Current status of transrectal ultrasound-guided prostate biopsy in the diagnosis of prostate cancer

In contemporary practice, most prostate cancers are either invisible on ultrasound or indistinguishable from concurrent benign prostatic hyperplasia. Diagnosis therefore rests on prostate biopsy. Biopsies are not simply directed at ultrasonically visible lesions, as these would miss many cancers; rather the whole gland is sampled. The sampling itself is systematic, using patterns based on prostate zonal anatomy and the geographical distribution and frequency of cancer. This review explains the evolution of the prostate biopsy technique, from the classical sextant biopsy method to the more recent extended biopsy protocols (8, 10, 12, >12 and saturation biopsy protocols). Extended protocols are increasingly being used to improve diagnostic accuracy, especially in those patients who require repeat biopsy. This trend has been facilitated by the ongoing improvement in safety and acceptability of the procedure, particularly with the use of antibiotic prophylaxis and local anaesthesia. The technical details of these extended protocols are discussed, as are the current data regarding procedure-related morbidity and how this may be minimized.

New pyrimidine based ligand capped gold and platinum nano particles: Synthesis, characterization, antimicrobial, antioxidant, DNA interaction and in vitro anticancer activities

In this research work, we have synthesized new pyrimidine based Schiff base ligand, 2-((4,6-dimethoxypyrimidine-2-yl)methyleneenamino)-6-methoxyphenol (DPMM) capped gold (Au) and platinum (Pt) nanoparticles (NPs) by modified Brust-Schiffrin method. The characteristics of DPMM-Au NPs and DPMM-Pt NPs have been examined by UV-Visible, FTIR, SEM, TEM and powder XRD analysis. SEM analysis result shows that surface morphology of the DPMM-Au NPs and DPMM-Pt NPs are in granular and spherical shape, correspondingly. The size of the DPMM-Au NPs and DPMM-Pt NPs are approximately 38.14±4.5 and 58.64±3.0nm respectively, which confirmed by TEM analysis. The DPMM-Au NPs and DPMM-Pt NPs have potent antimicrobial against Escherichia coli, Klebsiella pneumonia, Pseudomonas fluorescens, Shigella sonnei, Staphylococcus aureus and Aspergillus niger, Candida albicans, Candida tropicalis, Mucor indicus, Rhizopus strains. The DPMM-Au NPs and DPMM-Pt NPs have good antioxidant activities than the free ligand (DPMM). The spectroscopic and viscometric measurement confirms the hydrophobic DNA binding abilities of the newly prepared DPMM capped metal NPs. Moreover, the in vitro anticancer activity of DPMM, DPMM-Au NPs and DPMM-Pt NPs against cancer (MCF-7, HeLa & HEp2) and normal (NHDF) cell lines have performed using MTT assay. These results reveals that, DPMM-Au NPs and DPMM-Pt NPs having significant cytotoxic activity against the cancer cell lines and least toxic effect on normal cell line as compared to standard drug cisplatin.

Evaluation of antioxidant, DNA targeting, antimicrobial and cytotoxic studies of imine capped copper and nickel nanoparticles

