Impact of Oral Metronomic Therapy on Quality of Life in Advanced/Recurrent Head and Neck Squamous Cell Carcinoma Patients

Introduction: Metronomic chemotherapy (MC) is an emerging therapeutic option in clinical oncology and it may prove usefulat least in metastatic head and neck squamous cell carcinoma (HNSCC) patients. To develop rational therapeutic strategies,it is important to identify molecular targets that are linked to the pathogenesis of HNSCC.Aim: The aim of the study was to assess the effect of oral MC on changes in quality of life (QOL) in advanced/recurrent HNSCCpatients.Materials and Methods: Patients with advanced, metastatic, and recurrent HNSCC patients who are not amenable to localtreatment with surgery, radiotherapy, and chemotherapy were included in the study. QOL assessed with the European organizationfor research and treatment of cancer (EORTC) QLQ-C30 and QLQ-H&N 35 questionnaires.Results: In this study, 50 patients were included, 37 patients (74%) become pain-free at the end of 6 months. A decreasedpain grade was observed in another 13 patients (26%). Mean QLQ-C 30 score at the time of presentation was 68.67, 75.35at 2 months, 81.26 at 4 months, and 85.38 at the end of 6 months. Mean QLQ-H&N 35 score at the time of presentation was61.53, 72.16 at 2 months, 76.43 at 4 months, and 81.69 at the end of 6 months. In subgroup analysis, both QLQ-C30 andQLQ-H&N 35 significantly correlated with disease progression.Conclusion: The use of oral metronomic therapy with methotrexate and celecoxib significantly improves the QOL and improvespain control in patients with advanced/recurrent HNSCC

A Study of Multi - Organ Involvement in Leptospirosis.

Background: Awareness about the infection is scarce especially in the developing countries as a consequence of which, it is rarely thought of in the differential diagnosis of febrile illnesses. Failure to diagnose leptospirosis is particularly unfortunate: severely ill patients often recover completely with prompt treatment but if therapy is delayed or not given, death or renal are likely to ensure. Methods: A total 50 patients who were admitted with fever at JSS hospital, medicine department over a period of 2 years that is during August 2005 to August 2007 who have been diagnosed to have leptospirosis fulfilling the inclusion and exclusion criteria. Present study design is a prospective study during which patient will be followed up during hospital stay, recovery and one month after discharge. Results: In our study out of 5 patients 16 patients (32%) had no complications, 34 patients (68%) have developed various complications. 4 patients (8%) developed ARF, 7 patients (14%) developed hepatitis, 17 patients (34%) ARF with Hepatitis, 2 patients (4%) Hepatitis with altered sensorium, 1 patient (2%) developed Myocarditis; Hepatitis; ARF, 1 patient (2%) developed ARF; ARDS; Hepatitis; Myocarditis, 2 patients (4%) ARDS with ARF and Hepatitis. Conclusion: Early diagnosis & initiation of treatment of leptospirosis prevents mortality and morbidity.

Apical stress distribution on maxillary central incisor during various orthodontic tooth movements by varying cemental and two different periodontal ligament thicknesses: A FEM study.

Context: During fixed orthodontic therapy, when the stress levels in the periodontal ligament (PDL) exceedsan optimum level, it could lead to root resorption. Aims: To determine an apical stress incident on the maxillary central incisor during tooth movement with varying cemental and periodontal ligament thickness by Finite Element Method (FEM) modeling. Settings and Design: A three dimensional finite element model of a maxillary central incisor along with enamel, dentin, cementum, PDL and alveolar bone was recreated using EZIDCOM and AUTOCAD software. ALTAIR Hyper mesh 7.0 version was used to create the Finite Element meshwork of the tooth. This virtual model was transferred to Finite Element Analysis software, ANSYS where different tooth movements were performed. Materials and Methods: Cemental thickness at the root apex was varied from 200 μm to 1000 μm in increments of 200 μm. PDL thickness was varied as 0.24 mm and 0.15 mm. Intrusive, Extrusive, Rotation and Tipping forces were delivered to determine an apical stress for each set of parameters. Results: Results indicated that an apical stress induced in the cementum and PDL, increased with an increase in cementum and PDL thickness respectively. Apical stress induced in the cementum remained the same or decreased with an increase in the PDL thickness. Apical stress induced in the PDL decreased with an increase in the cementum thickness. Conclusion: The study concluded that the clinical delivery of an orthodontic forces will cause stress in the cementum and PDL. Hence, it is necessary to limit the orthodontic force to prevent root resorption.

