Self-Assembled Redox-Sensitive Polymeric Nanostructures Facilitate the Intracellular Delivery of Paclitaxel for Improved Breast Cancer Therapy

A two-tier approach has been proposed for targeted and synergistic combination therapy against metastatic breast cancer. First, it comprises the development of a paclitaxel (PX)-loaded redox-sensitive self-assembled micellar system using betulinic acid-disulfide-d-α-tocopheryl poly(ethylene glycol) succinate (BA-Cys-T) through carbonyl diimidazole (CDI) coupling chemistry. Second, hyaluronic acid is anchored to TPGS (HA-Cys-T) chemically through a cystamine spacer to achieve CD44 receptor-mediated targeting. We have established that there is significant synergy between PX and BA with a combination index of 0.27 at a molar ratio of 1:5. An integrated system comprising both BA-Cys-T and HA-Cys-T (PX/BA-Cys-T-HA) exhibited significantly higher uptake than PX/BA-Cys-T, indicating preferential CD44-mediated uptake along with the rapid release of drugs in response to higher glutathione concentrations. Significantly higher apoptosis (42.89%) was observed with PX/BA-Cys-T-HA than those with BA-Cys-T (12.78%) and PX/BA-Cys-T (33.38%). In addition, PX/BA-Cys-T-HA showed remarkable enhancement in the cell cycle arrest, improved depolarization of the mitochondrial membrane potential, and induced excessive generation of ROS when tested in the MDA-MB-231 cell line. An in vivo administration of targeted micelles showed improved pharmacokinetic parameters and significant tumor growth inhibition in 4T1-induced tumor-bearing BALB/c mice. Overall, the study indicates a potential role of PX/BA-Cys-T-HA in achieving both temporal and spatial targeting against metastatic breast cancer.

ASPERGILLOSIS: THE DISEASE AT A GLANCE. REVIEW ARTICLE

Aspergillosis is mainly a lung infection in human. This is caused by the fungus Aspergillus. Though, most of the strains are harmless to humans, only a few of them can cause serious diseases mostly in immunocompromised individuals. The individuals with a medical history of respiratory problems are at high risk of infection. An aspergillosis patient if not treated well within time it may result in invasive aspergillosis developing lung fibrosis, huge hemoptysis and multiple organ failures, CNS and brain infections, endocarditis and death. The present paper deals with their disease causing abilities, diagnosis and treatment in human in the light of recent researches done so far in the field of medical microbiology and pathology.

Role of Intravenous Iron Sucrose in Severe Anemia in Late Pregnancy: A Case Report From Rural Ballabgarh, Haryana

Severe anemia is a high-risk factor in pregnancy and needs to be treated appropriately to prevent poor maternal and fetal outcomes. A pregnant woman with severe anemia reluctant for blood transfusion due to issues of accessibility was given four doses of 300 mg intravenous iron sucrose (IVIS) in 300 ml normal saline starting at 31 weeks 5 days of gestation and her hemoglobin level increased by 4.2 gm/dl over a period of five weeks without any complications and without any intake of iron and folic acid tablets during the entire duration. Intravenous iron sucrose is a useful intervention for severe anemia of pregnancy even in late pregnancy with rapid increase in haemoglobin levels and can be used regularly for treating severe anemia in pregnant women alternative to blood transfusion who have limited accessibility to blood transfusion facilities.

