A Torquoselective Thermal 6π-Electrocyclization Approach to 1,4-Cyclohexadienes via Solvent-Aided Proton Transfer: Experimental and Theoretical Studies

The thermal 6π-electrocyclization of hexatriene typically delivers 1,3-cyclohexadiene (1,3-CHD). However, there is only limited success in directly synthesizing 1,4-cyclohexadiene (1,4-CHD) using such an approach, probably due to the difficulty in realizing thermally-forbidden 1,3-hydride shift after electrocyclic ring closure. The present study shows that by heating (2E,4E,6E)-hexatrienes bearing ester or ketone substituents at the C1-position in a mixture of toluene/MeOH or EtOH (2 : 1) solvents at 90-100 °C, 1,4-CHDs can be selectively synthesized. This is achieved through a torquoselective disrotatory 6π-electrocyclic ring closure followed by a proton-transfer process. The success of this method depends on the polar protic solvent-assisted intramolecular proton transfer from 1,3-CHD to 1,4-CHD, which has been confirmed by deuterium-labeling experiments. There are no reports to date for such a solvent-assisted isomerization. Density functional theory (DFT) studies have suggested that forming 1,3-CHD and subsequent isomerization is a thermodynamically feasible process, regardless of the functional groups involved. Two possible successive polar solvent-assisted proton-transfer pathways have been identified for isomerization.

Thermally Activated Geometrical Regioselective E→Z Isomerization-Enabled Cascade Sequences of Conjugated Dienals: Experimental and DFT Studies

The geometrical regioselective E→Z isomerization of a conjugated alkene under thermal activation pose a challenge due to microscopic reversibility. Herein we report that such reversibility issues can be circumvented by integrating E→Z isomerization with subsequent cyclization cascade, particularly in the absence of commonly employed light, acids, or metal-catalysts. Thus, linearly conjugated dienals in a mixture of toluene-alcohol (2 : 1) solvents or only with alcohol at 60-70 °C can be converted to γ-alkoxybutenolides in moderate to good yields. The intermediary 2Z,4E-isomer can be isolated, which includes the first example of isolating the regioselective isomerization product under thermal conditions. Density functional theory (DFT) studies have been employed to shed light on the feasibility of geometrical alkene isomerization and ensuing cascade sequences. It has been observed that the regioselective 2E,4E→2Z,4E isomerization of dienal is a thermodynamically facile (ΔG <0) process. Structural elucidation further reveals that the presence of a certain charge transfer and a non-covalent interaction may be the primary reasons for the enhanced stability of the 2Z,4E-isomer. The thermodynamic plausibility of the subsequent cascade reaction from the Z-isomer to the anticipated product in the presence of a polar protic solvent (here MeOH) is also explicated. Out of the two probable pathways, the "hemiacetal pathway" involving a relay proton transfer is kinetically more feasible due to the diminished activation barrier than the "conjugate addition pathway".

CardioSim: a PC-based cardiac signal simulator using segmental modeling of electrocardiogram

Background: ECG modeling has wide application in signal representation, compression and synthetic ECG generation. Method: CardioSim generates synthetic ECG waveform in real-time using PC-based system. It provides dual facility of interface-based visualization with hardware-based waveform generation. It has two stages viz., development of reference model parameter database using Fourier model and generation of synthetic ECG waveform based on user defined parameters using normal and abnormal records (H, APC, PVC, LBBB, RBBB, P) from mitdb under PhysioNet. Result: It generates ten various ECG waveforms including one healthy and nine diseased rhythms from a single dynamic model with flexible user defined parameters. It gives higher reconstruction performance in terms of SNR and MSE. The mean SNR for different beat morphology is 89.2(H), 88.37(V), 86.32(A), 85.35(L), 97.22(P) and 83.3(R) and mean MSE is 2.45 × 10-6(H), 3.14 × 10-6(V), 8.98 × 10-6(A), 5.82 × 10-6(L), 0.43 × 10-6(P) and 0.25 × 10-6(R). Conclusion: It improves the performance parameters over published research work on ECG modeling and simulation. It can be used as a self-learning tool for entry level medical students.

Laryngeal Schwannoma Triggered Life-threatening Acute Airway Obstruction- A Rare Case Report with Review of Literature

Schwannoma in larynx is a rare presentaion. Laryngeal schwannomas are characterstically slow growing benign tumour usually arising from false cord and aryepiglottic fold with globus sensation being the most common presentation. Seldom it can present as stridor which need immediate intervention for survival of the patient. We present a case of 53 year female who presented with stridor at emergency and emergency tracheostomy was done. This patient had a history of dysphagia to solid food, hoarseness of voice and symptoms of aspirations. 70 degree rigid endoscopy and CEMRI of neck was performed to see the extent of the laryngeal lesion causing stridor. Tumor was excised completely by external transcervical approach. Histopathological reports suggested this tumor as schwannoma. Large obstructive laryngeal schwannoma though a unusual presentation but with immediate tracheostomy, proper diagnostic work up and precise surgical approach can give excellent recovery and post operative outcome for the patient.

