Modified FOLFIRINOX compared to Gemcitabine & nab-Paclitaxel in advanced pancreatic ductal adenocarcinoma - results of a match-pair analysis

Background & objectives: FOLFIRINOX and gemcitabine plus nab-paclitaxel (GN) are the most commonly used regimens in advanced pancreatic ductal adenocarcinomas (PDACs). As there is limited data on comparison of these two regimens, the present study was aimed to compare survivals and tolerance for both regimens through a match-pair analysis. Methods: The data of 350 patients with metastatic and locally advanced PDAC, treated between January 2013 and December 2019, were retrieved. A 1:1 matching, using age and performance status, without replacement was performed by using nearest neighbour matching method. Results: A total of 260 patients (130 modified FOLFIRINOX and 130 GN) were matched. The median overall survival (OS) was 12.98 months [95% confidence interval (CI) 7.257-8.776 months] in modifications of FOLFIRINOX (mFOLFIRINOX) cohort and 12.06 months (95% CI 6.690-8.88 months) in GN group (P=0.080). The incidence of grade 3 and 4 infections, diarrhoea, oral mucositis, and fatigue was higher with mFOLFIRINOX. Patients who received second line therapy had improved OS as compared to those who did not (14.06 vs. 9.07 months, P<0.001). Interpretation & conclusions: GN and mFOLFIRINOX appear to have similar survival outcomes in an unselected match paired patient population with advanced PDAC. A markedly increased incidence of non-myelosuppressive grade 3 and grade 4 side-effects and lack of survival improvements suggest a need for nuanced use of the mFOLFIRINOX regimen. Administration of second-line chemotherapy improves OS in patients with advanced PDAC.

An interesting case of dermatomyositis with classical presentation

Dermatomyositis, a connective tissue disorder, is an idiopathic inflammatory myopathy characterised by skin manifestation.The diagnosis of dermatomyositis is based on rashes on the skin, progressive muscle weakness, elevated serum muscle enzymes, abnormal electromyogram, and abnormal findings on muscle biopsy. Hereby presenting this rare case of a 57-year-old female with dermatomyositis with all the typical clinical findings with interstitial lung disease.

A neglected cause of anaemia: hereditary hemorrhagic telangiectasia

Hereditary hemorrhagic telangiectasia (HHT) or Osler-Weber-Rendu syndrome is an inherited disorder characterized by vascular dysplasiasleading to hemorrhages. If affects approximately 1 in10,000 Caucasian people. The most common presentation is chronic and recurrent epistaxis whereas bleeding from other sites can lead to life-threatening complications.

An acute case of herpes zoster ophthalmicus with post-herpetic neuralgia and cranial nerve neuropathies

Herpes zoster is a common diagnosis in the emergency department which is caused by reactivation of varicella zoster virus (VZV). Reactivation in ophthalmic division of trigeminal nerve causes Herpes zoster ophthalmicus. It is associated with a rash in the distribution of the trigeminal nerve dermatomes especially in ophthalmic and maxillary divisions. The most often complications of HZO are episcleritis, keratitis, glaucoma, and cataracts. HZO with cranial neuropathy is a very rare condition. So herewith wereport a case 51years old female with swelling, redness in right eye and drooping of eyelids on the right side. She had tearing and double vision. She was diagnosed with herpes zoster ophthalmicus with neuropathy of 3rd,4thand 6th cranial nerves. The patient was treated and discharged in a healthy condition. Timely diagnosis and treatment can decrease morbidity and prevent the complication.

A Comparative Study on Microwave Tissue Processing and Conventional Tissue Processing

Introduction: The field of medical technology is ever evolving which necessitates traditional techniques replaced by newer technologies. Contrary to this histotechniques in histopathology has remained static with hardly any changes where tissue preparation for microscopic examination still remains time consuming. However recent emergence of automatic tissue processor and microwaves has successfully reduced the time from several days to 1-2 days. Materials and Methods: 133 different tissue blocks from the department of Oral and Maxillofacial Pathology were used in the current study. Each tissue received was fixed in 10% formalin overnight, sectioned into approximately two halves. One tissue was sent for routine processing whereas the other was sent for microwave processing. After processing the sections were embedded, section and stained with H and E. A pathologist evaluated the stained slides and the results so obtained were analyzed statistically. Results: Microwave processing considerably cut down the processing time from days to merely hours. Microwave stained slides showed no loss of cellular and nuclear details, uniform-staining characteristics and was of excellent quality. Conclusion: The cellular details, nuclear details and staining characteristics of microwave stained sections were better than or equal to the routine stained sections. The overall quality of microwave-stained sections was found to be better than the routine stained sections in majority of cases

