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Background: An association has been described between tuberculosis (TB) and common mental disorders. We aimed to evaluate the patterns of psychiatric morbidities in patients with pulmonary TB. Methods: This was a prospective study conducted over a period of 1 year. A total of 100 patients were recruited for the study. Baseline psychiatric morbidity was assessed after 2 weeks of diagnosis and at the end of an intensive phase (IP). Results: In the present study, 56% of patients with pulmonary TB had morbid baseline psychiatric disorders. The major depressive episode was the most common morbid psychiatric disorder (39%), followed by panic disorder (9%), generalized anxiety disorder (GAD) (6%), and agoraphobia (2%). The psychiatric morbidity dropped to 15%. Major depressive episode dropped to 13%, followed by GAD and panic disorder (1%) each at the end of an IP. Conclusion: Because of high burden of psychiatric morbidity associated with pulmonary TB, there is a need for psychiatric services to be made available to these patients.
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ABSTRACT Extranodal NK/T- cell lymphoma (ENKTCL) is an aggressive lymphoma driven by Epstein-Barr virus (EBV) infection in genetically susceptible individuals. It was historically called a lethal midline granuloma. Due to the angio-destructive nature of ENKTCL, lymphoma cells are often accompanied and masked by necrosis and dense inflammation in the biopsy. Further, the biopsy may show vasculitis, which can mimic granulomatosis with polyangiitis. Due to these masquerades, ENKTCL is often misdiagnosed in the biopsy. Several biopsies may be required to establish the diagnosis. We describe the clinical course and autopsy findings of a young female who presented with a hard-palate ulcer. Antemortem biopsies failed to establish the diagnosis. The autopsy revealed an advanced nasal subtype of Extranodal NK/T-cell lymphoma with dissemination to the kidneys, adrenals, liver, spleen, and small intestine.
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Purpose@#Classification of focal skeleton/bone marrow uptake (BMU) can be challenging. The aim is to investigate whether an artificial intelligence–based method (AI), which highlights suspicious focal BMU, increases interobserver agreement among a group of physicians from different hospitals classifying Hodgkin’s lymphoma (HL) patients staged with [ 18 F]FDG PET/CT. @*Methods@#Forty-eight patients staged with [ 18 F]FDG PET/CT at Sahlgenska University Hospital between 2017 and 2018 were reviewed twice, 6 months apart, regarding focal BMU. During the second time review, the 10 physicians also had access to AI-based advice regarding focal BMU. @*Results@#Each physician’s classifications were pairwise compared with the classifications made by all the other physicians, resulting in 45 unique pairs of comparisons both without and with AI advice. The agreement between the physicians increased significantly when AI advice was available, which was measured as an increase in mean Kappa values from 0.51 (range 0.25–0.80) without AI advice to 0.61 (range 0.19–0.94) with AI advice (p = 0.005). The majority of the physicians agreed with the AI-based method in 40 (83%) of the 48 cases. @*Conclusion@#An AI-based method significantly increases interobserver agreement among physicians working at different hospitals by highlighting suspicious focal BMU in HL patients staged with [ 18 F]FDG PET/CT.
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Background & objectives: Transmission of dengue virus by Aedes aegypti mosquito is one of the major global health concerns. The present study was aimed to explore the larvicidal potential of oil extracted from kinnow peel waste to be used as an efficient, economic and safe agent against Ae. aegypti. Methods: Kinnow peel oil was extracted and its five concentrations at 40, 50, 60, 70 and 80 ppm were tested against 4th instar larvae of Ae. aegypti. Larval mortality (%) and LC50 and LC90 values of toxicity were determined followed by evaluation of the residual activity effect of its leftover effective concentration on larval mortality, development and emergence. Effect of storage (2, 4 and 6 months) on larvicidal potential of kinnow peel oil was also determined. Results: Out of the tested concentrations, 70 ppm of kinnow peel oil was found to be the effective concentration against 4th instar larvae of Ae. aegypti. LC50 and LC90 toxicity values were 47.26 and 61.56 ppm, respectively. No residual activity effect in terms of larval mortality was found, however a significant delay in development (L4 to adult) was observed after placing new larvae in the leftover effective oil concentration. No effect of storage on larvicidal potential of 2, 4 and 6 months old kinnow peel oil in comparison to freshly extracted oil was observed. Interpretation & conclusion: Kinnow peel oil proved to have a good potential as a biolarvicide against Ae. aegypti and could be used as an effective and eco-friendly mosquito control agent in the future.