In this work, we have synthesized pyrimidine derivatives of Schiff base ligand 2-(4,6-dimethoxypyrimidin-2-ylimino)methyl)-6-methoxyphenol (DPMM) stabilized copper nanoparticles (DPMM-CuNPs) and nickel nanoparticles (DPMM-NiNPs) by modified Brust-Schiffrin technique as two step phase transfer assisted method and confirmed by UV-Visible, SEM and TEM analysis. The free radical scavenging activity of DPMM, DPMM-CuNPs &DPMM-NiNPs with 2, 2'-diphenylpicryl hydrazyl (DPPH), hydrogen peroxide (H₂O₂) super oxide dismutase (SOD) and nitric oxide (NO) shows that the antioxidant activity of DPMM-CuNPs is higher than DPMM &DPMM-NiNPs. Interaction study of DPMM-CuNPs &DPMM-NiNPs with CT-DNA has been investigated by absorption spectral titration, fluorescence studies, cyclic voltammetry and viscometric measurements. Dose dependent antibacterial and antifungal studies of DPMM-CuNPs & DPMM-NiNPs against five different bacteria Shigella sonnei, Staphylococcus aureus, Escherichia coli, Klepsiella pneumoniae, Pseudomonas fluoroscens and five different fungi Aspergillus niger, Candida albicans, Candida tropicalis, Mucor indicus and Rhizopus show that the compounds have significant antibacterial and antifungal activity. Cytotoxicity studies of DPMM-CuNPs &DPMM-NiNPs on human breast cancer cell line (MCF-7) were studied by 3-(4, 5-dimethylthiazol-2-yl-)-2, 5-diphenyltetrazolium bromide (MTT) assay. 50% cell viability was found at 25μg/mL for DPMM-CuNPs and 300μg/mL for DPMM-NiNPs. Collective biological results reveal that the synthesized DPMM-CuNPs is more biologically active than DPMM-NiNPs.

Endovascular repair of iliac artery injury complicating lumbar disc surgery

Vascular injury as a complication of disc surgery was first reported in 1945 by Linton and White. It is a rare but potentially fatal complication. The high mortality rate (40-100%) is attributed to a combination of rapid blood loss and the failure to recognise the cause of the deteriorating patient. Early diagnosis and treatment is essential. Treatment has traditionally been by open vascular surgical repair, however with modern imaging and endovascular techniques, minimally invasive treatment should be considered first line in patients who are stable. We present the case of a 51-year-old woman who sustained common iliac artery injury during lumbar spinal surgery that was treated successfully using a covered stent.

The clinical relevance of sexual dysfunction in systemic sclerosis

Systemic sclerosis is a chronic multi-organ autoimmune disease, leading to important clinical and psychological implications. Among organ complications, sexual dysfunction is a major issue for both male and female gender, with high prevalence and great impact on quality of life, although frequently not addressed by both clinicians and patients. While erectile dysfunction is the most common cause of sexual problems in males, genital tract and general physical changes are major contributors to sexual impairment in females. This review presents current state of the art on this topic, discussing published data on presentation, evaluation and therapeutic options.

Removal of hexavalent chromium by biochar derived from Azadirachta indica leaves: Batch and column studies

This report details the preparation, characterization, and applications of an inexpensive adsorbent obtained from Azadirachta indica leaves (Neem biochar (NBC)) and used to remove Cr(VI) from the synthetic waste water. The obtained NBC was characterized by XRD, FTIR, FESEM, EDX and Zeta potential measurements. Adsorption experiments conducted at various pH levels confirmed that 58.54 mg g^-1 of Cr(VI) was removed by NBC at pH 2. Experiments conducted at various temperatures revealed that the Cr(VI) adsorption on NBC fits the Langmuir-type adsorption isotherm. A fixed-bed column study was conducted to obtain breakthrough curve for the adsorption process, which confirmed that the NBC usage rate was 4.63 g/L. Cr(VI)NBC was reactivated by NaOH treatment, and the reactivated NBC was used as a sorbent to remove fresh Cr(VI) from the synthetic waste water repeatedly. A cost analysis was also performed for the Cr(VI) removal confirmed that the process was less expensive.

Asian earthquake: report from the first volunteer British hospital team in Pakistan

At 8:52 am on 8 October 2005 a massive earthquake wracked northern Pakistan and Kashmir. Various teams were sent to Islamabad and the disaster region from the UK. We discuss the types of injury patterns seen and recommend that a central register of volunteers should be created to deal with similar situations in the future.

