Expert survey on management of prostate cancer in India: Real?world insights into practice patterns

To gain insights on the diverse practice patterns and treatment pathways for prostate cancer (PC) in India, the Urological Cancer Foundation convened the first Indian survey to discuss all aspects of PC, with the objective of guiding clinicians on optimizing management in PC. A modified Delphi method was used, wherein a multidisciplinary panel of oncologists treating PC across India developed a questionnaire related to screening, diagnosis and management of early, locally advanced and metastatic PC and participated in a web朾ased survey (WBS) (n = 62). An expert committee meeting (CM) (n = 48, subset from WBS) reviewed the ambiguous questions for better comprehension and reanalyzed the evidence to establish a revote for specific questions. The threshold for strong agreement and agreement was ?90% and ?75% agreement, respectively. Sixty?two questions were answered in the WBS; in the CM 31 questions were revoted and 4 questions were added. The panelists selected answers based on their best opinion and closest to their practice strategy, not considering financial constraints and access challenges. Of the 66 questions, strong agreement was reached for 17 questions and agreement was achieved for 22 questions. There were heterogeneous responses for 27 questions indicative of variegated management approaches. This is one of the first Indian survey, documenting the diverse clinical practice patterns in the management of PC in India. It aims to provide guidance in the face of technological advances, resource constraints and sparse high?level evidence.

Utility of the Epworth sleepiness scale: Hindi version in identifying obstructive sleep apnoea in adult patients with symptoms of sleep disordered breathing in a tertiary care centre

Background: Excessive daytime sleepiness is a key symptom in patients with sleep- breathing disorders (SBD) and represents a new major public health issue due to its repercussions. The ESS is a simple and validated method, which measures the probability of falling asleep in a variety of situations. Aims and objectives is to study the accuracy of the Epworth Sleepiness Scale (ESS) questionnaire in the identification of Obstructive Sleep Apnoea (OSA) in patients with symptoms of sleep disordered breathing in a tertiary care centre.Methods: This present study was conducted in the Department of Respiratory medicine, New Medical College, Kota on 70 adult patients who presented with symptoms of Sleep Disordered Breathing and underwent Type 2 Polysomnography after answering Epworth sleepiness score in Hindi Language.Results: Epworth sleepiness scale has predicted excessive day time sleepiness in 60% of study subjects with ESS score more than 10 taken as cut off. Mean value for ESS in the study was 10.78. 35.71% of the patients had severe OSA diagnosed by polysomnography and 30% patients had moderate OSA. Mild OSA was detected in 7.14% patients. Sensitivity of the ESS score >10 in diagnosing OSA was found to be 72.5%. Specificity of the scale was 73.6%.There was significant correlation between ESS score and diagnosis of OSA (p value <0.001).Conclusions: The study concludes that ESS has got good relevance in predicting OSA in patients with sleep disordered breathing.

Role of medical thoracoscopy in the management of parapneumonic effusion and empyema thoracic

Background: The treatment modality use in early pleural empyema mainly depends on the antimicrobial therapy along with thoracocentesis. In case of complicated empyema this modality does not work and lung not fully expand, until removal of adhesions. The main purpose of the current study is to analyze the experience of management of complicated parapneumonic effusion and empyema thoracic through rigid medical thoracoscopy under local anaesthesia. Aim and objective is to study the role of medical thoracoscopy in the management of empyema thoracic and parapneumonic effusion at tertiary health centre.Methods: This is a descriptive case series study in which 49 patients were recruited, who have clinically and radiologically show empyema thoracic, from department of Respiratory medicine, GMC, Kota, Rajasthan. All patients underwent medical thoracoscopy under local anesthesia. Written Informed consent was taken from the study participants. Ethical approval was obtained from Ethical Review Committee of the hospital. Patients who have HIV and Hbsag positive, those with multiple organ failure and bleeding disorders were excluded.Results: Total 49 patients, out of them 41(84%) were male and 8(16%) were female with mean age 45 years (range 18 to 70 years). Final evolution through chest x-ray revealed complete resolution or successful thoracoscopy done in 37 case of fibrinopurulent (92.50%) and 5 cases of organizing empyema (55.56%). overall success rate 85.71%. Total 7 cases (3 case of fibrinopurulent and 4 cases of organizing empyema) refer to higher center for decortications.Conclusions: Medical Thoracoscopy under local anaesthesia is a safe procedure, efficient and cost-effective intervention for early management of complicated empyema, particularly in early stage of empyema (fibro purulent).

