Studies on bioaccumulation patterns, biochemical and genotoxic effects of copper on freshwater fish, Catla catla: an in vivo analysis

Abstract During present study, the copper (Cu) mediated oxidative stress was measured that induced DNA damage by concentrating in the tissues of fish, Catla catla (14.45±1.24g; 84.68±1.45mm) (Hamilton,1822). Fish fingerlings were retained in 5 groups for 14, 28, 42, 56, 70 and 84 days of the exposure period. They were treated with 2/3, 1/3, 1/4 and 1/5 (T1-T4) of 96h lethal concentration of copper. Controls were run along with all the treatments for the same durations. A significant (p < 0.05) dose and time dependent concentration of Cu was observed in the gills, liver, kidney, muscles, and brain of C. catla. Among organs, the liver showed a significantly higher concentration of Cu followed by gills, kidney, brain, and muscles. Copper accumulation in these organs caused a significant variation in the activities of enzymes viz. superoxide dismutase (SOD), catalase (CAT) and peroxidase (POD). The SOD activity varied significantly in response to the exposure time of Cu as 56 > 70 > 42 > 84 > 28 > 14 days while CAT activity exhibited an inverse relationship with the increase in Cu concentration. POD activity showed a significant rise with an increase in Cu exposure duration. Comet assay exhibited significant DNA damage in the peripheral erythrocytes of Cu exposed C. catla. Among four exposure concentrations, 2/3rd of LC50 (T1) caused significantly higher damage to the nuclei compared to control. Increased POD and SOD activity, as well as a decrease in CAT activity in response to Cu, demonstrates the involvement of a protective mechanism against reactive oxygen species (ROS), whereas increased ROS resulted in higher DNA damage. These above-mentioned molecular markers can be efficiently used for the biomonitoring of aquatic environments and conservation of edible fish fauna.

A rare presentation of idiopathic small bowel diaphragm disease - A case report

INTRODUCTION

Diaphragm disease, typically associated with long-term non-steroidal anti-inflammatory drug (NSAID) use, manifests as diaphragm-like small bowel strictures, often resulting in bowel obstruction.

CASE DESCRIPTION

A 75-year-old male presented with features of recurrent subacute intestinal obstruction, later diagnosed with multiple small bowel strictures via CT imaging. Surgical intervention, including resection and anastomosis, was performed to alleviate the obstruction. Histopathological examination of the resected specimen confirmed diaphragm disease, challenging its traditional association with NSAID use.

DISCUSSION

Diaphragm disease, characterized by mucosal and submucosal diaphragm-like strictures, is typically attributed to NSAID usage. However, this case underscores the possibility of diaphragm disease in the absence of NSAID exposure. Pathological findings supported the presence of diaphragm-like strictures, despite the patient's denial of NSAID use.

CONCLUSION

This case emphasizes the importance of considering diaphragm disease as a differential diagnosis in patients with intermittent bowel obstruction, even in the absence of NSAID history.

Association between oxidative stress, antioxidant enzymes, and homocysteine in patients with polycystic ovary syndrome

OBJECTIVE

Polycystic ovary syndrome (PCOS) is a prevalent health condition that commonly affects adolescent girls and young women. The purpose of this study was to evaluate the correlation between levels of total glutathione (TG), reduced glutathione (GSH), superoxide dismutase (SOD), lipid peroxidation, and homocysteine with PCOS.

PATIENTS AND METHODS

This study employed a cross-sectional case-control design, involving a target population of 305 Sudanese females. Among them, 205 individuals were categorized as cases, and 100 served as controls. The TG, GSH, SOD, lipid peroxidation, and homocysteine levels were measured in the serum of study participants through enzyme-linked immunosorbent essay.

RESULTS

Total glutathione (1,174.5 ± 271.4 vs. 986.1 ± 191.5, p = 0.01), GSH (801.3 ± 132.2 vs. 748.6 ± 103.1, p = 0.007), SOD (225.2 ± 57.8 vs. 195.5 ± 49.6, p = 0.009), lipid peroxidation (3.4 ± 1.1 vs. 2.4 ± 0.7, p = 0.03), and homocysteine (14.9 ± 2.1 vs. 13.5 ± 1.6, p = 0.04), showed significant differences between the two groups (cases vs. controls). A moderate positive correlation between TG, GSH, SOD, lipid peroxidation, homocysteine, BMI, age, and duration of PCOS was observed. Furthermore, a strong positive correlation between BMI, age, and duration of PCOS was noted within the patient group.

CONCLUSIONS

In conclusion, this study demonstrates that patients with PCOS have elevated levels of TG, GSH, SOD, lipid peroxidation, and homocysteine compared to the control group. These findings suggest a potential association between PCOS and oxidative stress, lipid metabolism, and homocysteine pathways. Moreover, the observed positive correlation with BMI, age, and duration of PCOS indicates the importance of these factors in disease progression.

