Supracarinal lymph node positivity in esophageal squamous cell carcinoma (ESCC) and factors predicting metastasis in supracarinal compartment nodes: Should a total mediastinal node dissection be the standard of care?

Background: Adequate lymphadenectomy in middle? and lower?third esophagus cancer is still a matter of debate. This study aims to find out the extent of histopathological supracarinal lymph nodes positivity rate to establish an adequate lymph node dissection in esophageal squamous cell carcinoma cases operated up?front or after neoadjuvant chemotherapy (CT) + radiotherapy (RT) and its short?term oncological outcome. Materials and Methods: After approval from institutional board review, a retrospective study was conducted from April 2017 to September 2019. A total of 76 patients having mid? or lower?third carcinoma esophagus were operated at our institute for partial/total esophagectomy with extended two?field lymph node dissection were followed. Intraoperative nodal stations were harvested separately and lebeled individually according to the Japanese Esophageal Classification and sent for histopathological examination. Results: The patients had an average age of 52 years. Histologically all were squamous cell carcinoma (SCC). Forty?four patients received preoperative concurrent RT plus drug therapy, whereas 18 cases were operated up?front. Fourteen patients were operated after palliative treatment (CT/RT). The average total lymph node yield was 22 nodes (range 3�). In 26 patients (34.2%), lymph nodes were positive (N+ disease). Supracarinal nodes were positive in 20 cases (26.31%). The average supracarinal lymph node yield was 10.33 nodes (range 2�). Five patients (6.5%) had only supracarinal lymph nodes positive on histopathological examination. Seventeen patients had a complete pathological response rate (pCR). Conclusion: In cases of mid?third esophageal carcinoma, extended two fields with supracarinal lymphadenectomy is strongly recommended even after the patient has received neoadjuvant treatment, although the same for lower?third/gastroesophageal (GE) junction tumors should be considered.

Comparison of Hemodynamic Response and Vasopressor Requirement Following Spinal Anesthesia between Normotensive and Hypertensive Women Undergoing Elective Cesarean Section

Introduction: Spinal anesthesia (SA) is the technique of choice in cesarean sections, but it is not widely accepted in hypertensiondue to fear of sudden and extensive sympathetic blockade. Sympathetic blockade induced hypotension may occur in up to64–100% of pregnant women who have been given spinal anesthesia for cesarean delivery, especially when hyperbaric solutionsare used. Severely pre-eclamptic patients were previously believed to be at high risk of severe hypotension, with maternaland fetal consequences because of reduced plasma volume and because of the need to limit i.v. fluids to avoid iatrogenicpulmonary edema.Methodology: The present study, “comparison of hemodyanamic response and vasopressor requirement following spinalanesthesia between normotensive and hypertensive women undergoing elective cesarean section” 100 women of age20–35 years, the American Society of Anesthesiologists physical Status Ι and ΙΙ carrying a singleton pregnancy and scheduledto have elective cesarean section in Netaji Subhash Chandra Bose Medical College, Jabalpur, were enrolled into two groups.GroupA: 50 were normotensive women and Group B: 50 were hypertensive women. All patients received a standard subarachnoidblock under all aseptic precautions with 12.5 mg 0.5% hyperbaric bupivacaine.Results: Based on the data from our study, it could be concluded that after spinal anesthesia in patients undergoing electivecesarean section-hypertensive group of parturients had less fall in mean systolic blood pressure (SBP), diastolic BP, and meanarterial BP in comparison to normal healthy pregnant women which were statistically significant (P < 0.05). Hypertensive group ofpatients required less ephedrine to treat hypotension in comparison to normotensive patients which were statistically significant(P < 0.05). The incidence of hypotension was almost 7 times less in hypertensive parturients than healthy parturients (oddsratio = 23.14, relative risk of hypotension in Group A = 7.2, confidence interval = 7.6–70.3).Conclusion: To summarize, our results showed that hypotension following SA administered for cesarean section wassignificantly less in hypertensive patient than in healthy pregnant women. In addition, vasopressor requirements were also lessin hypertensive parturients and neonatal outcome was comparable between the two groups. Therefore, subarachnoid blockis an acceptable technique to perform in hypertensive parturients due to its virtue of simplicity, rapidity, cost-effectiveness,and intensity of block.

