Normalizing Arterial Blood Pressure in Patients with Aortic Stenosis Does Not Prevent Grading Discrepancies Between Pre?Cardiopulmonary Bypass Transesophageal Echocardiography and Transthoracic Echocardiography

Background: Aortic stenosis (AS) grading discrepancies exist between pre?cardiopulmonary (pre?CPB) transesophageal echocardiography (TEE) and preoperative transthoracic echocardiography (TTE). Prior studies have not systematically controlled blood pressure. Aims: We hypothesized that normalizing arterial blood pressure during pre?CPB TEE for patients undergoing valve replacement for AS would result in equivalent grading measurements when compared to TTE. Setting: Single University Hospital Design: Prospective, Interventional Methods: Thirty?five adult patients underwent procedures for valvular AS between February 2017 and December 2020 at Medical University of South Carolina. Study participants had a TTE within 90 days of their procedure that documented blood pressure, peak velocity (Vp ), mean gradient (PGm), aortic valve area (AVA), and dimensionless index (DI). During pre?CPB TEE, if a patient抯 mean arterial pressure (MAP) fell more than 20% below their baseline blood pressure obtained during TTE, measurements were recorded as 搊ut of range.� Phenylephrine was administered to restore MAP to the baseline range and repeat TEE measurements were recorded as 搃n?range.� Statistical Analysis: Differences between imaging modalities and grading parameters were examined using a series of linear mixed models. P values were Bonferroni?adjusted to account for multiple comparisons. Main Results: Significant discrepancies between TEE and TTE were observed for Vp , PGm, and DI despite blood pressure normalization across all subjects and for out?of?range measures and corrected measures. There were no statistically significant differences between TEE and TTE for AVA. Conclusions: Blood pressure normalization during pre?CPB TEE is not sufficient to avoid AS grading discrepancies with preoperative TTE.

Delayed SARS-COV-2 clearance in infected persons in Ghana

Objective: This study aimed to determine the duration of SARS-CoV-2 clearance in persons in Ghana. The research question was whether the duration of virus clearance in Ghana matched the 14 days recommended by the World Health Organization (WHO); this had direct implications for transmission, which was key in managing the COVID-19 pandemic. Design: This was a retrospective analytical study. Setting: All facilities that submitted clinical specimens to Noguchi Memorial Institute for Medical Research (NMIMR) for SARS-CoV-2 diagnosis between March to June 2020 were included in the study. Interventions: Samples from 480 persons who tested positive for SARS-CoV-2 by RT-PCR from March to June 2020 at NMIMR and submitted at least two follow-up samples were retrospectively analysed. Individuals with two consecutive negative RT-PCR retesting results were considered to have cleared SARS-CoV-2. Results: The median time from the initial positive test to virus clearance was 20 days (IQR: 5-56 days). This was six days longer than the WHO-recommended 14 days, after which infected persons could be de-isolated. Sputum and nasopharyngeal swabs proved more sensitive for detecting viral RNA as the infection progressed. At a significance level of 0.05, age and sex did not seem to influence the time to SARS-CoV-2 clearance. Conclusions: The median time to SARS-CoV-2 clearance in this study was 20 days, suggesting that SARS-CoV-2 infected persons in Ghana take longer to clear the virus. This finding calls for further investigations into whether patients who remain PCR positive continue to be infectious and inform isolation practices in Ghana.

Cyclophosphamide Pulse Therapy in the Treatment of Systemic Sclerosis Associated Interstitial Lung Disease: An Observational Study

