Definitive Surgery after Neoadjuvant Chemotherapy for Locally Advanced Oral Cavity Cancers: Experience from a Tertiary Care Center

Mansi AgrawalVidya KonduruBackground  Oral cavity cancers require definitive surgical resection as the primary treatment, but with advanced T stage, complete resection with pathologically negative margins might be difficult to achieve. Induction chemotherapy helps achieve the balance between resection and morbidity in locally advanced technically unresectable tumors. The aim of this study was to analyze the impact of surgery in locally advanced, technically unresectable oral cavity cancers after neoadjuvant chemotherapy (NACT). Materials and Methods  A retrospective analysis of patients with borderline resectable, locally advanced oral cavity cancers who were given NACT between February 2017 and December 2021 was conducted. Data regarding clinical and pathological characteristics, NACT, surgery, adjuvant therapy, and recurrences was analyzed. Results  Of the 69 patients in the study, 69.6% had tongue cancer, rest were gingivobuccal complex cancers. All tumors were resected based on the post-NACT tumor volume and clear margins were achieved in 42% of cases. About 85.4% of the tongue cancers required a lesser resection than anticipated, thereby following the concept of organ and functional preservation post-NACT as proposed by Licitra et al. About 30.4% had ypT0 and 17.4% had ypN0. Recurrence and survival rates noted in our study were comparable to those reported in literature. Lymph node density of more than or equal to 0.07 was found in all recurrent cases. Conclusions  Induction chemotherapy offers a chance of achieving adequate surgical resection while reducing morbidity and improving functional outcomes for patients with technically unresectable oral cavity cancers. Nodal disease may not respond to chemotherapy as well as the primary tumor. There is a need for comprehensive evaluation of prognostic factors, which could help identify the patients who will most benefit with NACT.

Role of Infrared Thermography in Planning and Monitoring of Head and Neck Microvascular Flap Reconstruction

Background

Reconstruction using microvascular free flaps has become the standard of care in head and neck cancer surgery, and their success lies in appropriate planning, adequate revascularization, and early detection of flap compromise so that prompt salvage is possible. This study evaluates the role of infrared thermography in the planning, execution, and postoperative monitoring of microvascular flaps in head and neck reconstructions.

Methods

This is a single institutional, prospective observational study conducted at a tertiary care hospital in South India for 13 months. Twenty patients were included, and their thermographic images were captured in the preoperative, intraoperative, and postoperative settings using the infrared camera FLIR T400. These images were analyzed along with the Doppler, and clinical monitoring findings in all the settings and the temperature difference were calculated postoperatively.

Results

Hotspot perforator marking was made using infrared camera, and perforator marking was made using hand-held Doppler preoperatively, which correlated in 93% of cases. Intraoperatively, flap rewarming was successfully demonstrated in 19 of 20 cases. Postoperatively, flap compromise was observed on infrared thermography during the first 24 hours but not on clinical monitoring in three cases. The temperature difference values recorded were 5.4°C, 2.4°C, and 4.9°C. The mean of temperature difference of the healthy flaps was 1.0°C (range 0.1°C-1.8°C).

Conclusion

Infrared thermography provides simple and reliable imaging, which can be used in perforator marking and flap designing preoperatively and checking the flap perfusion and vascular anastomosis patency intra- and postoperatively.

Lane-Hamilton syndrome - Is it really a needle in a haystack?

Introduction

The association of pulmonary hemosiderosis with celiac disease (Lane-Hamilton syndrome) is extremely rare.

Case Details

A five-year-old female child presented with fever, cough, breathlessness, and pallor for 20 days, without any previous history of recurrent lower respiratory tract infections, tuberculosis, or cardiac disease. There was no history of pica, chronic diarrhea, bleeding, or personal or family history of repeated blood transfusions. She had tachycardia, tachypnea, severe pallor, stunting, rickets, and bilateral fine lung crepitations. Peripheral smear and blood indices revealed dimorphic anemia. Anti-tissue transglutaminase IgA antibody levels were high (>200 U/mL) and the upper gastrointestinal endoscopy with duodenal biopsy confirmed the diagnosis of celiac disease. The child was discharged on a gluten-free diet (GFD) and oral hematinic, but her dietary compliance was poor. Interestingly, the child had persistent bilateral pulmonary infiltrates, which was initially attributed to congestive cardiac failure (CCF), which persisted even despite treatment. HRCT chest revealed interstitial thickening and bilateral alveolar shadows and bronchoalveolar lavage showed a few inflammatory cells. The child was readmitted four times with similar complaints and was given packed red cell transfusions. In the fourth admission, a lung biopsy was done, which revealed extensive pulmonary hemosiderosis. The patient was given a course of oral steroids for 6 weeks, with a gluten-free diet, following which both the anemia and the pulmonary infiltrates resolved.

Conclusion

Pulmonary hemosiderosis is an important cause of anemia in cases of celiac disease and may be misdiagnosed as CCF due to severe anemia. A strict GFD, with or without corticosteroids, can reverse the clinical and radiological picture.