Association of serum beta hCG levels in women with palpable malignant breast lesions

This study aims to determine whether serum Beta hCG can be used as a tumour marker in Breast malignancies. The objective of this study is to evaluate the serum Beta hCG in various stages of breast carcinoma and to correlate its level with disease severity and prognosis. Cross sectional analytical study of assessing serum Beta hCG in 200 patients with palpable breast malignancies at hospitals in urban Mangalore, India. In our study there was No increase in serum Beta hCG, in women with breast malignancies, but there was a pattern amongst the negative results. A Beta hCG of < 5mIU/mL is taken as negative, but in our study of 200 individuals, a mean value of 2mIU/mL was used as differentiation between low and high risk individuals. With our study we tried to correlate the value of Beta hCG with malignant breast lesions, and even though women with such lesions did not have a value of > 5mIU/mL, we found substantial evidence that women who had a value of > 2mIU/mL had a more advanced disease, be it in terms of staging, and comparing it with markers like ki67. A direct correlation between Beta hCG and severity of the disease in terms of staging was proved, hereby directly affecting the outcome of patients. Higher the level of Beta hCG, graver the prognosis. Even though Beta hCG cannot be used as tumour marker, it can be used to prognosticate the severity in women with palpable breast malignancies.

Propofol Infusion Versus Isoflurane/Nitroglycerine Combination for Controlled Hypotensive Anesthesia in Neurosurgery

Background: The use of hypotensive anesthesia is one of several techniques that have been used to lessen the intraoperative loss of blood and improve visibility in the operative field. A procedure that requires a clear area and little intraoperative bleeding, which can affect the surgeons' abilities, is Neurosurgery. Objective: The current study aimed to assess how both anesthetics affected tissue perfusion, blood loss, operating field visibility, and extubation time. Settings and Design: A prospective quasi-experiment was used in the design of this clinical trial Practical Implication: The practical implication for choosing between propofol infusion and the isoflurane/nitroglycerine combination for controlled hypotensive anesthesia in neurosurgery includes considering several factors. Firstly, the patient's individual characteristics and medical history should be taken into account to determine the most suitable anesthesia approach. Secondly, the surgical procedure and the desired level of hypotension required should be evaluated. Thirdly, the availability and expertise of the anesthesia team in managing either method should be considered. Finally, potential side effects and complications associated with each technique should be weighed. Ultimately, a well-informed decision must be made based on these considerations to ensure the safety and efficacy of controlled hypotensive anesthesia in neurosurgery. Patients and Methods: Sixty individuals with ASA I or II were separated into two groups; Group P received both induction and maintenance doses of propofol, while Group I received isoflurane for maintenance with nitroglycerine. Blood loss, heart rate, mean arterial pressure, and the degree of surgical field clarity were all monitored every ten minutes. Results: As opposed to the isoflurane group, the propofol group substantial reduction in blood loss (p=0.01), improved clarity of the surgical field (p=0.002), and reduced time to extubation (p=0.001). Conclusion: Even with the addition of the hypertension medication nitroglycerine to isoflurane, propofol for craniotomy improved surgical conditions and gave a quicker recovery than isoflurane. Keywords: Nitroglycerin, Isoflurane, Propofol, Hypotensive Anesthesia, and Neurosurgery

Determinants of change in code status among patients with cardiopulmonary arrest admitted to the intensive care unit

BACKGROUND

Patients with cardiopulmonary arrest often have a poor prognosis, prompting discussion with families about code status. The impact of socioeconomic factors, demographics, medical comorbidities and medical interventions on code status changes is not well understood.

METHODS

This retrospective study included adult patients presenting with cardiac arrest to the intensive care unit of a hospital group between 5/1/2010-5/1/2020. We extracted chart data on socioeconomic factors, demographics, and medical comorbidities.

RESULTS

We identified 1,254 patients, of which 57.5% were males. Age was different across the groups with (61.2 ± 15.5 years) and without (61.2 ± 15.5 years) code status change (p= <0.0001). Code status was changed in 583 patients (46.5%). Among patients with code status change, the highest prevalence was White patients (34.8%), followed by African Americans (30.9%), and Hispanics (25.4%). Compared to patients who did not have a code status change, those with a change in code status were older (66.7 ± 14.8 years vs 61.2 ± 15.5 years). They were also more likely to receive vasopressor/inotropic support (74.6% vs 58.5%), and broad-spectrum antibiotics (70.3% vs 57.7%). Insurance status, ethnicity, religion, education, and salary did not lead to statistically significant changes in code status.

CONCLUSIONS

In patients with cardiopulmonary arrest, code status change was more likely to be influenced by the presence of medical comorbidities and medical interventions during hospitalization rather than by socioeconomic factors.

Effects of Non-Thermal Processing Methods on Physicochemical, Bioactive, and Microbiological Properties of Fresh Pineapple (Ananas comosus L. Merr.) Juice

Background: Pineapple juice processing is an art of preservation, and the processing technologies play important role in pineapple juice quality. Therefore, this study aimed to explore the potential impacts of non-thermal processing methods on the physicochemical, bioactive, and microbiological properties of fresh pineapple juice. Methods: Extracted juices were subjected to several non-thermal processes including microwave processing, vacuum evaporation, mild pasteurization, pulsed electric field, and ultra-sonication. Physicochemical properties including Total Soluble Solids (TSS), pH, titratable acidity, and color; Total Phenolic Content (TPC); Total Anthocyanin Content (TAC); antioxidant capacity; and microbiological properties were evaluated. Data were statistically analyzed by Minitab statistical software (version: 18.1). Results: TSS, pH, acidity (%) of processed juices ranged from 11.03-12.03, 4.07-4.27, and 0.42-0.49, respectively. In terms of color properties both ultra-sonication and microwave processing showed the highest values of L (luminosity), a* (redness), and b* (yellow). The highest TPC was reported in ultra-sonication treatment 11.996±0.002 mg Gallic Acid Equivalents (GAE)/100 ml. The TAC varied from 0.179-0.235 mg Total Anthocyanin (TA)/100 ml, where ultra-sonication and mild pasteurization treatment yielded the highest and lowest contents, respectively. Conclusion: Perfect phenolic content, antioxidant capacity, retention of anthocyanin content, and attractive color in pineapple juices when treated with non-thermal techniques.

