Early response to chemotherapy in children with Langerhans cell histiocytosis predicts long-term disease-free survival

Background: Langerhans cell histiocytosis (LCH) is a rare clonal malignancy of the monocyte-macrophage system. Patients with lesions in 搑isk organs� have significantly higher risk of mortality than patients with lesions limited to 搉on-risk� sites. The influence of early response to therapy on long-term survival in this heterogeneous multi-system disease was analyzed. Methods: During a 7-year period, we retrospectively analyzed the findings in 24 consecutive patients who required systemic chemotherapy for LCH [single system with multifocal bone involvement and multisystem involvement with or without risk organ (RO) involvement]. All patients were started on vinblastine and prednisolone. Progressive disease was treated with salvage protocols or targeted therapy. Positron emission tomography-computed tomography (PET-CT)/conventional CT based response assessment was performed at week 6 of chemotherapy, and if needed after week 12 of chemotherapy. Results: MFO bone, MS ROneg, and MS ROpos LCH was observed in 3, 4, and 17 patients, respectively. Age range of patients varied from 1 month�years (median = 18 months). The EFS and OS were 100% and 100% for MFO bone, 50% and 100%, respectively, for MS ROneg and 35% and 52%, respectively, for MS ROpos. OS was 93% and 100% for CR attained at 6 and 12 weeks respectively regardless of the risk status (P < 0.01). Conclusion: Rapid early response, that is, complete remission at 6 and 12 weeks was associated with significantly improved overall survival. In slow responders, early salvage with alternative regimens or targeted therapy may result in better outcomes

Study of maternal and perinatal outcome in abruptio placentae

Background: Abruptio placentae is very frequently seen in our population. Few studies have reported maternal and fetal morbidity and mortality associated with this condition. No work has been done on abruptio placentae in our setup. The data generated will help to improve maternal and fetal morbidity and mortality by planning prompt management of future cases of placental abruption. Objective of this study was to study possible etiological factors of abruptio placentae, analyse maternal outcome, perinatal outcome in the form of maternal morbidity and mortality and discuss possible preventive measures and future management optionMethods: The retrospective observational study it was included all cases presenting with ante partum haemorrhage during the study period. Subjects selected for the study were all cases diagnosed as having abruptio placentae. All other causes of APH like placenta previa and other extraplacental causes were excluded.Results: In the present study incidence of abruptio placentae is higher in 25-30 year that were 42.5% and more in 2nd gravida patient. PIH was accounting for 50%, most of the patients (95%) were anaemic at admission and majority of them required blood transfusion.one maternal mortality (2.5%) occurred, perinatal mortality was 75%.Conclusions: Abruptio placentae serious condition with manifestation of significant maternal and perinatal morbidity and mortality. Complications can be reduced by provisional antenatal care to every woman and with improvement in medical facilities, availability of blood transfusion, proper management of shock. With liberalization of caesarean section, the rate of maternal morbidity and mortality is gradually on the decline.

The effectiveness of therapeutic ultrasound in patients with oral submucosal fibrosis

CONTEXT: Oral submucosal fibrosis (OSMF) is a chronic disease occurring due to a reduction in fibroelasticity of the oral mucosa leading to trismus and inability to open the mouth that mostly affects habitual betel quid chewers. AIMS: The present study aims to find the effectiveness of therapeutic ultrasound (US) in addition to conventional exercises in patients with OSMF. SETTINGS AND DESIGN: It was a randomized controlled trial, carried out at KM Patel Institute of Physiotherapy, Shree Krishna Hospital, Karamsad, Anand, India. Both males and females with the confirmed diagnosis of OSMF and who were referred for physiotherapy treatment were included. MATERIALS AND METHODS: A total of 20 patients were randomized by using shuffling cards into two groups (10 in each): experimental (ultrasound and jaw opening exercises) and control (jaw opening exercises). The maximal mouth opening was measured before and after intervention in both the groups. STATISTICS: The maximal mouth opening was compared within the group before and after the treatment using paired t-test and the improvement in mouth opening between the groups was measured using unpaired t-test (P < 0.05). RESULTS: The results showed significant improvement in mouth opening in both groups that is increased mouth opening by 0.47 ± 0.09 cm (P = 0.002)* in the experimental group and 0.25 ± 0.05 cm (P = 0.003)* in the control group. However, patients in the experimental group had more improvement by about 0.22 cm (P = 0.006)* compared to the control group (*P < 0.05). CONCLUSION: Therapeutic US and conventional jaw opening exercises prove more beneficial compared to only jaw opening exercises in OSMF.