Retromaxillary Cell: Radiological Analysis and Clinical Significance

Retromaxillary cell (RMC), one of the anatomical variations of the posterior ethmoidal cell and is often overlooked during primary functional endoscopic sinus surgery. The incomplete removal of the disease from RMC leads to need for revision surgery. This study was aimed at analyzing Computed tomography scans of patients' paranasal sinuses for the incidence, types and radiological evaluation of Retromaxillary cell. Incidence of RMC was 74% (74/100 sides). The sex distribution was 31 (62%) males and 19 (38%) females. 34 patients (85%) had bilateral RMC and 6 patients (15%) had unilateral RMC. Lateral extension of RMC ranged from 1.03 to 11.3 mm. Out of 74 sides examined, 20 (27.02) were type I, 36 were type II (48.64%) and 18 (24.32%) were type III. The incidence of maxillary sinus disease on RMC sides and non-RMC sides has no significant difference (p < 0.5). RMC is lateral extension of posterior ethmoidal cell beneath the orbit and posterosuperior to maxillary sinus. The depth of the RMC is highly variable. The risk of residual disease in FESS is high in Type III RMC and one should pay attention to presence or absence of RMC and type of RMC prior to the endoscopic sinus surgery. Radiological study of RMC helps in preoperative planning and therefore intraoperative complete clearance of disease in endoscopic sinus surgery.

Unusual Foreign Bodies in the Head & Neck Region

Introduction: Injuries in the Head Neck region due to impacted or penetrating foreign bodies are not uncommon in ENT ER or OPD. These injuries carry the risk of retained foreign bodies with dramatic consequences if remain untreated. Therefore, it is mandatory to detect any foreign body during clinical workup. The objective of our study is to evaluate the location of foreign bodies and to plan concerned surgical approach. Method: A Case Series of 9 patients, presenting with foreign body injury in the Head and Neck region in the Outpatient Department or Emergency of Department of Otorhinolaryngology and Head and Neck Surgery of a tertiary care hospital in Kolkata in a span of 3years, has been presented. Result: All the foreign objects were retrieved successfully without any surgical complication. Conclusion: History taking and Clinical examinations are the crucial steps in Investigation. Imaging studies can significantly increase the chance of detecting a foreign body.

Capillary Hemangioma of the External Auditory Canal Extending to Middle Ear and Mastoid Cavity: A Rare Case Report with Review of Literature

Capillary hemangioma  involving external auditory canal, middle ear and mastoid cavity is a very rare entity. Due to infrequent incidence but multiple overlapping clinical and radiological features amongst some common middle ear pathologies this benign vascular tumour often can be misdiagnosed. Histopathological report helps us to get definitive diagnosis. 40 years old female presented with diminished hearing and mass in right ear cavity for last 3 years. The otoscopic examination of right ear showed a pinkish polypoidal mass at the external auditory canal and tympanic membrane could not be visualized. Patient had a history of cortical mastoidectomy 2 years back for the similar problem. HRCT temporal bone revealed a single cavity with soft tissue density content in right mastoid cavity which was extending into right middle ear and external ear. Contrast Enhanced MRI showed a long polypoidal heterogeneously but strong enhancing T2 and STIR hyperintense lesion within mastoid antrum extending into middle ear cavity and external auditory canal forming an aural polyp. Excision of the mass was done by canal wall down mastoidectomy and also type IIIc tympanoplasty performed in same sitting. There is no recurrence noted after 6 months of follow up and hearing improvement noticed. Capillary haemangioma of mastoid antrum extending to middle ear and external auditory canal requires surgical excision as preferred treatment modality, pre-operative imaging guide us to choose the preferred surgical approaches.

The importance of laryngoscopic findings as predictors of the treatment outcomes of laryngopharyngeal reflux: a retrospective review of 143 cases

Background

Laryngopharyngeal reflux can be described as even a single episode of reflux of gastric acid peptic contents into the larynx and hypopharynx. A large number of new researches show non-acid reflux to be an important cause of LPR symptoms. The present study explores the role of laryngoscopic findings in predicting the treatment outcomes of empirical PPI therapy for LPR.

Methods

A total of 143 patients diagnosed clinically with LPR were evaluated by rigid laryngoscopy and classified into 3 groups based on the Belafsky reflux findings score, as normal (0–7), mild to moderate (8–16), and moderate to severe (17–26).

Results

Twelve out of 39 patients in the normal group, 44 out of 61 patients in the mild to moderate group, and 31 out of 43 patients in the moderate to severe group reported symptomatic improvement after 3 months of PPI therapy and lifestyle modifications. The results were statistically significant.

Conclusion

Pretherapy laryngoscopic findings can be an important predictor of successful treatment outcomes of empirical PPI therapy for LPR.

