A Rare Case of Intravenously Managed Hypertensive Emergency Arising from a Perirenal Hematoma Subsequent to a Native Kidney Biopsy

Page kidney is a pathologic and rare occurrence caused by a compression of renal parenchyma leading to hypertension. When infiltrated or engulfed by extrinsic matter, the subcapsular region surrounding the renal tissue may cause blanket compression, leading to the activation of the renin-angiotensin-aldosterone system secondary to renal hypoperfusion. While most cases of Page kidney are secondary to blunt trauma to the costovertebral angle, herein we present a case of Page kidney due to renal parenchymal core needle biopsy. The rarity of our case is not due to the cause of such an incidence but because our case resulted in a hypertensive emergency treated with dual intravenous infusions.

Rare Case of Refractory Hypokalemia in a Patient with Acute Monocytic Leukemia

BACKGROUND Refractory hypokalemia has been rarely demonstrated in patients with acute monocytic leukemia (AMoL). Hypokalemia develops in these patients owing to renal tubular dysfunction, secondary to lysozyme enzymes that are released by monocytes in AMoL. Additionally, renin-like substances are produced from monocytes and can lead to hypokalemia and metabolic alkalosis. There is also an entity called spurious hypokalemia, in which high numbers of metabolically active cells in blood samples increase sodium-potassium ATPase activity, resulting in influx of potassium. Additional research is warranted regarding this specific demographic to create standardized treatment approaches to electrolyte repletion. CASE REPORT In this case report, we demonstrate a rare case of an 82-year-old woman with AMoL, complicated by refractory hypokalemia, who presented with concerns of fatigue. The patient's initial laboratory results were significant for leukocytosis with monocytosis and severe hypokalemia. Refractory hypokalemia was noted, despite administration of aggressive repletions. During her hospitalization, AMoL was diagnosed and an extensive workup was performed to evaluate the underlying cause of hypokalemia. Ultimately, the patient died on day 4 of hospitalization. We describe the correlation between severe refractory hypokalemia and leukocytosis and provide a literature review of multiple etiologies of refractory hypokalemia in patients with AMoL. CONCLUSIONS We evaluated the numerous pathophysiologic mechanisms responsible for refractory hypokalemia in patients with AMoL. Our therapeutic outcomes were limited owing to the patient's early death. It is of high importance to evaluate the underlying cause of hypokalemia in these patients and to treat accordingly with caution.

Priming effects of nZVI on carbon sequestration and iron uptake are positively mediated by AM fungus in semiarid agricultural soils

We investigated the priming effect of nanoscale zero-valent iron (nZVI) on carbon sink and iron uptake, and the possible mediation by AMF (arbuscular mycorrhizal fungi, Funneliformis mosseae) in semiarid agricultural soils. Maize seed dressings comprised of three nZVI concentrations of 0, 1, 2 g·kg^-1 and was tested with and without AMF inoculation under high and low soil moistures, respectively. The ICP-OES observations indicated that both low dose of nZVI (1 g·kg^-1) and high dose of nZVI (2 g·kg^-1) significantly increased the iron concentrations in roots (L: 54.5-109.8 %; H: 119.1-245.4 %) and shoots (L: 40.8-78.9 %; H: 81.1-99.4 %). Importantly, the absorption and translocation rate of iron were substantially improved by AMF inoculation under the low-dose nZVI. Yet, the excess nanoparticles as a stress were efficiently relieved by rhizosphere hyphae, and the iron concentration in leaves and stems can maintain as high as about 300 mg·kg^-1 while the iron translocation efficiency was reduced. Moreover, next-generation sequencing confirmed that appropriate amount of nZVI clearly improved the rhizosphere colonization of Funneliformis mosseae (p < 0.001) and the development of soil fungal community. Soil observations further showed that the hyphae development and GRSP (glomalin-related soil protein) secretion were significantly promoted (p < 0.05), with the increased R_0.25 (< 0.25 mm) by 35.97-41.16 %. As a return, AMF and host plant turned to input more organic matter into soils for microbial growth and Fe uptake, and such interactions became more pronounced under drought stress. In contrast, high dose of nZVI (2 g·kg^-1) tended to agglomerate on the surface of hyphae and spores, causing severe deformation and inactivation of AMF symbionts. Therefore, the priming effects of nZVI on carbon sequestration and Fe uptake in agricultural soils were positively mediated by AMF via the feedback loop of the plant-soil-microbe system for enhanced adaptation to global climate change.