Understanding esports industry and impact of Covid-19 on it: a review of literature

COVID-19 brought the whole world to a halt suddenly and forced it to go on social distancing & lockdown. COVID-19 has impacted every industry worldwide differently and mostly negatively, so we wanted to look at its impact on the ‘esports industry,’ especially in the Indian context. To understand the impact, we did a detailed literature review of academic papers, articles, industry reports to determine the current trend and predict possibility in the future. Our findings indicate that although the industry is facing issues, COVID-19 actually might have helped the esports industry in the long term and expedite its progress among the young generation. Once everything was done, we analyzed the complete literature review, and based on that; we listed out our findings, and based on our findings, we did a final evaluation. We reviewed the existing work of academicians, business reports, industry reports, trends captured by news/media organizations, and the current state of video games to find the trends & reasons which could help us solve our question.

Minimally invasive techniques as a first line approach in the management of emphysematous pyelonephritis - A single centre experience

Context:

Emphysematous pyelonephritis (EPN) is a dangerous necrotizing infection of the kidney involving the diabetics with a high case fatality rate. Recent medical literature has shown shifting of treatment strategy from conventional radical approach to minimally invasive approach.

Aims:

The aim of our study was to assess the role of minimally invasive stepwise decompression techniques in the management of EPN and preservation of the renal unit.

Settings and Design

: This was a retrospective observational study conducted from June 2017 to April 2020 at a tertiary care centre.

Material and Methods:

We reviewed the hospital online records of 18 patients diagnosed with EPN for patient demographics, clinical profiles, co-morbidities, laboratory and, radiological investigations, surgical interventions performed and the outcomes. The severity of EPN was graded as per the Huang classification. Patients underwent surgical interventions as per the treatment protocol and response was assessed.

Statistical Analysis Used:

Descriptive statistics was applied.

Results:

Diabetes mellitus was present in 15 (83.3%) patients along with urinary tract obstruction in 8 (44.4%) patients. Flank pain (77.7%) was the most common presenting clinical feature while Escherichia coli (55.5%) were the most common causative organism. Most patients (50%) had Type- II EPN, all of which were managed successfully by minimally invasive procedures. In total seventeen patients (94.4%) responded well while one patient (5.5%) underwent nephrectomy with no mortality.

Conclusions:

Renal salvage in EPN requires multidisciplinary approach including the initial medical management followed by properly selected stepwise decompressive surgical techniques. Conservative management and decompression techniques have shown to improve patient's outcome, reducing the traditional morbidity associated with nephrectomy.

Effects of plant age on performance of the tropical perennial fodder grass, Cenchrus ciliaris L. subjected to elevated ultraviolet-B radiation

Abiotic stress, notably high ultraviolet-B (eUV-B), limit growth and productivity of many crop plants, but information on response of forage grasses to eUV-B radiation is rather limited. The present study was therefore conducted to increase our understanding of differential age-related responses on growth, metabolism and fodder quality of Cenchrus ciliaris-3108 (Buffel grass) to elevated UV-B (eUV-B: 7.2 kJ·m^-2 ·day^-1 ). Plant growth at both growth stages was notably reduced in response to eUV-B, except for the number of nodes and tillers at vegetative and reproductive stages. At anthesis, tillering increased due to the perennial habit of this plant, but leaf senescence reduced the number of leaves per tiller. Unlike ambient UV-B, eUV-B at the vegetative stage resulted in diversion of photosynthate for the formation of secondary metabolites (tannins and phenolics), providing dual protection from photooxidative damage and from herbivory. The forage biomass as well as quality showed a marked decline under eUV-B and relative nutritive value was reduced at both growth stages.

Comparative evaluation of a single 2.0-mm AO locking reconstruction plate with conventional miniplate osteosynthesis for treatment of linear non-comminuted fractures of symphysis and parasymphsis region of the mandible

The objective of the study was to evaluate and compare the relative efficacy of treating linear non-comminuted mandibular fracture of symphysis and parasymphysis region using single 2.0-mm AO locking reconstruction plate or using two conventional miniplates. In this study, 80 patients of symphysis or parasymphysis fracture were divided randomly in two equal groups and treated with open reduction and internal fixation using two 2.5-mm miniplates or with a single 2.0-mm AO locking reconstruction plate. Operating time in case of open reduction and fixation using a single 2.0-mm locking reconstruction plate was significantly less when compared to open reduction and fixation using two conventional miniplates. Both groups showed satisfactory fracture reduction and healing. No postoperative malocclusion was noted, and both groups showed comparable improvement in masticatory efficiency. In conclusion, fracture fixation using a single 2.0-mm AO locking reconstruction plate without use of a second plate at the superior border for treatment of linear non comminuted mandibular fracture in symphysis and parasymphysis region gives comparable results as with treatment by conventional miniplate system and provides significant savings in operating time, ease of use and decrease in amount of hardware incorporated in the body.