Antibodies Against Unusual Forms of Sialylated Glycans

Previous studies have shown that in the blood of healthy donors (1) there are no natural antibodies against sialylated glycoproteins, which contain Neu5Acα (N-acetylneuraminic acid) as the most widespread form of human sialic acid, and (2) there is a moderate level of antibodies capable of binding unnatural oligosaccharides, where Neu5Ac is beta-linked to a typical mammalian glycan core. In the present study, we investigated antibodies against βNeu5Ac in more detail and verified the presence of Kdn (2-keto-3-deoxy- D-glycero-D-galacto-nonulosonic acid) as a possible cause behind their appearance in humans, taking into account the expected cross-reactivity to Kdn glycans, which are found in bacterial glycoconjugates in both the α- and β-forms. We observed the binding of peripheral blood immunoglobulins to sialyllactosamines (where “sialyl” is Kdn or neuraminic acid) in only a very limited number of donors, while the binding to monosaccharide Kdn occurred in all samples, regardless of the configuration of the glycosidic bond of the Kdn moiety. In some individuals, the binding level of some of the immunoglobulins was high. This means that bacterial Kdn glycoconjugates are very unlikely to induce antibodies to βNeu5Ac glycans in humans. To determine the reason for the presence of these antibodies, we focused on noninfectious pathologies, as well as on a normal state in which a significant change in the immune system occurs: namely, pregnancy. As a result, we found that 2/3 of pregnant women have IgM in the blood against Neu5Acβ2-3Galβ1-4GlcNAcβ. Moreover, IgG class antibodies against Neu5Acβ2-3Galβ1-4GlcNAcβ and Neu5Acβ2-6Galβ1-4GlcNAcβ were also detected in eluates from the placenta. Presumably, these antibodies block fetal antigens.

Water, Sanitation, and Hygiene Practices in Urban Slums of Eastern India

Background

The Sustainable Development Goals identified universal access to water and sanitation facilities as key components for improving health. We assessed water, sanitation, and hygiene (WASH) practices and associated determinants among residents of urban slums in Kolkata, India.

Methods

Information on WASH practices was collected in 2 surveys (2018 and 2019) from participants of a prospective enteric fever surveillance conducted in 2 municipal wards of Kolkata. A composite WASH practice score was computed and a hierarchical stepwise multiple linear regression model constructed to identify key determinants of improved WASH score.

Results

Over 90% of households had access to piped water; 6% reported access to continuous supply. Adult women (61% in 2018; 45% in 2019) spent 20 minutes daily to fetch water. Access to improved latrines was almost universal, although 80% used shared facilities. Unhealthy disposal of children’s stools was reported in both rounds. Food hygiene practices were high, with most (>90%) washing uncooked items before eating; frequent consumption of street food items was reported.

Conclusions

The study area reported high WASH coverage. Unhygienic behavioral patterns predisposing to food- or water-borne diseases were also noted. Awareness building and sustainable community mobilization for food hygiene needs to be emphasized to ensure community well-being.

A Radiological Evaluation of Bone Healing in Postextraction Sockets Following Bone Grafting Using Beta-Tricalcium Phosphate and Calcium Phosphosilicate: A Controlled Comparative Study

BACKGROUND

Healing unbinds a well choreographed array of cellular, physiologic, biochemical, and molecular processes directed toward restoring the integrity and functional capacity of the damaged structures. The rate and degree of healing vary among individuals but is greatest during the first few months or years after tooth loss. Evidence suggests that alveolar bone ridge resorption may be prevented, initially by reconstructive surgical techniques using several materials which are employed at the time of extraction. This droves to the development of bone substitutes materials such as hydroxyapatite, beta tricalcium phosphate (β TCP), and bioactive glasses. These regenerative materials not only act as an osteoconductive scaffold but also interact with the surrounding tissues and impart an osseostimulatory effect.

METHODS

Twenty adult patients who required bilateral removal of homologous tooth, were informed and described regarding post extraction socket grafting using β TCP and CPS followed by covering with Collagen Membrane. Radiographic densitometry evaluation of postoperative visits of immediate; 1st month; 3rd month; and 6th month using orthopantomograph was done.

RESULTS

The Karl Pearson's Correlation coefficient was used to determine the degree of bone density with adjacent bone preoperatively and postoperatively. The statistical evaluation, CPS was more superior to β TCP, with a difference of 58.75 and P value showed more significance (<0.0001).

CONCLUSION

This article evaluates radiographically quality and quantity of bone formation in the socket, following extraction and bone grafting using Calcium Phosphosilicate (CPS) and β TCP, it is concluded that the two modalities of treatment were efficient in improving the clinical outcome parameters as well as showed comparable regenerative effects when used in the treatment of "socket grafting" while between them CPS more superior to β TCP biomaterials by Osteogenic properties.