Spectrophotometric and fluorometric detection of DNA/BSA interaction, antimicrobial, anticancer, antioxidant and catalytic activities of biologically active methoxy substituted pyrimidine-ligand capped copper nanoparticles

New Schiff base ligand (DPMN) was synthesized from the condensation of 2-hydroxy-5-nitrobenzaldehyde and 2-amino-4,6-dimethoxypyrimidine which was confirmed by spectroscopic and analytical methods. Solid air stable copper nanoparticles (DPMN-CuNPs) were synthesized from its copper chloride salt and it is stabilized by the prepared Schiff base ligand by phase transfer assisted synthesis which is a modified Brust-Schiffrin technique. The formation of ligand stabilized copper nanoparticles was confirmed by UV-Visible and FT-IR spectroscopic techniques. The size, surface morphology and quality of DPMN-CuNPs were analyzed by SEM and TEM techniques. Antioxidant activities of DPMN and DPMN-CuNPs with DPPH, SOD, peroxide and nitrous oxide were analyzed by electronic absorption spectroscopy. DNA interaction between DPMN and DPMN-CuNPs with CT-DNA was carried out using electronic absorption, fluorescence, viscometric measurements and cyclic voltammetric techniques. Interaction between BSA and the synthesized compounds analyzed by electronic absorption spectroscopy, Antimicrobial studies confirmed that the synthesized DPMN-CuNPs possess significant biological activities than DPMN. Anticancer results suggest that prepared DPMN-CuNPs have significant anticancer activity against different cancer cell lines and least toxic effect against the normal (NHDF) cell line. Other than the positive response in biological evaluation, our DPMN-CuNPs possess good catalytic activity in methyl orange reduction, methylene blue degradation and nitro phenol reduction.

Sleep Quality of Call Handlers Employed in International Call Centers in National Capital Region of Delhi, India

Background:

Call center sector in India is a relatively new and fast growing industry driving employment and growth in modern India today. Most international call centers in National Capital Region (NCR) of Delhi operate at odd work hours corresponding to a time suitable for their international customers. The sleep quality of call handlers employed in these call centers is in jeopardy owing to their altered sleep schedule.

Objective:

To assess the sleep quality and determine its independent predictors among call handlers employed in international call centers in NCR of Delhi.

Methods:

A cross-sectional questionnaire-based study was conducted on 375 call handlers aged 18–39 years employed in international call centers in NCR of Delhi. Sleep quality was assessed using Athens Insomnia scale along with a pre-tested, structured questionnaire.

Results:

The mean age of respondents was 24.6 (SD 2.4) years. 78% of participants were male. 83.5% of respondents were unmarried. 44.3% of call handlers were cigarette smokers. Physical ailments were reported by 37% call handlers. 77.6% of call handlers had some suspicion of insomnia or suspected insomnia; the rest had no sleep problem. Smoking, poor social support, heavy workload, lack of relaxation facility at office, and prolonged travel time to office were independent predictors of sleep quality (p<0.05).

Conclusion:

Call handlers have to compromise upon their sleep owing to the contemporary work settings in call centers. Safeguarding their health becomes an occupational health challenge to public health specialists.

Acute epididymo-orchitis in an undescended testicle

Establishing the diagnosis of a groin lump may be difficult, largely due to the large number of potential differential diagnoses. Indeed, this case was originally referred as a strangulated hernia. Despite the final diagnosis being infection of an undescended testicle, the patient did not report that he only ever had one scrotal testicle despite his 78 years of age.

Paediatric sclerotherapy of vascular anomalies of the hand and digits

AIM

Vascular anomalies in the hands and digits can cause pain, swelling and restrict the range of motion. Additionally, the small compartments they reside within portend challenges and possible risks in treatment. This study aims to evaluate the safety and efficacy of percutaneous sclerotherapy to treat vascular malformations in the hand and digits in paediatric patients.

MATERIALS AND METHODS

Metrics including size and location characteristics of the anomaly, procedural specifics, technical success, clinical success, and adverse events were recorded and further analysed.