Awareness and practice of breast self-examination (BSE) with its socio-demographic associates: a cross-sectional survey in the capital of Rajasthan, India

Introduction: Breast cancer is the most common cancer of women worldwide. Early diagnosis of it has a very important role in its management. Breast self-examination (BSE) is a key to the early diagnosis of breast cancer. Materials and Methods: A community-based cross-sectional study was conducted on 300 females of Jaipur city. This study was conducted by a house-to-house survey through a systematic random sampling technique in the field practice area of the Urban Health Training Centre (UHTC) of SMS medical college, Jaipur (Rajasthan), India. A predesigned semi-structured questionnaire containing predesigned questions regarding knowledge and practice of BSE was used to collect data. A Chi-square test was used to find out associations. Results: Only 18% of females were aware of BSE and 5.7% of the females were practicing BSE. Health professionals (31.03%) were the main source of knowledge. Only 50% of females who have heard the name of BSE, knew that it is performed by self. Awareness and practice of BSE both were found to be associated with religion, education, socioeconomic status, and occupation and there was no association with age and marital status. Females with higher education and socioeconomic status were more aware of BSE. The most common (94.69%) reason for not practicing BSE was the lack of awareness of steps followed by ‘find it unnecessary’. Conclusion: As knowledge and practice of BSE were observed very poor and considering the important role that can be played by BSE in the early diagnosis and management of breast cancer, there is an urgent need to implement and reinforce BSE in the existing cancer awareness and screening programs. IEC activities regarding BSE also motivated proper knowledge of BSE.

The Importance of Vednaadhyaya in Clinical Diagnosis of Childhood Diseases

The knowledge of Ayurveda have been divided in eight branches i.e., Ashtangayurveda. Out of which Kaumarbhritya is the branch of Ayurveda, which deals with the knowledge of diseases and care of child right from conception till adolescence. Kashyap Samhita is the most important and main classical text of the Kaumarbhritya. The Kashyap Samhita is divided in various sections (Sthana) of which Vedanadhyaya is 25th Chapter of Sutrasthana where the symptomology of various diseases in children’s are explained and it helps in pediatric examination and diagnosis as children are not capable to speak about their symptoms themselves. The present review article is the humble effort to investigate the classical text of the Vedanadhyaya and its modern aspects. It is observable that Acharya Kashyap has integrated a broad collection of diseases of different system like skin, ENT, gastro-biliary, hematology and urinary system and has also included the Balgrahas. The symptoms described are truthful and rational in modern logical era also. Therefore, a comprehensive study of Vedanadhyaya is necessary for appropriate understanding of Ayurvedic point of view for pediatric diseases and their ordinary discriminative symptoms. It reinforces the view, that children are not miniature adults and diseases in pediatric age group have different features and requires understanding of it. This review article highlights the importance of Vednaadhyaya in clinical diagnosis of childhood diseases.

Replication of SARS-CoV-2 in cell lines used in public health surveillance programmes with special emphasis on biosafety