Introduction: Scleroderma is a multisystem autoimmune connective tissue disease with approximately 90% of patients having lung involvement. It is the leading cause of morbidity and mortality in scleroderma. There is no effective treatment once there is lung involvement in the form of fibrosis. Study setting: Conducted in a tertiary care center between January 2017 and December 2019. Aim: To evaluate the efficacy of intravenous cyclophosphamide in patients with scleroderma-associated interstitial lung disease (ILD). Study population: Symptomatic patient with scleroderma with high-resolution computed tomography (HRCT)-proven non-specific interstitial pneumonia (NSIP)-pattern ILD. Methodology: Patients received 12 cycles of cyclophosphamide at a dose of 10 mg/kg every 4 weeks. Patients were followed up for 1 year after treatment completion. A six-minute walk test (6MWT) and spirometry were done at baseline and then every 6 months up to 2 years. Diffusing capacity of lung for carbon monoxide (DLCO) was done at baseline and then yearly for up to 2 years. Results: A total of 38 patients completed the study. The majority of patients had diffuse cutaneous type of systemic sclerosis. Throughout the study period, there was a gradual worsening of dyspnea as measured by the Modified Medical Research Council (mMRC) scale. Mean forced vital capacity (FVC) improved with 1 year of treatment, but later steadily decreased during follow-up. Similarly, DLCO also improved during 1-year treatment, but the improvement was not sustained during follow-up. There was a statistically significant improvement in 6MWD at the end of 6 months. This was followed by a gradual fall in 6MWD during follow-up. The only adverse event noted was persistent leukopenia in one patient. Conclusion: Intravenous pulse cyclophosphamide therapy in patients with scleroderma-associated ILD is associated with stabilization of pulmonary function during the treatment period, but not maintained during follow-up.

Barrett’s Esophagus: A Comparison Study between Two Cohorts of Gastroesophageal Reflux Disease

Introduction: Barrett’s esophagus (BE) is a complication of gastroesophageal reflux disease (GERD). It is seen among 15% of GERD patients as per a population-based study by Ronkainen et al. Barrett’s has malignant potential and annual progression to carcinoma depends on the presence or absence of dysplasia. There are various risk factors for the development of BE. We compared two symptomatic cohorts of GERD patients from the same geographical area who were evaluated for the presence of Barrett’s and various factors that can contribute to Barrett’s Materials and methods: Cross-sectional study. Two GERD cohorts, one from Kottayam and the other from Trivandrum were taken. The presence of Barrett’s and the factors contributing to the development of Barrett’s were analyzed between the two groups. Since biopsy data of all patients were not available, endoscopically suspected esophageal metaplasia (ESEM) was taken as Barrett’s Results: 415 patients were enrolled for the study (203 from Trivandrum and 212 from Kottayam). 192 females (99 from Trivandrum and 93 from Kottayam), and 223 males (104 from Trivandrum and 119 from Kottayam). Barrett’s esophagus and especially long-segment Barrett’s were significantly more common in Kottayam than Trivandrum (68 vs 22 and 36 vs 9) (p-value <0.001). Among the factors that were traditionally thought to contribute to the development of Barrett’s esophagus, age (>50 years) was not statistically significant among the two cohorts (mean age of Trivandrum was 48 years and Kottayam was 49 years). Duration of GERD symptoms was significantly more in the Trivandrum cohort compared to Kottayam (p-value <0.001). Hiatus hernia and body mass index (BMI) were more common in Kottayam. There were no statistically significant differences in erosive esophagitis and antral gastritis (%age?) between the two cohorts. Conclusion: Both Trivandrum and Kottayam belong to the same geographical area and are separated by a distance of only 150 km. The Kottayam cohort is more prone to develop distal esophageal carcinoma as the BE is more in Kottayam. This data also suggests the need for GERD registries so that high-risk population can be targeted and early intervention can lead to a decrease in the incidence of distal esophageal carcinomas.

ALK-positive large B-cell lymphomas: A clinicopathologic study

Background and Aim: Anaplastic lymphoma kinase (ALK)-positive large B-cell lymphomas (ALK+-LBCLs) are aggressive CD20-negative lymphomas, accounting for <1% of diffuse LBCLs. Being rare and with peculiar immunophenotypic characteristics, these can be easily misdiagnosed. We present 11 cases of ALK+-LBCLs diagnosed over a period of 11 years at a tertiary care hospital in South India to analyze the clinical, morphological, and immunophenotypic profile of these tumors. Subjects and Methods: ALK+-LBCL cases diagnosed from September 2009 to August 2020 were included. Clinical details were obtained from stored electronic records and summarized. Available hematoxylin and eosin (H and E) stained slides and immunohistochemistry slides were reviewed and observations tabulated. Results: Eleven patients (nine males and two females) were diagnosed with ALK+-LBCLs in the study period with seven presenting primarily with extranodal disease manifestations. Tumors in the lymph nodes showed diffuse architecture effacement and variable sinusoidal invasion. All tumors showed immunoblastic and plasmablastic-type large lymphoid cells with scattered anaplastic/multinucleate large cells, including rare Reed–Sternberg-like cells. Cytoplasmic granular ALK-1 staining, CD20 negativity, and immunohistochemical features of plasmablastic differentiation were noted in all. Of eight patients treated, only one achieved remission with multi-agent chemotherapy but relapsed after 6 months. Two patients died of disease and five others had progressive/persistent disease and were lost to follow-up. Conclusion: Although rare, these tumors should always be in the differential diagnoses of tumors with plasmablastic and immunoblastic morphology, especially in extranodal sites to avoid diagnostic delay/misdiagnosis.