Effect of plant growth promoting rhizobacteria (PGPR) on growth and yield of bitter gourd.

A field study was conducted to determine the effect of plant growth promoting rhizobacteria (PGPR) on growth and yield of bitter gourd. Four PGPR strains (Azospirillum, Phosphorous solubilising bacteria, Pseudomonas flourescens and Bacillus subtilis), one commercial organic product (Aishwarya) and non inoculated control were used. The study revealed that seeds inoculated with Azospirillum (basal @ 5 kg ha-1 + 40 days after sowing (DAS) @ 5 kg ha-1) recorded early germination (6.48 days). The maximum vine length (4.42 m) was recorded in basal @ 2 l/plant application of both Bacillus subtilis and Pseudomonas flourescens @ 2.5 kg ha-1. Number of primary branches was maximum (4.80) in plants applied with phosphorous solubilising bacteria (PSB) as basal @ 5 kg/ha and 40 DAS @ 5 kg/ha. Tap root length (23.57 cm) and secondary root length (39.88 cm) were highest in the plants supplied with Azospirillum (basal @ 5 kg ha-1 + 40 DAS @ 5 kg ha-1) where as, dry root weight (4.64 g) was more in case of double application of Bacillus subtilis basal @ 2 l plant -1 + 40 DAS @ 2 l plant -1. Two time application of Bacillus subtilis basal + 40 DAS @ 2 l plant -1 produced the maximum yield plant -1 and yield plot -1 (2.72 kg and 16.33 kg respectively).

Clinical validation of a low-cost telemedicine equipment remote medical diagnostics kit at a tertiary care hospital.

BACKGROUND: The Remote Medical Diagnostics kit is an indigenous and low-cost technology that can measure and transmit via the internet 6 clinical parameters viz. Blood pressure (BP), pulse, temperature, oxygen saturation, 12-lead Electrocardiogram (ECG) and heart/breath sounds. Prior to commercial use, it needs clinical validation. METHODS: Fifty three patients (including 1 acute myocardial infarction) were evaluated for the above parameters using accepted standard methods and the Remote Medical Diagnostics kit. RESULTS: The intraclass correlation coefficient (ICC) for systolic BP (SBP), diastolic BP (DBP), saturation pulse, manual pulse and temperature was 0.927, 0.904, 0.989, 0.99 and 0.912 indicating a high degree of agreement between the two methods. For oxygen saturation, the ICC was 0.763 indicating a moderately high agreement. For heart sounds, the kappa coefficient (kappa) for inter-rater reliability was 0.48 (observed agreement of 96.1%). For breath sounds, the 'kappa' value was 0.48 indicating moderate agreement. For the breath sounds, the 'kappa' value was 0.38, indicating fair agreement (the observed agreement of 94.2%). For the ECG, the observed agreement was 94.4% by visual assessment. CONCLUSION: At the bedside, the Remote Medical Diagnostics kit was clinically validated for the above 6 parameters.