Does Maternal Education Affect Maternal and Child Health Care Utilization?: A Community Based Study in a Urban Slum Area of Western India.

In order to examine the relationship between maternal education and maternal and child mortality a survey was carried out in urban slum area of Surat city. The sample for this survey was designed to provide estimates on a large number of indicators on the situation of children and women living in the area where RCH services are provided by the Health Department of Surat Municipal Corporation. We included the mothers who had delivered in the past 1 year and their babies.Various variables with respect to maternal care and child care were investigated. A logistic regression was applied for variables found significantly associated with maternal education. This study showed that maternal education was independently associated with various aspects of maternal health care and child health care services. It is recommended that the local authorities should make effort to increase the maternal education for the betterment of the society.

Congenital malformation - A biological accident (A 6 years 9 months study in a rural based tertiary care hospital).

Background: Birth of live congenitally abnormal child especially at term is a great mental and social trauma to parents, family and to the society. In developed countries it is one of the main causes of infant mortality. It accounts 8-15% of peri-natal deaths and 13-16% of neonatal deaths in India. Aims & Objectives : To find out the incidence of congenital anomalies in live and still births and to find out association of major and minor anomalies to maternal demographic profile and to various obstetrics and medical parameters. Materials & Methods: This study was carried on rural based tertiary care referral hospital. All the deliveries occurred during 1st September 2004 to 30th June 2011 (81months) comprised 7053 births were enrolled. The new born were examined systematically by obstetrician and pediatrician. System wise distribution of anomalies and correlation with risk factors were analyzed. Results: Out of total 7053 deliveries, 6433 were live births and 620 were still births. Total number of congenital malformed babies were 71 (1.006%). 31 (43.66%) of the 71 malformed babies were still born and 27 (38.02%) were NND (neonatal death). It means out of 100 stillborn, 43 babies had structural malformation. Major malformation was present in 58 and minor anomalies were present in 13 fetus. Marginal Male predominance 40 (56.33 %) was noted. Central nervous system malformation was most common in live births followed by respiratory system and musculo skeletal system. 64% patients had not taken ANC (antenatal care) and in them 92% had major anomalies. 81.3% anomalies were detected by 2nd trimester USG (ultra sonography) and 18% anomalies were not detected by USG out of which 98% were minor anomalies. Conclusion: Congenital anomalies are a major cause of still births and infant mortality. Regular ANC, 2nd trimester USG for early detection and folic acid supplementation for prevention are the important factors to be considered to decrease the burden of congenital malformation.

Multiple dental anomalies and aggressive periodontitis: A coincidence or an association.

Aggressive periodontitis (AgP) comprises a group of rare, often severe, rapidly progressive forms of periodontitis mostly characterized by an early age of clinical manifestation and a distinctive tendency for cases to aggregate in families. Abnormal dental morphology and position have been associated with severe periodontal diseases. The purpose of this paper is to report a case of multiple dental anomalies associated with AgP. This paper reports a case of unusual association of multiple dental anomalies to AgP. Clinical findings and history led to the diagnosis of localized AgP, and radiologically. It was associated with multiple dental anomalies, especially supernumerary roots. Thus, the present case represents a very interesting demonstration of AgP association with supernumerary roots and the nature of this association merits further investigations.

Role of cyclooxygenase-2 in tumor progression and immune regulation in lung cancer.

Lung cancer is the leading cause of cancer death all over the world. The low 5-year survival rate (under 15%) has changed minimally in the last 25 years. Amongst different types of lung cancers, non-small cell lung carcinoma (NSCLC) types account 25-40%. To improve the survival of lung cancer patients, new therapeutic strategies are needed. The search for improved therapies has led to the investigation of agents that target novel pathways involved in tumor proliferation, invasion, survival and immune regulation. Cyclooxygenase-2 (COX-2) is one of the novel targets under evaluation for NSCLC therapy and chemoprevention. Although multiple genetic alterations are necessary for lung cancer invasion and metastasis, COX-2 may act as central element in orchestring these processes. COX-2 plays an important role in all aspects of tumor development and growth. It also plays a pivotal role in regulation of cytokines and immune responses in NSCLC patients. In this article, we review the experimental and clinical evidences on the possible link between COX and NSCLC.