Esophageal Stab Wounds Repaired Endoscopically: A Case Report and Comprehensive Literature Review

Esophageal injuries are typically iatrogenic after endoscopic/surgical procedures, but they are rarely caused by penetrative or blunt trauma. We present a case of patient who suffered multiple stab wounds to the neck and underwent surgical repair for hemorrhagic shock but was ultimately diagnosed and treated successfully via endoscopy for a thoracic esophageal injury. Early detection is imperative and usually diagnosed via contrast studies but less commonly via direct visualization endoscopically. Moreover, endoscopic treatment is also less commonly utilized, even if diagnosed from that modality. Cervical injuries also confer a lower mortality than thoracic injuries.

Aleukemic Acute Promyelocytic Leukemia: How Concomitant HIV, Hepatitis C, and Chronic Alcohol Use Disorder May Have Hidden an Underlying Malignancy

BACKGROUND Acute promyelocytic leukemia (APL) is a rare subtype of acute myeloid leukemia (AML) and is characterized by a genetic translocation affecting the retinoic acid receptor-alpha gene, leading to blockage in the differentiation of granulocytic cells. The accumulation of promyelocytes in bone marrow leads to cytopenias and life-threatening coagulopathies. Definitive diagnosis is made with bone marrow biopsy. Differentiation of APL from other leukemias is important to appropriately treat with all-trans retinoic acid (ATRA) and arsenic trioxide. Patients with HIV are at a higher risk to develop AML. This article identifies how multiple comorbidities and social factors can contribute to difficulties in diagnosing AML. CASE REPORT We present a 67-year-old man with a past medical history of hypertension and substance use disorder who presented with progressive exertional dyspnea and was found to have HIV, chronic hepatitis C, and APL with pancytopenia. His bone marrow biopsy confirmed AML. This was a case of co-existing HIV and aleukemic leukemia. CONCLUSIONS APL can present with pancytopenia, weakness, failure to thrive, or bleeding complications, which can be similar to presentations of those diagnosed with HIV. Diagnosis of APL can be differentiated between hypergranular and hypogranular; our patient demonstrated APL with only 52% blasts, which can make for a challenging diagnosis. Given increased mortality of APL, immediate ATRA therapy is warranted. Aleukemic leukemia is a rare presentation typically accompanied by skin manifestations. Our case highlights the importance of having high clinical suspicion for malignancy in patients with comorbidities that can interfere with the classic presentation of leukemia.

A Rare Presentation of Gastrointestinal Stromal Tumor Causing Gastroduodenal Intussusception

Adult intussusception is exceedingly rare and most commonly occurs in the stomach or ileum. It is less common for adult intussusception to be classified as gastroduodenal, which also carries a higher mortality rate. Adult intussusception usually warrants surgical intervention as the underlying cause is often malignancy. However, rarely, the etiology is a gastrointestinal stromal tumor (GIST). Here, we present the case of a patient who presented with abdominal pain, vomiting, and hemorrhagic shock and was diagnosed with gastroduodenal intussusception secondary to a gastric GIST.

Rhizosphere effect of nanoscale zero-valent iron on mycorrhiza-dependent maize assimilation