Trigger related outcomes of takotsubo syndrome in a cancer population

Background

Takotsubo syndrome (TTS) occurs more frequently in cancer patients than in the general population, but the effect of specific TTS triggers on outcomes in cancer patients is not well studied.

Objectives

The study sought to determine whether triggering event (chemotherapy, immune-modulators vs. procedural or emotional stress) modifies outcomes in a cancer patient population with TTS.

Methods

All cancer patients presenting with acute coronary syndrome (ACS) between December 2008 and December 2020 at our institution were enrolled in the catheterization laboratory registry. Demographic and clinical data of the identified patients with TTS were retrospective collected and further classified according to the TTS trigger. The groups were compared with regards to major adverse cardiac events, overall survival and recovery of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) after TTS presentation.

Results

Eighty one of the 373 cancer patients who presented with ACS met the Mayo criteria for TTS. The triggering event was determined to be "cancer specific triggers" (use of chemotherapy in 23, immunomodulators use in 7, and radiation in 4), and "traditional triggers" (medical triggers 22, and procedural 18 and emotional stress in 7). Of the 81 patients, 47 died, all from cancer-related causes (no cardiovascular mortality). Median survival was 11.9 months. Immunomodulator (IM) related TTS and radiation related TTS were associated with higher mortality during the follow-up. Patients with medical triggers showed the least recovery in LVEF and GLS while patients with emotional and chemotherapy triggers, showed the most improvement in LVEF and GLS, respectively.

Conclusion

Cancer patients presenting with ACS picture have a high prevalence of TTS due to presence of traditional and cancer specific triggers. Survival and improvement in left ventricular systolic function seem to be related to the initial trigger for TTS.

Percutaneous coronary intervention in patients with cancer using bare metal stents compared to drug-eluting stents

Background

Management of coronary artery disease (CAD) is unique and challenging in cancer patients. However, little is known about the outcomes of using BMS or DES in these patients. This study aimed to compare the outcomes of percutaneous coronary intervention (PCI) in cancer patients who were treated with bare metal stents (BMS) vs. drug-eluting stents (DES).

Methods

We identified cancer patients who underwent PCI using BMS or DES between 2013 and 2020. Outcomes of interest were overall survival (OS) and the number of revascularizations. The Kaplan–Meier method was used to estimate the survival probability. Multivariate Cox regression models were utilized to compare OS between BMS and DES.

Results

We included 346 cancer patients who underwent PCI with a median follow-up of 34.1 months (95% CI, 28.4–38.7). Among these, 42 patients were treated with BMS (12.1%) and 304 with DES (87.9%). Age and gender were similar between the BMS and DES groups (p = 0.09 and 0.93, respectively). DES use was more frequent in the white race, while black patients had more BMS (p = 0.03). The use of DES was more common in patients with NSTEMI (p = 0.03). The median survival was 46 months (95% CI, 34–66). There was no significant difference in the number of revascularizations between the BMS and DES groups (p = 0.43). There was no significant difference in OS between the BMS and DES groups in multivariate analysis (p = 0.26). In addition, independent predictors for worse survival included age &gt; 65 years, BMI ≤ 25 g/m2, hemoglobin level ≤ 12 g/dL, and initial presentation with NSTEMI.

Conclusions

In our study, several revascularizations and survival were similar between cancer patients with CAD treated with BMS and DES. This finding suggests that DES use is not associated with an increased risk for stent thrombosis, and as cancer survival improves, there may be a more significant role for DES.

The Effect of SGLT-2 inhibitors and GLP-1RA on Major Cardiovascular Conditions: A Meta-Analysis.. [DOI: 10.21203/rs.3.rs-1930982/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Objective Sodium-glucose co-transporter 2 (SGLT-2) inhibitors and Glucagon-like Peptide-1 Agonists (GLP-1RA) are two common anti-hyperglycemic agents prescribed by clinicians. The effects on cardiovascular conditions such as heart failure (HF) hospitalization, stroke, myocardial infarctions, and other cardiovascular conditions are not well studied. The purpose of this study is to analyze existing data on the effect of SGLT-2 inhibitors and GLP-1RA on preventing these cardiovascular conditions. Methods A retrospective meta-analysis of all existing literature of the effect of SGLT-2 inhibitors and GLP-1RA on the rates of the following categories was researched: primary cardiovascular outcomes, heart failure hospitalizations, atrial fibrillation, stroke, myocardial infarction, left ventricle ejection fraction (LVEF), and heart failure symptoms. Hazard ratios for each category were obtained, and overall Hazard Ratio (HR)’s to determine overall statistical significance were computed. Result Both medication classes provided statistically significant reduction in preventing major cardiovascular events. Only SGLT-2 inhibitors provided statistically significant reduction in heart failure hospitalizations. Only GLP-1RA provided statistically significant reduction in preventing stroke. Neither medication class provided a statistically significant benefit in preventing myocardial infarctions or improving LVEF. More studies are needed on effects of either SGLT-2 inhibitors or GLP-1RA agonists on preventing HF symptoms or atrial fibrillation. Conclusion This study demonstrates that SGLT-2 inhibitors and GLP-1RA are important for improving both diabetic and cardiovascular health. In patients at risk for a major cardiovascular event, SGLT-2 inhibitors or GLP-1RA may be prescribed by clinicians. More studies must be performed to draw more conclusions.

