THE IMPACT OF CLIMATE CHANGE ON INFECTIOUS DISEASES: A COMPREHENSIVE ANALYSIS OF VECTOR-BORNE DISEASES, WATER-BORNE DISEASES, AND PUBLIC HEALTH STRATEGIES

Climate change is long-term modifications to weather patterns and a rise in extreme weather events. It might modify the hazard to human health and exacerbate current problems. The article explores the scientific data in a description of the effects of Infectious diseases in humans and climate change. It identifies scientific advancements and gaps in potential responses from human civilization and how it might prepare for the changes that come with it by adjusting to them. The impact reflects three aspects, such as climate variables, selected infectious diseases, and infectious disease components. This study demonstrates how vulnerable people are to any ill consequences that climate change may have on their health. Humans can actively influence controllable correlated health impacts by taking proactive measures, such as increasing our understanding of the detrimental effects associated with specific diseases and the patterns in climate change. We can also carefully distribute technology and resources, encouraging exercise and public awareness. It is advised to take the following adaption measures: Considering how infectious diseases and climate change are not the only things that science has discovered and create locally efficient early warning systems for those effects to produce more scientific justifications and go beyond scientific reports. Improve prediction of the spatiotemporal processes behind climate change and changes in infectious illnesses connected at different temporal and spatial scales.

Venoms classification and therapeutic uses: a narrative review

The mere glimpse of venomous animals has always terrified humans because of the devastating effects of their venoms. However, researchers across the globe have isolated therapeutically active ingredients from these venoms and continue to explore them for drug leads. These efforts lead to the discovery of therapeutic molecules that the US-FDA has approved to treat different diseases, such as hypertension (Captopril), chronic pain (Ziconotide), and diabetes (Exenatide). The main active constituents of most venoms are proteins and peptides, which gained more attention because of advancements in biotechnology and drug delivery. The utilization of newer screening approaches improved our understanding of the pharmacological complexity of venom constituents and facilitated the development of novel therapeutics. Currently, with many venom-derived peptides undergoing different phases of clinical trials, more are in pre-clinical drug development phases. This review highlights the various sources of venoms, their pharmacological actions, and the current developments in venom-based therapeutics.

Independent prognostic value of ventricular premature complexes during exercise and recovery in asymptomatic patients: a meta-analysis of observational studies

Introduction

Ventricular premature contractions (VPCs) are a common finding during a cardiac stress test. The independent prognostic value of these findings in asymptomatic participants is not clear.

Purpose

To investigate the cumulative independent prognostic value of VPC for adverse outcomes.

Methods

We conducted a systematic review and meta-analysis of observational studies in the following databases: MEDLINE, Embase®, and Cochrane Central from inception till January 28, 2022. The primary outcome was the cumulative hazard of all-cause mortality with VPCs during exercise or recovery in asymptomatic participants. The secondary outcome was cardiovascular mortality. We stratified results based on VPC during exercise or recovery.

We included studies with participants with no known CV disease and known CV disease. If there was known CV disease at baseline, the study should have adjusted for at least ≥1 known confounder. If a study reported low risk or higher risk VPCs, we included outcomes with higher risk VPCs to make the data comparable across literature. Random effect meta-analyses were used to predict cumulative hazard ratios. The review was registered with PROSPERO (registration number CRD42022297028)

Results

We found 10 studies with 47,497 participants that met our inclusion criteria (8 studies with all-cause and CV mortality, 2 studies with CV mortality only). Three studies included patients with baseline CV disease (proportion 12–33%). Follow-up duration ranged from 5.3 to 20.3 years. Definition of VPCs differed in the individual studies.

Both VPCs during exercise and recovery were associated with a higher hazard of all-cause mortality (HR 1.21, 95% confidence interval [CI] 1.07, 1.34 and 1.32, 95% CI 1.06, 1.58, p<0.001 and low heterogeneity for both, respectively, Figure 1A). There was no small study treatment effect bias.

Similarly, both VPCs during exercise and recovery were associated with a higher hazard of CV mortality (HR 1.63, 95% CI 1.30, 1.96 and 1.68, 95% CI 1.00, 2.35, p<0.001, and low heterogeneity for both, respectively, Figure 1B).

The presence of VPC had a numerically stronger association with CV mortality than all-cause mortality. VPCs during recovery seem to have more prognostic value than VPC during rest.

Conclusion

After adjusting for known confounders, VPCs during exercise and recovery predict a higher risk of all-cause and CV mortality. The risk is higher with VPCs during recovery.

Funding Acknowledgement

Type of funding sources: None.

Use of pulse oximetry during nitrous oxide- oxygen inhalation sedation: mandatory or recommended?

AIM

There is skepticism amongst many dentists about the interference of nitrous oxide with the physiological parameters. This commentary attempts to make clear recommendations on the use of pulse oximeter during nitrous oxide inhalation sedation.