Rhizosphere effect of nanoscale zero-valent iron (nZVI) is crucial but little reported. Maize seeds were dressed with four nZVI concentrations (0, 1.0, 1.5, 2 g kg^-1 ) and inoculated with arbuscular mycorrhizal fungus (AMF) (Funneliformis mosseae). The SEM images illuminated that excessive nZVI particles (2 g kg^-1 ) were agglomerated on the surface of hyphae and spore, causing severe deformation and inactivation of AMF symbionts and thereafter inhibiting water uptake in maize seedlings. This restrained the scavenging effects of enzymatic (superoxide dismutase, peroxidase) and non-enzymatic compounds (proline & malondialdehyde) on ROS, and leaf photoreduction activity and gas exchange ability (p < 0.05). Interestingly, the inoculation with AMF effectively alleviated above negative effects. In contrast, appropriate dose of nZVI, that is, ≤1.5 g kg^-1 , can be evenly distributed on the hyphae surface and form the ordered symbionts with AMF. This help massively to enhance hyphae growth and water and nutrient uptake. The enhanced mycorrhizal infection turned to promote rhizosphere symbiont activity and leaf Rubisco and Rubisco activase activity. Light compensation point was massively lowered, which increased photosynthetic carbon supply for AMF symbionts. Particularly, such priming effects were evidently enhanced by drought stress. Our findings provided a novel insight into functional role of nZVI in agriculture and AMF-led green production.

Dual effects of nZVI on maize growth and water use are positively mediated by arbuscular mycorrhizal fungi via rhizosphere interactions

Nanoscale zero-valent iron (nZVI) might generate positive and negative effects on plant growth, since it acts as either hazardous or growth-promotion role. It is still unclear whether such dual roles can be mediated by arbuscular mycorrhizal fungi (AMF) in plant-AMF symbiosis. We first identified that in 1.5 g kg^-1 nZVI (≤1.5 g kg^-1 positively), maize biomass was increased by 15.83%; yet in 2.0 g kg^-1 nZVI, it turned to be declined by 6.83%, relative to non-nZVI condition (CK, p < 0.05), showing a negative effect. Interestingly, the inoculation of AMF massively improved biomass by 45.18% in 1.5 g kg^-1 nZVI, and relieved the growth inhibition by 2.0 g kg^-1 nZVI. The event of water use efficiency followed similar trend as that of biomass. We found that proper concentration of nZVI can positively interact with rhizosphere AMF carrier, enabling more plant photosynthetic carbon to be remobilized to mycorrhiza. The scanning of transmission electron microscopy showed that excessive nZVI can infiltrate into root cortical cells and disrupt cellular homeostasis mechanism, significantly increasing iron content in roots by 76.01% (p < 0.05). Simultaneously, the images of scanning electron microscopy showed that nZVI were attached on root surface to form an insoluble iron ion (Fe³⁺) layer, hindering water absorption. However, they were efficiently immobilized and in situ intercepted by extraradical hyphae in mycorrhizal-nZVI symbiosis, lowering iron translocation efficiency by 6.07% (p < 0.05). Herein, the optimized structure remarkably diminished aperture blockage at root surface and improved root activities by 30.06% (p < 0.05). Particularly, next-generation sequencing demonstrated that appropriate amount of nZVI promoted the colonization and development of Funneliformis mosseae as dominant species in rhizosphere, confirming the positive interaction between AMF and nZVI, and its regulatory mechanism. Therefore, dual effects of nZVI can be actively mediated by AMF via rhizosphere interactions. The findings provided new insights into the safe and efficient application of nanomaterials in agriculture.

166 ReAudit - Review of Elective Procedures for Pilonidal Disease in a Single Centre, Jan 2020 – Aug 2021

Review of elective procedures for pilonidal disease in a single centre, Jan 2020 – Aug 2021

Introduction

Pilonidal disease continues to be managed with a variety of surgical techniques. We review results with Bascom 2 operation comparing to other practices at our institution.

Method

All elective procedures for pilonidal disease reviewed from Jan 2020 to August 2021. Age, gender, previous emergency and elective procedures for pilonidal disease, follow-up, recurrence and dehiscence rates, all-cause morbidity was examined retrospectively.

Results

In the study period there were 44 procedures. Average age was 26.4 years (range 16–44). Male to female ratio was 2:1. Procedure techniques performed included modified Bascoms flap (20), excision and primary closure (20), excision and packing (3) and Rhomboid flap (1). The number of previous emergency and elective procedures in the cohort were 18 and 3 respectively. In 24 (55%) procedures there was documented follow up, at a mean time of 49 days (median 56 days, range 3–84). Overall modified Bascom dehiscence (partial / full) dehiscence and recurrence rates were 10% and 5% respectively. Overall median number of bed related days length of stay was 0 days (range 0–3 days).