Effect of a novel dietary supplement Khejri, and Spirulina supplementation on lipid profile in cricket players

Prosopis cineraria (Fabaceae) is known as Khejri in India or the golden tree of Indian deserts. It's potential as a dietary supplement in sports nutrition and its effect on regulating lipid profile has never been investigated. Spirulina (Arthrospira platensis) is a superfood with high nutritional value and is a popular supplement among athletes. In the current study, Spirulina and Khejri were used as supplements by cricket players to improve their physical fitness and lipid profile. Both supplements were given to individual groups and in combination to see the combined effect. The intervention period was 21 days, and supplements were given in 500 mg doses daily. Lipid profile assessments were done before and after the intervention period. 40 cricket players were divided into 4 groups: Group 1 (n = 10): Both supplements, Spirulina and Khejri, Group 2 (n = 10): Supplement Spirulina, Group 3 (n = 10): Supplement Khejri, and Group 4 (n = 10): Control. When experimental groups 1, 2 and 3 were compared to the control group 4, significant reduction was observed in triglyceride levels (Group1 vs. control: 141.53 ± 14.74 vs. 199.28 ± 27.24, p < 0.05; Group 2 vs. control: 137.5 ± 14 vs. 199.28 ± 27.24, p < 0.05; Group 3 vs. control: 135.32 ± 17.34 vs. 199.28 ± 27.24, p < 0.05) and significant reduction in cholesterol levels was found post-intervention after 21 days of supplementation (Group1 vs. control: 149.75 ± 7.08 vs. 207.86 ± 11.69, p < 0.001; Group 2 vs. control: 178.28 ± 9.43 vs. 207.86 ± 11.69, p < 0.05; Group 3 vs. control: 142.92 ± 10.01 vs. 207.86 ± 11.69, p < 0.001). Cholesterol and Triglyceride levels were significantly decreased pre- vs. post-intervention by Khejri and Spirulina supplements in cricket players.

Ultra-fast and Robust Capture of Fluoride by Amino Terephthalic Acid Facilitated Lanthanum Based Organic Framework: Insight into Performance and Mechanisms

A sorbent consisting of a lanthanum-loaded metal-organic framework, involving terephthalic acid (La@TPA) and amino terephthalic acid as organic linker (La@ATPA), was synthesized and evaluated for fluoride (F) removal from groundwater....

Comparison between LMA ProSeal and I-gel airway in anesthetized patients on spontaneous ventilation during daycare procedures: A prospective randomized study

Background

General anesthesia remains the most popular technique for ambulatory surgeries with patients, surgeons, and anesthesia providers. The supraglottic airway (SGA) devices result in fewer incidences of sore throat, laryngospasm, coughing, and hoarseness as compared to inserting a tracheal tube. This study was conducted to compare two second-generation SGA devices, LMA ProSeal and I-gel airway, in anesthetized patients on spontaneous ventilation during daycare procedures to establish the superior SGA device.

Methodology

This prospective randomized study was done on 90 patients of either sex aged 15-60 years, ASA grade I-II, Mallampatti grade I and II, and BMI between 20 and 30 kg/m2 scheduled for elective surgeries of duration less than 90 min. Patients were randomly allocated into two groups-group A (I-gel) and group B (LMA ProSeal). Insertion parameters, hemodynamic responses, oxygenation, ventilation, peak airway pressure (PAP), and postoperative complications were recorded. Statistical analysis was done using SPSS version 21.0 statistical analysis software.

Results

Mean insertion time of LMA ProSeal was found to be significantly higher as compared to I-gel (33.27 ± 3.88 vs 18.49 ± 3.18 s; P < 0.001). No significant difference was found between the groups in the number of attempts and of operators attempted for insertion, as well as in hemodynamic response, oxygenation, and ventilation. Postoperative complications were lesser in group A.

Conclusion

I-gel is an easy-to-insert cuffless SGA device requiring lesser time for insertion, provides adequate ventilation with lesser postoperative complications and thus appears to be better than LMA ProSeal.