BACKGROUND

Nitrous oxide is used commonly in dentistry as a tool to reduce fear/ anxiety and build a positive dental attitude. Dentists use pulse oximeter to monitor oxygen saturation during the period of administration of nitrous oxide. There is no consensus amongst various guidelines across the world on the necessity of using pulse oximeter during the period of administration of nitrous oxide CONCLUSION: Pulse oximetry may not be considered mandatory when nitrous oxide gas is being administered for minimal sedation to a healthy patient having no pre- existing diseases/illness.

Lung Function Tests in Hairdressers of Gangtok: A Cross-Sectional Study

Background

Hairdressers undergo extensive and prolonged exposure to a variety of chemical substances present in the air in their salons. Although in low concentrations, the various products used for hair care are harmful as most of these products generate chemical aerosols during different procedures. These aerosols which have irritant or sensitizing effects on respiratory mucosa have been found to enter into the airways.

Aim

The aim of this study is to assess the impairment of lung function in hairdressers in Gangtok.

Method

This is a cross-sectional, comparative study conducted on 50 hairdressers and 50 age- and sex-matched non-hairdresser comparison group. The sampling technique used was simple random sampling. Permission from Institutional Ethical Committee was obtained before beginning the study. A standard questionnaire was used to record the respiratory symptoms. The pulmonary function parameters of the subjects were measured using portable spirometer HELIOS 720.

Results

All the parameters were decreased in hairdressers and almost all the differences were statistically significant. FEV1 (P = 0.023) and FEV1/FVC ratio (P < 0.05) were reduced significantly. FEF25-75% and PEFR were also significantly reduced (P < 0.05 in both parameters). FVC was also reduced in hairdressers, but it was not statistically significant (P = 0.342).

Conclusion

Hairdressers undergo exposure to different chemicals in their workplace and carry the risk of decreased pulmonary function.

Assessment of prescribing pattern of drugs and completeness of prescriptions as per the World Health Organization prescribing indicators in various Indian tertiary care centers: A multicentric study by Rational Use of Medicines Centers-Indian Council of Medical Research network under National Virtual Centre Clinical Pharmacology activity

OBJECTIVE

The rational use of medicines as per the World Health Organization (WHO) should be practiced globally. However, data regarding the completeness of the prescriptions and their rational use is lacking from developing countries like India. Thus, the aim of this study was to assess the prescribing patterns of drugs and completeness of prescriptions as per WHO core drug use and complementary indicators to provide real-life examples for the Indian Council of Medical Research (ICMR) online prescribing skill course for medical graduates.

METHODS

Prescriptions of the patients, fulfilling inclusion criteria, attending Outpatient Departments of various specialties of tertiary care hospitals, were collected by thirteen ICMR Rational use of medicines centers located in tertiary care hospitals, throughout India. Prescriptions were evaluated for rational use of medicines according to the WHO guidelines and for appropriateness as per standard treatment guidelines using a common protocol approved by local Ethics committees.

RESULTS

Among 4838 prescriptions, an average of about three drugs (3.34) was prescribed to the patients per prescription. Polypharmacy was noted in 83.05% of prescriptions. Generic drugs were prescribed in 47.58% of the prescriptions. Further, antimicrobials were prescribed in 17.63% of the prescriptions and only 4.98% of prescriptions were with injectables. During the prescription evaluation, 38.65% of the prescriptions were incomplete due to multiple omissions such as dose, duration, and formulation.

CONCLUSION

Most of the parameters in the present study were out of the range of WHO-recommended prescribing indicators. Therefore, effective intervention program, like training, for the promotion of rational drug use practice was recommended to improve the prescribing pattern of drugs and the quality of prescriptions all over the country.

Metachronous isolated inferior vena cava tumour thrombus in renal cell cancer: a rare aftermath

Renal cell cancer (RCC) accounts for 3% of all solid malignancies. Synchronous tumour thrombus in the renal vein or inferior vena cava is reported in 4-10% cases and is a surgical challenge. Contemporary imaging modalities that are used to define the presence and extent of venous thrombus include colour Doppler, contrast-enhanced computed tomography and magnetic resonance venography. Surgical management depends upon the degree of tumour thrombus. We report isolated recurrence of RCC in the inferior vena cava 2 years after radical nephrectomy, and discuss its pathophysiology and management.

The SARS-CoV-2 Spike protein alters human cardiac pericyte function and interaction with endothelial cells through a non-infective mechanism involving activation of CD147 receptor signalling

Background

Human cardiac pericytes (PC) were proposed as the main cellular target for SARS-CoV-2 in the heart due to high transcriptional levels of the angiotensin-converting enzyme 2 (ACE2) receptor. Emerging reports indicate CD147/Basigin (BSG), highly expressed in endothelial cells (EC), is an alternative SARS-CoV-2 receptor. To date, the mechanism by which the virus infects and disrupts the heart vascular cells was not identified yet. Moreover, cleaved Spike (S) protein molecules could be released into the bloodstream from the leaking pulmonary epithelial-endothelial barrier in patients with severe COVID-19, opening to the possibility of non-infective diseases in organs distant from the primary site of infection.