Background & objectives: Polio, measles, rubella, influenza and rotavirus surveillance programmes are of great public health importance globally. Virus isolation using cell culture is an integral part of such programmes. Possibility of unintended isolation of SARS-CoV-2 from clinical specimens processed in biosafety level-2 (BSL-2) laboratories during the above-mentioned surveillance programmes, cannot be ruled out. The present study was conducted to assess the susceptibility of different cell lines to SARS- CoV-2 used in these programmes. Methods: Replication of SARS-CoV-2 was studied in RD and L20B, Vero/hSLAM, MA-104 and Madin–Darby Canine Kidney (MDCK) cell lines, used for the isolation of polio, measles, rubella, rotavirus and influenza viruses, respectively. SARS-CoV-2 at 0.01 multiplicity of infection was inoculated and the viral growth was assessed by observation of cytopathic effects followed by real-time reverse transcription–polymerase chain reaction (qRT-PCR). Vero CCL-81 cell line was used as a positive control. Results: SARS-CoV-2 replicated in Vero/hSLAM, and MA-104 cells, whereas it did not replicate in L20B, RD and MDCK cells. Vero/hSLAM, and Vero CCL-81 showed rounding, degeneration and detachment of cells; MA-104 cells also showed syncytia formation. In qRT-PCR, Vero/hSLAM and MA-104 showed 106 and Vero CCL-81 showed 107 viral RNA copies per ?l. The 50 per cent tissue culture infectious dose titres of Vero/hSLAM, MA-104 and Vero CCL-81 were 105.54, 105.29 and 106.45/ml, respectively. Interpretation & conclusions: Replication of SARS-CoV-2 in Vero/hSLAM and MA-104 underscores the possibility of its unintended isolation during surveillance procedures aiming to isolate measles, rubella and rotavirus. This could result in accidental exposure to high titres of SARS-CoV-2, which can result in laboratory acquired infections and community risk, highlighting the need for revisiting biosafety measures in public health laboratories

Nasal Mucociliary Clearance in Smokers: A Systematic Review

Abstract Introduction Smoking is one of the most important causes of mortality and morbidity in the world, as it is related to the risk factor and etiology of respiratory-tract diseases. Long-term smoking causes both structural and functional damage in the respiratory airways, leading to changes in nasal mucociliary clearance (NMC). Objectives The aim of the present study was to look systematically into the current literature and carefully collect and analyze results to explore NMC in smokers. Data Synthesis Two independent reviewers conducted a literature search on some Electronic database: Pubmed, Medline, Ebsco, Springer Link, Science Direct, Scopus, and Proquest searching for articles fulfilling the inclusion and exclusion criteria. The lead author independently assessed the risk of bias of each of the included studies and discussed their assessments with the other two authors to achieve consensus. Of the 1,654 articles identified in the database search, 16 met the criteria for this review. Most of the articles (15 out of 16) showed the impairment of NMC in smokers. Conclusion The present systematic review suggests that there is an impairment of NMC in smokers. The impairment is not only observed in cigarette smoking, but also in passive smoking, bidi smoking, electronic smoking, and hookah smoking. The impairment of NMC in chronic exposure to smoking is caused by the ciliotoxic effect, hypersecretion and viscoelastic change of mucous, airway surface liquid depletion, increased oxidative stress, and deteriorations in the inflammatory and immune systems.

Vasant Kusmakar Ras, an ayurvedic herbo-mineral formulation prevents the development of diabetic retinopathy in rats

Background: Diabetic retinopathy is a slow progressing complication of diabetes mellitus with multifactorial aetiology affecting approximately 80% of diabetics worldwide. Chronic hyperglycemic milieu ofDiabetes induces biochemical changes which contribute to the pathogenesis of Diabetic retinopathy.Objective: The present study examined the protective effect of Vasant Kusumakar Ras, an Ayurvedicherbo-mineral formulation, in diabetic retinopathy.Materials and Methods: Diabetes was induced in rats by intraperitoneal injection of streptozotocin (45mg/kg). Rats were kept without any treatment for period of three weeks for induction of Diabeticretinopathy followed by treatment with Vasant Kusumakar Ras (11.25 mg/kg, p.o) for further 5 weeks.Fasting blood glucose levels, lipid profile and HbA1c were determined. Eye tissue homogenates weresubjected to biochemical analysis to determine the levels of oxidative stress parameters (superoxidedismutase, catalase, reduced glutathione, lipid peroxidation), vascular endothelial growth factor andaldose reductase activity. Histopathological analysis of retinal tissue was conducted using Hematoxylinand Eosin staining.Results: Vasant Kusumakar Ras treatment restored serum lipid profile which was altered in diabetic rats.Treatment with Vasant Kusumakar Ras significantly ameliorated the oxidative stress in eye tissueresulting in decreased lipid peroxidation and increase in endogenous antioxidant levels. Levels of aldosereductase and vascular endothelial growth factor in eye tissue were significantly decreased in VasantKusumakar Ras treated rats. Hematoxylin and Eosin staining indicated that the Vasant Kusumakar Rastreatment significantly restored the normal architecture of the retinal tissue.Conclusion: Vasant Kusumakar Ras exhibits protective effect and prevents the development of Diabeticretinopathy through its effects on multiple biochemical pathways implicated in pathogenesis of Diabeticretinopathy.