Fungal Systematics and Evolution: FUSE 5

Thirteen new species are formally described: Cortinarius brunneocarpus from Pakistan, C. lilacinoarmillatus from India, Curvularia khuzestanica on Atriplex lentiformis from Iran, Gloeocantharellus neoechinosporus from China, Laboulbenia bernaliana on species of Apenes, Apristus, and Philophuga (Coleoptera, Carabidae) from Nicaragua and Panama, L. oioveliicola on Oiovelia machadoi (Hemiptera, Veliidae) from Brazil, L. termiticola on Macrotermes subhyalinus (Blattodea, Termitidae) from the DR Congo, Pluteus cutefractus from Slovenia, Rhizoglomus variabile from Peru, Russula phloginea from China, Stagonosporopsis flacciduvarum on Vitis vinifera from Italy, Strobilomyces huangshanensis from China, Uromyces klotzschianus on Rumex dentatus subsp. klotzschianus from Pakistan. The following new records are reported: Alternaria calendulae on Calendula officinalis from India; A. tenuissima on apple and quince fruits from Iran; Candelariella oleaginescens from Turkey; Didymella americana and D. calidophila on Vitis vinifera from Italy; Lasiodiplodia theobromae causing tip blight of Dianella tasmanica 'variegata' from India; Marasmiellus subpruinosus from Madeira, Portugal, new for Macaronesia and Africa; Mycena albidolilacea, M. tenuispinosa, and M. xantholeuca from Russia; Neonectria neomacrospora on Madhuca longifolia from India; Nothophoma quercina on Vitis vinifera from Italy; Plagiosphaera immersa on Urtica dioica from Austria; Rinodina sicula from Turkey; Sphaerosporium lignatile from Wisconsin, USA; and Verrucaria murina from Turkey. Multi-locus analysis of ITS, LSU, rpb1, tef1 sequences revealed that P. immersa, commonly classified within Gnomoniaceae (Diaporthales) or as Sordariomycetes incertae sedis, belongs to Magnaporthaceae (Magnaporthales). Analysis of a six-locus Ascomycota-wide dataset including SSU and LSU sequences of S. lignatile revealed that this species, currently in Ascomycota incertae sedis, belongs to Pyronemataceae (Pezizomycetes, Pezizales).

Electrocardiographic Parameters in Indian Newborns

OBJECTIVE

To generate data of electrocardiogram (ECG) parameters according to gestational age in Indian newborns.

METHODS

An observational study was carried out over 7 months in neonatology unit of a tertiary care teaching hospital. Following auscultation, ECG parameters were recorded simultaneously in 12 leads, on third day of life, in hemodynamically stable neonates. Data from 364 babies were analyzed, keeping at least 30 records for each gestational age between 30 to 42 weeks.

RESULTS

There was no difference in mean heart rate recorded through auscultation and ECG traces. The mean (SD) values recorded were: P wave duration 0.04 (0.01) s, P wave amplitude 1.3 (0.4) mm, T wave duration 0.07 (0.02) s, T wave amplitude 1.1 (0.6) mm, PR interval 0.09 (0.02) s, QRS duration 0.04 (0.01) s, QT interval 0.26 (0.02) s, QTc 0.4 (0.03) s and QRS axis 127 (22) degree. Gestation age-wise percentile charts of different ECG parameters were generated.

CONCLUSIONS

These gestational age-wise percentile charts of different ECG parameters for Indian newborns can be used as reference for neonatal ECG.

A Comparative Evaluation of Ischemic Mitral Regurgitation in AMI Patients Managed by Revascularization Vs Optimal Medical Therapy

Objectives: Ischemic mitral regurgitation (IMR) is one of the frequent complications associated with coronary artery disease (CAD); but the optimal management of IMR is controversial. Our aim was to evaluate and compare the impact of medical therapy versus revascularization on the degree of MR.Methods: We performed observational follow up study on 114 patients admitted to our hospital with AMI and mild to moderate degree of MR. Multiple parameters were used to assess the severity of MR at baseline and after 1 year of follow up to assess the change in MR severity after medial therapy and revascularization.Results: In the medically managed group, MR grade improved in 28.57% of patients while 53.57% patients remained in the same grade as before. The grade of MR deteriorated from moderate to severe in 17.86% patients during follow up. In revascularization group; improvement in MR grade was observed in 60.71% of patients while 32.14% patients remained in the previous grade. Deterioration from moderate to severe occurred in 7.14% of patients. PCI and CABG subgroup analysis showed almost similar impact on degree of MR during follow up.Conclusion: From our study we concluded that revascularization; either in form of PCI or CABG, is associated with improvement in degree of MR when compared to optimal medical therapy alone.

Formulation and chemical characterization of Clerodendrum infortunatum leaf extract in relation to anti-fungal activity

The study explored to develop an eco-friendly herbal fungicide from chloroform extract of Clerodendrum infortunatum leaves. The extract upon activity guided purification using flash chromatography yielded eight fractions F3 through F10. Total phenol and flavonoid contents in the fractions ranged from 0.12-48.25 mg GAE/g and 0.03–25.29 mg QE/g. LC-MS/MS analysis confirmed the identification of seven phenolic acids across different fractions, the total of which varied between 0 and 2.17 mg/g. Emulsifiable Concentrate (20%) formulation was made with the extract and fractions and tested against Phomopsis vexans causing fruit rot disease in brinjal. Of the various fractions, F8 displayed highest antifungal activity (ED₅₀ = 46.8 μg/ml). Antifungal activity of leaf extract/fractions was correlated with total phenol, total flavonoid and total phenolic acids (r = -0.60 to -0.69). Among the phenolic acids, benzoic acid showed maximum antifungal activity followed by t-cinnamic acid. The relationship between phenolic composition and activity is also reported.