Inclusion of physical medicine and rehabilitation in the medical curriculum: A step in the right direction

Background Although physical medicine and rehabilitation (PMR) was first introduced in India in the 1960s, it was not until the 1990s when it was offered as an optional rotation to Indian medical graduates. Lately, with the introduction of a competency-based undergraduate curriculum in 2018, PMR has been included as an essential subject in the medical graduate curriculum, to be implemented from 2019. We aimed to ascertain the importance of incorporating PMR in the medical graduate curriculum while also discussing the awareness about PMR among Indian healthcare professionals. Methods We drafted an online questionnaire-based survey and sent that to participants through cloud-based software. Responses were collected over a period of 4 weeks and a descriptive analysis was performed. Results The initial hypothesis was that most healthcare professionals would be unaware of the scope of PMR as a medical specialty. The results of this study did not support our hypothesis with 96.8% of the participants being familiar with PMR as a medical specialty. In addition, 85% of the participants reported being introduced to PMR either in their medical school or during their residency training and 92% of the participants appreciated the late integration of PMR within the medical graduate curriculum. Conclusions Introduction of medical graduates to PMR would help in bridging the gaps faced by people with disabilities in accessing healthcare facilities. It would also help clinicians from other specialties to collaborate with physiatrists in a more coordinated manner.

A Case Report of Acute Severe Necrotizing Pancreatitis following the Johnson & Johnson Vaccine against the Novel SARS-CoV-2

Acute pancreatitis is an inflammatory condition, which is a leading gastrointestinal cause of hospitalization in the United States. Several conditions are associated with acute pancreatitis. More recently, there have been a few cases reported of acute pancreatitis following the Pfizer-BioNTech COVID-19 mRNA vaccine. To our knowledge, no cases of acute pancreatitis have been yet reported following the Johnson & Johnson's Janssen COVID-19 vaccine (J& J vaccine). Herein we report a 34-year-old male with no significant past medical history admitted with acute necrotizing pancreatitis, the day following the receipt of the J&J vaccine. Based on the Naranjo and the modified Naranjo scale, the patient met the requirements for probable drug induced pancreatitis. This case report has the objective to raise awareness of a potentially severe side effect of the J&J vaccine. We hope to use this case to support screening all patients for previous history of acute pancreatitis before administration of the J& J vaccine.

Air quality assessment in the central Indian State of Chhattisgarh

Background

Era's one of the utmost scourges is air pollution, owing to not only its impact on climate change but also its impact on public and individual's health due to combined morbidity and mortality.

Objectives

The current study was intended to monitor the air quality data from two districts of Chhattisgarh, namely Raipur and Korba, so that policymakers will be able to take corrective measures to control individual's health-related issues associated with polluted air.

Methods

All air samples were collected from around Raipur and Korba city of Chhattisgarh and submitted to the Chester LabNet, a laboratory based in 3 Oregon, USA, for analysis. Particulate matter (PM2.5) was determined by using the gravimetry technique and used the X-ray fluorescence 4 technique to detect the presence of heavy metals.

Results

PM2.5 levels in all samples in Raipur and Korba ranged from 131.4-653.8 μg/m³ to 150.3-1699.2 μg/m³ which is 2.18-10.88 and 2.5-28.3 times higher than standards prescribed by the Ministry of Environment, Forest and Climate Change (MoEFCC) of 60 μg/m³. Heavy metals such as silica (Si), lead (Pb), nickel (Ni), and manganese (Mn) levels were recorded higher than the standard level reported by the National Ambient Air Quality Standards in locations of Raipur and Korba, Chhattisgarh.

Conclusion

Although Chhattisgarh, a state in Central India covered with 45% forest, but it is suffering from low air quality due to developing township and industrial area, which is causing a lot of commotion in the local community. At this time, the government should approach to take immediate action and measures to control air pollution and to reduce the terrible impact on the health of local citizens.