RESULTS

Eight paediatric patients (5 males, 3 females) aged 5-17 years (mean 12 years) with vascular anomalies of the hands and digits treated with sclerotherapy were included. Three patients had arteriovenous malformation (AVMs), two venous malformation (VMs), and three venolymphatic malformation (VLMs) based upon imaging. Presenting symptoms included localised pain (n=8), swelling (n=7), decreased range of motion and function (n=3) and distal upper extremity numbness (n=1). Technical success was achieved in all (100%) patients. Seven of the eight patients (87.5%) followed up at six weeks and all reported at least partial reduction of symptoms (100%). Follow-up imaging was available for three patients with all showing decrease in the size of the malformation. There were no intraoperative complications or major adverse events. Three patients (37.5%) reported Society of Interventional Radiology (SIR) grade A/B minor adverse events (swelling [n=3], transient pain [n=3], and poor capillary refill [n=1]). Two patients (25%) benefited with a steroid prescription that successfully abated their symptoms.

CONCLUSION

Sclerotherapy appears to be a safe and effective treatment for vascular malformations in the hand and digits in paediatric patients.

Expression of cytokine-mRNA in peripheral blood mononuclear cell of human immunodeficiency virus-1 subtype C infected individuals with opportunistic viral infections from India (South)

Human immunodeficiency virus (HIV) disease progression is associated with a marked change in the level of plasma cytokines. The study reported here investigated the level of mRNA expression of different cytokines: Tumour necrosis factor-alpha (TNF-α), interferon (INF)-gamma, interleukin-10 (IL-10) and IL-21 in the peripheral blood mononuclear cell among the antiretroviral therapy naive subtype C HIV-1 infected individuals and normal healthy controls by real time polymerase chain reaction. The mRNA expressions of all the 4 cytokines in HIV-1 infected individuals were significantly higher compared to healthy controls (P value range 0.0004-0.01). The mean level of IL-10, INF-gamma and TNF-α were higher in HIV infected individuals with low CD4 counts (<300 cells/μl). The IL-10 expression showed a significant negative correlation with CD4 counts (r=-0.25, P=0.04) while IL-21 showed a positive correlation with CD4 counts (r=0.26, P=0.03). There was a significant negative correlation between the cytomegalovirus (CMV) viral load and IL-21 expression. Cytokine levels by mRNA detection avoids the inherent problem of measuring plasma level and this study also provide information on the cytokine levels and CD4+ T cell level among HIV-1 subtype C infected individuals with opportunistic viral infections like CMV.

O102 We know about left gastric artery embolisation and will embio provide the next solution to treat obesity?

Introduction

Left gastric artery embolisation (LGAE) is a minimally invasive procedure which has shown promising results for weight loss in recent studies and could play a key role as a treatment option in-between our current tier-3 and tier-4 services. Imperial College NHS Trust will sponsor the EMBIO trial, the first multi-centre double blinded randomised controlled trial comparing LGAE vs Placebo procedure to evaluate its efficacy on weight loss and obesity related comorbidities over a 12 month follow up period. Here, we perform a systematic review of the existing literature.

Methods

9 studies were reviewed. Studies which investigated weight loss as a % +- Ghrelin % change at 3,6 and 12 months were included as these pre-defined time points correlate with the EMBIO protocol. 6 studies met our inclusion criteria, 5 single arm studies and 1 single blinded RCT.

Results

N=62 patients were included in our analysis. Mean weight loss reported was 8.5%, 8.8% and 10% at 3, 6 and 12 months respectively post LGAE. Ghrelin levels reduced by 36%, 16.2% and 16.5% at 3, 6 and 12 months respectively post LGAE. To date, the only reported adverse events recorded include superficial gastric erosions healed on endoscopy by day 90 and one case of subclinical pancreatitis.

Conclusion

LGAE potentially offers a day case procedure under local anaesthesia and sedation to treat obesity and its metabolic complications. The EMBIO trial will provide level 1 evidence to confirm if LGAE is a viable intervention for obesity and evaluate its safety profile.

Take-home message

Left gastric artery embolisation could be the perfect solution to treat obesity in between existing tier-3 and tier-4 treatments.