High dose rate brachytherapy in nasopharyngeal carcinoma: a neglected practice

Nasopharyngeal carcinomas (NPCs) are one of the most chemo- and radio- sensitive cancers of the head and neck region. It differs from other head and neck cancers in terms of signs and symptoms, treatment response and overall survival. Surgery is not the preferred treatment option, with chemoradiation being the treatment of choice, with an excellent local control rate, prognosis and overall survival. But the management of recurrent NPC is quite challenging and the treatment options available includes re-irradiation, chemotherapy, brachytherapy or surgery in rare cases. Re-irradiation in case of recurrent NPC is very difficult due to the already irradiated tissue in the radiation path, but re-irradiation with brachytherapy is an excellent treatment option for giving further doses of radiation to the nasopharynx in cases of recurrence or residual disease, by taking in consideration the already irradiated area and the radiation dose given before, and achieving a good local control rate and overall survival.

Revisiting ureteral substitution and its outcome in children: single centre 13 year experience

Background: Objective of this study is to explore various ureteric substitutes in pediatric age group and their outcomes.Methods: Retrospective analysis was done from 2003-2016, of all patients operated in this hospital that had undergone ureteral replacement. Thirteen such patients (5 from initially published paper (1) and 8 new patients) were followed up to find conduit patency, renal function and related complications with their outcomes assessed.Results: Ureteric substitution was done in 8 patients. Age of the patient ranged from 4 months to 8 years. Out of these for 2 patients monti tube was created; one with colon and other jejunum, rest of the 6 patient appendix was used. On follow up one patient had early appendico-ureteral leak requiring re-anastomosis and one patient had partial obstruction at 6 months corrected by dividing mesentry and untwisting appendix. With a mean follow up of 3.8 years all patients have preserved renal functions and drainage present. Also 5 patients of ureteral substitution performed at this institution and published prior were followed up with mean follow up of 10.4 years having no complaints with preserved function and unobstructed drainage.Conclusions: This small series supports that not only appendix and ileum but even colon as well as jejunum should be considered as Monti's tube for ureteric replacement, when confronting with short ureter in paediatric age group.

Evaluation of long term outcome of congenital diaphragmatic hernia survivors: a single centre 8 years’ experience in a developing nation with limited facilities

Background: The objective of the study was to find out incidence of long term complications in congenital diaphragmatic hernia (CDH) survivors in a developing nation with limited facilities.Methods: A retrospective study was done on patients who underwent CDH repair at our institution from 2012 to 2019. 71 patients were identified of these 55 patients operated in neonatal age were considered. After applying exclusion criteria 42 patients included in the study were then divided in 2 groups. Group 1 (26 patients): neonates requiring ventilation within 6 hrs of birth and group 2 (16 patients): not requiring ventilation or intubated after 6hrs of birth. Data from medical records were supplemented by a questionnaire regarding perceived physical function and medical follow up till date. Respiratory, central nervous, musculoskeletal and gastrointestinal systems were concentrated upon and questionnaire set. These were then compared with respect to their long term outcomes. Also, overall incidence of these in the two groups combined was noted compared with other studies.Results: On comparing these 2 groups incidence of long term complications was found more in group 1; however on statistical analysis difference was not significant. As also incidence of individual long term complications in all patients together were identical or lower than in other published series. Mortality in our study was 8 of 49 neonates which was 17% of all patients presenting with CDH or born at our centre.Conclusions: Despite the growing population of CDH survivors the morbidity is not very significant and most patients lead a normal average active life.

Avaliação de parâmetros bioquímicos séricos em Tartarugas-da-Amazônia (Podocnemis expansa) mantidas em cativeiro / Evaluation of serum biochemical parameters in Amazon turtles (Podocnemis expansa) hatchlings kept in captivity

Amostras de sangue de Tartaruga-da-Amazônia mantidas em cativeiro foram analisadas com o propósito de avaliar os constituintes bioquímicos séricos e de relacionar ao que já foi relatado por outros pesquisadores, além de gerar mais informações, tendo em vista a escassez de dados envolvendo a espécie estudada. Foram utilizados 35 animais, com idade entre 3 e 7 meses, os quais foram contidos fisicamente para coleta de sangue em tubo sem anticoagulante. As análises bioquímicas foram processadas através de métodos cinéticos (enzimas) e colorimétricos (demais análises), e os valores médios obtidos foram: cálcio 7,0±1,9mg/dL, fóforo 2,8±1,2mg/dL, ácido úrico 1,8±0,8mg/dL, uréia 10,4±3,9mg/dL, alanina aminotransferase (AST) 75,5±33,6 UI/L, proteína total 1,9±0,8g/dL, triglicerídeos 22,9±9,8mg/dL e colesterol 45,3±19,7mg/dL. Observou-se que os valores dos componentes séricos avaliados assemelham-se aos que foram encontrados por outros pesquisadores em estudos bioquímicos séricos com Podocnemis expansa e outras tartarugas de água doce. Importante ressaltar que, no decorrer deste estudo observou-se a escassez de dados publicados sobre parâmetros sanguíneos de tartarugas do gênero Podocnemis, especialmente a espécie Podocnemis expansa, o que corroborou a alta relevância do desenvolvimento de mais pesquisas que envolvam a questão.(AU)