Predictors of Pharmacotherapy and Quality of Life Among Patients With Diabetic Foot Syndrome: A Cross-Sectional Study from a Tertiary Care Hospital in India

Objective: To assess the patterns and predictors of pharmacotherapy and QOL in DFS patients in an Indian tertiary care hospital. Methods: A cross-sectional study was conducted among inpatients with DFS. Data on sociodemographic and clinical factors, pharmacotherapy, clinical outcomes, and QOL were analyzed using the chi-squared test, independent sample t-test, and binary logistic regression. Results: We screened 3284 inpatients and included consecutive 87 (2.7%) DFS patients. The mean age was 56.08 ± 11.05 years, with a male preponderance (75.8%). Mean HbA1c was 9.9 ± 2.483. About 75% of patients received insulin, and polypharmacy was noticed in 82.7%. About 67.8% of DFS patients had other vascular complications of diabetes, with diabetic retinopathy being the most common in 89%. Amputations were noticed in 32.1% of patients. Overall, poor QOL was seen in 79.3% of patients. The mean scores for different domains were as follows: physical, 41.51 ± 14.15; psychological, 42.90 ± 11.16; social relationships, 43.06 ± 19.36; and environment, 47.17 ± 13. The presence of complications from diabetes was a significant predictor of the utilization of antihypertensives (OR: 2.92, CI [1.09, 7.79], P = 0.03) and poor QOL (OR: 4.54, CI [0.965, 21.41], P = 0.05). Conclusion: DFS patients in this study were found to be younger with poor glycemic control and other vascular complications of diabetes. The presence of other complications of diabetes in DFS patients was found to be a predictor of pharmacotherapy and poor QOL.

68Ga-Prostate-specific membrane antigen (PSMA) positron emission tomography (pet) in prostate cancer: a systematic review and meta-analysis

ABSTRACT Introduction: Prostate cancer (PC) is the second most commonly diagnosed cancer in males. 68Ga-PSMA PET/CT, a non-invasive diagnostic tool to evaluate PC with prostate-specific membrane antigen (PSMA) expression, has emerged as a more accurate alternative to assess disease staging. We aimed to identify predictors of positive 68Ga-PSMA PET and the accuracy of this technique. Materials and methods: Diagnostic accuracy cross-sectional study with prospective and retrospective approaches. We performed a comprehensive literature search on PubMed, Cochrane Library, and Embase database in search of studies including PC patients submitted to radical prostatectomy or radiotherapy with curative intent and presented biochemical recurrence following ASTRO 1996 criteria. A total of 35 studies involving 3910 patients submitted to 68-Ga-PSMA PET were included and independently assessed by two authors: 8 studies on diagnosis, four on staging, and 23 studies on restaging purposes. The significance level was α=0.05. Results: pooled sensitivity and specificity were 0.90 (0.86-0.93) and 0.90 (0.82-0.96), respectively, for diagnostic purposes; as for staging, pooled sensitivity and specificity were 0.93 (0.86-0.98) and 0.96 (0.92-0.99), respectively. In the restaging scenario, pooled sensitivity and specificity were 0.76 (0.74-0.78) and 0.45 (0.27-0.58), respectively, considering the identification of prostate cancer in each described situation. We also obtained specificity and sensitivity results for PSA subdivisions. Conclusion: 68Ga-PSMA PET provides higher sensitivity and specificity than traditional imaging for prostate cancer.