A Rare Pigmented Lesion of the Eyelid

This study aims to report a rare case of melanoacanthoma of the eyelid. Melanoacanthoma is very rare variant of seborrheic keratosis presenting as a rare benign pigmented lesion composed of both melanocytes and keratinocytes usually presenting over the head, neck, and trunk of elderly people. A 61-year-old female presented with 8 mm × 4 mm × 3 mm brownish black mass in her right lower lid for the past 4 years associated with itching. Clinical differential diagnosis of seborrheic keratosis and nevus was offered. The patient underwent shave biopsy, and biopsy tissue was sent for histopathological examination. A diagnosis of melanoacanthoma was made on histopathology. Melanoacanthoma of the eyelid is a rare entity, and one should consider in differential diagnosis of pigmented lesion of the eyelid mass.

Assessment of Activity of Daily Living Among Older Adult Patients in Home Healthcare and Skilled Nursing Facilities: An Integrative Review

Older adult's ability to self-manage illness is dependent on their ability to perform activities of daily living (ADL). Forty-five percent of those older than 65 years will have ongoing clinical needs after hospital discharge and require postacute care (PAC) services in settings such as home healthcare (HHC) and skilled nursing facilities (SNF). The Improving Medicare Post-Acute Care Transformation Act of 2014 requires PAC providers to begin collecting and reporting ADL data to build a coordinated approach to payment and standardize patient assessments and quality measurement. The aim of this integrative review was to compare the methods of assessing ADLs in HHC to SNF. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used to ensure results were reported systematically. A scientific literature search without date restriction within the PubMed and Cumulative Index of Nursing and Allied Health Literature databases was conducted. Two independent investigators assessed study quality using the quality appraisal instrument developed by Kmet et al. Study quality was high. Of the 18,749 articles identified by the search, 8 met inclusion criteria and four tools were identified that are used to assess ADLs in SNF and HHC. Although SNF and HHC collect similar ADL information, the range of content covered, item definitions, scoring, and psychometrics are not comparable across settings.

The evolution of artificial hair implantation

From the beginning, artificial hair implantation has aroused a lot of interest, sometimes controversial, in the field of hair restoration. The artificial fiber must be of high quality and biocompatible. Biofibre® is a very fine fiber having diameter of 80 m. The standard length of this fiber is 15 or 30 cm, to satisfy multiple patient requests. They are available in 13 colors and 3 different shapes (straight, wavy and curly). Artificial hair implant is indicated in all (male and female) cases of androgenetic alopecia, especially for those who show dismal response to medical therapies and have poor donor area supply for hair transplantation. It has also shown good results to treat scars. One hundred thirty-three cases of androgenetic alopecia were treated with Biofibre® and followed-up for 3 years. A clinical evaluation was carried out after 1 month, 4 months and every other 4 months after the implant. The fiber loss was no more than 10% per year in 91.4% of the cases, 15% in 7.8% of the cases and 20% in 0.8% of the cases. 96.2% of patients declared themselves to be satisfied with the result of the implant while 3.8% declared to be not satisfied. To conclude, modern artificial hair implantation can be considered a safe and easy mode of hair restoration, for male and female patients, especially in donor depleted cases or when an immediate aesthetic result is required.

When potion becomes poison! A case report of flecainide toxicity

We report a 48-day-old female infant, who developed cardiac conduction abnormalities and seizures secondary to supratherapeutic doses of oral flecainide. Flecainide was started in this infant for treatment of supraventricular tachycardia. The drug was withdrawn with successful normalization of the QRS complex and no further recurrence of seizures. The Naranjo probability score for adverse drug reaction was 8, making the causality “probable.” The case restates an important message that physicians should be aware of the side effects of the drugs that they prescribe, especially of those drugs which have a narrow therapeutic window.

Sphincter of Oddi disorder (SOD): Is it necessary to investigate and treat?

Sphincter of Oddi disorder (SOD) is a part of functional gastrointestinal disorder which is a non-calculous obstructive disorder. This disease is more common in middle-aged women with a prevalence of around 1.5% but in patients with post-cholecystectomy syndrome (PCS) the prevalence rate is markedly higher (9-55%). This high variability maybe attributed to lack of uniformity in patient selection criteria, definition of SOD, and the diagnostic method used. Abdominal pain is the most common symptom occurring due to obstruction at the SO leading to ductal hypertension, ischemia from spastic contraction and hypersensitivity of papilla. Clinical diagnosis of SOD can be achieved by Rome III criteria. Various classifications are used (Milwaukee billiary and modified Milwaukee group classification) for billiary and pancreatic SOD. Not a single non-invasive method is diagnostic. Sphincter of Oddimanometry (SOM) is the gold standard method for evaluating and deciding the management of an SOD patient. The symptomatic relief rate varies from 55% to 95%, so risk-benefit ratio should be evaluated with each patient.