Forced degradation study of efonidipine HCl ethanolate, characterization of degradation products by LC-Q-TOF-MS and NMR

Efonidipine HCl Ethanolate is an antihypertensive drug with 1,4 dihydropyridine and phosphinane derivative. Forceddegradation study was performed in Efonidipine as per the guidelines by International Conference on Harmonization(ICH) Q1A (R2). Extensive degradation and slight degradation were observed in alkaline and photolytic conditions,respectively, whereas acidic, oxidative, and thermal conditions did not show any degradation. Degradation productswere separated on Thermo Hypersil BDS C18 column (250 × 4.6 mm, 5 µ), mobile phase in gradient mode usingammonium acetate buffer and acetonitrile with detection at a wavelength of 254 nm. Six degradation products in alkalinecondition and four degradation products in photolytic condition were identified by HPLC and characterized by massspectrometry using LC-Q-TOF-MS, and degradation pathway was proposed. This is the typical case of degradation,where co-solvent methanol reacts with Efonidipine to form pseudo degradation products such as DP1, DP4, DP5, andDP6. Three degradation products DP1, DP3, and DP4 in alkaline condition were isolated by preparative HPLC andwere characterized by LC-Q-TOF-MS, 1H/13C NMR, and IR techniques. By characterization with these techniques,DP1 is characterized as 3-2-(N-benzylanilino)ethyl 3-oxo-2,2-dimethylpropyl hydrogen 1,4-dihydro-2,6-dimethyl-4-(3-nitrophenyl) pyridin-3-yl-3-phosphonate, DP3 is characterized as 2-(N-benzyl-N-phenylamino) ethanol, and DP4is characterized as 3-methoxy-2,2-dimethylpropyl hydrogen 1,4-dihydro-2,6-dimethyl-5-methyloxycarbonyl-4-(3-nitro)phenylpyridin-3-yl-3-phosphonate. The developed method was validated as per guidelines by ICH with respectto linearity, accuracy, precision, limit of detection, and robustness.

A retrospective study of serious adverse drug reactions and associated risk factors in a tertiary care hospital

Background: Serious adverse drug reactions (ADRs) cause physical, psychological and economic harm to patients and society. This study was undertaken to understand serious ADRs in a tertiary care hospital and risk factors associated with it.Methods: The serious adverse reactions that occurred over a one-year period were assessed. The serious adverse drug reactions, action taken, outcome, predictability, suspect drug, causality, patient demographics and risk factors for the reaction was collected. Chi-square test was applied for observing relationships of predisposing factors for serious ADRs.Results: Out of a total of 984 reported adverse drug reactions, 94 (9.55%) were serious. Hematological disorders (41.05%) were the common serious ADRs followed by electrolyte disturbances (18.94%). Anticancer agents were the suspect drugs for majority of serious ADRs. Serious ADRs contributed to 39 (0.05%) admissions in the hospital. Recovery occurred in 97.87% of the patients. The causality was possible in 91.48% (n=86) and probable in 8.51% (n=8) of the serious adverse drug reactions. Males, patients even with a single concomitant disease and those with more than 2 concomitant medications were at increased risk (p<0.05) for developing serious ADRs.Conclusions: Serious ADRs are a significant problem in health care. Measures should be taken to detect and treat them at the earliest to reduce suffering of the patient.

Short Communication: Predicting receptor for mannose-binding lectin on neutrophil surface

Neutrophils play as major phagocytes that participate in the various effector phase of immunity. Mannosebinding lectin (MBL) assisted priming of neutrophils could trigger various processes including modulationof endocytosis rate, reactive oxygen production, chemotaxis, etc., through interactions with cell surfacereceptors. The physiological receptor for MBL on neutrophil's surface is still unreported. Macromoleculardocking could be attempted to determine the protein-protein interactions which are important forunderstanding cellular function and organization. The study was performed to identify the interacting partnerof MBL present on neutrophils surface which leads to the activation of various cell processes. Protein networkanalysis, homology modeling, and Rigid docking were performed to explore structural features and bindingmechanism of MBL with its cellular receptors. The results indicates that CR1 interact with the MBL and mayact as MBL receptor.