Data management during COVID-19 outbreak response in Ghana: a reference laboratory perspective on key issues and measures

The COVID-19 pandemic caused by SARS-CoV-2 is an important subject for global health. Ghana experienced lowmoderate transmission of the disease when the first case was detected in March 12, 2020 until the middle of July when the number of cases begun to drop. By August 24, 2020, the country's total number of confirmed cases stood at 43,622, with 263 deaths. By the same time, the Noguchi Memorial Institute for Medical Research (NMIMR) of the University of Ghana, the primary testing centre for COVID-19, had tested 285,501 with 28,878 confirmed cases. Due to database gaps, there were initial challenges with timely reporting and feedback to stakeholders during the peak surveillance period. The gaps resulted from mismatches between samples and their accompanying case investigation forms, samples without case investigation forms and vice versa, huge data entry requirements, and delayed test results. However, a revamp in data management procedures, and systems helped to improve the turnaround time for reporting results to all interested parties and partners. Additionally, inconsistencies such as multiple entries and discrepant patient-sample information were resolved by introducing a barcoding electronic capture system. Here, we describe the main challenges with COVID-19 data management and analysis in the laboratory and recommend measures for improvement

SARS-CoV-2 detection among international air travellers to Ghana during mandatory quarantine

Objectives: To determine the prevalence of SARS-CoV-2 detection among international travellers to Ghana during mandatory quarantine. Design: A retrospective cross-sectional study. Setting: Air travellers to Ghana on 21st and 22nd March 2020. Participants: On 21st and 22nd March 2020, a total of 1,030 returning international travellers were mandatorily quarantined in 15 different hotels in Accra and tested for SARS-CoV-2. All of these persons were included in the study. Main outcome measure: Positivity for SARS-CoV-2 by polymerase chain reaction. Results: The initial testing at the beginning of quarantine found 79 (7.7%) individuals to be positive for SARS-CoV2. In the exit screening after 12 to 13 days of quarantine, it was discovered that 26 of those who tested negative for SARS-CoV-2 in the initial screening subsequently tested positive. Conclusions: Ghana likely averted an early community spread of COVID-19 through the proactive approach to quarantine international travellers during the early phase of the pandemic

Clinical and functional profile of 6-12-year-old children with attention deficit hyperactivity disorder referred to a tertiary care center in South India

Objective: To describe the clinical, socio-demographic, and functional profile of children with Attention Deficit Hyperactivity Disorder (ADHD) referred to a tertiary care center in Kerala, India. Methods: A retrospective descriptive study was conducted from records of developmental evaluation clinic over a period of one year. All-consecutive cases the first time diagnosed as ADHD were enrolled. Autism Spectrum Disorder, genetic disorders, and children with sensory impairments were excluded. Clinical profile was based on presenting symptoms, gender, and socio-demographic characteristics; functional status assessed by Conner’s 3 Parent Scale and cognitive status by Intelligence Quotient. Results: ADHD prevalence in a clinically referred sample was 12.7%. Boy to girl ratio was 6:1. The mean age of presentation was 8.2 years (SD 6.09). The most common presenting symptom was hyperactivity and behavioral problems followed by poor scholastic performance and poor memory. The functional status assessment showed major concerns in all six domains - Inattention, Hyperactivity, Learning Problem, Executive Functioning, Aggression, and Peer relation, in the majority of children. Children presenting with ADHD symptoms at a later age (9-12 years) had lower IQ scores than those diagnosed at a younger age. Conclusion: Course of childhood ADHD shows a consistent clinical and functional pattern. Early diagnosis and quantification of difficulties at the outset is suggested, which can help in providing early intervention and is likely to improve long-term outcome in these children.

COVID-19 pandemic: ten research questions Africa must answer for itself

The COVID-19 pandemic is spreading through Africa and governments are making frantic efforts to control spread, hospitalizations and deaths. While control measures are being taken, research into the biomedical and socio-cultural aspects of the pandemic, relevant to the African population, should not be ignored. It should not be assumed that research performed in Asian, American and European populations will always be applicable to Africa. Rather, research should be done in Africa to answer questions peculiar to the epidemic on the continent and help inform international guidelines. National guidelines for treatment and prevention, patient recoveries and discharge, and public health control measures should be based on research performed in the appropriate context for them to be effective and robust. Urgent research is needed in viral immunology and shedding, treatment and prevention trials, protection of healthcare personnel, and antimicrobial use among others. In this article, we propose ten research questions that when answered in a timely manner by scientists in Africa, will enhance Africa's response to the pandemic