Conclusions

The modified Bascoms procedure is both technically simple and reproducible and offers comparatively good dehiscence and recurrence rates relative to other pilonidal sinus procedures.

Nano-enabled improvements of growth and colonization rate in wheat inoculated with arbuscular mycorrhizal fungi

Arbuscular mycorrhizal fungi display desired potential to boost crop productivity and drought acclimation. Yet, whether nanoparticles can be incorporated into arbuscular mycorrhizal fungi for better improvement and its relevant morphologic and anatomical evidences are little documented. Pot culture experiment on wheat (Triticum aestivum L.) was conducted under drought stress (30% FWC) as well as well watered conditions (80% FWC) that involved priming of wheat seeds with iron nanoparticles at different concentrations (5mg L^-1, 10 mg L^-1 and 15 mg L^-1) with and without the inoculation of Glomus intraradices. The effects of treatments were observed on morphological and physiological parameters across jointing, anthesis and maturity stage. Root colonization and nanoparticle uptake trend by seeds and roots was also recorded. We observed strikingly high enhancement in biomass up to 109% under drought and 71% under well-watered conditions, and grain yield increased to 163% under drought and 60% under well-watered conditions. Iron nanoparticles at 10 mg L^-1 when combined with Glomus intraradices resulted in maximum wheat growth and yield, which mechanically resulted from higher rhizosphere colonization level, water use efficiency and photosynthetic rate under drought stress (P < 0.01). Across growth stages, optical micrograph observations affirmed higher root infection rate when combined with nanoparticles. Transmission electron microscopy indicated the penetration of nanoparticles into the seeds and translocation across roots whereas energy dispersive X-ray analyses further confirmed the presence of Fe in these organs. Iron nanoparticles significantly enhanced the growth-promoting and drought-tolerant effects of Glomus intraradices on wheat.

Density- and moisture-dependent effects of arbuscular mycorrhizal fungus on drought acclimation in wheat

Arbuscular mycorrhizal fungus (AMF) is widely viewed as an ecosystem engineer to help plants adapt to adverse environments. However, a majority of the previous studies regarding AMF's eco-physiological effects are mutually inconsistent. To clarify this fundamental issue, we conducted an experiment focused on wheat (Triticum aestivum L.) plants with or without AMF (Funneliformis mosseae) inoculation. Two water regimes (80% and 40% field water capacity, FWC80 (CK) and FWC40 (drought stress) and four planting densities (6 or 12 plants per pot as low densities, 24 or 48 plants per pot as high densities) were designed. AMF inoculation did not show significant effects on shoot biomass, grain yield, and water use efficiency (WUE) under the low densities, regardless of water regimes. However, under the high densities, AMF inoculation significantly decreased shoot biomass, grain yield and WUE in FWC80, while it significantly increased these parameters in FWC40, showing density and/or moisture-dependent effects of AMF on wheat performance. In FWC40, the relationships between reproductive biomass (y-axis) vs. vegetative biomass (x-axis) (R-V), and between grain biomass (y-axis, sink) vs. leaf biomass (x-axis, source) fell into a typical allometric pattern (α > 1, P < 0.001), and the AMF inoculation significantly increased the values of α. Yet in FWC80, they were in an isometric pattern (α ≈ 1, P < 0.001) and AMF addition had no significant effects on α. Similarly, AMF did not significantly change the isometric relationship between leaf biomass (i.e., metabolic rate) and shoot biomass (body size) in FWC80, while it significantly decreased the α of allometric relationship between both of them in FWC40 (α > 1, P < 0.001). We therefore, sketched a generalized model of R-V and sink-source relationships as affected by AMF, in which AMF inoculation might enhance the capabilities of sink acquisition and utilization under drought stress, while having no significant effect under the well watered conditions. Our findings demonstrate dual density- and moisture-dependent effects of AMF on plant development and provide new insights into current ecological applications of AMF as an ecosystem engineer.