Purposes

(1) to confirm that human primary cardiac PC express ACE2 and CD147; (2) to verify if PC are permissible to SARS-CoV-2 infection; (3) to investigate if the recombinant SARS-CoV-2 S protein alone, without the other viral elements, can trigger molecular signalling and induce functional alterations in PC; (4) to explore which viral receptor is responsible for the observed events.

Methods and results

Cardiac PC express both the ACE2 and CD147 receptors at mRNA and protein level. Incubation of PC for up to 5 days with SARS-CoV-2 expressing the green fluorescent protein (GFP) did not show any evidence of cell infection or viral replication. Next, we exposed the PC to the recombinant S protein (5.8 nM) and confirmed that the protein engaged with cellular receptors (western blot analysis of S protein in treated and control PC). Incubation with the S protein increased PC migration (wound closure assay, P&lt;0.01 vs ctrl) and reduced the formation of tubular structures between PC and EC in a Matrigel assay (P&lt;0.01 vs ctrl). Moreover, the S protein promoted the production of pro-inflammatory factors typical of the cytokine storm in PC (ELISA measurement of MCP1, IL-6, IL-1β, TNFα, P&lt;0.05 vs ctrl), and induced the secretion of pro-apoptotic factors responsible for EC death (Caspase 3/7 assay, P&lt;0.05 vs ctrl). Signalling studies revealed that the S protein triggers the phosphorylation/activation of the extracellular signal-regulated kinase 1/2 (ERK1/2) through the CD147 receptor, but not ACE2, in cardiac PC. The neutralization of CD147, using a blocking antibody, prevented ERK1/2 activation in PC, and was reflected into a partial rescue of the cell functional behaviour (migration and pro-angiogenic capacity). In contrast, blockage of CD147 failed to prevent the pro-inflammatory response in PC.

Conclusions

We propose the novel hypothesis that COVID-19 associated heart's microvascular dysfunction is prompted by circulating S protein molecules rather than by the direct coronavirus infection of PC. Besides, we propose CD147, and not ACE2, as the leading receptor mediating S protein signalling in cardiac PC.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): BHF project grant “Targeting the SARS-CoV-2 S-protein binding to the ACE2 receptor to preserve human cardiac pericytes function in COVID-19” BHF Centre for Vascular Regeneration II

516 Does the Use of Adjuvant Chemotherapy Increase Incisional Hernia Rates in Colorectal Cancer Patients – A Retrospective Single Centre Cohort Study

Aim

Incisional hernias (IH) are a known complication of any major abdominal surgery. It is known that chemotherapy impairs healing processes via delayed inflammation, impaired collagen synthesis and reduced fibrin deposition and wound contraction. There are currently, to our knowledge, no trials examining the effect of adjuvant chemotherapy on incidence of IH in patients with colorectal cancer. This study aims to assess the same by comparing IH rates between chemotherapy and non-chemotherapy patient groups.

Method

All the patients who had major surgery for colorectal cancer between January 2009 and January 2014 were divided into two groups of chemotherapy (A) and non-chemotherapy (B). Records of first 160 patients from each group were retrospectively analysed.

Results

There were non-significant differences between groups for sex, tumour location, primary operation, and type of procedure (emergency or elective). Significant differences were observed for age (more elder patients in group B, p = 0.000011), method of access (more open procedures in group B and more laparoscopic procedures in group A, p = 0.0007) and Charlson co-morbidity scores (more advanced score in group B, p = 0.029). We found that 21/120 (21.21%) patients in the chemotherapy group and 12/99 (13.79%) patients in non-chemotherapy group developed Incisional hernias. Although there was a higher rate of IH in the chemotherapy group, this was not statistically significant (p = 0.27).

Conclusions

Although this study fails to demonstrate any statistically significant difference in IH incidence between two groups, but this study can act as a pilot in order to fuel further high-quality research to draw more valid conclusions.

Implementation of an acute tonsillitis management protocol within a clinical decisions unit

INTRODUCTION

With tonsillectomy surgery subject to increasingly strict commissioning criteria over the past 20 years in the UK, the total number of admissions for acute tonsillitis has been rising steadily. Multiple single-centre studies have demonstrated how introduction of a standardised management protocol can be effective in improving the delivery of treatment for acute tonsillitis in the emergency department.

METHODS

Using a novel approach, we aimed to implement an acute tonsillitis management protocol within a formal clinical decisions unit (CDU) pathway. Following a retrospective baseline audit, we carried out two post-intervention cycles of data collection to assess safety and efficacy.

RESULTS

The median number of initial treatments increased significantly from two of five at baseline, to three of five in both the first (U = 86, p = 0.004) and second (z = 2.959, p = 0.003) audit cycles. Admission rate was reduced from 0.79 to 0.44 in the first cycle, representing a 44.6% relative risk reduction [95% confidence interval (CI) 0.304-1.012; p = 0.0547]. Admission rate remained reduced at 0.48 in the second cycle, with a relative risk reduction of 39.2% compared with baseline (95% CI 0.380-0.972; p = 0.038).

CONCLUSIONS

Utilisation of the CDU led to an improvement in the delivery of initial treatment, an extended period of observation and subsequently a greater percentage of patients being discharged. An acute tonsillitis management protocol within a CDU appears to be a safe and effective model and is now standard practice in our hospital.