Evaluation of academic performance of undergraduate dental students in a government medical university in Kerala, India

Introduction: Dentistry is considered to be a high-stress profession. The educational period in dental schools is viewed as a highly demanding and stressful learning environment. The aim of the study was to evaluate the academic performance of undergraduate dental students of 2010, 2011, and 2012 batches admitted at Kerala University of Health Sciences. Materials and Methods: The present retrospective study evaluated the performance of dental students of 2010, 2011, and 2012 batches from their first Bachelor of Dental Surgery (BDS) to the completion of final BDS Part 2 examination. The study was carried out from August 2010 to March 2017. The data were analyzed using SPSS version 19 software. Chi-square test was used for analyzing the significance of difference between proportions. The level of significance was set at P < 0.05. Results: The results of first BDS students of 2010, 2011, and 2012 batches were 35.8%, 49.9%, and 55.5%, respectively. Whereas, the results of the final BDS Part 2 students of 2010, 2011, and 2012 batches were 92.6%, 88.4%, and 92.5%, respectively. Conclusion: The present study shows a decline in performance of dental students at the time of inception of the university, and as time progressed, the results of the students showed significant improvement.

Will ceftazidime/avibactam plus aztreonam be effective for NDM and OXA-48-Like producing organisms: Lessons learnt from In vitro study

Introduction: Carbapenem resistance (CR) in Klebsiella pneumoniae is mainly mediated by bla NDM and bla OXA-48 carbapenemases. Newer Food and Drug Administration-approved antimicrobial ceftazidime/avibactam (C/A) has a potent activity against bla OXA-48-like producers. However, its activity is limited in organisms co-producing bla NDM and bla OXA-48-like. Addition of aztreonam (ATM) to C/A potentially expands the spectrum of coverage for carbapenemase co-producers. With this, we aimed to determine the synergistic activity of combination of C/A plus ATM against bla NDM, bla OXA-48-like and co-producers of bla NDM + bla OXA-48-like producing CR Klebsiella pneumoniae (CRKp). Materials and Methods: A total of 12 isolates of CRKp-harbouring genes encoding bla NDM and bla OXA-48-like were tested. Minimum inhibitory concentrations (MICs) were determined for several antimicrobial agents, including C/A (0.5�?g/ml) by broth microdilution method. Checkerboard assay was performed for the combination of C/A plus ATM at varying concentrations. Fold differences in the MIC of C/A with and without addition of ATM were determined to infer synergistic effects. Results: MIC of C/A and ATM ranged from 0.5 to >8 ?g/ml and 64 to 2048 ?g/ml, respectively. Two isolates were susceptible to C/A with MIC of 0.5 and 1 ?g/ml, while others were resistant with MIC of >8 ?g/ml. Synergistic effects of >8-fold MIC difference in C/A MIC were noted with addition of ATM at 4 ?g/ml. This was observed for all CRKp with profiles of bla NDM, bla OXA-48-like and co-producers of bla NDM + bla OXA-48-like genes, which was a promising effect. Notably, all five of the colistin-resistant CRKp were inhibited with >8-fold MIC difference in the combination of C/A plus ATM at 4 ?g/ml. Conclusion: With the increasing burden of CRKp, the use of C/A with ATM combination seems to be very promising, especially for bla NDM, bla OXA-48-like and co-producers of bla NDM + bla OXA-48like carbapenemases.

Antibiotic sensitivity pattern of bacterial isolates in patients with chronic rhinosinusitis in Kaduna, Nigeria