Gynecologic-tract sparing extra peritoneal retrograde radical cystectomy with neobladder

OBJECTIVE: We report on a series of female patients with transitional cell carcinoma of the bladder who underwent extraperitoneal retrograde radical cystectomy sparing the female reproductive organs with neobladder creation. MATERIALS AND METHODS: 14 female patients between the ages of 45 and 72 years who underwent gynecologic-tract sparing cystectomy (GTSC) with neobladder between 1997 and 2002 were retrospectively reviewed. Our surgical technique is also described. Radical cystectomy is accomplished by a retrograde method sparing the uterus, adnexa, vagina and distal urethra. An orthotopic neobladder was constructed using small bowel or sigmoid colon, brought extraperitoneally, and anastomosed to the distal urethra. RESULTS: Operating time ranged from 4.5 to six hours with a mean of 5.3 hours. Ten patients were able to void satisfactorily while four required self-catheterization for complete emptying of the bladder. Seven patients were continent day and night and another 7 reported varying degrees of daytime and nighttime incontinence. One patient died of metastases and another of pelvic recurrence. There were no urethral recurrences. Patient satisfaction with the procedure was high. CONCLUSIONS: Gynecologic-tract sparing cystectomy with orthotopic neobladder is a viable alternative in female patients with muscle invasive traditional cell carcinoma of the bladder, providing oncological safety with improved quality of life. Our extraperitoneal technique, which is an extension of our successful experience with retrograde extraperitoneal radical cystectomy in men, minimizes intraoperative complications and simplifies the management of post-operative morbidity with the neobladder.

Aspiration of a tracheostomy tube flange.

Foreign body aspiration is a common pediatric emergency. Aspiration of a metallic tracheostomy tube flange into the left main bronchus and the resultant subacute respiratory distress is presented. Being the only case of its kind in reported pediatric literature, a review of the etiology, clinical presentation and prevention of this accident is appended.

Isolation and evaluation of diagnostic value of two major secreted proteins of Mycobacterium tuberculosis.

Two secreted antigens of Mycobacterium tuberculosis, namely the antigen 85 complex (30/31) and 38kDa antigens, were purified from the whole culture filtrate by using two dimensional preparative electrophoresis and anion exchange chromatography, respectively. Individual components of the antigen 85 complex namely, antigen 85A, 85B and 85C, were separated using hydrophobic interaction chromatography. The humoral antibody activity to these antigens in sputum positive cases of active pulmonary tuberculosis and normal healthy volunteers was determined by enzyme linked immunosorbent assay (ELISA) and immunoblot. Recombinant 38kDa and antigen 6 were used as reference antigens for the assay. None of the healthy volunteers reacted with the 38kDa antigen, while 52% of the TB sera reacted with it. Of the three components of the antigen 85 complex, 85B gave the highest positivity of 40 per cent. The results of combination of 38kDa with antigen 6 offered better results with 76% positivity.

Translocation Down syndrome.

Cytogenetic investigations carried out on 1021 cases of Down syndrome revealed translocation in 46 cases. The most frequent was of t(14;21) and t(21;21) types. Most of the translocation DS cases (n = 31) were born to younger mothers (< 25 years), when compared to pure trisomy 21 DS cases. Parental karyotypes, family history and parental ages has helped us greatly in offering genetic counseling, prenatal diagnosis and estimating the risk for the next conception.

Translocation Down syndrome.

Cytogenetic investigations carried on 1021 cases of Down syndrome revealed translocation in 46 cases. The most frequent was of t(14;21) and t(21;21) types. Most of the translocation DS cases (n = 31) were born to younger mother's (< 25 years), when compared to pure trisomy 21 DS cases. Parental karyotypes, family history and parental ages has helped us greatly in offering genetic counseling, prenatal diagnosis and estimating the risk for the next conception.

Beta2-glycoprotein I dependent anticardiolipin antibodies and lupus anticoagulant in patients with recurrent pregnancy loss.