Comparative evaluation of the conventional tube test and column agglutination technology for ABO antibody titration in healthy individuals: a report from India

Determination of accurate anti-A/-B titers is important for treatment selection in ABO-incompatible stem cell and solid-organ transplants. The standard method for ABO antibody titration is the conventional tube test (CTT). Dithiothreitol (DTT) is commonly used to inactivate the IgM antibody component. The aim of this study was to compare six different methods for ABO antibody titration and to observe the effectiveness of DTT on antibody estimation. A total of 90 healthy voluntary blood donors were enrolled in this study, including 30 each for blood groups A, B, and O. Antibody titrations were performed and tested using the CTT-immediate spin (IS), CTT-antihuman globulin (AHG) with and without DTT, column agglutination technology (CAT)-IS, and CAT-AHG with and without DTT methods. Bead-CAT was used, and the positive cutoff value was set to 1+ for each method to determine the endpoint of the titer. The median values of anti-A/-B titers by IS were found to be higher than those values by AHG in CTT and CAT among group B and A individuals, whereas no statistically significant differences were observed in values from group O individuals for IS and AHG anti-A/-B titers, estimated by each method. Although there was positive correlation between the anti-A/-B titer results obtained using the CTT and CAT in all blood groups, testing using AHG showed poor agreement with and without DTT pretreatment (kappa value of 0.11 and 0.20, respectively). Moderate agreement was observed between CTT-IS and CAT-IS (kappa value of 0.46). Median anti-A/-B AHG titers were reduced by the use of DTT in all blood group samples. Significant differences in the interpretability of anti-A/-B titers were observed among different methods. A uniform approach for selecting the method for ABO antibody titration is highly recommended, and DTT pretreatment of plasma to neutralize IgM activity should be considered to obtain precise values of IgG anti-A/-B titers. Immunohematology 2021;37:25-32 .

Determination of accurate anti-A/-B titers is important for treatment selection in ABO-incompatible stem cell and solid-organ transplants. The standard method for ABO antibody titration is the conventional tube test (CTT). Dithiothreitol (DTT) is commonly used to inactivate the IgM antibody component. The aim of this study was to compare six different methods for ABO antibody titration and to observe the effectiveness of DTT on antibody estimation. A total of 90 healthy voluntary blood donors were enrolled in this study, including 30 each for blood groups A, B, and O. Antibody titrations were performed and tested using the CTT-immediate spin (IS), CTT-antihuman globulin (AHG) with and without DTT, column agglutination technology (CAT)-IS, and CAT-AHG with and without DTT methods. Bead-CAT was used, and the positive cutoff value was set to 1+ for each method to determine the endpoint of the titer. The median values of anti-A/-B titers by IS were found to be higher than those values by AHG in CTT and CAT among group B and A individuals, whereas no statistically significant differences were observed in values from group O individuals for IS and AHG anti-A/-B titers, estimated by each method. Although there was positive correlation between the anti-A/-B titer results obtained using the CTT and CAT in all blood groups, testing using AHG showed poor agreement with and without DTT pretreatment (kappa value of 0.11 and 0.20, respectively). Moderate agreement was observed between CTT-IS and CAT-IS (kappa value of 0.46). Median anti-A/-B AHG titers were reduced by the use of DTT in all blood group samples. Significant differences in the interpretability of anti-A/-B titers were observed among different methods. A uniform approach for selecting the method for ABO antibody titration is highly recommended, and DTT pretreatment of plasma to neutralize IgM activity should be considered to obtain precise values of IgG anti-A/-B titers. Immunohematology 2021;37:25–32 .

908 Personal Protective Equipment (PPE) Guidance During A Global Pandemic: A Statistical Analysis of National Perceived Confidence, Knowledge, And Educational Deficits Amongst U.K. Based Doctors

Introduction

March 11th, 2020 saw the World Health Organisation declare a global pandemic following the eruption of the novel coronavirus disease 2019. Unprecedented global demand for personal protective equipment (PPE) was complicated by limited availability and conflicting guidance from healthcare bodies. This study aimed to assess perceived confidence and knowledge of Public Health England’s PPE guidance amongst doctors of varying specialties and grades.

Method

A nationwide 11-point survey comprising of multiple-choice questions (MCQs) and a Likert scale assessing perceived confidence (1=not confident, 5=very confident) was disseminated to U.K. based doctors using multiple platforms.

Results

Data collated from 697 respondents revealed average perceived confidence was low. Notably, 59% felt they had received insufficient education regarding up-to-date guidance, with 81% advocating further training. Anaesthetics and ophthalmology were the highest and lowest scoring specialties in knowledge based MCQs, achieving 59% and 31% respectively. Subsequent statistical analysis revealed significant differences between specialties."

Conclusions

Ensuring consistency in published PPE guidance and education can develop doctor’s confidence and knowledge of appropriate PPE use. The absence of a unified consensus and global education regarding the use of PPE poses significant ramifications for patient and healthcare professional (HCP) safety whilst risking further depletion of already sparse resources.