1623 Atrial Fibrillation Post Aortic Valve Replacement: Prevalence and Causative Factors

Aim

Atrial fibrillation (AF) is the most prevalent arrhythmia. Post-Operative AF (POAF) occurs in a third of patients post cardiac surgery. We aim to explore the incidence of AF post aortic valve replacement (AVR) and whether clinical and echocardiographic parameters can predict the likelihood of AF and therefore influence the management of patients.

Method

Our study consisted of 985 patients who underwent AVR between 2018 – 2019 from a single major cardiothoracic surgery centre in the UK. Data was collected from the electronic patient records retrospectively.

Results

Mean age of the cohort was 71.8 years (27-92). There were more males (68.2%, n = 672) than females (31.8%, n = 313). A majority of patients (51.8%, n = 510) developed an episode of AF in the post-operative period, of which 65.1% was new onset (n = 330). Incidence of post-operative AF was associated with more HTN (p = 0.007), poor left ventricular function as well as increased left atrial diameter (P = &lt;0.001).

Conclusions

There is a high incidence of AF following AVR surgery. Comorbidities as well as left atrial diameter have a statistically significant relationship with this incidence and could be used as predictors of postoperative atrial fibrillation.

Antiviral activities of Cholistani plants against common poultry viruses

Herbal medicines are becoming more popular and acceptable day by day due to their effectiveness, limited side effects, and cost-effectiveness. Cholistani plants are reported as a rich source of antibacterial, antifungal, antiprotozoal, antioxidant, and anticancer agents. The current study has evaluated antiviral potential of selected Cholistani plants. The whole plants were collected, ground and used in extract formation with n-hexane, ethyl acetate and n-butanol. All the extracts were concentrated by using a rotary evaporator and concentrate was finally dissolved in an appropriate vol of the same solvent. All of the extracts were tested for their antiviral potential by using 9-11 days old chick embryonated eggs. Each extract was tested against the Avian Influenza virus H9N2 strain (AIV), New Castle Disease virus Lasoota strain (NDV), Infectious bronchitis virus (IBV) and an Infectious bursal disease virus (IBDV). Hemagglutination test (HA) and Indirect Hemagglutination (IHA) tests were performed for different viruses. The overall order of the antiviral potential of Cholistani plants against viruses was NDV>IBV>IBDV>AIV. In terms of antiviral activity from extracts, the order of activity was n-butanol>ethyl acetate>n-hexane. The medicinal plants Achyranthes aspera, Neuroda procumbens, Panicum antidotale, Ochthochloa compressa and Suaeda fruticose were very effective against all four poultry viruses through their extracts. The low IC50 values of these extracts confirm the high antiviral potential against these viruses. It is worth to mention that Achyranthes aspera was found positive against IBDV through all its extracts which overcome the problem of unavailability of any known drug against IBDV. In short, the study proved that Cholistani plants are rich source of antiviral agent and their extracts can be used as good source of antiviral drugs both in crude and in purified form.

Green route to synthesize Zinc Oxide Nanoparticles using leaf extracts of Cassia fistula and Melia azadarach and their antibacterial potential

Development of plant based nanoparticles has many advantages over conventional physico-chemical methods and has various applications in medicine and biology. In present study, zinc oxide (ZnO) nanoparticles (NPs) were synthesized using leaf extracts of two medicinal plants Cassia fistula and Melia azadarach. 0.01 M zinc acetate dihydrate was used as a precursor in leaf extracts of respective plants for NPs synthesis. The structural and optical properties of NPs were investigated by X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectroscopy, scanning electron microscope (SEM), ultraviolet-visible spectrophotometer (UV-Vis) and dynamic light scattering (DLS). The antibacterial potential of ZnO NPs was examined by paper disc diffusion method against two clinical strains of Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) based on the zone of inhibition and minimal inhibitory indices (MIC). Change in color of the reaction mixture from brown to white indicated the formation of ZnO NPs. UV peaks at 320 nm and 324 nm, and XRD pattern matching that of JCPDS card for ZnO confirmed the presence of pure ZnO NPs. FTIR further confirmed the presence of bioactive functional groups involved in the reduction of bulk zinc acetate to ZnO NPs. SEM analysis displayed the shape of NPs to be spherical whereas DLS showed their size range from 3 to 68 nm. The C. fistula and M. azadarach mediated ZnO NPs showed strong antimicrobial activity against clinical pathogens compared to standard drugs, suggesting that plant based synthesis of NPs can be an excellent strategy to develop versatile and eco-friendly biomedical products.