AIM: The present study was aimed to define the incidence of antiphospholipid antibodies of different types lupus anticoagulant (LAC), venereal disease research laboratory test (VDRL) and Beta2-glycoprotein I dependent anticardiolipin antibodies Beta2 I aCL) in our cohort of population experiencing recurrent pregnancy loss (RPL) from Andhra Pradesh, South India. SETTING AND DESIGN: A referral case-control study at a tertiary centre over a period of 5 years. PARTICIPANTS: 150 couples experiencing 3 or more recurrent pregnancy losses with similar number of matched controls. MATERIAL AND METHODS: LAC activity was measured by the activated partial thromboplastin time (aPTT) according to the method of Proctor and Rapaport with relevant modifications. VDRL analysis was performed by the kit method supplied by Ranbaxy Diagnostics Limited and Beta2 Glycoprotein I dependent anticardiolipin antibodies were estimated by ELISA kit (ORGen Tech, GmbH, Germany) with human Beta2 Glycoprotein I as co-factor. STATISTICAL ANALYSIS: Statistical analysis was performed using Student's t test. RESULTS: LAC activity was found positive in 11 women (10.28%). The mean +/- SE Beta2 I aCL concentration in the study group was 14.53 (micro/ml) +/- 1.79 (range 0 to 90.4 micro/ml) which was higher than the control group with a mean +/- SE of 7.26 (micro/ml) +/- 0.40 (range 0 to 18 u/ml). The binding of the antibodies to the antigen was observed in 40.24% (n=33) of the cases compared to 6.09% (n=5) in controls. VDRL test was positive in 7(2.34%) individuals (3 couples and 1 male partner) and none among controls. CONCLUSIONS: The present study indicates the importance of antiphospholipid antibodies in women experiencing RPL and suggests the usefulness of screening for these antibodies as a mandatory routine for instituting efficient therapeutic regimens for a successful outcome of pregnancy.

Cholecystoduodenoplasty for high-output duodenal fistula.

External duodenal fistulae from sutured duodenal ulcer perforation sites are difficult to manage and most patients succumb to septicemia and undernutrition. This is due to failure of closure of the perforation site in the duodenum. Most techniques described in the past to facilitate closure have failed to give satisfactory results. We have devised a new procedure where the duodenal ulcer perforation is closed by mobilizing the gall bladder. A hole is made in the fundus of the gall bladder and it is anastomosed to the freshened edges of the duodenal opening. We have treated six patients by this technique. In five patients the leak was satisfactorily sealed. Three patients died - one due to persistent leak and two due to jejunostomy leak.

Age-related proximal femur bone mineral loss in South Indian women: a dual energy X-ray absorptiometry study.

OBJECTIVES: i) To collect normative data for proximal femur bone mineral density (BMD) in South Indian women using dual energy X-ray absorptiometry (DXA) and ii) to study the rate and significance of hip bone mineral loss with advancing age in this population. MATERIAL AND METHODS: Forty five women, whose age ranged from 16 to 84 years were studied. This sample was drawn randomly from general medical practice at KJ Hospital, Chennai, South India during November, 1997 to April, 1998. Of these 45 cases, 21 were pre-menopausal (mean +/- SD age = 30.9+/-8.8 years) and 24 post-menopausal (mean +/- SD age = 62.1+/-11.0 years). Subjects with secondary bone diseases were excluded. Also excluded were those taking any drugs known to affect calcium metabolism e.g., thiazide diuretics, oestrogen and calcium. Subjects were divided into seven decadal age groups from 15-24 years to 75-84 years. BMD of the right proximal femur was evaluated using a QDR-1000 DXA bone densitometer (Hologic Inc., Waltham, Massachusetts, USA). Data analysis was done with SPSS/PC statistical software package. RESULTS: Linear regression analysis showed significant (p < 0.001) negative correlations between all hip BMD variables at different regions of interest and patient's age. Relative to that at 30 years of age, rates of BMD loss in the neck of femur, trochanter, intertrochanter, total hip and Ward's triangle were 0.68%, 0.65%, 0.58%, 0.61% and 1.05% per annum respectively. Over the age of 65 years, the above mentioned regions BMD decreased by 0.91%, 0.84%, 0.72%, 0.78% and 1.66% per annum respectively. CONCLUSION: Normative data for proximal femur BMD in South India women have been evaluated and it may prove useful for diagnosing osteoporosis in the women of South India.

Production & characterization of monoclonal antibodies to Mycobacterium tuberculosis.