A clinico-histopathological study on skin appendageal tumors

Background: Skin Appendageal tumors are a large and diverse group of tumors that are commonly classified according to their state of appendageal differentiation: follicular, sebaceous, eccrine and apocrine. Objectives of this study were to study the clinic-epidemiological profile of skin appendageal tumors and to correlate the clinico-histopathological diagnosis.Materials and Methods: This was a retrospective and prospective study which included all cases of skin adnexal tumours diagnosed histologically during the period of f

"FISHed" out the diagnosis: A case of DiGeorge syndrome

Our patient presented with congenital heart disease (CHD: Tetralogy of Fallot), hypocalcemia, hypoparathyroidism, and facial dysmorphisms. Suspecting DiGeorge syndrome (DGS), a fluorescence in situ hybridization (FISH) analysis for 22q11.2 deletion was made. The child had a hemizygous deletion in the 22q11.2 region, diagnostic of DGS. Unfortunately, the patient succumbed to the heart disease. DGS is the most common microdeletion syndrome, and probably underrecognized due to the varied manifestations. This case stresses the importance of a detailed physical examination and a high index of suspicion for diagnosing this genetic condition. Timely diagnosis can help manage and monitor these patients better and also offer prenatal diagnosis in the next pregnancy.

Steady state temperature distribution in dermal regions of an irregular tapered shaped human limb with variable eccentricity

The investigators in the past have developed some models of temperature distribution in the human limb assuming it as a regular circular or elliptical tapered cylinder. But in reality the limb is not of regular tapered cylindrical shape. The radius and eccentricity are not same throughout the limb. In view of above a model of temperature distribution in the irregular tapered elliptical shaped human limb is proposed for a three dimensional steady state case in this paper. The limb is assumed to be composed of multiple cylindrical substructures with variable radius and eccentricity. The mathematical model incorporates the effect of blood mass flow rate, metabolic activity and thermal conductivity. The outer surface is exposed to the environment and appropriate boundary conditions have been framed. The finite element method has been employed to obtain the solution. The temperature profiles have been computed in the dermal layers of a human limb and used to study the effect of shape, microstructure and biophysical parameters on temperature distribution in human limbs. The proposed model is one of the most realistic model as compared to conventional models as this can be effectively employed to every regular and nonregular structures of the body with variable radius and eccentricity to study the thermal behaviour.

Responses of Beta vulgaris exposed to cadmium and zinc through soil drenching

The present study investigates the responses of Indian palak (Beta vulgaris L. cv. All Green H1) exposed to cadmium (Cd) and zinc (Zn) at growth, biochemical and physiological levels. The results revealed that Cd and Zn accumulation was higher in shoots as compared to the roots of B. vulgaris plants. The increased application rates of Zn in combination with Cd significantly reduced the accumulation of Cd in below and above ground parts of B. vulgaris, whereas it increased Zn accumulation. Treatments of B. vulgaris with Cd and Zn individually or in combination significantly reduced the leaf area, biomass, photosynthetic pigments, photosynthetic rate, Fv/Fm ratio and protein contents at p < 0.05. Contrary to this, lipid peroxidation, ascorbic acid, proline and thiol contents and peroxidase activity increased significantly as compared to control at p < 0.05. The results also revealed that the combined effectof Cd and Zn were more pronounced at higher concentrations as compared to other treatments. Thus, the present study suggests that Zn may be applied to Cd contaminated field to reduce Cd accumulation in plants. However, finding of a suitable dose and toxicity level of Zn must be worked out further its application.

MDR1 expression predicts outcome of Ph+ chronic phase CML patients on second-line nilotinib therapy after imatinib failure

In the face of competing tyrosine kinase inhibitors (TKIs), identification of chronic myeloid leukemia (CML) patients expecting favorable response to second-line treatment is warranted. At the time of imatinib resistance, the investigation of multidrug-resistance protein 1 (MDR1) and BCR-ABL yielded the following results: (i) Patients with high MDR1 transcript levels showed superior response at 48 months as compared with low-level MDR1 patients: major molecular response (MMR) in 41% vs 16% (P=0.014), complete cytogenetic response (CCyR) in 58% vs 39% (P=0.044), and progression-free survival (PFS) in 67% vs 46% (P=0.032). (ii) Patients with BCR-ABL(IS) <28% achieved higher MMR rates (48% vs 21%, P=0.009). (iii) PFS at 48 months was associated with in vitro resistance of BCR-ABL kinase domain mutations: 63% (no mutation) vs 61% (sensitive, intermediately sensitive or unknown IC50 (median inhibitory concentration)) vs 23% (resistant, P=0.01). (iv) Single-nucleotide polymorphisms (SNPs) at positions 1236 and 2677 were associated with higher MDR1 expression in comparison to wild type. (v) Nilotinib was able to impede proliferation of MDR1-overexpressing imatinib-resistant cells. High MDR1 gene expression might identify patients whose mode of imatinib resistance is essentially determined by increased efflux activity of MDR1 and therefore can be overcome by second-line nilotinib treatment.

Direct measurement of magnon temperature: new insight into magnon-phonon coupling in magnetic insulators

We present spatially resolved measurements of the magnon temperature in a magnetic insulator subject to a thermal gradient. Our data reveal an unexpectedly close correspondence between the spatial dependencies of the exchange magnon and phonon temperatures. These results indicate that if--as is currently thought--the transverse spin Seebeck effect is caused by a temperature difference between the magnon and phonon baths, it must be the case that the magnon temperature is spectrally nonuniform and that the effect is driven by the sparsely populated dipolar region of the magnon spectrum.