Prevalence and Association of Undernutrition with Quality of Life among Swedish People Aged 60 Years and Above: Results of the SNAC-B Study

OBJECTIVES

This study aimed to assess the prevalence of undernutrition among elderly and to investigate the association of risk of undernutrition with health-related quality of life and life satisfaction controlling for age, gender, marital status, economic status, housing arrangement, education level, functional ability, and diseases.

DESIGN

A cross-sectional study design was used for this study. The baseline data (2001-2003) of "The Swedish National Study of Aging and Care-Blekinge (SNAC-B)" was used.

SETTING

This population-based study focused on both home-living and special-housing residents.

PARTICIPANTS

The participants (n=1402) were randomly selected and included both males and females 60-96 years of age residing in a municipality of south-east Sweden.

MEASUREMENTS

The risk of undernutrition was estimated by the occurrence of at least one anthropometric measure (body mass index, mid-arm circumference, and calf circumference) below cut-off, in addition to the presence of at least one subjective measure (declined food intake, weight loss, and eating difficulty). The dependent variables, health-related quality of life and life satisfaction, were measured by the validated short form health survey (SF-12) and Liang's life satisfactions index A (LSIA), respectively.

RESULTS

According to the criterion, 8.5% of the participants were at risk of undernutrition, and subjects at nutritional risk were significantly older, female, unmarried/widowed/divorced, residing in special housing, and functionally impaired. The risk of undernutrition was significantly associated with poor health-related quality of life, both in the physical (OR 2.31, 95% CI 1.18-4.52) and mental (OR 2.34, 95% CI 1.22-4.47) dimensions. However, no significant association was observed between nutritional status and life satisfaction (OR 1.30, 95% CI 0.70-2.40).

CONCLUSION

The risk of undernutrition significantly increases the risk of poor physical and mental health-related quality of life but has negligible impact on life satisfaction. This study also highlights the importance of functional ability both for the prevention of undernutrition and promotion of quality of life. However, more studies are needed to validate the tool used here for undernutrition risk assessment before it can be used in clinical or population settings.

Prevalence of and factors associated with obesity among Pakistani schoolchildren: a school-based, cross-sectional study

Childhood obesity is nowadays a concern in the developing world. This cros-sectional study was conducted on 501 randomly selected students from 10 high schools in an urban setting in Hyderabad, Pakistan. Children who were underweight were excluded. Interviews were conducted to determine demographic data, dietary intake, physical activity and other variables that may be associated with obesity. Overall 58 students (12%) had body mass index (BMI)>or=95th percentile, 40 (8%) BMI>or=85th percentile and 403 (80%) had BMI<85th percentile (WHO age- and sex-specific cut-offs). The prevalence of obesity was higher in boys than girls (15% than 8% respectively). In multivariate regression analysis significant risk factors for obesity/overweight were male sex, middle socioeconomic status, poor self-rated athletic ability, trying to lose weight and eating fruit<4 times per week. Childhood obesity is determined by factors in the home, school and society and a multidisciplinary approach is needed to prevention.

Implementing a public-private mix model for tuberculosis treatment in urban Pakistan: lessons and experiences

SETTING

Six towns of Karachi, Pakistan.

OBJECTIVES

1) To strengthen the capacity of general practitioners (GPs) in providing tuberculosis (TB) treatment through DOTS; and 2) to enhance collaboration between the public and private sectors in TB management and case reporting.

DESIGN

A quasi-experimental study design was adopted to ensure enrolment of TB patients through trained GPs with the support of laboratory networks and to improve the case detection rate.