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Ayurveda being the science of life, primarily focuses on enhancing health of healthy individuals and removal of disease causing entities in a diseased person. Swarna (gold) has substantial therapeutic value, which has been indicated in different classics of Ayurveda. Swarna (gold) is desired by every human for many centuries. The desire is not only for its ornamental or commercial value but also because of its great medicinal value by which it increases strength and immunity. Swarna is converted into suitable dosage forms like Parpati, Pottali, Vati etc. Swarna kalpas are the unique blend of herbomineral formulations where Gold is used as one of the main ingredient. Swarna kalpas are widely used as therapeutic as well as life saving agents (in some emergencies). These formulations are helpful in treating many chronic disease conditions but it also acts miraculous when used for Rasayana purpose. In this review most commonly used Swarna kalpas such as Yogendra ras, Rasraj Ras, Vasant Kusumakar ras, Swarna malini vasant are discussed on the basis of different therapeutic angles
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Oxidative stress and sperm DNA fragmentation (SDF) have been linked to idiopathic male infertility (IMI). Various antioxidants have been tried to improve semen parameters and fertility potential in IMI patients, but with inconsistent results. The study aimed to compare the effects of coenzyme Q10 (CoQ10) and Centrum multivitamins on semen parameters, seminal antioxidant capacity, and SDF in infertile men with idiopathic oligoasthenospermia (OA). Methods: This prospective controlled clinical study involved 130 patients with idiopathic OA and 58 fertile controls. The patients were divided randomly into two groups: the first group received CoQ10 (200 mg/day orally) and the second group received Centrum multivitamins (1 tablet/day) for 3 months. Semen parameters, CoQ10 levels, reactive oxygen species (ROS), total antioxidant capacity (TAC), catalase, SDF, and serum hormone levels (follicle-stimulating hormone, luteinizing hormone, testosterone, and prolactin) were compared at baseline and after 3 months. Results: Both CoQ10 and Centrum improved sperm concentration and motility, but the improvement was greater with Centrum therapy (p<0.05). Similarly, both therapies improved antioxidant capacity, but TAC and catalase improvement was greater (p<0.01 and p<0.001 respectively) with CoQ10, whereas ROS (p<0.01) and SDF (p<0.001) improvements were greater with Centrum administration. Centrum therapy was associated with reduced serum testosterone (p<0.05). Conclusion: In conclusion, both CoQ10 and Centrum were effective in improving semen parameters, antioxidant capacity, and SDF, but the improvement was greater with Centrum than with CoQ10. Therefore, Centrum—as a source of combined antioxidants—may provide more effective results than individual antioxidants such as CoQ10 in the treatment of infertile men with idiopathic OA.
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This study aimed to evaluate whether human chorionic gonadotropin (hCG) therapy is beneficial for improving semen parameters and clinical hypogonadism symptoms in hypogonadic oligozoospermic or severe oligozoospermic men with low or borderline testosterone levels. Methods: A weekly dose of 250 μg (equivalent to approximately 6,500 IU) of hCG was administered subcutaneously for 3–6 months to 56 hypogonadic oligozoospermic or severe oligozoospermic men. Semen, biochemical, and genetic analyses were performed before the start of treatment followed by analyzing semen parameters every 3 months after the start of therapy. We grouped participants into responders and non-responders depending on positive changes in semen parameters. Results: Out of 56 men, 47 (83.93%) responded, while 9 (16.07%) did not. Upon statistical analysis, it was found that age did not affect the overall outcomes (p=0.292); however, men with higher body mass index (BMI; 28.09±3.48 kg/m2 ) showed better outcomes than those with low BMI (25.33±3.06 kg/m2 ) (p=0.042). The duration of therapy (in months) was higher in non-responders than in responders (p=0.020). We found significant improvements in sperm concentration (p=0.006) and count (p=0.005) after 3 months of therapy. Sperm motility and progressive motility were also found to be higher in responders, but did not show statistically significant changes. Conclusion: We conclude that hCG therapy can be beneficial in men with hypogonadic oligozoospermia or severe oligozoospermia.
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Anaplastic lymphoma kinase (ALK) positive, anaplastic large cell lymphoma involving the non-mammary implant is an extremely rare presentation. Irrespective of the type or site, the implant-associated primary ALCL is morphologically and immunophenotypically similar to ALK-negative ALCLs. Herein, we present the case of a 42-year-old male who developed a lytic lesion after an implant for a right femur fracture. The lytic lesion biopsy revealed anaplastic large cell lymphoma with ALK protein expression. Imaging findings showed the widespread dissemination of disease all over the body, entrapping the implant too. ALCL involving the bone implant is a very unusual and rare presentation that needs to be documented.