Left sided Amyand hernia - A case report

INTRODUCTION

Amyand hernia is a clinical condition wherein content of the inguinal hernial sac is formed by the vermiform appendix.

CASE PRESENTATION

1 year 3-month-old male child presented to our OPD with an irreducible left inguinal hernia for which he was taken up for an emergency herniotomy. The terminal ileum, caecum and appendix were found to be the contents of the hernial sac.

DISCUSSION

As the appendix is anatomically located on the right, Amyand hernia more commonly occurs on the right, however its occurrence on the left, is a rare event and is usually associated with congenital anomalies like Intestinal malrotation, Situs inversus and mobile caecum.

CONCLUSION

Amyand hernia presenting on the left is extremely rare and high index of clinical suspicion is required to manage such patients. We report one such rare case of a Left sided Amyand hernia in a young child.

Prosthetic Aortic Valve Thrombosis: Surgery or Thrombolysis

Mechanical prosthetic valve thrombosis is a serious complication which necessitates immediate intervention. The presenting signs and symptoms of this illness are somewhat variable, but physical examination and trans-esophageal-echocardiography enable rapid diagnosis. Valve replacement or thrombolysis in the correct hospital setting must be performed to avoid life-threatening complication without delay. But it is not proven entirely which therapy is superior. For any given patient, the risks of thrombolytic therapy, including bleeding, systemic embolism and failure to restore valvular function, must be weighed against the risks of surgical intervention. In spite of aggressive therapy, morbidity and mortality from prosthetic valve thrombosis and its treatment are not less indeed. This report describes the case of a woman with aortic prosthetic valves who presents with heart failure and evidence of severe prosthetic aortic valve dysfunction after a period of suboptimal anticoagulation.

Evaluation of Methylation Panel in the Promoter Region of p16INK4a , RASSF1A, and MGMT as a Biomarker in Sputum for Lung Cancer

Lung cancer is the most common cause of cancer death in the world. Effective early detection and appropriate medications can help treat this deadly cancer. Therefore, early detection of lung cancer is of utmost importance, especially in screening high-risk populations (such as smokers) with an urgent need to identify new biomarkers. The present study aimed to demonstrate the potential of using the panel of DNA methylation as a biomarker for the early diagnosis of lung cancer from sputum samples. The methylated promoter of p16^INK4a , RASSF1A, and MGMT genes was estimated by the methylation-specific polymerase chain reaction in a sample of 84 lung cancer patients (65 smokers and 19 non-smokers). Based on the results, p16^INK4a promoter methylation was significantly associated with smoking habit and lung cancer progression in terms of histological grading and patient staging. The sensitivity and specificity of the p16^INK4a gene as a biomarker for lung cancer were 71% and 90%, respectively. The methylated promoter of RASSF1A was less sensitive (48%) as a biomarker for lung cancer with 83%. The results demonstrated a strong association between promoter methylation of RASSF1A and late stages of lung cancer (P=0.0007). The sensitivity of the MGMT gene as a biomarker for lung cancer was 61% with high specificity (92%), compared to other candidate genes in this study. The epigenetic alteration in the promoter region of p16^INK4a , RASSF1A, and MGMT genes is highly associated with cancer cell development. It is suggested that the use of these candidate biomarkers can be used as an adjunct to computed tomography screening to diagnose patients at high risk for lung cancer after validation.

Predictors of Recurrence and Survival in Cancer Patients With Pericardial Effusion Requiring Pericardiocentesis

Aim

This study investigated the factors predicting survival and the recurrence of pericardial effusion (PE) requiring pericardiocentesis (PCC) in patients with cancer.

Materials and Methods

We analyzed the data of patients who underwent PCC for large PEs from 2010 to 2020 at The University of Texas MD Anderson Cancer Center. The time to the first recurrent PE requiring PCC was the interval from the index PCC with pericardial drain placement to first recurrent PE requiring drainage (either repeated PCC or a pericardial window). Univariate and multivariate Fine-Gray models accounting for the competing risk of death were used to identify predictors of recurrent PE requiring drainage. Cox regression models were used to identify predictors of death.

Results

The study cohort included 418 patients with index PCC and pericardial drain placement, of whom 65 (16%) had recurrent PEs requiring drainage. The cumulative incidences of recurrent PE requiring drainage at 12 and 60 months were 15.0% and 15.6%, respectively. Younger age, anti-inflammatory medication use, and solid tumors were associated with an increased risk of recurrence of PE requiring drainage, and that echocardiographic evidence of tamponade at presentation and receipt of immunotherapy were associated with a decreased risk of recurrence. Factors predicting poor survival included older age, malignant effusion on cytology, non-use of anti-inflammatory agents, non-lymphoma cancers and primary lung cancer.

Conclusion

Among cancer patients with large PEs requiring drainage, young patients with solid tumors were more likely to experience recurrence, while elderly patients and those with lung cancer, malignant PE cytology, and non-use of anti-inflammatory agents showed worse survival.

Abstract 157: Clinical And Social Determinants Of Change In Code Status Among Patients Hospitalized With Covid-19

Background: Patients hospitalized with COVID-19 who develop cardiopulmonary arrest often have poor prognosis, prompting discussions with families about goals of care. The relationship between clinical and social determinants of code status change is poorly understood.