RESULTS

The following challenges were faced during implementation of the model in urban settings: no systematic list of GPs was available; the majority of the GPs were untrained health practitioners working in squatter settlements, where formally trained GPs are most needed; the motivation of GPs with high patient loads is very low; and access to a laboratory is difficult. Of 35 patients enrolled in the first quarter (third quarter 2009), 87% completed their treatment successfully.

CONCLUSION

Public-private mix (PPM) DOTS is feasible in the cities of Pakistan. However, the cost, time and effort required to establish the programme is higher than in many other developing countries.

Size controlled synthesis of biocompatible gold nanoparticles and their activity in the oxidation of NADH

Size and shape controlled synthesis remains a major bottleneck in the research on nanoparticles even after the development of different methods for their preparation. By tuning the size and shape of a nanoparticle, the intrinsic properties of the nanoparticle can be controlled leading tremendous potential applications in different fields of science and technology. We describe a facile route for the one pot synthesis of gold nanoparticles in water using monosodium glutamate as the reducing and stabilizing agent in the absence of seed particles. The particle diameter can be easily controlled by varying the pH of the reaction medium. Nanoparticles were characterized using scanning electron microscopy, UV-vis absorption spectroscopy, cyclic voltammetry, and dynamic light scattering. Zeta potential measurements were made to compare the stability of the different nanoparticles. The results suggest that lower pH favours a nucleation rate giving rise to smaller particles and higher pH favours a growth rate leading to the formation of larger particles. The synthesized nanoparticles are found to be stable and biocompatible. The nanoparticles synthesized at high pH exhibited a good electrocatalytic activity towards oxidation of nicotinamide adenine dinucleotide (NADH).

Hyperfractionated radiation therapy and concurrent chemotherapy for advanced head and neck cancer

PURPOSE

To investigate the feasibility of combining hyperfractionated radiotherapy regimen with concomitant chemotherapy and to assess its toxicity in patients with advanced head and neck carcinoma (HNC). Progression free survival (PFS) and overall survival (OS) were set as secondary end points.

PATIENTS AND METHODS

Between November 2003 and November 2007, 48 patients with stage III and IV HNC who met the eligibility criteria were enrolled in the study. Hyperfractionated Radiation consisted of 120 Gys twice daily, 6 hours apart, for a total of 69.6 Gys in 58 fractions over 6 weeks and boost of 6 Gys in 3 fractions in case of residual disease. Three cycles of concurrent chemotherapy in the form of Cisplatin 75 mg/ m² on day 1 and Fluorouracil 750 mg/m² 24 hour infusion on day 1-4 during weeks 1, 4 and 6 of irradiation.

RESULTS

48 patients have completed the treatment to date. The median radiation dose was 72 Gys including the boost to residual lymph node or primary site. The treatment was delivered in a median overall period of 54 days, with a recorded median delay of 7 days. Grade 4 skin toxicity was experienced by 4.1% of patients only. Therapy was well tolerated (grade 3 mucositis in 21%, grade 4 in 26%, grade 3 leukopenia in 10%). Weight loss of more than 10 kg was reported in 10 (16.7%) of the cases. The most common late toxicity was mild to moderate xerostomia which was encountered in 34 (70.8%) cases and improved thereafter. Hypothyroidism was encountered in 7 (14.6%) of the cases. Complete response (CR) was observed in 40 patients (83.3%). Partial response (PR) was achieved in the remaining 8 patients (16.7%). Disease relapse occurred in 9 patients (18.8%) after complete response and 2 patients developed progressive disease after partial response. 3 patients relapsed locally, 5 patients developed distant metastasis and 1 patient developed both local and distant metastasis. 2 patients (4.1%) died of treatment complications, 8 patients (16.7%) died with progressive locoregional, and metastatic disease. The 2- year disease free survival was 77% and the 2- year overall survival was 79%.

CONCLUSION

Hyperfractionated radiotherapy and concurrent chemotherapy is tolerable. Results regarding LC and OS are encouraging as compared to conventional radiotherapy and concurrent chemotherapy.