A study of radiological presentation in bronchogenic carcinoma along with prevelance of pulmonary TB in a tertiary center

Background: Lung cancer is most common cause of cancer related death in men and women world wise responsible for over 1 million death annually. Lung cancer is leading cause of cancer death in united states and worldwide. Lung cancer is the most common neoplasm contributing more frequent among males causing cancer related mortality in both sexes. Objective of this study was to radiological presentation in bronchogenic carcinoma along with   prevalence of pulmonary TB in a tertiary center.Methods: Total of 100 patients with histologically proven lung cancer, from July 2018 to June 2019 at a tertiary center Kota Rajasthan. Data of participants regarding demographics, history of smoking habit, clinical presentation, histopathological type, radiographic findings on chest radiograph, ultrasonography, computed tomography (CT) scan, Statistical analysis was performed using descriptive statistics of the collected data.Results: Most common age group of bronchogenic carcinomas was seen between 60-69 years of age (37%) with male predominance (82%).  smoking history present in about (80%) patients.  Most common radiological presentation was a mass lesion present in 91% patients (n=91) followed by unilateral hilar prominence present in 44% of patients (n=44). Other common finding includes mediastinal widening (38%), collapse (26%). pleural effusion (22%), metastasis (22%), cavitation (13%), consolidation (12%), bony erosion (11%), pneumothorax (5%), and pancost tumor (4%).  prevalence of pulmonary TB in bronchogenic carcinoma is 9% and this is due to high burden of pulmonary TB in India.Conclusions: In this study adenocarcinoma was found to be most common type of lung cancer. Smoking is most common risk factor. Pulmonary TB coexistence with bronchogenic carcinoma was more common. The local immunity is deteriorated in cancer cases.

Awareness of Oral Hygiene Practices among Patients Visiting the Department of Conservative Dentistry in UCMS

Background: Oral conditions are a prime public health issueowing to the high incidence and their actions on the subject’slife quality. Although only a poor relation is present betweenknowledge and behavior in various cross-sectional studies,there are researches that form an association. The presentstudy was conducted with the aim to determine the awarenessof oral hygiene practices among patients visiting thedepartment of conservative dentistry in UCMS.Materials and Methods: The present cross sectionaldescriptive study was conducted in the Department ofConservative Dentistry and Endodontics, UCM College ofDental Surgery, Nepal. The questionnaire consisted ofinformation regarding the demographic detail like age, genderand questions regarding oral hygiene practice etc. All the datathus obtained was arranged in a tabulated form and analyzedusing SPSS software.Results: The study enrolled 150 patients with the mean age of28.98+/-3.54 years. Horizontal method was opted by 60%patients and vertical direction was opted by 40% patients.There were 16 patients who sometimes resorted to finger andtooth powder for brushing, 12 subjects who opted for neemstick, 5 subjects brushed with salt at times.Conclusion: The study clearly elaborates that there was a lackof oral hygiene knowledge amongst people that lead to poororal hygiene practices.

Role of cartridge-based nucleic acid amplification test to diagnose tuberculosis at tertiary care teaching hospital in Rajasthan, India

Background: Tuberculosis is one of the top 10 causes of death worldwide as per the Global TB report 2017, the estimated incidence of TB in India was approximately 28,00,000 cases accounting for about a quarter of the world’s TB cases (10 million). It is of utmost important to diagnose early and treat it to reduce disease transmission. GeneXpert MTB/RIF, an automated cartridge-based molecular technique detects Mycobacterium Tuberculosis and rifampicin resistance within two hours, has been recommended by WHO for rapid diagnosis of TB.Methods: Author conducted a retrospective study in the Department of TB and Chest, of tertiary care center at Jhalawar Medical College (JMC), Jhalawar to evaluate and analyze the role of CBNAAT to diagnose tuberculosis from 1st January 2018 to 31st December 2018. Author included all patients who came to department of TB and Chest of JMC, Jhalawar either new/ relapsed/ defaulters/ referred cases from ART/ ICTC center, Pediatric Department; Gynaecology and Obstetrics Department, peripheral Government Health Care Facilities and Private Hospitals of Jhalawar District catering about 15.5 lac population were subjected to both ZN staining/ Fluorescent microscopy and CBNAAT in the study period.Results: A total of 3078 samples (pulmonary 2739+EP 339) were tested for ZN staining / Fluorescent microscopy and CBNAAT during the study period. Mean age of the study population was 36.5±10.3 years. 1873 tested were negative and 1205 samples were positive for CBNAAT. Of these 1205 positive samples, 1174 were sputum/ BAL samples and 31 were extra pulmonary samples. Authors found rifampicin resistance rate of 6.98% (82/1174) in pulmonary tuberculosis cases, 3 rifampicin resistance cases were detected in extra pulmonary samples. CBNAAT could identify 255 cases (14.01%) that were smear negative. Author found TB-HIV coinfection rate of 18.75%.Conclusions: Author found CBNAAT to be an important diagnostic modality especially in smear negative patients for early diagnosis and treatment. Author could detect Mycobacterium Tuberculosis in 14.01% of patients with negative smear microscopy for AFB. In PLHIV, CBNAAT detected Mycobacterium Tuberculosis in 18.75% (12/64) of patients. Author found rifampicin resistance rate of 6.98% (82/1174) in pulmonary tuberculosis cases.