The Novel Role of Mitochondrial Citrate Synthase and Citrate in the Pathophysiology of Alzheimer's Disease

Citrate synthase is a key mitochondrial enzyme that utilizes acetyl-CoA and oxaloacetate to form citrate in the mitochondrial membrane, which participates in energy production in the TCA cycle and linked to the electron transport chain. Citrate transports through a citrate malate pump and synthesizes acetyl-CoA and acetylcholine (ACh) in neuronal cytoplasm. In a mature brain, acetyl-CoA is mainly utilized for ACh synthesis and is responsible for memory and cognition. Studies have shown low citrate synthase in different regions of brain in Alzheimer's disease (AD) patients, which reduces mitochondrial citrate, cellular bioenergetics, neurocytoplasmic citrate, acetyl-CoA, and ACh synthesis. Reduced citrate mediated low energy favors amyloid-β (Aβ) aggregation. Citrate inhibits Aβ25-35 and Aβ1-40 aggregation in vitro. Hence, citrate can be a better therapeutic option for AD by improving cellular energy and ACh synthesis, and inhibiting Aβ aggregation, which prevents tau hyperphosphorylation and glycogen synthase kinase-3 beta. Therefore, we need clinical studies if citrate reverses Aβ deposition by balancing mitochondrial energy pathway and neurocytoplasmic ACh production. Furthermore, in AD's silent phase pathophysiology, when neuronal cells are highly active, they shift ATP utilization from oxidative phosphorylation to glycolysis and prevent excessive generation of hydrogen peroxide and reactive oxygen species (oxidative stress) as neuroprotective action, which upregulates glucose transporter-3 (GLUT3) and pyruvate dehydrogenase kinase-3 (PDK3). PDK3 inhibits pyruvate dehydrogenase, which decreases mitochondrial-acetyl-CoA, citrate, and cellular bioenergetics, and decreases neurocytoplasmic citrate, acetyl-CoA, and ACh formation, thus initiating AD pathophysiology. Therefore, GLUT3 and PDK3 can be biomarkers for silent phase of AD.

Ultrasound-guided noninvasive pancreas ablation using histotripsy: feasibility study in an in vivo porcine model

Pancreatic cancer is a malignant disease associated with poor survival and nearly 80% present with unresectable tumors. Treatments such as chemotherapy and radiation therapy have shown overall improved survival benefits, albeit limited. Histotripsy is a noninvasive, non-ionizing, and non-thermal focused ultrasound ablation modality that has shown efficacy in treating hepatic tumors and other malignancies. In this novel study, we investigate histotripsy for noninvasive pancreas ablation in a pig model. In two studies, histotripsy was applied to the healthy pancreas in 11 pigs using a custom 32-element, 500 kHz histotripsy transducer attached to a clinical histotripsy system, with treatments guided by real-time ultrasound imaging. A pilot study was conducted in 3 fasted pigs with histotripsy applied at a pulse repetition frequency (PRF) of 500 Hz. Results showed no pancreas visualization on coaxial ultrasound imaging due to overlying intestinal gas, resulting in off-target injury and no pancreas damage. To minimize gas, a second group of pigs (n = 8) were fed a custard diet containing simethicone and bisacodyl. Pigs were euthanized immediately (n = 4) or survived for 1 week (n = 4) post-treatment. Damage to the pancreas and surrounding tissue was characterized using gross morphology, histological analysis, and CT imaging. Results showed histotripsy bubble clouds were generated inside pancreases that were visually maintained on coaxial ultrasound (n = 4), with 2 pigs exhibiting off-target damage. For chronic animals, results showed the treatments were well-tolerated with no complication signs or changes in blood markers. This study provides initial evidence suggesting histotripsy's potential for noninvasive pancreas ablation and warrants further evaluation in more comprehensive studies.

Covalent surface modification of nickel ferrite nanoparticles for electrochemical supercapacitor performance

Magnetic nanoparticles play vital roles in diverse applications, due to their high surface-to-volume ratio, tuneable optical, electrical, catalytic, biological, nanofluidic, electrochemical supercapacitor, and data storage applications. However, there is a...