Interrater reliability of the Psychiatric Research Interview for Substance and Mental Disorders in an HIV-infected cohort: experience of the National NeuroAIDS Tissue Consortium

The interrater reliability of the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) was assessed in a multicentre study. Four sites of the National NeuroAIDS Tissue Consortium performed blinded reratings of audiotaped PRISM interviews of 63 HIV-infected patients. Diagnostic modules for substance-use disorders and major depression were evaluated. Seventy-six per cent of the patient sample displayed one or more substance-use disorder diagnoses and 54% had major depression. Kappa coefficients for lifetime histories of substance abuse or dependence (cocaine, opiates, alcohol, cannabis, sedative, stimulant, hallucinogen) and major depression ranged from 0.66 to 1.00. Overall the PRISM was reliable in assessing both past and current disorders except for current cannabis disorders when patients had concomitant cannabinoid prescriptions for medical therapy. The reliability of substance-induced depression was poor to fair although there was a low prevalence of this diagnosis in our group. We conclude that the PRISM yields reliable diagnoses in a multicentre study of substance-experienced, HIV-infected individuals.

Neuropsychiatric impact of hepatitis C on advanced HIV

OBJECTIVE

To determine whether hepatitis C (HCV) contributes to CNS dysfunction among HIV-infected individuals.

METHODS

Using a cross-sectional design, the neuropsychiatric profile of individuals with advanced HIV coinfected with hepatitis C (HIV+/HCV+) was compared to similarly advanced HIV patients without HCV coinfection (HIV+/HCV-). Participants were derived from the Manhattan HIV Brain Bank and underwent neurocognitive testing and semistructured psychiatric interviews. Evidence of HCV infection was determined by serology performed prior to study entry. Hepatic function was determined by serum chemistries (bilirubin, creatinine, and international normalized ratio) at the time of the cognitive assessments.

RESULTS

Coinfected (HIV+/HCV+) individuals were significantly more likely to have had past opiate or cocaine or stimulant dependence. HIV+/HCV+ participants also had significantly greater rates of past substance-induced major depression. There were no significant differences in rates of primary mental disorders. Forty-two percent of both the HIV+/HCV+ and HIV+/HCV- participants met criteria for current major depression. There was a trend for HIV+/HCV+ patients to perform worse neurocognitively. On tests of executive functioning, HIV+/HCV+ individuals exhibited a greater rate of impairment and had significantly more perseveration. Differences in cognitive functioning were associated with serology but did not correlate with indices of liver disease severity. The HCV+ patients were also more likely to be diagnosed with HIV-associated dementia.

CONCLUSIONS

There appears to be a neuropsychiatric impact of HCV that is detectable even among an advanced HIV cohort.

Capacitively coupled electrical stimulation treatment: results from patients with failed long bone fracture unions

OBJECTIVE

To determine the extent to which capacitively coupled electrical stimulation (CCEST) at a long bone fracture site can promote healing of nonunited fractures.

DESIGN

Sixteen patients with nonunited fractures of nine to seventy-six months were treated with CCEST. Thirteen patients had previously undergone one or more surgical procedures, and the other three had been given plaster casts. A sixty-three-kilohertz, six-volt peak-to-peak sine wave signal was applied across two forty-millimeter-diameter stainless steel plates placed on the skin at opposite sides of the fracture site. The device was used for up to thirty weeks until either healing occurred or it was removed after this period and considered to have failed.

RESULTS

Eleven of the nonunions achieved union at an average of fifteen weeks of stimulation. The only significant factor determining the success of healing was the distance between the plates; a distance of eighty millimeters or less resulted in healing in all cases. Healing was not affected significantly by any of the following factors: whether or not the nonunion had been treated surgically prior to stimulation, whether or not it had been infected, whether or not the patient bore weight after treatment, or by the presence or absence of metal at the fracture site from previous surgery.

CONCLUSIONS

These findings confirm those of previous studies that CCEST promotes bone healing of fracture nonunions. The dependence of healing on the interplate distance suggests that maintaining sufficient current across the plates is necessary to allow healing, which for larger bones may be achieved by increasing the area of the plates, the applied voltage, or the excitation frequency of the stimulation signal.