Fatty acid synthase as a potential therapeutic target in feline oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) is an aggressive and treatment-resistant malignancy in both feline and human patients. Recent work has demonstrated aberrant expression of fatty acid synthase (FASN) and an increased capacity for lipogenesis in human OSCC and other cancers. In human OSCC, inhibition of FASN decreased cell viability and growth in vitro, and diminished tumour growth and metastasis in murine preclinical models. This study aimed to characterize FASN as a therapeutic target in feline OSCC. Immunohistochemistry revealed high FASN expression in primary feline OSCC tumours, and FASN expression was detected in OSCC cell lines (3 feline and 3 human) by immunoblotting and quantitative real-time-polymerase chain reaction (qRT-PCR). Orlistat, a FASN inhibitor, substantially reduced cell viability in both feline and human OSCC lines, although feline cell lines consistently displayed higher sensitivity to the drug. FASN mRNA expression among cell lines mirrored sensitivity to orlistat, with feline cell lines expressing higher levels of FASN. Consistent with this observation, diminished sensitivity to orlistat treatment and decreased FASN mRNA expression were observed in feline OSCC cells following incubation under hypoxic conditions. Treatment with orlistat did not potentiate sensitivity to carboplatin in the cell lines investigated; instead, combinations of the 2 drugs resulted in additive to antagonistic effects. Our results suggest that FASN inhibition is a viable therapeutic target for feline OSCC. Furthermore, cats may serve as a spontaneous large animal model for human oral cancer, although differences in the regulation of lipogenesis between these 2 species require further investigation.

Traumatic Perforation of the Tympanic Membrane: Etiologies and Risk Factors for Healing and Intervention

Objective: To study various etiologies of traumatic tympanic membrane perforation; evaluate the factors involved in healing of traumatic tympanic membrane perforation; and identify patients with perforations unlikely to benefit from conservative management. Methods Study Design:  Prospective observational study Setting:            Tertiary Government Medical College and Hospital Subjects:          64 consecutive cases of traumatic tympanic membrane perforation seen over one year were followed for 3 months. Perforations were assessed in terms of size, etiology, condition of edge and other associated factors or combinations of factors with regards to spontaneous healing, using descriptive statistics and chi-square tests.  Results: Of the 64 cases, 51 perforations healed while 13 did not. There were significant associations between tympanic membrane condition after 3 months and explosive mode of injury (χ2 = 23.30; p=.00001) as well as with size of perforation ((χ2 = 25.75; p=.00001). The risk of persistence of a tympanic membrane perforation was 34.57 times more among patients with a perforation size >50% compared to those with perforation size ≤50%  [OR-34.57 (6.28, 190.14); p= .00001]. Combined, explosive etiology and perforation size >50% were significantly associated with non-healing ((χ2 = 37.60; p = .00001). There were no significant associations with the condition of the edge of the perforation and upper respiratory tract infection. Conclusions: An explosive etiology and tympanic membrane perforation size >50% may be significant risk factors predicting non-healing of the perforation. Risk stratification of patients having one or both of these risk factors, with early intervention for those with both, and close monitoring for those with any one of these may lessen unnecessary morbidity. Bigger multicenter future studies are necessary to confirm these initial findings. Keywords: tympanic membrane perforation, tympanic membrane, risk factors, wound healing, early intervention

Congenital Pulmonary Vein Stenosis and Pulmonary Artery Branch Stenosis: A Rare Combination

Congenital pulmonary vein stenosis is a rare entity caused due to failed incorporation of common right and/or left pulmonary vein into the left atrium. Below is a case report of a combination of predominantly left-sided pulmonary vein stenosis with right pulmonary artery branch stenosis. The patient was an adolescent boy with mild symptoms. Clinical examination revealed features of pulmonary artery hypertension. Echocardiography and computed tomography scan were done to confirm the disease.

Use of fluoroscopic guidance to remove a migrating esophageal foreign body

Ingested foreign bodies that migrate extraluminally are rare. In such cases, exploration of the neck via an external approach is the recommended procedure to remove the object. However, locating such a foreign body can be a difficult task. We report what we believe is the first adult case of fluoroscopically guided localization of an accidentally ingested foreign body that had migrated into the soft tissues of the neck. We also review the other methods used to locate a migrating foreign body.

An Asymptomatic Pointed Foreign Body in the Hypopharynx-A Rare Case Report

Introduction Foreign body ingestion is an ENT emergency frequently encountered in both children and adults. Case Report A case of an open safety pin in the hypopharynx in a fifteen year old boy is reported, which remained impacted there for the past 15 days without any significant symptom or complication. CT scan, performed before surgical intervention, did not show any migration of this foreign body from its intraluminal site. This was removed by ‘Magill forceps technique’. Postoperative period was uneventful. Conclusion Pointed foreign body may present with negligible symptoms and that too may stay in the cricopharynx for long without migration. Magill forceps technique can be a good surgical option in such cases.