Non-Extraction Treatment of Severe Anterior Crowding with Unilateral Distalization

Introduction: Recent developments in mechanotherapy andchanges in concepts have reduced the need for extraction inseveral types of discrepancies.Case report: This case report explains a non-extractiontreatment in a patient with severe anterior crowding with theuse of a modified Hilger’s Pendulum appliance. The patientshowed unilateral half unit Class II molar relation on theleft. The appliance was modified to cater to the treatmentneeds and activation was done unilaterally to achieve thedesired results. Post distalization, fixed orthodontic treatmentwas initiated and crowding was relieved with levelling andaligning.Conclusion: An ideal overjet and overbite along withmaintenance of the pleasing profile was achieved at the endof the treatment

Comparative study of anti-mutated citrullinated vimentin, anti-cyclic citrullinated peptides, and rheumatoid factor predictability in the diagnosis of rheumatoid arthritis.

Background: Rheumatoid arthritis (RA) is characterized by synovial joint inflammation, which often leads to progressive joint destruction and disability. Several other auto-antibodies specific to RA have been found .Among them, antibodies against cyclic citrullinated peptides (CCP) are useful for diagnosing RA. Antibodies to mutated citrullinated vimentin (MCV) were described recently in RA. The aim of this study was to determine the diagnostic values of ACCP compared to anti-MCV and Rheumatoid Factor in rheumatoid arthritis patients. Methods: This study included 92 patients with Rheumatoid arthritis (RA) and 35 matching healthy controls. Blood samples were obtained from patients and controls for Erythrocyte Sedimentation Rate (ESR), C Reactive Protein (CRP), Rheumatoid factor (RF). Anti-CCP2 and anti-MCV were determined using ELISA technique. Results: RA group was significantly higher than control group as regard ESR, CRP, RF, Anti-CCP, and Anti- MCV. Conclusion: It was concluded, compared to ACCP, anti-MCV has approximately the same accuracy for the diagnosis of rheumatoid arthritis but higher than Rheumatoid Factor. Level of Evidence: Level II, prospective study, as per guidelines for authors.

Sternal tuberculous osteomyelitis: a series of four cases.

Tuberculous osteomyelitis of sternum presenting as an acute swelling over chest is a rare entity accounting for less than 7% cases even in countries with endemic tuberculous disease. We herein report four such cases which were diagnosed by CT scan showing lytic lesion of sternum. Tuberculous osteomyelitis of sternum is rare and therefore differential diagnosis of chest wall mass must be considered. A series of four patients suffering from tuberculosis of the sternum with a mean follow-up of 2 yr is presented. All were treated with antituberculous therapy. All showed good healing.

Estimation of magnitude of various health conditions under 4Ds approach, under RBSK Programme in Devendranagar block of Panna District, Madhyapradesh, India.

Background: The Rashtriya Bal Swasthya Karyakram (RBSK) aims early detection and management of the 4Ds - Defects at birth, Diseases in children, Deficiency conditions and Developmental Delays including Disabilities in children in the community which are hidden may be due to unawareness or unaffordbility for treatment. Methods: We followed the operational guidelines of ‘Child Health Screening and Early Intervention Services’ under RBSK. Surveys done along with RBSK team for 6 months. Results: Total 26977 children were screened. Out of which 53 children were found to have birth defects, 434 children were found to have some kind of deficiency, 21768 children were found to have diseases and 113 children were found with developmental delay including disabilities. Globally, 200 million children do not reach their developmental potential in the first five years because of poverty, poor health, nutrition and lack of early stimulation. Here in our study 83% children deprived of good health due to 4Ds. Conclusion: We observed that still there are many children are undiagnosed and deprived of treatment for curable diseases. Child Health Screening and promotion of Early Intervention Services is most beneficial for improvement in health status of children in rural community.