An unusual cause of central cyanosis in a nine-year-old boy

Pulmonary arteriovenous malformations are rare vascular anomalies which rarely present in childhood. We discuss a nine-year-old male child who presented with the classical triad of exertional dyspnea, cyanosis and clubbing since six years of age. Pulmonary arteriovenous malformation was suspected on chest radiography and was later confirmed on computed tomography scan. A bubble contrast echocardiography showed the presence of an extracardiac shunt. Pulmonary angiography was done to delineate the anatomy of the pulmonary vasculature and to plan embolization. The child has undergone two sittings of transcatheter coil embolization with improvement in oxygenation.

Growth, yield and tuber quality of Solanum tuberosum L. under supplemental ultraviolet-B radiation at different NPK levels

In many areas, decreases in the stratospheric ozone layer have resulted in an increase in ultraviolet-B (UV-B, 280-315 nm) radiation reaching the Earth's surface. The present study was conducted to evaluate the interactive effects of supplemental UV-B (sUV-B) and mineral nutrients on a tuber crop, potato (Solanum tuberosum L. var Kufri Badshah), under natural field conditions in a dry tropical environment. The nutrient treatments were the recommended dose of NPK (F(o)), 1.5 times the recommended dose of NPK (F(1)), 1.5 times the recommended dose of N (F(2)) and 1.5 times the recommended dose of K (F(3)). The response of potato plants to sUV-B varied with nutrient treatment and concentration. sUV-B adversely affected growth, yield and quality of tubers, causing an increase in reducing sugars in the tubers and thus reducing the economic value. Growth and fresh weight of tubers was maximal with sUV-B at 1.5 times recommended NPK, but the dry weight of tubers were highest with the recommended NPK dose. Reducing sugar content was lower in potato plants treated with sUV-B and the recommended NPK than with sUV-B and 1.5 times the recommended NPK. This study thus clearly shows that growing potato with 1.5 times the recommended NPK or 1.5 times the recommended dose of N/K does not alleviate the sUV-B induced changes in yield and quality of tubers compared to the recommended NPK dose.

Comparative clinical study of effect of neostigmine and ketamine for postoperative analgesia

The purpose of the study was to evaluate and compare the role of neostigmine and ketamine as an additive to epidural bupivacaine to prolong the duration of postoperative analgesia. A double-blind randomised study was done on 60 adult patients, of both sexes, between 18 and 50 years, belonging to ASA grades I and II, undergoing below umbilical surgeries under epidural anaesthesia. All the patients were divided into three groups of 20 each to receive 20 ml of 0.5% bupivacaine with either 1 ml of normal saline, 100 mg of neostigmine or 50 mg of ketamine (both diluted with 1 ml normal saline). The mean (+/- SD) time to the first rescue analgesic administration was significantly prolonged by neostigmine [543.30 (+/- 133.40) minutes] and ketamine [292.00 (+/- 71.93) minutes] compared to the control group with saline [212.80 (+/- 62.49) minutes]. Postoperative 24-hour pain score was also less in neostigmine group. When compared to ketamine group neostigmine showed superior postoperative pain relief. Both neostigmine and ketamine demonstrated better haemodynamic stability with less incidence of hypotension. There was no increased incidence of nausea and vomiting or any other side-effects. In conclusion, it can be said neostigmine is a good adjuvant to epidural block to produce adequate pain relief without increased incidence of adverse effects.

Screening three cultivars of Vigna mungo L. against ozone by application of ethylenediurea (EDU)

Three Indian black gram cultivars (Vigna mungo L. cv. Barkha, Shekhar and TU-94-2) were grown at a tropical suburban site in Varanasi, India to evaluate the varietal differences in response to ambient O(3) under field conditions using ethylenediurea (EDU). EDU (400 ppm) was given as soil drench at 10-day intervals during the growth period of the cultivars. O(3) monitoring data clearly showed high concentrations with a mean value ranging between 41.3 and 59.9 ppb. EDU treatment caused significant increases in various growth parameters and total biomass accumulation in Barkha and Shekhar. EDU caused retention of more biomass in leaves during vegetative period and translocated more photosynthates towards reproductive parts, which resulted into yield enhancement. Weight of seeds plant(-1) was higher by 36.4% and 35.6% in Barkha and Shekhar, respectively, treated with EDU compared to non-EDU-treated plants. However, TU-94-2 did not exhibit any significant difference in weight of seeds plant(-1). Starch, total sugar, amino acids and K contents increased in seeds of EDU-treated plants leading to improvement in quality response index (QRI) of seeds. EDU helped in identifying the cultivar susceptibility to O(3) stress and therefore is very useful as a monitoring tool to assess the impact of ambient O(3) on plants under natural field conditions particularly in areas experiencing moderate concentrations of O(3).