Subject(s)
Humans , Male , Adult , Lymphoma, Large-Cell, Anaplastic , Femoral Fractures/complications , Anaplastic Lymphoma Kinase , Prostheses and ImplantsABSTRACT
Male infertility has a complex etiopathology, which mostly remains elusive. Although research has claimed that oxidative stress (OS) is the most likely underlying mechanism of idiopathic male infertility, the specific treatment of OS-mediated male infertility requires further investigation. Coenzyme Q10 (CoQ10), a vitamin-like substance, has been found in measurable levels in human semen. It exhibits essential metabolic and antioxidant functions, as well as playing a vital role in mitochondrial bioenergetics. Thus, CoQ10 may be a key player in the maintenance of biological redox balance. CoQ10 concentrations in seminal plasma directly correlate with semen parameters, especially sperm count and sperm motility. Seminal CoQ10 concentrations have been shown to be altered in various male infertility states, such as varicocele, asthenozoospermia, and medical or surgical regimens used to treat male infertility. These observations imply that CoQ10 plays an important physiological role in the maintenance and amelioration of semen quality. The present article thereby aimed to review the possible mechanisms through which CoQ10 plays a role in the regulation of male reproductive function, and to concisely discuss its efficacy as an ameliorative agent in restoring semen parameters in male infertility, as well as its impact on OS markers, sperm DNA fragmentation, pregnancy, and assisted reproductive technology outcomes.
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Background@#This study evaluated the outcomes of patients with refractory/relapsed Hodgkin lymphoma (RRHL) treated with a bendamustine-based regimen in combination with ifosfamide, etoposide, and vinorelbine (VIBE). @*Methods@#Consecutive RRHL patients who were treated with the VIBE regimen were identified and studied for clinicopathologic characteristics, response to VIBE regimen, event-free survival (EFS), and feasibility of an autologous stem-cell transplant (autoSCT). @*Results@#In total, 24 patients received the VIBE regimen, and a median of 3 cycles were administered. In this cohort, 80% of the patients had received ≥2 prior lines of therapy. The overall and complete response rates with VIBE were 79% and 42%, respectively. After a median follow-up (following VIBE regimen) of 14 months (range, 3‒76), the 3-year EFS and OS were 46% and 74%, respectively. Of the eligible patients, 92% underwent successful AutoSCT. The mean CD34+ cell count in the autograft was 5.5×106/kg (SD 2.07). Neutropenia was the commonest hematologic toxicity and it was observed in 42% of the patients. However, only 9% of the patients developed grade III/IV febrile neutropenia. Chemotherapy-induced nausea and vomiting were the second most common grade III/IV toxicities in our cohort of patients. @*Conclusion@#In this retrospective analysis, the combination regimen, VIBE, has shown good efficacy in heavily pre-treated patients with RRHL without compromising stem cell collection. These encouraging results provide a rationale for further development of this regimen.
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Chondrosarcoma is a cartilaginous tumor of mesenchymal origin. The histology and grade of the tumor determine the chances of relapse and survival. These tumors usually respond poorly to chemo-radiotherapy in cases of non-resectable and recurrent disease. 18F-FDG PET/CT has been used in evaluation of recurrence. However, these tumors show only mild to moderate FDG avidity due to their lower mitotic activity and large acellular matrix. These tumors are known to have a high degree of angiogenesis, especially in those of higher grade. We present a case of a 53-year-old man with grade II chondrosarcoma of the left femur showing only mild avidity on 18F-FDG PET/CT but showing moderate to intense tracer avidity on 68Ga-DOTA-RGD2PET/CT. This may enable the use of angiogenesis-targeted positron and beta-emitting radiopharmaceuticals as a potentially new theranostic alternative treatment in cases of refractory metastatic chondrosarcoma.
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Hodgkin’s lymphoma most commonly presents as painless lymphadenopathy and systemic B symptoms like fever, night sweats, and weight loss. But rarely, it can present with unusual paraneoplastic manifestations. In the present case, we report a 30-year-old woman who presented with sub-acute onset pan-cerebellar symptoms. The serum neuronal antibody panel was negative. She underwent F-18 FDG PET/CT to evaluate the neoplastic etiology as the underlying cause, which demonstrated both the primary etiology and the paraneoplastic changes in the brain.