Introduction: A common practice in the management of patients with chronic rhinosinusitis (CRS), the empirical use of antibiotics may contribute to treatment failure and to the development of antimicrobial resistance. Objective: To determine the antibiotic sensitivity pattern of aerobic and anaerobic bacteria associated with CRS. Methods: This was a prospective cross-sectional study in which endoscopically guided middlemeatal swabs (IBMSpss, version 16.0, Chicago, IL, USA) were aseptically taken from patients diagnosed with CRS after obtaining informed consent and ethical clearance. The samples were sent to the laboratory for qualitative and semiquantitative analysis via gram stain, aerobic, anaerobic cultures and antibacterial sensitivity tests. The collected data was analyzed using SPSS for Windows, version 16 (SPSS Inc, Chicago, IL, USA). Simple statistical parameters and paired sample t-test were used, as appropriate. Results: There were 74 (56.92%) bacterial growths, out of which 55 (74.32%) were aerobic and 19 (25.68%) were anaerobic isolates, from a total of 130 patients. About 13 (17.5%- 18%) of these bacterial growths yielded a mixed growth of aerobic and anaerobic isolates. Themost common bacterial isolates were 26 (35.14%) Staphylococcus aureus, Haemophilus influenzae 9 (12.16%), Streptococcus viridians 8 (10.81%), and Streptococcus pneumoniae 5 (6.76%). Augmentin, ciprofloxacin, and Peflacine were found to bemost effective, followed by levofloxacin, Rocephin, erythromycin and Zinat in that order (AU)

Effect of intensive lifestyle modification & metformin on cardiovascular risk in prediabetes: A pilot randomized control trial

Background & objectives: Prediabetes is associated with increased prevalence of cardiovascular disease (CVD). In participants with prediabetes, the effects of exercise and metformin were evaluated on high-sensitivity C-reactive protein (hsCRP) and carotid intima-media thickness (CIMT), surrogate markers of atherosclerosis and CVD compared with standard care. Methods: In a pilot randomized control trial, the participants were randomized in to three arms: standard care (STD), intensive lifestyle modification (ILSM) or ILSM and metformin (ILSM+Met) and followed up for six months. Monitoring of ILSM was done by a trained healthcare facilitator. hsCRP, CIMT and other relevant parameters were measured before and after intervention. Results: A total of 103 participants were randomized into three arms and followed up for six months. At six months, there was a reduction from baseline in weight and fasting blood sugar (FBS) (P <0.01) in all three arms and a reduction in haemoglobin A1c (P =0.03) only in the ILSM+Met arm. The differences in hsCRP over six months within the STD, ILSM and ILSM+Met arms were ?0.12 (95% confidence interval, ?1.81, 2.08), ?0.58 (?2.64, 0.43) and ?0.11 (?1.84, 1.56), respectively. There was no difference in hsCRP, CIMT (right) or CIMT (left) between the three arms at six months. Interpretation & conclusions: There was a reduction in weight and FBS from baseline in all three arms. There was, however, no difference seen in hsCRP and CIMT in the two intervention arms compared to standard care. Larger studies with long-term follow up need to be done to detect differences in risk markers for CVD in prediabetes.

Performance of an in-house real-time PCR assay for detecting Cytomegalovirus infection among transplant patients from a tertiary care centre

Background: Quantitative Cytomegalovirus (CMV) polymerase chain reactions are increasingly being used for monitoring CMV DNAemia in haematopoietic stem cell transplants and solid organ transplants. Objective: In this study, a commercial CMV viral load assay was compared with an in-house viral load assay. Materials and Methods: A total of 176 whole-blood samples were tested for CMV DNAemia using both assays. Results: Our evaluation showed a difference of 1 log10copies/ml between the two assay systems in determining CMV viral loads in the clinical samples. Conclusion: The in-house viral load assay had a better correlation with clinical findings compared to the commercial assay. Quality assessment of these assays was done by the United Kingdom National External Quality Assessment Scheme (UKNEQAS), an external proficiency testing programme, and by the National Institute for Biological Standard and Control (NIBSC) standard. For UKNEQAS and NIBSC standards, the bias between the assays was 0.73 log10and 0.85 log10, respectively. This difference is well within the acceptable range already reported in the literature.