Ultrasound-guided sacral multifidus plane block for analgesia following excision of sacrococcygeal teratoma in two neonates

Peri-operative pain management in the neonate with a sacrococcygeal teratoma poses significant challenges to the anaesthetist. Involvement of the sacrococcygeal area by the tumour often prevents the use of conventional regional anaesthetic techniques such as caudal or epidural analgesia, with a subsequent reliance on intravenous opioids and paracetamol. Since opioids are associated with respiratory depression, constipation and urinary retention, there is high incidence of opiophobia with consequent inappropriate dosage prescription, particularly in the paediatric population. We describe the use of an ultrasound-guided sacral multifidus plane block in two neonates undergoing surgical excision of sacrococcygeal teratoma. The block is technically easy to perform and also avoids traversing critical structures. Hence, it may be regarded as a promising analgesic technique for painful interventions in the sacrococcygeal area.

Psychological assessment and lived experiences of recovered COVID-19 patients who presented for convalescent plasma donation

Background

Increasingly, it has been seen that patients recovering from COVID-19 may face a second battle of coping with its mental health ramifications. These psychological issues can even be experienced by patients who were asymptomatic or had mild to moderate symptoms, potentially impacting their quality of life.

Methodology

This was a prospective observational study to analyse the psychological impact of COVID-19 in recovered patients who presented as prospective convalescent plasma (CP) donors. An interview for the psychological assessment of the prospective donors was carried out. Depression and anxiety in the participants were assessed by HAM-A, and HAM-D scores and Quality of Life were assessed using the WHOQOL-BREF scale.

Results

A total of 51 prospective donors were assessed, with a mean age of 34.37 (±9.08) years, with the majority being males (46). No clinically significant depression and anxiety were found on the basis of HAM-D and HAM-A scores. The worst affected quality of life parameter, based on the WHOQOL-BREF scale, was physical quality of life followed by environmental, psychological, and social relationships. Moreover, due to infection, social stigma was experienced by 49.02% of the donors, while 21.97% had anxiety related to convalescent plasma donation as a common livid experience.

Conclusion

Poor quality of life and social stigma during the recovery phase is prevalent in COVID-19 recovered patients, for which formulation of holistic support strategies are the need of the hour.

Cognitive Performance and Neuro-Metabolites in HIV Using 3T Magnetic Resonance Spectroscopy: A Cross-Sectional Study from India

BACKGROUND

Cognitive impairment in patients with human immunodeficiency virus (HIV) is associated with higher morbidity. The prevalence of the metabolite changes in the brain associated with cognitive impairment in anti-retroviral therapy naïve patients with HIV is unknown.

OBJECTIVE

To estimate the prevalence of the neurometabolites associated with cognitive impairment in antiretroviral therapy (ART) naïve patients with HIV.

METHODS

We conducted a cross-sectional study among ART naïve patients with HIV aged 18-50 years in a tertiary care center in India. Cognition was tested using the Post Graduate Institute battery of brain dysfunction across five domains; memory, attention-information processing, abstraction executive, complex perceptual, and simple motor skills. We assessed the total N-acetyl aspartyl (tNAA), creatine (tCr) and glutamate + glutamine (Glx) using 3T magnetic resonance spectroscopy. Cognitive impairment was defined as an impairment in ≥2 domains.

RESULTS

Among 43 patients eligible for this study, the median age was 32 years (IQR 29, 40) and 30% were women. Median CD4 count and viral load were 317 cells/μL (IQR 157, 456) and 9.3 copies/ μL (IQR 1.4, 38), respectively. Impairment in at least one cognitive domain was present in 32 patients (74.4%). Impairment in simple motor skills and memory was present in 46.5% and 44% of patients, respectively. Cognitive impairment, defined by impairment in ≥2 domains, was found in 22 (51.2%) patients. There was a trend towards higher concentration of tNAA (7.3 vs. 7.0 mmol/kg), tGlx (9.1 vs. 8.2 mmol/kg), and tCr (5.5 vs. 5.2 mmol/kg) in the frontal lobe of patients with cognitive impairment vs. without cognitive impairment but it did not reach statistical significance (p>0.05 for all). There was no difference in the concentration of these metabolites in the two groups in the basal ganglia.

CONCLUSION

There is a high prevalence of cognitive impairment in ART naïve patients with HIV. There is no difference in metabolites in patients with or without cognitive impairment. Further studies, with longitudinal follow-up are required to understand the underlying pathophysiological mechanisms.

Embryonal tumors with multilayered rosettes: A tertiary care centre experience

BACKGROUND

Embryonal tumors with multilayered rosettes (ETMR) is an extremely rare and highly aggressive tumor. It includes three distinct entities i.e, embryonal tumor with abundant neuropil and true rosettes (ETANTR), ependymoblastoma (EBL) and medulloepithelioma (MEPL). Here, we present our institutional experience of seven ETMR cases treated over a period of five years.