Leprosy beyond MDT: study of follow-up of 100 released from treatment cases

Appearance of new skin and/or nerve lesions during or after fixed duration of multidrug therapy (MDT), in leprosy, is not uncommon. It could be a lesion due to leprosy reaction or relapse. Differentiation is easy in classical reactions both clinically and histopathologically. But, difficult in other situations especially when the relapse cases present with features of reaction at the onset. A study was done to find the reasons for released from treatment (RFT) cases to come to clinic and to follow in terms of clinical and neurological activity, leprosy reactions and deformity progression. Out of them, 14 cases and 86 cases had received paucibacillary (PB) and multibacillary (MB) multidrug therapy respectively. Skin lesions either old or new were noticed in 74% cases which might be due to inactivity or activity were noticed in 74% cases which might be due to inactivity or activity in forms of relapse and reaction. Relapse was seen in 26 cases. Out of these, 10 and 16 cases were previously diagnosed as PB and MB cases respectively. PB cases relapsed into MB cases while MB cases relapsed into MB cases. 46 cases presented with either type 1 or type 2 reaction. After declared as RFT, parasthesia in 34 cases, weakness in 18 cases, paresis and paralytic deformity in 6 cases were seen. So, all the RFT cases need regular follow-up, IEC and physiotherapy to prevent deformity and to diagnose relapse and reactions at the earliest.

Physiological, biochemical and growth responses of lady's finger (Abelmoschus esculentus L.) plants as affected by Cd contaminated soil

Cadmium contamination of the soil is a common cause of environmental concern in the suburban areas of developing cities in India The present research paper describes the changes in physiological, biochemical, growth and yield characteristics, and bioaccumulation potential of lady's finger (Abelmoschus esculentus L.), an important vegetable crop at different levels of Cd in the soil. Cadmium accumulation was maximum in roots followed by stems, leaves and fruits at 100 mg Cd kg(-1) in the soil. Cd accumulation in lady's finger negatively affected the physiological and biochemical characteristics, growth and yield. The magnitude of negative effect enhanced with increasing Cd concentration. The study suggests that due to higher potential of bioaccumulation of Cd in lady's finger and consequent reductions in growth and yield, this plant may not be a suitable option for cultivation in Cd contaminated soil.

Variations in heavy metal accumulation, growth and yield of rice plants grown at different sewage sludge amendment rates

Use of sewage sludge in agriculture is an alternative disposal technique for this waste. The present field study was conducted to assess the suitability of sewage sludge amendment in soil for rice (Oryza sativa L. cv. Pusa sugandha 3) by evaluating the heavy metal accumulation, growth, biomass and yield responses of plants grown at 0, 3, 4.5, 6, 9, 12 kgm(-2) sewage sludge amendment (SSA) rate. Sewage sludge amendment modified the physico-chemical properties of soil, thus increasing the availability of heavy metals in soil and consequently with higher accumulation in plant parts. Root length decreased, whereas shoot length, number of leaves, leaf area and total biomass increased significantly when grown under various SSA rates. Yield of rice increased by 60%, 111%, 125%, 134% and 137% at 3, 4.5, 6, 9 and 12 kgm(-2) SSA, respectively, as compared to those grown in unamended soil. Sewage sludge amendment rates above 4.5 kgm(-2) though increased the yield of rice, but caused risk of food chain contamination as concentrations of Ni and Cd in rice grains were found to be above the Indian safe limits (1.5 mgkg(-1)) of human consumption above 4.5 kgm(-2) SSA and of Pb (2.5 mgkg(-1)) above 6 kgm(-2) SSA. Since aboveground parts of the rice also showed higher concentration than the permissible levels of Ni, Cd and Pb at 4.5 kgm(-2) SSA rate, it cannot be used as fodder. The rice husk may be used as bioresource for energy production. Efforts should be made to treat the effluents from small scale industries before discharge into the sewerage system.

Biochemical and physiological responses of rice (Oryza sativa L.) grown on different sewage sludge amendments rates

Using sewage sludge, a biological residue from sewage treatment processes, in agriculture is an alternative disposal technique of waste. To study the biochemical and physiological responses of Rice (Oryza sativa L.) grown on different sewage sludge amendments (SSA) rates a field experiment was conducted by mixing sewage sludge at 0, 3, 4.5, 6, 9, 12 kg m(-2) rate to the agricultural soil. Rate of photosynthesis and stomatal conductance increased in plants grown at different SSA rate. Chlorophyll and protein contents also increased due to different SSA rates. Lipid peroxidation, ascorbic acid, peroxidase activity and proline content increased, however, thiol and phenol content decreased in plants grown at different SSA rates. The study concludes that for rice plant sewage sludge amendment in soil may be a good option as plant has adequate heavy metal tolerance mechanism showed by increased rate of photosynthesis and chlorophyll content and various antioxidant levels.