To Assess the Prevalence of Dental Caries Among Preschool Children in Bhairahawa Nepal

Dental caries is very common disease in the world. It is seen in all the age groups. The prevalence of dental caries worldwide around 35% for all ages. Dental caries is more common in children due to poor oral hygiene, food habits etc. The aim of the present study was to assess the prevalence of dental caries among preschool children in Bhairahawa Nepal. Methods: A cross-sectional study was conducted during june 2019 among preschool children. A structured questionnaire was used according to WHO criteria. Study was conducted in four preschools in Bhairahawa, Nepal. All the children of preschool was selected on the basis of complete enumeration system. The preschool children of age group of 3-6 years were included in the study. Children above 6 years, who were not interested to participate in the survey, edentulous arch and children absent during survey were excluded from the study. Data was analysed using SPSS 20 & descriptive statistics. Results: In our study, total children were 190 in which boys were 103 and 87 were girls. In the age group 3-4 years and 4-5 years boys were more than girls. In the age group 5-6 years girls were more than boys. In age group 3-4 years boys were 22.22% affected by dental caries and girls were 21.73% affected by dental caries. In age group 4-5 years boys were 22.72% affected by dental caries and girls were 22.58% affected by dental caries. In age group 5-6 years boys were 13.04% affected by dental caries and girls were 15.15% affected by dental caries. The dental caries was more prevalent in age group 4-5 years. Conclusion: Our study concluded that the dental caries was more prevalent in age group 4-5 years.

Effects of zolpidem on sleep parameters in patients with cirrhosis and sleep disturbances: A randomized, placebo-controlled trial

BACKGROUND/AIMS: The aim of this study was to study the efficacy and safety of zolpidem for sleep disturbances in patients with cirrhosis. METHODS: Fifty-two Child-Turcotte-Pugh (CTP) class A or B cirrhotics with Pittsburgh Sleep Quality Index >5 were randomized to either zolpidem 5 mg daily (n=26) or placebo (n=26) for 4 weeks. RESULTS: The therapy of 4 weeks was completed by 23 patients receiving zolpidem (3 stopped treatment due to excessive daytime drowsiness) and 24 receiving placebo (2 refused to continue the study). In the zolpidem group, after 4 weeks of therapy, there was significant increase in total sleep time (TST) and sleep efficiency compared to baseline and improvement in polysomnographic parameters of sleep initiation and maintenance (i.e., decrease in sleep latency time, decrease in wake time, and decreases in number of arousals and periodic limbs movements per hour of sleep), without any significant change in sleep architecture. CONCLUSIONS: Four weeks of 5 mg daily zolpidem in CTP class A or B cirrhosis patients with insomnia led to significant increases in TST and sleep efficiency and improvement in polysomnographic parameters of sleep initiation and maintenance without any significant change in sleep architecture.

Endodontic management of a maxillary first molar with seven root canals using spiral computed tomography

The main objective of this case report is to present a rare root canal configuration of maxillary molar with seven root canals; three mesiobuccal, two palatal and two dis-tobuccal canals diagnosed during treatment procedure confirmed by spiral computed tomography. A thorough knowledge of root canal morphology, proper clinical and radiographic examination, and use of dental operating microscopes are necessary for successful clinical outcomes. This article highlights the variations in the morphology of maxillary first molar and use of the latest techniques in successful diagnosis and negotiation of the additional canals

Ameliorating effect of Allium Sativum on high-fat diet induced fatty liver in albino rats

Objective: To assess the hepatoprotective effect provided by fresh garlic on fatty liver induced by high-fat diet

Methods: This experimental study was carried out at BMSI, JPMC from October to November 2008. Thirty adult albino rats, 200-240 gram weight, were divided into three groups. Group A received control diet, Group B received high-fat diet [20 mg butter/100 gm diet] and Group C received high-fat diet with fresh garlic [20 mg butter with 6 gm fresh garlic/100 gm diet]. The groups were further divided on the basis of duration of treatment, four weeks and eight weeks respectively. The rats were sacrificed, liver removed, weighed and relative liver weight calculated. Hepatic tissue was processed and tissue slides stained with haematoxylin and eosin