MATERIALS AND METHODS

Patients' records from 2015 to 2019 were reviewed manually and electronically to retrieve the data. Clinicopathological and outcome details of ETMR cases were entered in a predesigned proforma.

RESULTS

A total of seven cases of ETMR were registered from 2015 to 2019 with a median age at presentation of four years (range 3-7 years). All patients underwent surgery. However, only three patients completed the planned adjuvant treatment, comprising of focal radiotherapy (RT) alone, craniospinal irradiation (CSI) alone and CSI followed by six cycles of chemotherapy in one patient each respectively. Two patients commenced CSI but deteriorated during RT and thereafter needed best supportive care. Two patients could not be started on any adjuvant treatment. Unfortunately, six patients succumbed to their disease within one year of their diagnosis. Only one patient who received both CSI and adjuvant chemotherapy is alive at 15 months of diagnosis.

CONCLUSION

ETMR is a rare and aggressive entity. Majority of the patients die within one year of the diagnosis despite multimodality treatment.

Plant genetic resources in India: management and utilization

Plant genetic resources (PGR) are the foundation of agriculture as well as food and nutritional security. The ICAR-NBPGR is the nodal institution at national level for management of PGR in India under the umbrella of Indian Council of Agricultural Research (ICAR), New Delhi. India being one of the gene-rich countries faces a unique challenge of protecting its natural heritage while evolving mutually beneficial strategies for germplasm exchange with other countries. The Bureaus activities include PGR exploration, collection, exchange, characterization, evaluation, conservation and documentation. It also has the responsibility to carry out quarantine of all imported PGR including transgenics meant for research purposes. The multifarious activities are carried out from ICAR-NBPGR headquarters and its 10 regional stations located in different agro-climatic zones of India. It has linkages with international organizations of the Consultative Group on International Agricultural Research (CGIAR) and national crop-based institutes to accomplish its mandated activities. NBPGR collects and acquires germplasm from various sources, conserves it in the Genebank, characterizes and evaluates it for different traits and provides ready material for breeders to develop varieties for farmers. ICAR-NBPGR encompasses the National Genebank Network and at present, the National Genebank conserves more than 0.40 million accessions. NBPGR works in service-mode for effective utilization of PGR in crop improvement programmes which depends mainly on its systematic characterization and evaluation, and identification of potentially useful germplasm. NBPGR is responsible for identifying trait-specific pre-adapted climate resilient genotypes, promising material with disease resistance and quality traits which the breeders use for various crop improvement programmes. The system has contributed immensely towards safeguarding the indigenous and introducing useful exotic PGR for enhancing the agricultural production. Presently, our focus is on characterization of ex situ conserved germplasm and detailed evaluation of prioritized crops for enhanced utilization; assessment of impact of on-farm conservation practices on genetic diversity; genome-wide association mapping for identification of novel genes and alleles for enhanced utilization of PGR; identification and deployment of germplasm/landraces using climate analog data; validation of trait-specific introduced germplasm for enhanced utilization. Key words: plant genetic resources; gene banks; wild relatives; biotic and abiotic stresses; marker-assisted selection.

Effect of prophylactic granulocyte-colony stimulating factor (G-CSF) on acute hematological toxicity in medulloblastoma patients during craniospinal irradiation (CSI)

OBJECTIVES

Haematological toxicity and treatment breaks are common during cranio-spinal irradiation (CSI) due to irradiation of large volume of bone marrow. We conducted this study to see the effect of prophylactic granulocyte colony stimulating factor (GCSF) in reducing treatment breaks.

PATIENTS AND METHODS

The study was conducted over a period of 15 months from August 2017 to November 2018. Histopathologically proven Medulloblastoma patients received prophylactic GCSF during CSI. Acute hematological toxicities and treatment breaks were noted and effect of age and pretreatment blood counts were analyzed by SPSS (Statistical Package for Social Sciences) version 23.

RESULTS

A total of 28 patients were included in the study. During CSI, hematological toxicity leading to treatment breaks was observed in 11 (39.3 %) patients, of which grade 3 and 2 toxicities were seen in ten and one patients respectively. Younger age (<10 years) at diagnosis was significantly associated with the development of hematological toxicity (p = 0.028, Chi-Square). No correlation was found with pre-treatment blood counts.

CONCLUSION

Prophylactic use of GCSF may be effective in preventing radiation induced hematological toxicity and treatment breaks.

Aspirin as an adjuvant treatment for cancer: feasibility results from the Add-Aspirin randomised trial

BACKGROUND

Preclinical, epidemiological, and randomised data indicate that aspirin might prevent tumour development and metastasis, leading to reduced cancer mortality, particularly for gastro-oesophageal and colorectal cancer. Randomised trials evaluating aspirin use after primary radical therapy are ongoing. We present the pre-planned feasibility analysis of the run-in phase of the Add-Aspirin trial to address concerns about toxicity, particularly bleeding after radical treatment for gastro-oesophageal cancer.