Methods: This retrospective study included adult COVID-19 positive patients admitted to the intensive care unit with cardiac arrest in a multihospital center over the first 9 months of the pandemic (3/1/2020 - 12/1/2020). Data on medical and social factors was collected and adjudicated.

Results: We identified 208 patients over the study timeline. The mean age was 63.7 ± 14.5 years and 54.3% (n=113) were male. The majority of patients with cardiopulmonary arrest had pulseless electrical activity (PEA) as their initial rhythm (91.3%, n=190). Code status was changed in 56.3% (n=117) of patients. The majority of COVID-19 patients with cardiac arrest were Hispanic (53.4%, n=111), followed by African American (27.9%, n=58), and White patients (13.5%, n=28). Race/ethnicity did not affect the rate of code status change. COVID-19 patients who had a code status change were statistically more likely to have a lower salary ($54,838 vs $62,374), have a history of stroke/transient ischemic attack (15.4 vs 4.4%, 18:4), or heart failure (28.2 vs 15.6%, 33:14), all with P<0.05. Patients with code status change had shorter courses of cardiopulmonary resuscitation (11.9 vs 16.9 minutes, P<0.05). Both groups had similar levels of aggressive care received including continuous renal replacement therapy, vasopressor and broad-spectrum antibiotics requirements. Insurance status, ethnicity, religion, and education did not lead to statistically significant changes in code status in COVID patients.

Conclusion: Patients hospitalized with cardiopulmonary arrest and positive for COVID-19 are more likely to have a change in code status. This code status change is affected by cardiovascular comorbidities such as stroke and heart failure, along with lower income but not by insurance status, ethnicity, religion, and educational level.

Applications of indocyanine green in surgery: A single center case series

Background

Fluorescence imaging using indocyanine green (ICG) has revolutionized commonly performed general surgical procedures by providing superior anatomic imaging and enhancing safety for patients. ICG, when injected, shows a bright green fluorescence when subjected to the near infra-red (NIR) spectrum.

Materials and methods

We employed the use of ICG in Laparoscopic cholecystectomy, Intestinal Colorectal Anastomosis and Hernia to assess vascularity of resected ends and bowel viability, Sentinel Lymph node mapping, Vascular surgery to assess amputation stump success and in assessing Flap Vascularity and healing.

Results

ICG when administered had successfully shown bright green fluorescence in different cases thereby aiding in surgical procedures.

Conclusion

Routine intraoperative use of ICG could pave the way for a more objective assessment of different surgical circumstances and thereby reduce personalized barriers to aciurgy. ICG fluorescence therefore seems to be a promising apparatus in standard general surgical procedures minimizing untoward errors and improving patient conformance.

•

Fluorescence guided surgery, due to its enhanced visualization ability, has assisted surgeons in minimizing errors.

•

Indocyanine green (ICG) is the only fluorophore to be used in humans and has a wide margin of safety.

•

ICG shows a bright green fluorescence when subjected to near infra-red spectrum.

•

Fluorescence imaging using ICG is a valuable accompaniment to open and laparoscopic surgery.

•

Routine use of ICG provides better visual assessment which helps in decision making, thereby improving patient outcome.

Rare cause of thyroid enlargement: Localized AA amyloid goiter – A case report

Introduction

Case presentation

Discussion

Conclusion

•

Clinical enlargement of the thyroid gland due to amyloid infiltration is a rare phenomenon.

•

Identification of subtype of amyloidosis is important as the treatment differs for each.

•

AA amyloidosis is less frequent compared to other types, and currently, there are no guidelines for treatment of the same.

•

High index of clinical suspicion is needed to rule out other causes of goiter.

•

Patients have a better outcome when compared to those with concurrent systemic AA amyloidosis.

Double Delayed Enhancement: Concomitant Cardiac Amyloidosis and Acute Coronary Embolism

Hereditary cardiac amyloidosis (CA) is a relatively rare cause of nonischemic cardiomyopathy. The risk of intracardiac thrombi increases significantly in patients with CA. We report a case of a patient presenting with chest pain and acute myocardial infarction who was subsequently diagnosed with concomitant CA and acute coronary embolism.

Accuracy of Paper Point Technique for Final Working Length Measurement after Canal Preparation

Objective: The aim this study was to check the accuracy of paper point technique for final working length measurement after canal preparation. Study Design: Randomized controlled trial Place and Duration: Study was performed in department of operative dentistry, Liaquat University of Medical & Health Sciences, Jamshoro for one year duration from January 2017 to December 2017. Methodology: This study was performed on 78 patients divided equally into two groups. In one group working length was established by using electronic apex locator while in second group working length was established by using electronic apex locator with paper point technique. To check the working length master apical gutta percha point (GP point) was inserted into canal and radiograph were taken by paralleling angle technique. Results: There were 34 (43.6%) males while 44 (56.4%) patients were females. Mean age of patients was 30.5±8.9 years. Mean tooth number was 28.8±11.0. Group A is concerned that was treated only with Electronic Apex Locator showed lesser number of acceptable length than group B. on the other hand, group B was treated with electronic apex locator and paper point technique showed higher acceptable length of respondents with a difference of 4 frequencies or 7% in excess. A less value of chi-square test showed relationship between observed and expected data; whereas, significance value indicated no significant difference between group A and B. Conclusion: Paper point technique is as reliable as other techniques for final working length measurement. Key Words: Electronic Apex Locator, Paper Point Technique, Endodontic Working Length

Trends and instigators among young adolescent suicide in the United States

OBJECTIVES

The present investigation examined the role of factors involved in suicide ideation and suicide attempt using a nationally representative sample of US high school students.