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Somatostatin receptor (SSTR)-based imaging and therapy has emerged as well-established modality in neuroendocrine tumors. However, its role in inflammation imaging is still evolving. We present a 48-year-old male with metastatic neuroendocrine tumor who underwent lutetium-177-based somatostatin receptor-based therapy. The post-therapy scan showed a focal tracer uptake in the left calf muscle in addition to the expected tracer uptake at the primary and metastatic sites. Further, cross-sectional imaging and biochemical investigations revealed peripheral vascular disease (PVD). The incidental tracer uptake in the calf on post-therapy scan potentiates the role of somatostatin receptor scintigraphy in identifying macrophagespecific inflammatory reactions.
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Of all microorganisms in the human body, the largest and most complex population resides in the gastrointestinal (GI) tract. The gut microbiota continuously adapts to the host environment and serves multiple critical functions for their hosts, including regulating host immunity, procuring energy from food, and preventing the colonization of pathogens. Mounting evidence has suggested gut microbial imbalance (dysbiosis) as a core pathophysiology in the development of GI motility and metabolic disorders, such as irritable bowel syndrome and diabetes. Current research has focused on discovering associations between these disorders and gut microbial dysbiosis; however, whether these associations are a consequence or cause is still mostly unexplored. State-of-the-art studies have investigated how gut microbes communicate with our body systems through microbiota-derived metabolites and how they are able to modulate host physiology. There is now mounting evidence that alterations in the composition of small intestinal microbes have an association with GI dysmotility and metabolic disorders. Although treatment options for gut microbial dysbiosis are currently limited, antibiotics, fecal microbiota transplantation, probiotics, and dietary interventions are currently the best options. However, treatment with broad-spectrum antibiotics has been viewed with skepticism due to the risk of developing antibiotic resistant bacteria. Studies are warranted to elucidate the cellular and molecular pathways underlying gut microbiota-host crosstalk and for the development of a powerful platform for future therapeutic approaches. Here, we review recent literature on gut microbial alterations and/or interactions involved in the pathophysiology of GI dysmotility and metabolic disorders.
ABSTRACT
Male infertility has a complex etiopathology, which mostly remains elusive. Although research has claimed that oxidative stress (OS) is the most likely underlying mechanism of idiopathic male infertility, the specific treatment of OS-mediated male infertility requires further investigation. Coenzyme Q10 (CoQ10), a vitamin-like substance, has been found in measurable levels in human semen. It exhibits essential metabolic and antioxidant functions, as well as playing a vital role in mitochondrial bioenergetics. Thus, CoQ10 may be a key player in the maintenance of biological redox balance. CoQ10 concentrations in seminal plasma directly correlate with semen parameters, especially sperm count and sperm motility. Seminal CoQ10 concentrations have been shown to be altered in various male infertility states, such as varicocele, asthenozoospermia, and medical or surgical regimens used to treat male infertility. These observations imply that CoQ10 plays an important physiological role in the maintenance and amelioration of semen quality. The present article thereby aimed to review the possible mechanisms through which CoQ10 plays a role in the regulation of male reproductive function, and to concisely discuss its efficacy as an ameliorative agent in restoring semen parameters in male infertility, as well as its impact on OS markers, sperm DNA fragmentation, pregnancy, and assisted reproductive technology outcomes.
ABSTRACT
Background@#This study evaluated the outcomes of patients with refractory/relapsed Hodgkin lymphoma (RRHL) treated with a bendamustine-based regimen in combination with ifosfamide, etoposide, and vinorelbine (VIBE). @*Methods@#Consecutive RRHL patients who were treated with the VIBE regimen were identified and studied for clinicopathologic characteristics, response to VIBE regimen, event-free survival (EFS), and feasibility of an autologous stem-cell transplant (autoSCT). @*Results@#In total, 24 patients received the VIBE regimen, and a median of 3 cycles were administered. In this cohort, 80% of the patients had received ≥2 prior lines of therapy. The overall and complete response rates with VIBE were 79% and 42%, respectively. After a median follow-up (following VIBE regimen) of 14 months (range, 3‒76), the 3-year EFS and OS were 46% and 74%, respectively. Of the eligible patients, 92% underwent successful AutoSCT. The mean CD34+ cell count in the autograft was 5.5×106/kg (SD 2.07). Neutropenia was the commonest hematologic toxicity and it was observed in 42% of the patients. However, only 9% of the patients developed grade III/IV febrile neutropenia. Chemotherapy-induced nausea and vomiting were the second most common grade III/IV toxicities in our cohort of patients. @*Conclusion@#In this retrospective analysis, the combination regimen, VIBE, has shown good efficacy in heavily pre-treated patients with RRHL without compromising stem cell collection. These encouraging results provide a rationale for further development of this regimen.