METHODS

The Add-Aspirin protocol includes four phase 3 randomised controlled trials evaluating the effect of daily aspirin on recurrence and survival after radical cancer therapy in four tumour cohorts: gastro-oesophageal, colorectal, breast, and prostate cancer. An open-label run-in phase (aspirin 100 mg daily for 8 weeks) precedes double-blind randomisation (for participants aged under 75 years, aspirin 300 mg, aspirin 100 mg, or matched placebo in a 1:1:1 ratio; for patients aged 75 years or older, aspirin 100 mg or matched placebo in a 2:1 ratio). A preplanned analysis of feasibility, including recruitment rate, adherence, and toxicity was performed. The trial is registered with the International Standard Randomised Controlled Trials Number registry (ISRCTN74358648) and remains open to recruitment.

FINDINGS

After 2 years of recruitment (October, 2015, to October, 2017), 3494 participants were registered (115 in the gastro-oesophageal cancer cohort, 950 in the colorectal cancer cohort, 1675 in the breast cancer cohort, and 754 in the prostate cancer cohort); 2719 (85%) of 3194 participants who had finished the run-in period proceeded to randomisation, with rates consistent across tumour cohorts. End of run-in data were available for 2253 patients; 2148 (95%) of the participants took six or seven tablets per week. 11 (0·5%) of the 2253 participants reported grade 3 toxicity during the run-in period, with no upper gastrointestinal bleeding (any grade) in the gastro-oesophageal cancer cohort. The most frequent grade 1-2 toxicity overall was dyspepsia (246 [11%] of 2253 participants).

INTERPRETATION

Aspirin is well-tolerated after radical cancer therapy. Toxicity has been low and there is no evidence of a difference in adherence, acceptance of randomisation, or toxicity between the different cancer cohorts. Trial recruitment continues to determine whether aspirin could offer a potential low cost and well tolerated therapy to improve cancer outcomes.

FUNDING

Cancer Research UK, The National Institute for Health Research Health Technology Assessment Programme, The MRC Clinical Trials Unit at UCL.

Borrelia and Chlamydia Can Form Mixed Biofilms in Infected Human Skin Tissues

Our research group has recently shown that Borrelia burgdorferi, the Lyme disease bacterium, is capable of forming biofilms in Borrelia-infected human skin lesions called Borrelia lymphocytoma (BL). Biofilm structures often contain multiple organisms in a symbiotic relationship, with the goal of providing shelter from environmental stressors such as antimicrobial agents. Because multiple co-infections are common in Lyme disease, the main questions of this study were whether BL tissues contained other pathogenic species and/or whether there is any co-existence with Borrelia biofilms. Recent reports suggested Chlamydia-like organisms in ticks and Borrelia-infected human skin tissues; therefore, Chlamydia-specific polymerase chain reaction (PCR) analyses were performed in Borrelia-positive BL tissues. Analyses of the sequence of the positive PCR bands revealed that Chlamydia spp. DNAs are indeed present in these tissues, and their sequences have the best identity match to Chlamydophila pneumoniae and Chlamydia trachomatis. Fluorescent immunohistochemical and in situ hybridization methods demonstrated the presence of Chlamydia antigen and DNA in 84% of Borrelia biofilms. Confocal microscopy revealed that Chlamydia locates in the center of Borrelia biofilms, and together, they form a well-organized mixed pathogenic structure. In summary, our study is the first to show Borrelia-Chlamydia mixed biofilms in infected human skin tissues, which raises the questions of whether these human pathogens have developed a symbiotic relationship for their mutual survival.

Clinical and laboratory profile of anti-M

Anti-M is a frequently detected naturally occurring antibody that has been reported in various clinical settings and also in voluntary donors. We describe here the clinical and laboratory findings of 11 cases with anti-M detected at our center. This report is a retrospective study in which we reviewed our immunohematology laboratory records for cases involving anti-M. Both donor and patient data from a 28-month period (September 2014 to December 2016) were reviewed. During this period, 11 examples of anti-M were detected (8 patients, 1 voluntary whole blood donor, and 1 hematopoietic stem cell donor. Anti-M was also detected in one external quality assessment scheme sample received during this period. In conclusion, anti-M can be detected in various clinical settings. This antibody can be clinically significant; in the laboratory, it can present as a serologic problem such as an ABO group discrepancy or an incompatible crossmatch. After detection, management and course of action is determined by both the antibody characteristics and the clinical setting. Anti-M is a frequently detected naturally occurring antibody that has been reported in various clinical settings and also in voluntary donors. We describe here the clinical and laboratory findings of 11 cases with anti-M detected at our center. This report is a retrospective study in which we reviewed our immunohematology laboratory records for cases involving anti-M. Both donor and patient data from a 28-month period (September 2014 to December 2016) were reviewed. During this period, 11 examples of anti-M were detected (8 patients, 1 voluntary whole blood donor, and 1 hematopoietic stem cell donor. Anti-M was also detected in one external quality assessment scheme sample received during this period. In conclusion, anti-M can be detected in various clinical settings. This antibody can be clinically significant; in the laboratory, it can present as a serologic problem such as an ABO group discrepancy or an incompatible crossmatch. After detection, management and course of action is determined by both the antibody characteristics and the clinical setting.