METHODS

Data were collected from students in Grades 9-12 as part of the Youth Behavioral Survey (n = 11,328). Logistic regression models were used to examine factors associated with suicide ideation and suicide attempt. Variables included demographic characteristics (grade, sex, and race), psychosocial factors (physical fighting, sexual violence, sports participation, bullying, and electronic bullying), and substance use (cigarette usage, marijuana usage, and alcohol usage).

RESULTS

The factor most associated with suicide ideation was bullying (either electronic or physical), whereas the factor most associated with suicide attempt was sexual violence followed closely by physical bullying.

CONCLUSIONS

The multitude of instigators and commonality among gender, ethnicity, and socio-economic status give an indication of how to prevent suicide and who to target information regarding the hazards of suicide.

Exploiting circadian memory to hasten recovery from circadian misalignment

Recent years have seen a sustained interest in the development of circadian reentrainment strategies to limit the deleterious effects of jet lag. Due to the dynamical complexity of many circadian models, phase-based model reduction techniques are often an imperative first step in the analysis. However, amplitude coordinates that capture lingering effects (i.e., memory) from past inputs are often neglected. In this work, we focus on these amplitude coordinates using an operational phase and an isostable coordinate framework in the context of the development of jet-lag amelioration strategies. By accounting for the influence of circadian memory, we identify a latent phase shift that can prime one's circadian cycle to reentrain more rapidly to an expected time-zone shift. A subsequent optimal control problem is proposed that balances the trade-off between control effort and the resulting latent phase shift. Data-driven model identification techniques for the inference of necessary reduced order, phase-amplitude-based models are considered in situations where the underlying model equations are unknown, and numerical results are illustrated in both a simple planar model and in a coupled population of circadian oscillators.

Predicting recurrence in patients with sentinel node-negative melanoma: validation of the EORTC nomogram using population-based data

BACKGROUND

Identifying patients with sentinel node (SN)-negative melanoma who are at greatest risk of recurrence is important. The European Organization for Research and Treatment of Cancer (EORTC) Melanoma Group proposed a prognostic model that has not been validated in population-based data. The EORTC nomogram includes Breslow thickness, ulceration status and anatomical location as parameters. The aim of this study was to validate the EORTC model externally using a large national data set.

METHODS

Adults with histologically proven, invasive cutaneous melanoma with a negative SN biopsy in the Netherlands between 2000 and 2014 were identified from the Dutch Pathology Registry, and relevant data were extracted. The EORTC nomogram was used to predict recurrence-free survival. The predictive performance of the nomogram was assessed by discrimination (C-statistic) and calibration.

RESULTS

A total of 8795 patients met the eligibility criteria, of whom 14·7 per cent subsequently developed metastatic disease. Of these recurrences, 20·9 per cent occurred after the first 5 years of follow-up. Validation of the EORTC nomogram showed a C-statistic of 0·70 (95 per cent c.i. 0·68 to 0·71) for recurrence-free survival, with excellent calibration (R2 = 0·99; P = 0·999, Hosmer-Lemeshow test).

CONCLUSION

This population-based validation confirmed the value of the EORTC nomogram in predicting recurrence-free survival in patients with SN-negative melanoma. The EORTC nomogram could be used in clinical practice for personalizing follow-up and selecting high-risk patients for trials of adjuvant systemic therapy.

Predicting sentinel node positivity in patients with melanoma: external validation of a risk-prediction calculator (the Melanoma Institute Australia nomogram) using a large European population-based patient cohort

BACKGROUND

A nomogram to predict sentinel node (SN) positivity [the Melanoma Institute Australia (MIA) nomogram] was recently developed and externally validated using two large single-institution databases. However, there remains a need to further validate the nomogram's performance using population-based data.

OBJECTIVES

To perform further validation of the nomogram using a European national patient cohort.

METHODS

Patients with cutaneous melanoma who underwent SN biopsy in the Netherlands between 2000 and 2014 were included. Their data were obtained from the Dutch Pathology Registry. The predictive performance of the nomogram was assessed by discrimination (C-statistic) and calibration. Negative predictive values (NPVs) were calculated at various predicted probability cutoffs.

RESULTS

Of the 3049 patients who met the eligibility criteria, 23% (691) were SN positive. Validation of the MIA nomogram (including the parameters Breslow thickness, ulceration, age, melanoma subtype and lymphovascular invasion) showed a good C-statistic of 0·69 (95% confidence interval 0·66-0·71) with excellent calibration (R² = 0·985, P = 0·40). The NPV of 90·1%, found at a 10% predicted probability cutoff for having a positive SN biopsy, implied that by using the nomogram, a 16·3% reduction in the rate of performing an SN biopsy could be achieved with an error rate of 1·6%. Validation of the MIA nomogram considering mitotic rate as present or absent showed a C-statistic of 0·70 (95% confidence interval 0·68-0·74).

CONCLUSIONS

This population-based validation study in European patients with melanoma confirmed the value of the MIA nomogram in predicting SN positivity. Its use will spare low-risk patients the inconvenience, cost and potential risks of SN biopsy while ensuring that high-risk patients are still identified.

