is to compare the apical sealability of mineral trioxide aggregate (MTA) Fillapex and Endosequence BC sealer at three different lengths of remaining gutta-percha after postspace preparation.

MATERIALS AND METHODS

A total of 80 freshly extracted human maxillary anterior teeth were decoronated, biomechanically prepared, and randomly divided into four groups; Group A and Group B served as positive and negative control with 10 teeth each. The teeth in Group C and Group D (with 30 teeth each) were obturated with gutta-percha using MTA Fillapex sealer and Endosequence BC sealer, respectively. Teeth in Group C and Group D were further subdivided into three subgroups depending on the length of remaining apical gutta-percha, i.e., 3, 4, and 5 mm after postspace preparation. Apical leakage was assessed using dye penetration method under stereomicroscope.

RESULTS

In both the Groups C and D, there was overall no statistically significant difference in leakage; however, Group C showed slightly more leakage than Group D. There was a statistically significant difference in leakage at 3 mm and 5 mm level in both groups.

CONCLUSION

Although less microleakage occurred, the bioceramic sealers could not totally eliminate leakage.

Toxicity and mutagenicity of exhaust from compressed natural gas: Could this be a clean solution for megacities with mixed-traffic conditions?

Despite intensive research carried out on particulates, correlation between engine-out particulate emissions and adverse health effects is not well understood yet. Particulate emissions hold enormous significance for mega-cities like Delhi that have immense traffic diversity. Entire public transportation system involving taxis, three-wheelers, and buses has been switched from conventional liquid fuels to compressed natural gas (CNG) in the Mega-city of Delhi. In this study, the particulate characterization was carried out on variety of engines including three diesel engines complying with Euro-II, Euro-III and Euro-IV emission norms, one Euro-II gasoline engine and one Euro-IV CNG engine. Physical, chemical and biological characterizations of particulates were performed to assess the particulate toxicity. The mutagenic potential of particulate samples was investigated at different concentrations using two different Salmonella strains, TA98 and TA100 in presence and absence of liver S9 metabolic enzyme fraction. Particulates emitted from diesel and gasoline engines showed higher mutagenicity, while those from CNG engine showed negligible mutagenicity compared to other test fuels and engine configurations. Polycyclic aromatic hydrocarbons (PAHs) adsorbed onto CNG engine particulates were also relatively fewer compared to those from equivalent diesel and gasoline engines. Taken together, our findings indicate that CNG is comparatively safer fuel compared to diesel and gasoline and can offer a cleaner transport energy solution for mega-cities with mixed-traffic conditions, especially in developing countries.

Dicarboxylic acids and levoglucosan in aerosols from Indo-Gangetic Plain: Inferences from day night variability during wintertime

This study assesses daytime and nighttime atmospheric abundance and molecular distribution of dicarboxylic acids (DCA: C₂-C₁₀) and biomass burning tracers (levoglucosan and biomass burning derived potassium: K⁺_BB) in PM₁₀ (particulate matter with aerodynamic diameter≤10μm) from an urban location, Kanpur (in central Indo-Gangetic Plain: IGP) during wintertime (December 2015-February 2016). In this study, PM₁₀ varied from 130 to 242 and 175-388μgm^-3 during daytime and nighttime, respectively. The average ratios of OC/EC (day: 12.3; night: 9.3) and WSOC/OC (day: 0.74; night: 0.48) were relatively high during daytime (OC: organic carbon; EC: elemental carbon; WSOC: water-soluble organic carbon). Strong linear correlations (R²≥0.6; p<0.05) of OC with levoglucosan and K⁺_BB suggest biomass burning emission as predominant source of organic aerosols over the IGP. The measured concentrations of total DCA (ΣC₂-C₁₀) showed pronounced diurnal variability with a higher concentration during nighttime (2510±1025ngm^-3) as compared to that in daytime (1499±562ngm^-3). Concentrations of oxalic acid (C₂), succinic acid (C₄) and malonic acid (C₃) were predominantly high as compared to other congeners of DCA (C₂-C₁₀) over central IGP. Relatively higher mass fraction (73.4%) of C₂ in total DCA during nighttime than that in daytime (61.5%) indicates role of secondary organic aerosols (SOAs) formation involving aqueous-phase chemistry. Strong linear correlations of C₂ with C₃ and C₄ plausibly suggest that C₂ can have predominant formation pathways via decomposition of higher congeners of DCA. Overall, strong linear correlations of C₂ with levoglucosan and sulphate suggest that biomass burning emission and secondary transformations are predominant sources of DCA over IGP during wintertime.

Chemical characterization and quantitativ e assessment of source-specific health risk of trace metals in PM1.0 at a road site of Delhi, India

This study presents the concentration of submicron aerosol (PM_1.0) collected during November, 2009 to March, 2010 at two road sites near the Indian Institute of Technology Delhi campus. In winter, PM_1.0 composed 83% of PM_2.5 indicating the dominance of combustion activity-generated particles. Principal component analysis (PCA) proved secondary aerosol formation as a dominant process in enhancing aerosol concentration at a receptor site along with biomass burning, vehicle exhaust, road dust, engine and tire tear wear, and secondary ammonia. The non-carcinogenic and excess cancer risk for adults and children were estimated for trace element data set available for road site and at elevated site from another parallel work. The decrease in average hazard quotient (HQ) for children and adults was estimated in following order: Mn > Cr > Ni > Pb > Zn > Cu both at road and elevated site. For children, the mean HQs were observed in safe level for Cu, Ni, Zn, and Pb; however, values exceeded safe limit for Cr and Mn at road site. The average highest hazard index values for children and adults were estimated as 22 and 10, respectively, for road site and 7 and 3 for elevated site. The road site average excess cancer risk (ECR) risk of Cr and Ni was close to tolerable limit (10^-4) for adults and it was 13-16 times higher than the safe limit (10^-6) for children. The ECR of Ni for adults and children was 102 and 14 times higher at road site compared to elevated site. Overall, the observed ECR values far exceed the acceptable level.

Rate of recurrence in Indian patients presenting with acute pancreatitis and identification of chronicity on follow up: Possible risk factors for progression

BACKGROUND

To study the profile and long-term outcome of Indian patients presenting with acute pancreatitis and the possible risk factors for progression.

METHODS

Consecutive patients with acute or recurrent acute pancreatitis seen in our department during July 2013 to December 2014 were included. Details of past episodes were collected and patients were followed up till March 2015.

RESULTS

In the 97 patients included (mean age 47.2 [SD 16.9] years; 74 men), gallstones (37 [38.1%]) and alcohol (19 [19.6%]) were the major identified etiologies; the idiopathic (31 [32%]) group constituted a third of patients. Recurrences were more common with idiopathic etiology (14 patients out of 30 had recurrences [46.7%]) as compared to alcoholic (5 out of 19 [26.3%]) and biliary (4 out of 37 [10.8%]) pancreatitis and with mild index episode. Following the episode of acute pancreatitis, identification of chronic pancreatitis was more common with alcoholic (6 out of 18 [33%]) and idiopathic (9 out of 30 [30%]) etiology as compared to other etiologies. Longer duration of follow up, but not number of recurrent episodes, was associated with identification of chronicity in patients presenting as acute pancreatitis.

CONCLUSIONS

Out of 97 patients with acute pancreatitis, 27 (27.8%) developed recurrences with risk factors being idiopathic etiology and mild index episode. Eighteen of 97 (18.6%) patients had evidence of chronic pancreatitis on follow up, risk factors being the alcoholic and idiopathic varieties, and longer duration of follow up.