Community Awareness - A Key to the Early Detection of Head and Neck Cancer

INTRODUCTION Mortality and morbidity associated with head and neck cancers have decreased to a great extent in many developed countries of the world due to early diagnosis and treatment with advances in surgical techniques and better availability of radiotherapist and oncologists. But the situation in developing countries like India is quite different. AIMS AND OBJECTIVES This study was conducted amongst the patients attending the Otolaryngology department of a teaching hospital in Kolkata to find the incidence of various types and sites of head and neck cancer, to assess time delay from the date of onset of symptom to the final disease confirmation in relation to patients’ demographic profile, to assess time delay in histopathological diagnosis after reaching a tertiary care setup and also to correlate tobacco consumption and alcohol intake as risk factors for head and neck cancer and to note the reasons for late presentation, as described by the patient. MATERIALS AND METHODS The descriptive study was conducted at a tertiary level teaching hospital, in the Department of Otorhinolaryngology for a period from August 2013 to August 2015 with a study population of 133.  OBSERVATIONS  An average time lag from the onset of symptom to final diagnosis as malignancy was found to be 6 months to one year in nearly 72% of cases. Most of the patients were uneducated males of more than 50 years of age, hailing from rural areas. Cancer larynx was found to be the commonest of all head and neck cancers (31.6%). More than 65% of the patients were addicted to tobacco chewing or smoking or consumption of alcohol.  DISCUSSION  Poverty, lack of education, poor communication, lack of health care infrastructure in rural areas, community awareness about various risk factors, lack of effective health policy to achieve early diagnosis of head neck cancer were common factors related to delay in diagnosis.  CONCLUSION  Tobacco use and alcohol intake are the modifiable risk factors of head and neck cancer. Educating the field workers about the danger signs of head and neck cancer may promote early referral of the suspected cases to tertiary health care setup for early detection of cancer. 

Tumour, Oxidative Stress and Host T Cell Response: Cementing the Dominance

Reactive oxygen species (ROS) and free radicals are produced intrinsically during normal cellular metabolic processes or extrinsically due to ionizing radiations, UV rays, xenobiotic insult, etc. ROS are important signal mediators and are used by the immune system to destroy pathogens, but as these are highly reactive, they also have the capacity to cause DNA damage and alter protein and lipid components of a cell. As a result, cells have evolved a tight regulation of internal redox environment that involves a balanced interplay between free radicals produced and quenched by cellular antioxidants and enzyme systems. Any deregulation of this subtle balance can result in oxidative stress that can lead to various pathological conditions including cancer. Oxidative stress can be a cause of neoplasia, or it can be induced by a growing tumour itself. The link existing between oxidative stress and inflammation is also very strong. Suppressed cellular immune system, especially effector T cell system, is a characteristic of tumour-bearing host. Both the direct oxidative stress caused by tumour cell(s) and oxidative stress mediators present in tumour microenvironment play a significant role in the suppression of effector T cell function and induction of T cell death. This review discusses in detail the complex interplay between tumour-stroma-immune system in the light of oxidative stress that dominates every phase of cancer including initiation, progression and establishment. This review also addresses in detail the mechanisms of oxidative stress-induced T cell dysfunction in tumour-bearing host and also briefly points out the possible therapeutic interventions.

Comparison of Success of Clomiphene citrate and Letrozole in Ovulation Induction

The study was carried out to evaluate which drug is better in ovulation induction between clomiphene citrate and letrozole. The study was carried out in the infertility unit of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka and Centre for Assisted Reproduction (CARE) at Bangladesh Institute of Research and Rehabilitation in Diabetes Endocrine and Metabolic Disorders (BIRDEM), Dhaka from January 2007 to December 2007. One hundred and sixty five cases were taken for the study. It was a prospective interventional comparative study of clomiphene citrate and letrozole in infertile cases. The patients were divided into three groups. Group I--newly detected cases of sub fertility studied with clomiphene citrate. Group II--clomiphene citrate resistant cases studied with letrozole, Group III--newly detected cases of sub fertility studied with letrozole. The cases were followed up for outcome; (ovulation). The TVS was done on 12th or 13th day of menstruation and level of serum progesterone on 21st day of menstrual cycle to see the evidence of ovulation. Endometrial thickness was also measured. The data was collected on a predesigned questionnaire. The variables that influenced the study were-age, occupation, socioeconomic status, menstrual cycle, marital age, parity, history of MR, history of abortion, past medical and surgical history. In the current study it was observed that the signs of ovulation were significantly (p<0.05) higher in Group I treated with clomiphene citrate in comparison to Group II clomiphene citrate resistant cases treated with letrozole. The rate of ovulation was higher in Group I than that of Group III treated with letrozole, but the difference was not statistically significant (p>0.05). The signs of ovulation were present in 45(81.8%) cases in Group I, 33(60.0%) cases in Group II and 37(67.3%) cases in Group III. This findings of the study suggested that clomiphene citrate is higher successful than letrozole though not statistically significant. Letrozole can be preferred in clomiphene citrate resistant cases before starting other expensive therapies.

Trials and tribulations of conducting interventional studies in urban slums of a developing country: Experiences from Kolkata, India

Experimental studies involving human subjects provide most internally valid evidences in epidemiological research due to their robust methodology. While conducting population-based interventional studies, to achieve external validity, inclusion of information from vulnerable groups like urban slum-dwellers of the developing world, in the epidemiological estimates is of paramount importance. The challenges faced while conducting 2 consecutive large-scale, community-based vaccine trials in urban slums of Kolkata, India are presented in this article. Interventions in these communities often get constrained by issues pertaining to human rights and benefits, socio-cultural factors, political environment, methodological shortcomings in addition to the challenges in ensuring community participation. While conducting these trials although we intermittently faced obstacles, by virtue of having a long term and robust surveillance system and developing a trusted relationship between the researchers, community leaders and residents we were able to come up with a commendable community participation which culminated into the success of the interventions. Bridging the gap between research and field operations by incorporating knowledge gathered from interventional studies and making strategies to improve health conditions of these informal settlers is a major unfulfilled agenda. We believe the lessons learnt during our research will help researchers while developing efficient interventions in similar setting.