Impact of blanching pretreatment on physicochemical properties, and drying characteristics of cabbage (Brassica oleracea)

Cabbage (Brassica oleracea) is popular winter vegetables cultivated all over Bangladesh and contains essential nutrients. This study aimed to evaluate the efficacy of pre-blanching on the preservation of cabbage by drying. In this research work, cabbage was blanched at 80°C, 90°C, and 100°C temperature for 12, 8, and 2 mins, respectively. Then the samples were dried at 60°C maintaining 60% relative humidity. The moisture and ash content of untreated and treated dried samples was in the range of 16.07±0.04 to 10.80±0.01% and 5.71±0.06 to 3.81±0.02%, respectively. The total phenolic content in cabbage was 74.47±0.63 mg GAE/100g at 100°C blanching temperature for a short time of 2 mins, which was higher compared to 61.91±0.48 mg GAE/100g at 80°C for 12 mins. It was observed that the antioxidant activity and two water-soluble vitamins-ascorbic acid and beta carotene decreased in pre-blanched dried samples in contrast with fresh ones. Blanching at higher water temperature and a short period was found useful for the retention of total phenolic content and greenness of cabbage. Blanching pre-treatments were also found to have better color retention capacity than untreated dried cabbage. A proper combination of drying time and temperature, along with the incorporation of blanching pretreatment, might be useful to preserve cabbage for a long time.

Atrial Thrombus and Embolic Stroke in a Patient With Surgical Appendage Ligation and Maze Procedure

This case illustrates the incomplete protection of surgical ligation of left atrial appendage and maze procedure at the time of mitral valve replacement against thromboembolic complications and recurrence of atrial fibrillation. The utility of surgical left atrial appendage ligation as stroke prophylaxis and identification of selected high-risk subjects are reviewed. (Level of Difficulty: Intermediate.)

Enhancing a nutrition and self-management: An intervention program via teletherapy for teenager with ADHD. A pilot case study

Introduction

Several ADHD teenagers had difficult behavioral problems during countries closing down due to Covid-19 pandemic. One of these negative outcomes that parents cannot control children’s behavior toward desired unhealthy food and the impulsive consequences. It was a great opportunity to convention a teletherapy program as a tool of intervention seeking for help to reduce uncontrolled self- management and nutrition, which may affect all sorts of childhood growth, development, health and behavior. Furthermore, it can affects daily life and academic success.

Objectives

We tried through our study to enhance the teletherapy as a therapeutic tool, during the first and second phase of Covid-19 pandemic, trying to help parents and patient to overcome the impulsive behavior by using a specific therapy technique based on nutrition and behavioral therapy

Methods

Our case study is a young girl aged 12:4 Yrs. In middle bilingual Arabic/ American School. The therapeutic program designed via teletherapy program using multi-media and thru multi phases sessions, to increase focus attention, emotional control and reduce impulsivity.

Results

The outcomes of the enhancing nutrition and behavior teletherapy program, showed significant improvement for the specific goal. Sensible change in the girl’s impulsive behavior, more focusing, emotional control and more accepting about health nutrition habits.

Conclusions

The important finding that intensive, focused nutation and self-management techniques provided via teletherapy as solitary program brought benefits to individual’s, family and reduced impulsivity outcomes. In addition, family education to become an expert at learning simple techniques in daily life can brining a sense of pleasure for long life wellbeing.

Disclosure

No significant relationships.

Evaluation of the in vitro Antimicrobial Activity As well As Preservative Capacity of Several Popular Cosmetic Products Available in the Neighbouring Shops in Bangladesh

Cosmetic products are often inadequately preserved that provide favourable environment for microbial growth. These emphasize the need for regular investigation of cosmetics in terms of microbial quality and preservative capacity. This study aimed to evaluate the microbial quality, in vitro antibacterial activity and preservative capacity of several popular cosmetics collected from the neighbouring health-care stationary shops in Dhaka city from October 2019 to December 2019. Here, a total of five categories of seven different cosmetic products were subjected to evaluate microbial load, in vitro antibacterial activity and preservative capacity. Among the seven cosmetic products, the viable bacterial count in two cosmetics (All Clear and Sunsilk Shampoo) were found within the acceptable range that was <10³ CFU/ml. None of the cosmetics were found contaminated with fungus and pathogenic organisms. Conversely, three (one Mouthwash and two shampoo) products showed in vitro antibacterial activity against E. coli, S. aureus, Pseudomonas spp., Salmonella spp., Shigella spp. Only single cosmetic product (Cute coconut oil) did not meet the criteria of preservative capacity, while rest six products fulfil the requirements. Thus, our findings revealed a huge load of microorganisms in spite of having adequate preservative capacity in most of the tested products.

Mechanical Behavior of Friction Stir Welded AA-6061 Thick Plates in Different Heat Treatment Conditions

In this study, mechanical properties of friction stir welded Aluminum Alloy (AA) 6061 in three different heat treatment conditions i.e. Annealed (O), Artificially aged (T6) and Post Weld Heat Treated (PWHT) were compared. Plates were welded in a butt joint form. Parameters were optimized and joints were fabricated using tool rotational speed and travel speed of 500 rpm and 350 mm/min respectively. Two sets of plates were welded in O condition and out of which one was, later, subjected to post weld artificial aging treatment. Third set was welded in T6 condition. The welds were characterized by macro and microstructure analysis, microhardness measurement and mechanical testing. SEM fractography of the tensile fracture surfaces was also performed. Comparatively better mechanical properties were achieved in the plate with PWHT condition.