How involved are husbands in antenatal care? the perspective of women availing antenatal services at a maternity hospital in rural South Karnataka, India

Background: Male involvement in maternal health is associated with significant positive health outcomes in the mother. We aimed to assess the antenatal womens’ perception of their husbands’ involvement in antenatal care in a maternity hospital in rural Karnataka, India.Methods: 200 pregnant women in a maternity hospital in Karnataka were interviewed using a semi-structured pilot tested questionnaire on their perception about their husbands’ participation in antenatal care.Results: The mean score of women’s perception of husband’s awareness of antenatal care was 10.1±2.2 out of a maximum of 12, while that of husband’s attitude to antenatal care was 7.7±1.4 out of a maximum of 9 and of husband’s participation was 21.7±5.4 out of a maximum of 30. The score of perception of husband’s awareness was significantly higher among multigravidae and among women who had a planned pregnancy. The score of perception of husband’s attitude was significantly higher among women from nuclear families, multigravidae, those with a living child and those with no complications in the current pregnancy. The score of perception of husband’s participation was significantly higher among women with no complications in the current pregnancy.Conclusions: Husbands play a vital role in the antenatal care of their wives. This should be harnessed by health care workers by providing health education to them, encouraging husbands to accompany their wives to antenatal checkups and labour and promptly communicating clinical findings to them.

An Evaluation of SGOT among the Patient which Suffered from Thyroid Disorders

Alkaline phosphatase, ALP is found in all tissue of the body.(4) The enzyme responsible for extracellular catabolism of glutathione’s is Gamma glutamyltransferase, GGT]. It is the main thiol intracellular antioxidant agent. The larger function of enzyme is to transport amino acid and peptide into the cell across the cell membrane in the form of gamma glutamyl peptidase. The only iodine containing amine hormones in the vertebrate are Triiodothyronine (T3) and thyroxine (T4). Methods: All samples were taken from hypothyroid, hyperthyroid and euthyroid subjects who fasted for at least 8 hours before the blood collection.Serum separated and analyzed for T3, T4, TSH, CK-NAC, CK-MB, LDH and AST(SGOT) . The sample was processed in standardized manner under set protocol in the Department of Biochemistry. Results: Among the total of 300 subjects of ages 25 -50 years of both sexes were included in the study, 100 were hypothyroid, 100 were hyperthyroid and 100 were euthyroid. Their serum levels of T3, T4 and TSH were estimated and confirmed. Conclusion: The present study might be beneficial in public health and clinical practice, as both thyroid disorders and cardiovascular diseases are important issue of concern to reduce the morbidity and mortality.

Pattern of dietary practices and physical activity among school going adolescents in Haldwani block of Nainital district

Introduction: Adolescence is a period when individual starts coming up with their choices and develops personal lifestyle. This lifestyle includes unhealthy diet and physical inactivity which are the major risk factors of various non-communicable diseases of great public health importance like cardiovascular diseases, diabetes, obesity etc. Objective: To assess the pattern of dietary practices and physical activity among school going adolescents in Haldwani block of Nainital district. Material and Method: School based cross sectional study was done among 900 adolescents of 8th to 12th standard. Sample collected from 30 clusters/schools using simple random sampling. Results: Out of 900 students, majority were non-vegetarian. Daily intake of fruits and vegetable was observed among 31.9% and 73.3% of adolescents. Practice of eating junk food and meals outside home were seen more in urban adolescents. 55.6% of participants were found to be physically active, sedentary behavior was more common in urban area and adolescents studying in private schools.