Blood samples from the giant river turtle kept in captivity were analyzed in order to evaluate the serum biochemical constituents and relate to what has been reported by other researchers, beyond the purpose of generating further information, given the paucity of data involving this species. The turtle eggs were from the state of Tocantins and were obtained from direct sampling in their natural habitat. After being collected the eggs were kept in incubators and then the puppies were kept in tanks. Samples were collected after chemical restraint of these animals by intracardiac puncture or cardiocentesis. The samples were centrifuged to obtain serum. Biochemical analyzes were processed by kinetic and colorimetric methods, as described by the manufacturer, and the values obtained were: calcium 7.0±1.9mg/dL, phosphorus 2.8±1.2mg/dL, uric acid 1.8±0.8mg/dL, BUN 10.4±3.9mg/dL, alanine aminotransferase (AST) 75.5±33.6 IU/L, total protein 1.9±0.8g/dL, triglycerides 22.9±9.8mg/dL and cholesterol 45.3±19.7mg/dL. It was observed that the values of the evaluated blood components are similar to those found by other researchers in serum biochemical studies with samples of Podocnemis expansa. During this study we observed the paucity of published data on blood parameters of Podocnemis genus, especially P. expansa species, which confirmed the high relevance of the development of further research involving this topic.(AU)

Atividade da colinesterase plasmática como biomarcador de impacto ambiental em tartarugas verdes (Chelonia mydas) no litoral do Arquipélago de Fernando de Noronha, Pernambuco / Plasma cholinesterase activity as environmental impact biomarker for green turtles (Chelonia mydas) on the coast of Fernando de Noronha, Pernambuco, Brazil

Biomarcadores podem ser usados de forma preditiva, permitindo que sejam tomadas ações de controle antes que ocorram danos ambientais irreversíveis com consequências ecológicas severas, no entanto, espécies sentinelas são necessárias para avaliação desses marcadores. As tartarugas marinhas são consideradas espécies sentinelas quando acometidas por fibropapilomas, sendo sinalizadora do desequilíbrio ambiental marinho nas suas áreas de ocorrência. Com o objetivo de propor a determinação da atividade da colinesterase plasmática em tartarugas verdes (Chelonia mydas) como biomarcador, procedeu-se a determinação da atividade enzimática em animais saudáveis e em localidade de baixo impacto antrópico (Arquipélago de Fernando de Noronha, Pernambuco, Brasil) para servir como referência para comparação com animais capturados em locais de maior impacto antrópico. Ao todo foram analisadas amostras de plasma heparinizado de 35 animais capturados. Todas as amostras analisadas apresentaram alguma atividade enzimática de colinesterase plasmática. Os valores obtidos de colinesterase variaram de 162 a 379 UI/L, com média e desvio padrão de 216,4 ± 51,4 UI/L. Nos estudos de repetibilidade e reprodutibilidade obtiveram-se coeficientes de variação menor que 5% em todas as análises, portanto a metodologia analítica utilizada se mostrou confiável. A longevidade das tartarugas marinhas da espécie C. mydas, o comportamento alimentar, juntamente com o fato de possuirem atividade enzimática detectável podem indicar essa espécie como bioindicadora de exposição a poluentes que influenciam na atividade da colinesterase plasmática.(AU)

Biomarkers can be used in a predictive manner, permitting actions control to be taken before they occur irreversible damage with severe environmental ecological consequences, however, sentinel species are needed to evaluate these markers. Sea turtles affected by fibropapillomas are considered sentinel species, signaling the marine environmental imbalance in their areas of occurrence. With the objective to use the plasma cholinesterase activity in green turtles (Chelonia mydas) as a biomarker, the measurement of enzyme activity was evaluated in healthy animals and in location of low pollution impact (Fernando de Noronha, Pernambuco, Brazil) to serve as a reference for comparison with animals trapped in places with higher pollution impact. Were analyzed heparinized plasma samples from 35 captured animals. All samples analyzed showed enzymatic activity of plasma cholinesterase. The values obtained ranged between 162-379 IU/L, with mean and standard deviation of 216.4 ± 51.4 IU/L. In studies of repeatability and reproducibility were obtained variance coefficients of less than 5% in all analyzes, so the analytical methodology proved successful. The longevity of marine turtles of the species C. mydas, feeding behavior, along with the fact possess detectable enzyme activity may indicate this species as a bioindicator of exposure to pollutants that influence plasma cholinesterase activity.(AU)

Efficacy and safety of 24 hour rotigotine transdermal rotigotine patch in the treatment of early Parkinson's disease

Presently, treatment of PD focuses on symptomatic therapy, that is to control motor symptoms, at the lowest possible dose, so as nor to develop early drug resistance, and consequent extrapyramidal symtoms. However, there has been no clinical trial, to date that has provided definitive evidence of pharmacological neuroprotection. Among the drugs with possible neuroprotective effects are the dopamine agonists. OBJECTIVE: The objective of this study is to determine the efficacy and safety of Rotigotine transdermal patch in the treatment of early Parkinson's disease in terms of improvement in the functional capacity and the incidence of adverse effects in patients treatment with the said drug . METHODOLOGY: Literature search of all randomized controlled trials, published from 1999-2009 comparing rotigotine patch with placebo, in patients with Parkinson's disease. Types of outcome measures- The primary outcome studied was the number of responders described as those with> 20% decrease in UPDRS Scores. The secondary outcome include the mean change in UPDRS score and the total incidence of adverse effects on patients on rotigotine patch. RESULTS: The use of Rotigotine patch in early Parkinson's disease shows as trend toward benefit and was statistically significant (OR 0.33) in terms of number of patients who showed a significant change in UPRDS scores. In terms of UPDRS scoring, there was significant improvement for those who took Rotigotene (MD 5.2.5). However, incidence of adverse effects was higher in the Rotigotine group compared to the placebo group (OR 3.13) CONCLUSION: The evidence from this review supports the use of Rorigotine patch for the treatment of early Parkinson's disease. This has shown to produce clinical improvement in parkinsonian symptoms as measured by the significant decrease in the UPDRS Scores on follow-up. However, adverse events were similar to those found with other dopamine agonists.