Optimization of Maximum Tool Travel Speed for Friction Stir Welded AA-2014-T6 without Compromising the Mechanical Properties

In this study optimization of maximum travel speed that can be achieved for Friction Stir Welding of Aluminum Alloy 2014-T6 without compromising the mechanical properties was carried out. Joints were made at different travel speeds of 200, 300, 400, 500 and 600 mm/min with constant tool rotational speed of 800 rpm and tool tilt angle of 2.The samples were characterized by stereo microscopy, optical microscopy, scanning electron microscopy, Vickers microhardness testing and tensile testing. Microstructural features of as-welded samples revealed refined equiaxed grains in nugget zone and grain growth in the heat effected zone. Tensile test results showed that the tensile strength was maximum at travel speed of 500 mm/min but then decreased after further increasing the travel speed. Hardness in the nugget zones of all welds was lower than that of base material. Fractographic analysis exhibited significant variations in fracture surfaces of tensile samples. A relationship between the welding parameters and resultant heat inputs was also discussed.

Sentinel node biopsy in patients with melanoma improves the accuracy of staging when added to clinicopathological features of the primary tumor

BACKGROUND

It has been claimed, without supporting evidence, that knowledge of sentinel node (SN) status does not provide more accurate prognostic information than basic clinicopathological features of a primary cutaneous melanoma. We sought to investigate this claim and to quantify any additional value of SN status in predicting survival outcome.

PATIENTS AND METHODS

Data for a Dutch population-based cohort of melanoma patients (n = 9272) and for a validation cohort from a large Australian melanoma treatment center (n = 5644) were analyzed. Patients were adults diagnosed between 2004 and 2014 with histologically-proven, primary invasive cutaneous melanoma who underwent SN biopsy. Multivariable Cox proportional hazards analyses were carried out in the Dutch cohort to assess recurrence-free survival (RFS), melanoma-specific survival (MSS) and overall survival (OS). The findings were validated using the Australian cohort. Discrimination (Harrell's C-statistic), net benefit using decision curve analysis and net reclassification index (NRI) were calculated.

RESULTS

The Dutch cohort showed an improved C-statistic from 0.74 to 0.78 for OS and from 0.74 to 0.76 for RFS when SN status was included in the model with Breslow thickness, sex, age, site, mitoses, ulceration, regression and melanoma subtype. In the Australian cohort, the C-statistic increased from 0.70 to 0.73 for OS, 0.70 to 0.74 for RFS and 0.72 to 0.76 for MSS. Decision curve analyses showed that the 3-year and 5-year risk of death or recurrence were more accurately classified with a model that included SN status. At 3 years, sensitivity increased by 12% for both OS and RFS in the development cohort, and by 10% and 6% for OS and RFS, respectively, in the validation cohort.

CONCLUSIONS

Knowledge of SN status significantly improved the predictive accuracy for RFS, MSS and OS when added to a comprehensive suite of established clinicopathological prognostic factors. However, clinicians and patients must consider the magnitude of the improvement when weighing up the advantages and disadvantages of SN biopsy for melanoma.

COVID19 Acute respiratory distress syndrome and extra-corporeal membrane oxygenation; A mere option or ultimate necessity

Extracorporeal membrane oxygenation (ECMO) is considered a salvage therapy in patients with acute respiratory distress syndrome (ARDS) and refractory hypoxemia (hypoxemia persisting despite lung-protective ventilation). One aspect of ECMO is whether there would be an application of the technology related to the Coronavirus pandemic. The number of people diagnosed with Coronavirus disease (COVID19) has crossed the five million mark on 9 August 2020, with a case fatality rate of 5.2%. Due to this exponential increase in the number of coronavirus disease (COVID19) cases particularly the ones associated with ARDS, experts are evaluating the need for ECMO in intensive care units. Herein, we chronicle a review encompassing the available evidence on ECMO and its potential role in COVID19 ARDS, as we aim for optimal patient care with appropriate resource utilization and conservation.

Modified Short Proximal Femoral Nail for Intertrochanteric Fractures of Femur in Indian Patients - our Experience

Introduction

Proximal femoral nail (PFN) is a commonly used implant for intertrochanteric fractures which is designed according to western femoral measurements. However, anthropometry of proximal femur in Indian and in general, Asian, are smaller. So a modified short PFN with smaller dimensions was developed. This study analyses the radiological and functional outcome of treatment of intertrochanteric fractures with modified short PFN.

Materials and Methods

A retrospective study analysed 120 adult patients operated between 2014-2017 using modified short PFN for intertrochanteric fractures, having a minimum follow-up of 12 months. Clinical and radiological parameters including tip-apex distance (TAD), position of tip of lag screw in femoral head, lateral slide of lag screw as well as length of anti-rotation screw were measured. Final functional outcome was assessed using Barthel's index and Kyle's criteria.

Results

Good reduction was achieved in 90.83% cases and 79.16% had ideal placement of lag screw in femoral head. Intra-operative difficulties were encountered in 13.33% (n=16). Mean TAD AP (anteroposterior) was 11.8mm, TAD LAT (lateral) was 11.0mm and mean TAD TOT was 22.8mm. Overall mean lateral slide was 3.20mm and it was more in unstable fracture. We had five mechanical failures, one patient with screw breakage without loss of reduction and two peri-implant fractures after union. 81.66% returned to pre-injury levels of activity with 88.33% good to excellent outcome as per Kyle's criteria.

Conclusion

Although, not devoid of complications, modified short PFN results in good functional recovery of patients with intertrochanteric fractures of femur.