Imaging diagnosis and management of primary spinal hydatid disease: a case series

Background

Primary spinal hydatid disease (HD) is uncommon disease with significant morbidity. The diagnosis of this entity is not simple, unless the patient comes from an endemic area or has a history of HD elsewhere. Only few case reports and case series of this entity are available in the published literature. We report a series of three cases of primary spinal HD who had characteristic MR appearance and were managed successfully.

Case presentation

We report a series of 3 cases, two presenting with paraparesis and one with right lower limb weakness and hesitancy of micturition. MRI demonstrated multiloculated cystic lesion involving thoracic spine in two patients and lumbar spine in third patient. All the three patients were showing intraspinal extension with compression of neural structures. MRI features were characteristic of hydatid disease. All the three patients were managed surgically with gross total excision of the cysts followed by albendazole chemotherapy. Histopathology was consistent with hydatid cyst. Patients with dorsal spine disease showed improvement in motor weakness, but third one with lumbar spinal disease had to use foot splint for walking. None of the patient showed features of recurrence on follow-up.

Conclusion

Radiologist should be familiar with the typical and atypical manifestations of the disease and should keep it in the differential diagnosis of cystic spinal lesions. Radical surgical excision along with postoperative adjuvant albendazole chemotherapy is the mainstay of treatment.

Volumetric breast density evaluation using fully automated Volpara software, its comparison with BIRADS density types and correlation with the risk of malignancy

Background

Mammography is currently the modality of choice for mass screening of breast cancer, although its sensitivity is low in dense breasts. Besides, higher breast density has been identified as independent risk factor so it has been conceptualized that women with dense breasts should be encouraged for supplemental screening. In this study, we aimed to estimate the distribution of volumetric breast density using fully automated Volpara software and to analyze the level of agreement between volumetric density grades and Breast Imaging Reporting and Data System (BI-RADS) density grades. We also aim to estimate the distribution of breast cancer in different VDG and to find a correlation between VDG and risk of malignancy.

Results

VDG-c was most common followed by VDG-b and BIRADS grade B was commonest followed by grade C. The density distribution was found inversely related to the age. Level of agreement between VDG and BIRADS grades was moderate (κ = 0.5890). Statistically significant correlation was noted between VDG-c and d for risk of malignancy (p < 0.001).

Conclusion

Difficulties associated with the use of BI-RADS density categories may be avoided if assessed using a fully automated volumetric method. High VDG can be considered as independent risk factor for malignancy. Thus, awareness of a woman’s breast density might be useful in determining the frequency and imaging modality for screening.

Evaluation of volumetric breast density as a risk factor for breast carcinoma in pre- and postmenopausal women, its association with hormone receptor status and breast carcinoma subtypes defined by histology and tumor markers

Background

Mammographic breast density is acknowledged as an independent risk factor for breast cancer. Its association with different pathological types and tumors markers is still under evaluation. This study aims to assess the associations of volumetric density grades (VDG) with breast cancer risk in premenopausal and postmenopausal age groups separately. We also aim to assess the association of VDG with hormone receptor status and breast cancer subtypes defined by histology and tumor markers (ER, PR, Her 2-neu and Ki 67).

Results

This retrospective study was done with inclusion of two comparable groups of 185 breast cancer cases and 244 healthy controls. These groups were further divided into pre‑ and postmenopausal subgroups. Mammograms of the cases and controls were evaluated by fully automated volumetric breast density software-VOLPARA and classified into four VDG. The hormone receptor status and breast cancer subtypes defined by histological features and tumor markers in the various VDG were also evaluated. The risk of developing carcinoma was significantly higher in women with high-density breasts (VDG-c + VDG-d) as compared with low-density breasts (VDG-a + VDG-b) in both premenopausal and postmenopausal subgroups. No significant difference was seen in the histopathological characteristics of breast cancer among various VDG.

Conclusions

Our study suggests positive association between high VDG and risk of cancer in both premenopausal and postmenopausal group of Indian women. The hormone receptor status and breast cancer subtypes defined by histology and tumor markers did not reveal any relation to the grades of breast density.