An Open Label Non-inferiority Trial Assessing Vibriocidal Response of a Killed Bivalent Oral Cholera Vaccine Regimen following a Five Year Interval in Kolkata, India

BACKGROUND

The bivalent killed oral cholera vaccine (OCV) provides 65% cumulative protection over five years. It remains unknown whether a boosting regimen can maintain protection in previously immunized populations. This study examines the immunogenicity and safety of an OCV regimen given five years following initial dosing.

METHODOLOGY/PRINCIPAL FINDINGS

An open label controlled trial was conducted in 426 healthy Indian participants previously enrolled in a large efficacy trial. To assess whether an OCV regimen given after five years can elicit an antibody response equal to that of a primary series, we compared vibriocidal antibody titers in previously immunized participants receiving a two dose booster regimen to participants receiving a primary two dose immunization series. Among participants receiving a two dose primary series of OCV (n = 186), 69% (95% CI 62%-76%) seroconverted. In the intervention arm (n = 184), 66% (95% CI 59%-73%) seroconverted following a two dose boosting schedule given five years following the initial series. Following a single boosting dose, 71% (95% CI 64%-77%) seroconverted. Children demonstrated 79% (95% CI 69%-86%) and 82% (95% CI 73%-88%) seroconversion after primary and boosting regimens, respectively.

CONCLUSIONS/SIGNIFICANCE

Administration of an OCV boosting regimen elicits an immune response similar to those receiving a primary series in endemic areas. Though a single boosting dose induces a strong immune response, further investigations are needed to measure if these findings translate to clinical protection.

A Few Unusual Cases of Benign Laryngeal Lesions - Our Experience

Introduction: Benign laryngeal lesions may have some uncommon presentations.  Aims: The aim was to identify unusual benign vocal cord lesions and review their management and follow up.  Material and methods: The records of the patients presenting with different benign vocal cord lesions were reviewed retrospectively. Confirmed cases of vocal cord paralysis and malignancy were excluded from the study. Nine cases were imcluded in this study. Clinical findings, investigation reports, treatment and outcome were analysed.  Results: Most of the patients were from 18 years to 52 years (66%). Most common presenting feature was hoarseness of voice (89%) followed by respiratory distress (33%) . Microlaryngeal surgeries were done in 7 patients (78%) and 2 patients (22%) were  managed conservatively.  Conclusion: Diagnosis of benign vocal cord lesions may sometimes be difficult. Careful history, attention to the anatomy and the probable variations in presentation of the benign lesions of larynx, thorough clinical examination and different diagnostic tools are essential for satisfactory management.

An Aetiopathological Study on Epistaxis in Adults and its Management

  IntroductionEpistaxis is a common clinical problem in ENT practice. Idiopathic aetiology is said to be the most common.Aim of studyTo find out whether idiopathic epistaxis is the most common cause of primary adulthood epistaxis and to formulate the best treatment protocolMaterials & MethodsA prospective study was conducted in a tertiary healthcare setup from August 2013 to August 2014. 100 patients of more than 16 years of age of both sexes were studied. Patients presenting with active nasal bleeding in ENT ER and OPD were included.ResultsTruly idiopathic epistaxis was encountered in 37% of the study population followed by 20% cases in association with grossly deviated septum with septal spur(s). Most of the cases were managed by resuscitation alone with or without anterior nasal packing. Conclusion: With advances in endoscopy & imaging techniques, cause of the epistaxis can most often be elicited and by sticking to a management protocol recurrence can be reduced.  

Understanding cancer development processes after HZE-particle exposure: roles of ROS, DNA damage repair and inflammation

During space travel astronauts are exposed to a variety of radiations, including galactic cosmic rays composed of high-energy protons and high-energy charged (HZE) nuclei, and solar particle events containing low- to medium-energy protons. Risks from these exposures include carcinogenesis, central nervous system damage and degenerative tissue effects. Currently, career radiation limits are based on estimates of fatal cancer risks calculated using a model that incorporates human epidemiological data from exposed populations, estimates of relative biological effectiveness and dose-response data from relevant mammalian experimental models. A major goal of space radiation risk assessment is to link mechanistic data from biological studies at NASA Space Radiation Laboratory and other particle accelerators with risk models. Early phenotypes of HZE exposure, such as the induction of reactive oxygen species, DNA damage signaling and inflammation, are sensitive to HZE damage complexity. This review summarizes our current understanding of critical areas within the DNA damage and oxidative stress arena and provides insight into their mechanistic interdependence and their usefulness in accurately modeling cancer and other risks in astronauts exposed to space radiation. Our ultimate goals are to examine potential links and crosstalk between early response modules activated by charged particle exposure, to identify critical areas that require further research and to use these data to reduced uncertainties in modeling cancer risk for astronauts. A clearer understanding of the links between early mechanistic aspects of high-LET response and later surrogate cancer end points could reveal key nodes that can be therapeutically targeted to mitigate the health effects from charged particle exposures.

Migration of a fish bone from the upper aerodigestive tract to the skin of the neck: a case report

We describe an unusual case of a migratory foreign body (fish bone) in the neck of a 45-year-old woman. The 2.1-cm bone migrated from the esophagus and traversed through the entire soft tissue of the neck, and it almost extruded through the skin of the neck. With the patient under local anesthesia, the foreign body was easily extracted through an incision over the skin.