Responses of two cultivars of Trifolium repens L. to ethylene diurea in relation to ambient ozone

Three ethylene diurea (EDU) concentrations (0, 150 and 300 mg/L) were used to evaluate the negative impact of ozone (O3) on two cultivars of Trifolium repens L. cv. Vardan and Bundel grown under natural field conditions in a suburban area of Varanasi, India. Mean O3 concentrations varied from 30.3 to 46.6 microg/L during the experimental period. Higher photosynthetic pigments and ascorbic acid concentrations were noticed in both EDU-treated cultivars over non-EDU-treated ones, but a reverse trend was found for lipid peroxidation. Growth parameters and biomass also showed increments under EDU treatment of both cultivars. The ratio of variable fluorescence to maximum fluorescence increased significantly in Vardan but not in Bundel upon EDU treatment. Results revealed that EDU concentration of 300 mg/L was more effective to combat the oxidative stress as well as protecting plants from O3 injury symptoms. The test cultivar Vardan is relatively sensitive to O3, thereby can be used as a bioindicator of O3 pollution in areas having higher O3 concentrations. Results also indicated that Bundel has more efficient antioxidant defense system than Vardan and hence was more tolerant to O3 stress.

Effects of elevated ozone on photosynthesis and stomatal conductance of two soybean varieties: a case study to assess impacts of one component of predicted global climate change

Global climatic change scenarios predict a significant increase in future tropospheric ozone (O(3)) concentrations. The present investigation was done to assess the effects of elevated O(3) (70 and 100 ppb) on electron transport, carbon fixation, stomatal conductance and pigment concentrations in two tropical soybean (Glycine max L.) varieties, PK 472 and Bragg. Plants were exposed to O(3) for 4 h.day(-1) from 10:00 to 14:00 from germination to maturity. Photosynthesis of both varieties were adversely affected, but the reduction was higher in PK 472 than Bragg. A comparison of chlorophyll a fluorescence kinetics with carbon fixation suggested greater sensitivity of dark reactions than light reactions of photosynthesis to O(3) stress. The O(3)-induced uncoupling between photosynthesis and stomatal conductance in PK 472 suggests the reduction in photosynthesis may be attributed to a factor other than reduced stomatal conductance. An increase in internal CO(2) concentration in both O(3)-treated soybean varieties compared suggests that the reduction in photosynthesis was due to damage to the photosynthetic apparatus, leading to accumulation of internal CO(2) and stomatal closure. The adverse impact of O(3) stress increased at higher O(3) concentrations in both soybean varieties leading to large reductions in photosynthesis. This study suggests that O(3)-induced reductions in photosynthesis in tropical and temperate varieties are similar.

A t(X; 18) SYT-SSX2 positive synovial sarcoma in the pelvis of a young adult male: a rare case report with review of literature

Synovial sarcoma is uncommonly documented in the pelvis. Rarely, such cases have dealt with molecular analysis. A 19-year-old boy presented with pain and swelling in his left lower limb of two months duration. He developed acute urinary retention four days prior to his hospital admission, wherein radiological examination unraveled a large soft tissue mass, displacing his pelvic muscles, along with a lytic lesion involving his right pubic bone. Biopsy showed a cellular spindle cell sarcoma, exhibiting hemangiopericytoma-like vascular pattern with focal necrosis. Immunohistochemistry (IHC) showed positivity for vimentin, BCL-2, calponin and MIC 2. Cytokeratin (CK) and epithelial membrane antigen (EMA) were negative. MIB 1 count was 70% (high). P53 was positive. Diagnosis of a poorly differentiated synovial sarcoma was offered and confirmed with a positive t(X; 18) SYT-SSX2 translocation. This case highlights the value of molecular analysis in diagnosis of a synovial sarcoma at rare sites, especially when IHC results are equivocal and the biopsy material is limited.

Phase Ib dose finding trial of intravenous panobinostat with docetaxel in patients with castration-resistant prostate cancer (CRPC)

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Background: Panobinostat (LBH589) is a potent pan-deacetylase inhibitor that has demonstrated activity in both in vivo and in vitro prostate cancer models. Methods: An open-label, multicenter, dose-finding trial of i.v. panobinostat given on Days 1 and 8 (10, 15, and 20 mg/m2) with fixed-dose docetaxel on Day 1 (75 mg/m2) and prednisone (5 mg bid) in a 21-day cycle is being conducted in chemotherapy-naïve patients (pts) with CRPC. All pts have adequate organ function and ECOG performance status (PS) < 1. Pts with significant cardiovascular abnormalities or QTcF >450 msec on screening ECG are excluded. This treatment is continued until disease progression or intolerability. The primary endpoint is determination of the maximum tolerated dose (MTD) of i.v. panobinostat in combination with docetaxel using the Bayesian logistic regression model. Dose-limiting toxicities (DLTs) are defined in first cycle. Results: Twenty-one pts (Cohort 1, n = 8; Cohort 2, n = 10; Cohort 3, n = 3) have been treated, with a median age of 66 yrs (range 50–88), median Gleason score of 9 (range 7–9), and median entry PSA of 67.1 (range 1.3–7920). DLTs include: Gr 4 bradycardia in Cohort 1 (n = 1) and Gr 4 neutropenia, resulting in Day 8 panobinostat dose omission (Cohort 2, n = 2; Cohort 3, n = 1). Gr 3/4 adverse events (AEs) include: neutropenia (n = 12), febrile neutropenia (n = 3), dizziness (n = 2), DVT (n = 1). Other Gr 1 or 2 AEs include: thrombocytopenia (n = 4), fatigue (n = 10), alopecia (n = 7), diarrhea, nausea, and rash (n = 5). Among the 599 ECGs, there was 1 QTcF increase of >60 ms from baseline and no QTcF >480 ms. Preliminary Cohort 1 pharmacokinetic (PK) data shows the mean panobinostat AUC0-inf does not differ between Day 1 (239 ng*hr/mL ) and Day 8 (254 ng*hr/mL), and the mean clearance value appeared to be similar between Days 1 and 8. In Cohort 1, the median number of cycles was 6. Four of 8 pts received >6 cycles. Five and four pts had >30% and >50% PSA reduction from baseline, respectively. In Cohort 2, 9 of 10 pts are still on treatment after 3 cycles. Conclusions: The combination of panobinostat at 10 or 15 mg/m2 with docetaxel is feasible and to date no PK interaction is apparent. Full safety, efficacy, and PK results will be presented. Under DOD PCCTC.