BACKGROUND & OBJECTIVES: Monoclonal antibodies (MAbs) against Mycobacterium tuberculosis H37Rv culture filtrate (CF) were raised by immunizing BALB/c mice and characterization was done. Attempts have been directed towards identifying mycobacterial antigens in biological fluids by employing polyclonal and monoclonal antibodies specific for M. tuberculosis. Immunohistologic studies, using MAbs for the localization of whole or fragmented bacilli in the biopsy specimens were also carried out. METHODS: Intrasplenic IS and intraperitoneal i.p. routes of immunization, were compared. The MAbs were characterized for their isotype, binding specificity, nature of binding epitope, reactivity in immunoassays etc. RESULTS: IS and i.p. routes of immunization, were compared and i.p. was found superior. Ten MAbs designated TRC 1-10 were produced. Of these, 7 MAbs, TRC 1-7 reacted with the 30/31 kDa doublet (antigen 85 complex), TRC 8 with 12 kDa in addition to 30/31 kDa and TRC 9 and 10 with the 24 and 12 kDa antigens respectively. Six MAbs were classified as broadly cross reactive and 2 showed limited cross reactivity. TRC 8 and 10 showed species specificity. Employing TRC 8 in sandwich ELISA, antigen was detected in sera from 17 of 25 pulmonary tuberculosis patients and 3 of 20 controls. TRC 8 was found to be useful in detecting antigens specifically in M. tuberculosis and M. leprae infected tissues, by immunoperoxidase staining. INTERPRETATION & CONCLUSION: TRC 8 was found to be restricted in its reactivity to M. tuberculosis complex and M. leprae. TRC 8 may prove useful in immuno-diagnosis of tuberculosis.

Cytogenetic studies of 1001 Down syndrome cases from Andhra Pradesh, India.

Cytogenetic data obtained from investigating 1001 patients of Down syndrome (DS) and their parents over a period of 20 years (January 1979-January 1999) are presented. The frequency of pure trisomy, mosaicism and translocation was 87.92, 7.69 and 4.39 per cent respectively. The origin of the extra chromosome 21 due to meiotic non-disjunction was 79.24 per cent maternal and 20.76 per cent paternal. A high frequency of acrocentric chromosome associations was also observed in mothers of children of Down syndrome, this might have predisposed to an enhanced risk for non-disjunction. Birth order of DS showed a higher number of first and second borns. Reproductive performances of the parents indicated a high rate of abortions, compared to controls. Cytogenetic investigations carried out over these years greatly helped in the management of these children and for counseling the affected families.

Primary choriocarcinoma of the ovary. Report of two cases.

Primary choriocarcinoma of the ovary (PCO) is rare. This can be gestational (GCO) or nongestational (NGCO) in origin. It is difficult to differentiate between CGO and NGCO. NGCO carries a worse prognosis than GCO. We present two cases of metastatic GCO who were treated successfully with combination chemotherapy and are alive and disease free at the time of reporting.

Spontaneous oesophageal perforation due to mediastinal tuberculous lymphadenitis - atypical presentation of tuberculosis.

Spontaneous non-traumatic oesophageal perforation secondary to bursting of a mediastinal tuberculous abscess into the oesophagus is rare. The diagnosis is delayed, as perforation remains localised due to mediastinal lymph nodes. Patient can be effectively managed by paraoesophageal drainage of the mediastinal abscess and oesophageal diversion.

Microplate assay for detection of bacterial contamination in tissue culture media.

In the present study, a rapid and simple colorimetric technique has been described to determine the presence of bacteria in tissue culture medium used in animal cell culture. The microplate assay is based on utilization of MTT [3(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide] by bacteria resulting in formation of formazan crystals which can be measured colorimetrically. Contaminated medium, a standard gram-negative and gram-positive bacteria produce formazan from MTT which is related to the bacterial load. The assay has utility in screening tissue culture reagents to detect the presence of bacteria.

Early gastric carcinoma.

This is a retrospective analysis of 8 cases of early gastric carcinoma treated from 1988 to 1995 in Bangalore. All the cases underwent surgery after being diagnosed by endoscopy and biopsy. One patient died of an unrelated cause 2 years after surgery. The remaining 7 patients are asymptomatic and without recurrence.