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Myomectomy during the cesarean section is a debatable procedure because of raised risk of associated uncontrollable hemorrhage and postoperative morbidity. 38 years, elderly primigravida, who conceived after primary infertility with large leiomyoma in the lower uterine segment, underwent myomectomy during the cesarean section. Her intra-operative hemorrhage was within normal limits and post-partum period was uneventful. Conclusion of this study is Safety and feasibility of myomectomy along with cesarean largely depends upon the case selection, experience of the obstetrician and backup ICU and transfusion facilities.
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Pulmonary blastoma (PB) is a rare thoracic malignancy and preoperative diagnosis is challenging. A young man presented with dyspnea and chest pain for 3–4 months and chest-computed tomography (CT) revealed large mass in the left lung upper lobe and pleural effusion. Repeated CT-guided fine-needle aspiration cytology from the lesion and pleural fluid aspiration was negative for malignancy. F-18-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) revealed heterogeneous tracer avidity in left lung mass with areas of necrosis. Real-time PET-CT-guided biopsy from metabolically active component of the lesion revealed biphasic PB on histopathology.
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Background: Non-alcoholic fatty liver disease (NAFLD) is closely associated with metabolic syndrome. NAFLD is considered a disease of no consequence. Data on the effect of NAFLD on renal dysfunction in T2DM is sparse. Author aimed to study the association of NAFLD with CKD in Indian T2DM subjects.Methods: In an observational cross-sectional study at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India from February 2017 to March 2018. 197 out of 268 randomly selected type 2 diabetes mellitus (T2DM) subjects were selected for the study after considering the inclusion and exclusion criteria. CKD was defined as estimated GFR <60 ml/min per 1.73 m2 and/or albumin to creatinine ratio ≥30 mg/g. NAFLD was diagnosed using ultrasonography. The association between NAFLD and CKD was analyzed using SPSS (version 24.0).Results: On ultrasonography 133 (67.5%) T2DM subjects had NAFLD. Diabetic with NAFLD (133, 67.51%) had significantly more history of hypertension (p 0.006), higher systolic (p 0.03) and diastolic BP (p 0.009), higher BMI (p <0.001), waist circumference (p <0.001), fasting glucose (p 0.03), triglyceride (p<0.001) and higher urinary albumin-to-creatinine ratio (p <0.001). Diabetics with CKD (61, 30.96%), were older (p 0.03), hypertensive (p <0.001) and had higher fasting glucose (p 0.003). Subjects with CKD had a higher prevalence of underlying NAFLD (78.69% vs 62.5%, p 0.03) as compared with diabetics with no CKD. T2DM subjects with NAFLD had more than two times (OR 2.88 (1.1-6.78), p 0.03) the risk of developing CKD after multivariate analysis as compared to subjects without NAFLD.Conclusions: NAFLD is a risk factor for development of CKD in patients of type 2 diabetes mellitus. Screening and early preventive measures may go long way in reducing morbidity.
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Background: Spontaneous bacterial peritonitis (SBP) is common complication of cirrhosis caused by bacterial translocation. Bacterial colonization and overgrowth may occur in GI tract on suppression of gastric acid secretion. Beta-blockers have been postulated to reduce intestinal permeability. There is no significant Indian study to evaluate association of PPI with SBP in cirrhotic ascites. We aimed to assess the effect of PPI in cirrhotic patients decompensated with ascites.Methods: A retrospective case control study (January 2016 to April 2018), evaluated subjects with cirrhosis and ascites. Two study groups of cirrhotic subjects with and without SBP were formed. In each of the two study groups, 143 subjects, were enrolled by matching for age, year of admission, Child-Pugh-Turcotte (CTP) class after considering the inclusion and exclusion criteria. PPI use and various other correlates were compared in both study groups. SPSS ver 24.0 was used for statistical analysis.Results: About 69.23% subjects were using PPI prior to admission in SBP group, which was significant compared to only 31.47% in cirrhotics without SBP (p 0.003). On multivariate analysis PPI use was an independent risk factor for SBP (OR 2.24, 95% CI: 1.01-4.24; p value 0.033) and beta blocker use was protective (OR 0.58; 95% CI: 0.4-0.8; p 0.001).Conclusions: PPI use doubles the risk of development of SBP in cirrhotics decompensated with ascites. In contrast, Beta blockers use significantly lowers the risk of SBP.