Peripheral T cell lymphoma: Clinico-pathological characteristics & outcome from a tertiary care centre in south India

Background & objectives: Peripheral T cell lymphomas (PTCLs) are a heterogeneous group of non-Hodgkin's lymphomas (NHLs), with universally poor outcome. This study was undertaken to provide data on demographics and outcomes of patients with PTCL who underwent treatment in a single tertiary care centre in southern India. Methods: Retrospective study was done on all patients (age ?18 yr) diagnosed with PTCL from January 2007 to December 2012. The diagnosis of PTCL was made according to the WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues. Results: A total of 244 adult patients were diagnosed with PTCL (non-cutaneous). The most common subtype was PTCL-not otherwise specified (35.7%), followed by anaplastic large cell lymphoma (ALCL), ALK negative (21.3%), natural killer/T cell lymphoma, angioimmunoblastic T-cell lymphoma (AITL), ALCL, ALK positive, hepatosplenic T cell lymphoma (HSTCL) and adult T cell leukaemia/lymphoma followed in frequency with 13.1, 11.5, 8.6, 8.2 and 1.6 per cent cases, respectively. The three-year Kaplan-Meier overall survival (OS) and event-free survival (EFS) for the patients who received chemotherapy (n=122) were 33.8�0 and 29.3�7 per cent, respectively. Various prognostic indices developed for T cell lymphomas were found to be useful. Interpretation & conclusions: Except for ALCL, ALK positive, all other PTCLs showed poor long-term outcome with CHOP-based chemotherapy. Novel therapies are needed to improve the outcome.

Potential role of sorafenib as neoadjuvant therapy in unresectable papillary thyroid cancer

Summary Total thyroidectomy, radioiodine (RAI) therapy, and TSH suppression are the mainstay treatment for differentiated thyroid carcinomas (DTCs). Treatments for metastatic disease include surgery, external-beam radiotherapy, RAI, and kinase inhibitors for progressive iodine-refractory disease. Unresectable locoregional disease remains a challenge, as standard therapy with RAI becomes unfeasible. We report a case of a young patient who presented with unresectable papillary thyroid carcinoma (PTC), and treatment with sorafenib allowed total thyroidectomy and RAI therapy. A 20-year-old male presented with severe respiratory distress due to an enlarging cervical mass. Imaging studies revealed an enlarged multinodular thyroid gland, extensive cervical adenopathy, severe tracheal stenosis, and pulmonary micronodules. He required an urgent surgical intervention and underwent tracheostomy and partial left neck dissection, as the disease was deemed unresectable; pathology revealed PTC. Treatment with sorafenib was initiated, resulting in significant tumor reduction allowing near total thyroidectomy and bilateral neck dissection. Postoperatively, the patient underwent radiotherapy for residual tracheal lesion, followed by RAI therapy for avid cervical and pulmonary disease. The patient's disease remains stable 4 years after diagnosis. Sorafenib has been approved for progressive RAI-refractory metastatic DTCs. In this case report, we describe a patient with locally advanced PTC in whom treatment with sorafenib provided sufficient tumor reduction to allow thyroidectomy and RAI therapy, suggesting a potential role of sorafenib as an induction therapy of unresectable DTC.

Lack of efficacy of a herbal preparation (RCM-102) for seasonal allergic rhinitis: a double blind, randomised, placebo-controlled trial

BACKGROUND: A herbal preparation, known as RMIT Chinese Medicine 102 (RCM-102) consisting of eight herbs which demonstrates inhibition of the release of key inflammatory mediators associated with seasonal allergic rhinitis (SAR) was used. This study evaluated the efficacy and safety of RCM-102 for SAR. OBJECTIVE: This study evaluated the efficacy and safety of RCM-102 for SAR. METHODS: This randomised placebo-controlled trial involved subjects aged between 18 and 65 who were randomly assigned to either RCM-102 or a placebo group. After a two-week baseline period, all subjects took either RCM-102 or placebo capsules (two capsules each time, three times daily with a four hour interval) for a period of eight weeks. The primary end-points were the Five-Point Scale symptom scores. Rhinoconjunctivitis Quality of Life Questionnaire, relief medication usage, adverse events, kidney and liver function tests and full blood examination were secondary end-points. Intention-to-treat analysis was applied. RESULTS: One hundred and four subjects were randomised with 52 in each group. Ninety-five subjects (47 and 48 subjects in RCM-102 and placebo groups) completed the trial. Nine subjects withdrew from the study prior to the end of the second treatment week. At the end of the trial, there were no significant differences between the two groups with respect to all outcome measures. There were no liver or kidney function abnormalities reported. CONCLUSION: This mechanism-based RCM-102 was safe but not more beneficial than placebo for patients with SAR.