Study on Uric Acid as Biomarker for Insulin Resistance in Type 2 Diabetic Mellitus

Serum uric acid (SUA) is an end product of purine metabolism. SUA is excreted mainly through the kidneys. Multiple mechanisms have been reported to show the association of hyperuricemia with glucose intolerance. The association between insulin and renal resistance to absorption of urates has been found out to be the most important among these mechanisms. Methods: This comparative study contains 50 subjects of type 2 diabetes having an age group of 40-65 years were participated in case & 50 healthy subjects as control group. This case control study conducted in the department of department of biochemistry, LPS institute of Cardiology, GSVM medical college, Kanpur. Results: In the case-control study were found 54% male and 46% female in case group & 42% female and 58% female. We suggested that in study group 44% cases were belongs to 61-65 age group followed by other while in control group 42% were belongs to 61-65 age group followed by other age group. Conclusion: This study conclude that there were significant correlation between uric acid and HOMA-IR value. Hyperuricemia is related to risk factors for insulin resistance in type 2 diabetes. The study concluded a significant progressive relationship between increased uric acid level with respect to HOMA-IR levels which is an indices of insulin resistance.

Protective potential of Moringa oleifera Lam. along with curcumin and piperine against beryllium-induced alterations in hepatorenal biochemistry and ultramorphology in rats

Moringa oleifera Lam. (Moringaceae) is a medicinally important plant, used as traditional medicine all over the world particularly in South Asia and India. Hydroalcoholic (50% v/v) root extract of M. oleifera (150 mg/kg, p.o.) with piperine (2.5 mg/kg, p.o), or curcumin (5.0 mg/kg, p.o.) was administered daily for 1 week in Female Wistar albino rats against beryllium toxicity (1.0 mg/kg, i.p. daily for 5 weeks). Beryllium altered hepatorenal function and enhanced the leakage of AST, ALT, and LDH, depleted SALP activity, and increased the level of urea, uric acid, creatinine, triglyceride and total cholesterol in the blood. Beryllium altered tissue biochemical parameters by a decrease in SDH, ALPase, ATPase activities, and increased ACPase activity, depleted hemoglobin and ALAD activity with an increase in ALAS activity and serum bilirubin. A significant amount of beryllium deposited in the liver, kidney, spleen, and bones. M. oleifera with curcumin showed better antitoxic potential by reversal of hepatorenal function towards normal and restored the activity of SDH, ALPase, ATPase, ACPase, and hemoglobin level normal. M. oleifera with curcumin effectively mobilized beryllium from the body and restored ultrastructure of liver and kidney. It was concluded that curcumin enhances the antitoxic potential of M. oleifera root extract and reduces beryllium body burden in rats.

A comparative analysis of quality of life after postoperative intensity-modulated radiotherapy or three-dimensional conformal radiotherapy for cervical cancer

AIMS: The aim of this study is to compare the quality of life (QOL) between adjuvant three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT) for cervical cancer. MATERIALS AND METHODS: QOL assessment was done at the baseline and then longitudinally after completing (chemo) radiation. All patients completed EORTC QLQ-C30 and EORTC QLQ Cx-24 modules. Independent-sample t-test was used to compare the mean scores between the two groups. Analysis of variance was used to compare differences in QOL measures over the six time points (baseline, post-RT, 3, 6, 9, and 12 months after treatment) and between treatment groups (3DCRT vs. IMRT). Linear mixed model was also performed to account for attrition. RESULTS: Overall, 64 patients (image-guided IMRT, n = 40 and 3DCRT, n = 24) completed QOL assessment. The median age and follow-up period were 48 years and 15.5 months, respectively. General QOL domains such as emotional (at 12 months, P = 0.04) and social (at 3 months, P = 0.02 and 12 months, P = 0.03) were better with IMRT. Pain (12 months, P = 0.03); fatigue (12 months, P = 0.05); nausea and vomiting (12 months, P = 0.03); insomnia (post-RT, P = 0.05 and 12 months, P = 0.03); appetite loss (post-RT and 12 months, P = 0.04); and diarrhea (6 months, P = 0.02 and 12 months, P = 0.003) scores were significantly better with IMRT. On linear mixed model analysis, there was a significant interaction between treatment cohort and assessment intervals for physical, emotional, and social functioning, appetite loss, diarrhea, lymphedema, and menopausal symptom scores were significantly better with IMRT. CONCLUSIONS: Treatment technique (IMRT vs. 3DCRT) impacts early QOL in undergoing adjuvant radiation for cervical cancer.