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Switchable photoluminescence of CdTe nanocrystals by temperature-responsive microgels

In the present study, we report a method for preparing a fluorescent thermosensitive hybrid material based on monodisperse, thermosensitive poly( N-isopropyl acrylamide) (PNIPAM) microgels covered with CdTe nanocrystals of 3.2 nm diameter. The CdTe nanocrystals were covalently immobilized on the surface of PNIPAM microgels. The chemical environment around the CdTe nanocrystals was modified by changing the temperature and inducing the microgel volume-phase transition. This change provoked a steep variation in the nanocrystal photoluminescence (PL) intensity in such a way that when the temperature was under the low critical solution temperature (LCST) of the polymer (36 degrees C) the PL of the nanocrystals was strongly quenched, whereas above the LCST the PL intensity was restored.

Volkmann sign of non-ischaemic origin

This paper presents six cases who had a contracture of the long flexor tendons of the fingers and exhibited Volkmann's sign due to a chronic abscess or cysticercosis in the belly of the flexor digitorum profundus. All of them were treated conservatively, with full functional recovery in all the cases and with no recurrence.

Potential benefits and risks of land application of sewage sludge

Sewage sludge, also referred as biosolids, is a byproduct of sewage treatment processes. Land application of sewage sludge is one of the important disposal alternatives. Characteristics of sewage sludge depend upon the quality of sewage and type of treatment processes followed. Being rich in organic and inorganic plant nutrients, sewage sludge may substitute for fertilizer, but availability of potential toxic metals often restricts its uses. Sludge amendment to the soil modifies its physico-chemical and biological properties. Crop yield in adequately sludge-amended soil is generally more than that of well-fertilized controls. Bioavailability of metals increases in sludge amended soil at excessive rates of application for many years. Plants differ in their abilities to absorb sludge-derived metals from the soil. The purpose of this paper is to review the available information on various aspects of sewage sludge application on soil fertility and consequent effects on plant production to explore the possibility of exploiting this byproduct for agronomy and horticulture.

Effects of sewage sludge amendment on heavy metal accumulation and consequent responses of Beta vulgaris plants

Use of sewage sludge, a biological residue produced from sewage treatment processes in agriculture is an alternative disposal technique of waste. To study the usefulness of sewage sludge amendment for palak (Beta vulgaris var. Allgreen H-1), a leafy vegetable and consequent heavy metal contamination, a pot experiment was conducted by mixing sewage sludge at 20% and 40% (w/w) amendment ratios to the agricultural soil. Soil pH decreased whereas electrical conductance, organic carbon, total N, available P and exchangeable Na, K and Ca increased in soil amended with sewage sludge in comparison to unamended soil. Sewage sludge amendment led to significant increase in Pb, Cr, Cd, Cu, Zn and Ni concentrations of soil. Cd concentration in soil was found above the Indian permissible limit in soil at both the amendment ratios. The increased concentration of heavy metals in soil due to sewage sludge amendment led to increases in heavy metal uptake and shoot and root concentrations of Ni, Cd, Cu, Cr, Pb and Zn in plants as compared to those grown on unamended soil. Accumulation was more in roots than shoots for most of the heavy metals. Concentrations of Cd, Ni and Zn were more than the permissible limits of Indian standard in the edible portion of palak grown on different sewage sludge amendments ratios. Sewage sludge amendment in soil decreased root length, leaf area and root biomass of palak at both the amendment ratios, whereas shoot biomass and yield decreased significantly at 40% sludge amendment. Rate of photosynthesis, stomatal conductance and chlorophyll content decreased whereas lipid peroxidation, peroxidase activity and protein and proline contents, increased in plants grown in sewage sludge-amended soil as compared to those grown in unamended soil. The study clearly shows that increase in heavy metal concentration in foliage of plants grown in sewage sludge-amended soil caused unfavorable changes in physiological and biochemical characteristics of plants leading to reductions in morphological characteristics, biomass accumulation and yield. The study concludes that sewage sludge amendment in soil for growing palak may not be a good option due to risk of contamination of Cd, Ni and Zn and also due to lowering of yield at higher mixing ratio.