Global feedforward active noise control in vibro-acoustic cavities without increasing structural vibrations

Interior noise in vibro-acoustic cavities may be generated due to acoustic and structural disturbances. Earlier studies have shown that for global control, the maximum reduction in acoustic potential energy can be realised by using an optimum combination of acoustic and structural actuators. However, it is observed that this reduction in interior noise may also be accompanied with an increase in kinetic energy of the cavity structure. This paper presents the development of a feedforward technique for active noise control in vibro-acoustic cavities ensuring that the noise reduction does not lead to an increase in kinetic energy. The problem is formulated as a constrained minimisation problem to minimise the acoustic potential energy subject to a constraint that the kinetic energy does not increase. Through a numerical study, it is shown that the optimum solution of the above problem indeed is favourable in terms of reduction in acoustic potential energy in the cavity and kinetic energy of the structure. The paper further proposes a method for solution of this constrained minimisation problem using a penalty function method and solution of sequential unconstrained problems. The proposed method is validated through a numerical study on a car-like cavity for single- and multi-tonal noise.

Iontophoresis and topical application of 8% arginine-calcium carbonate to treat dentinal hypersensitivity

Aim and objectives

The aim and the objectives were. (1) to assess the efficacy of a desensitizing toothpaste containing 8.0% arginine-calcium carbonate (Colgate® Sensitive Pro-Relief™), (2) to assess the efficacy of a desensitizing toothpaste containing 8.0% arginine-calcium carbonate (Colgate® Sensitive Pro-Relief™) used in combination with iontophoresis, and (3) to compare the effectiveness of the above methods.

Subjects and Methods

Two groups of 40 patients each having dentinal hypersensitivity were treated using 8% proarginine and iontophoresis. The patients were recalled after 1, 2, and 4 weeks. The scores were tabulated and the results were analyzed using SPSS statistical software.

Results

Visual analog scale between the two groups showed a significant difference from the 1^st week till the 4^th week. ANOVA values showed the reduction in the dentinal hypersensitivity in Group 2 using the iontophoresis along with the 8.0% arginine-calcium carbonate toothpaste. The Cochran-Mantel-Haenszel correlation test of the Schiff's dentinal hypersensitivity cross-tabulation showed P < 0.001 which was statistically significant reduction after the 4^th week following the application of 8.0% arginine-calcium carbonate along with iontophoresis.

Conclusion

Iontophoresis, when used along with Colgate® Sensitive Pro-Relief™ toothpaste, can provide additional benefit as this provides a better sealing effect.

Tunica vaginalis flap for salvaging testicular torsion: A matched cohort analysis

INTRODUCTION

In testicular torsion, ischemia time from pain onset impacts testicular salvage. A tunica albuginea fasciotomy to relieve compartment pressure followed by a tunica vaginalis flap (TVF) may enhance salvage.

OBJECTIVE

To define the optimal window of ischemia time during which TVF may be most beneficial to avoid orchiectomy.

STUDY DESIGN

A retrospective cohort study of males presenting with testicular torsion at a single tertiary-care institution from January, 2003 to March, 2017. Ischemia time was defined as duration of pain from onset to surgery. Because TVF would be an option to orchiectomy, and it was found that ischemia time was longer in testicles that underwent orchiectomy, matching was performed. Cases of torsion treated with TVF were matched 1:1 with cases treated with orchiectomy on age at surgery, and ischemia time. Outcomes included postoperative viability, defined as palpable testicular tissue with normal consistency, and atrophy, defined as palpable decrease in size relative to contralateral testicle. Sensitivity analyses were performed restricting to the subgroups with postoperative ultrasound, >6 months' follow-up, and additionally matching for degrees of twist.

RESULTS

A total of 182 patients met eligibility criteria, of whom 49, 36, and 97 underwent orchiectomy, TVF, and septopexy alone, respectively. Median follow-up was 2.7 months; 26% of patients had postoperative ultrasound (61% of TVF group). In the orchiectomy, TVF, and septopexy groups, respectively, median ischemia times were 51, 11, and 8 h, postoperative viability rates were 0, 86, and 95%, and postoperative atrophy rates were 0, 68, and 24%. After matching, 32 patients with TVF were matched to 32 patients who underwent orchiectomy. In the TVF group, postoperative viability occurred in 95% (19/20) vs 67% (8/12) of patients with ischemia times ≤24 and >24 h, respectively. Atrophy occurred in 67% (12/18) vs 83% (10/12) of these same respective patients. Sensitivity analysis by ultrasound and longer follow-up found similar viability results, although atrophy rates were higher. Additional matching for degrees of twist showed lower viability and higher atrophy rates for increasing ischemia times.

DISCUSSION

Patients who presented with testicular torsion with ischemia times ≤24 h and who were being considered for orchiectomy may have benefitted most from TVF, albeit at high risk of atrophy. However, for ischemia times >24 h, TVF may still have preserved testicular viability in two-thirds of cases. A limitation was short follow-up.

CONCLUSION

A TVF was a valid alternative to orchiectomy for torsed testicles, albeit with high testicular atrophy rates.