Value addition of Palmyra palm and studies on the storage life

Palmyra palm (Borassus flabellifer L.) belonging to the family Palmae is referred to as tree of life with several uses including food, beverage, fibre, medicinal and timber. Unfortunately, the nutritionally enriched pulp of ripened palm has limited commercial use. Extraction of pulp has been accomplished by using water and heat to ensure maximum pulp recovery. Different recipes were tried for the preparation of two uncommon value added products like palm spread and palm toffee. On the basis of biochemical composition, organoleptic scores, microbial estimation and storage study both under ambient and refrigerated conditions; the suitable recipe was selected with the maximum acceptability. Gradual increase in total soluble solid (TSS), total sugar and reducing sugar while decrease in ascorbic acid, pH, β-carotene and protein content of processed products have been observed irrespective of storage condition. The results obtained from sensory evaluation and microbial status revealed that palm spread and toffee remained acceptable up to 9 months and 8 months, respectively at ambient temperature. The income per rupee investment for these two products was found to be remunerative.

A multicentric double blind randomised controlled trial of atenolol versus losartan as first line drug for mild to moderate essential hypertension

Ambulatory blood pressure monitoring provides a more reliable assessment of actual BP than office BP and is a more sensitive risk predictor of clinical cardiovascular outcomes. Recent international guidelines for hypertension have emphasised the usefulness of ambulatory BP for diagnosis and management of hypertension. We used ambulatory blood pressure monitoring to monitor the effect of the pharmacological treatment in patients with stage 1 or 2 hypertension. This was a multicentric randomised controlled trial having 360 subjects with 180 in each treatment arm. The duration of study was 6 months. The patients were randomly selected to receive atenolol or losartan as initial therapy. The dose of atenolol or losartan was 50 mg once daily at 8 am in the morning. Ambulatory BP assessment was done in a subgroup of subjects using Schiller BR-102 plus machine. One hundred and thirty patients were recruited for the study using ambulatory blood pressure monitoring. There were 66 patients in atenolol arm and 64 patients in the losartan arm. A significant white coat hypertension was noticed in both the arms. Out of 130 subjects in the ambulatory group, 41.53% had a white coat hypertension. Statistically significant reduction of office BP was observed with both atenolol and losartan; however, no significant difference in efficacy of the two drugs was found in reducing office BP. However, when using ambulatory blood pressure monitoring, the reduction with either drug was not significant. The dipper status was better in the atenolol group than the losartan group. Neither of the drugs prevent morning surge of BP when administered once daily in the morning. There was high prevalence of white coat hypertension in patients with stage 1 and stage 2 hypertension. There was similar reduction of systolic blood pressure and diastolic blood pressure by the 2 study drugs. Atenolol scores over losartan in converting non-dipper to dipper but its' impact on clinical outcome is not known. Morning surge of BP was unaffected by either of the study drugs.

Epidermoid cysts in head and neck: our experiences, with review of literature

Epidermoid cysts are benign lesions, characterized by cystic spaces lined by simple squamous epithelium (epidermoid cyst), containing skin adnexa ("true" dermoid cyst) or tissues of all three germ layers (teratoid cyst). Head and neck constitute ~7% of all cases of epidermoid and dermoid cysts. There is often a diagnostic dilemma with the more common cystic lesions of this region. A retrospective case-series study of histologically proved epidermoid cysts in the head-neck region, from February 2008 to January 2011, in the Department of Otorhinolaryngology and Head-Neck Surgery of a tertiary Government teaching hospital in eastern India. The diagnosis was reached by fine needle aspiration cytology FNAC and subsequent histopathology where feasible. Necessary imaging was done for evaluation and management. A total of 28 cases were analyzed. 5 were female, with a male: female ratio of 4.6. Age range was from 2 to 60 years (mean = 30). Excision was the preferred treatment in 20 cases (71.4%). Various sites like the submandibular region (5), pinna (5), sublingual region (1), periorbital (6), suprasternal (6), along the anterior border of sternocleidomastoid (1) and glabella (3) were involved, along with an iatrogenic implantation epidermoid cyst in a tracheostomy scar. Some of the interesting cases presenting with clinical dilemma have been emphasized. Epidermoid cysts are relatively less common in the head-neck region, hence are liable to be misdiagnosed. In this case-series, few cases presenting with enough elements of confusion and dilemma are discussed with overall analysis and review of the related literature.

Bilateral Antro-Choanal Polyps in an Elderly Female

Objective: To report the first case of primary bilateral antro-choanal polyps in the elderly age group.   Methods:        Design: Case Report        Setting: Tertiary Government Hospital        Patient: One   Result: A 60-year-old, non-allergic female with progressive bilateral nasal obstruction was subsequently diagnosed with bilateral antro-choanal polyps. Endoscopic sinus surgery was performed and the patient remained asymptomatic on one year follow-up.   Conclusion: Antro-choanal polyps can occur bilaterally in the elderly age group. To the best of our knowledge, this is the first reported case of primary bilateral antro-choanal polyps in an elderly female.   Keywords: antro-choanal polyp; bilateral; elderly; female