Results: There was significant increase in relative liver weight in group B animals as compared to the control animals, which decreased significantly in group C. Haematoxylin and eosin stained sections revealed ballooned hepatocytes having vesicular appearance with pyknotic nuclei in high-fat group which were preserved to a great extent in group C animals

Conclusion: This study has shown that use of fresh garlic along with high-fat diet prevents its damaging effects on liver to a great extent

Angiosarcoma of penis: case report of an aggressive penile cancer

Angiosarcoma is a very rare mesenchymal tumor of penis. Though extremely unusual, it should be considered in the differential diagnosis in patients presenting with a penile growth or a localized subcutaneous penile lesions as they are very aggressive and there is a high chance of recurrence. One such case is reported here, which was aggressively treated with total penectomy and the patient did not show any recurrence in 2 years of follow-up

The Use of Dentascan to Diagnose and Treat Mandibular Premolar with Multiple Canals.

Introduction: For successful endodontic therapy it is vital to have thorough knowledge of morphology of the root canal system and its variations besides proficient aseptic intraoperative condition. Mandibular second premolars are usually single rooted tooth with single root canal system. The incidence of the number of roots and the number of canals varies greatly in the literature. Methods and Results: This case report describes an unusual case of mandibular second premolar with two roots and five root canals. This was confirmed by radiographs, dentascan and dental operating microscope (DOM), and was successfully treated using K files system, guttapercha and AH plus sealer in lateral condensation manner. Conclusion: The clinical significance of this case report is that the precise awareness about the aberrant morphologies of the root canal system can only be appreciated when advanced radiographic techniques, magnification and illumination are used to treat such type of cases.

Radioprotective effect of growth radiation and growth hormone hormone [somatotrophin] on irradiated long bones of young albino rats

To evaluate possible effects of Growth hormone in ameliorating the harmful effects of radiation on growing long bones of young albino rats. Experimental study. This study was carried out at Department of Anatomy, Basic Medical Sciences Institute [BMSI], Jinnah Postgraduate Medical Centre [JPMC] Karachi from January 2009 to June 2009. 30 litters of 10 days of age of albino rats were taken for this study. They were divided into three groups: Group A [Control],Group B[Irradiated] was given 5Gy gamma radiation and Group C was given radiation and injection somatotrophin [Growth hormone]. Each Group was further subdivided into two sub Groups according to their respective time period of treatment i-e., 2 and 4 weeks respectively. Their weight was observed weekly. Animals were sacrificed by etheranasthesia. Dissection was done and the long bones i,e., humerus and femur were taken out and their length and width measured by digital caliper. A significant decrease in weight was noted and there was significant decrease in length and width of long bones in irradiated sub Groups B as compared to control Group A. There was significant increase in weight, length and width in long bones of irradiated and somatotrophin treated sub Groups of C as compared to irradiated sub Groups of B. Irradiation causes severe bone growth retardation. Growth hormone protects the bone injury and reverses the damage

Cutaneous adverse drug reactions in a tertiary healthcare centre in Ajman, United Arab Emirates

To study the various clinical patterns of cutaneous adverse drug reactions [ADRs] and to identify the causative drugs. A cross-sectional hospital based study was carried out with patients reporting with cutaneous ADRs to the Department of Dermatology at GMC Hospital, Ajman, U. A. E., between 2010 and 2012. Medical records of the patients were used to obtain demographic, diagnostic and ADR-related information. The data were subjected to detailed statistical analysis using SPSS. 19 software. A total of 43 patients were included [46.5% males and 53.5%females] in the study. The mean age of the patients was 30.07+.-13.63 years. The majority of the patients were from the Middle East, followed by Asian countries. The commonest cutaneous ADRs seen were maculo-papular rash [48.8%], Erythroderma [18.6%], urticaria [11.7%] and Fixed drug eruption [11.7%]. The drugs most responsible for the various cutaneous ADR were antimicrobials in 11[48.8%] and NSAIDs in 14 [32.5%] cases. Carbamazepine and Ciprofloxacin were responsible for two cases [6%] of life-threatening Stevens Johnson syndrome. Mean reaction timewas 5.63 +/- 0.5 days. Reactions were mild [46.7%], moderate [40%] and severe [13.3%]. Based on the WHO Causality assessment of ADRs, 34 [80%] cases were probable in nature; 8 [27%] possible and 1 [3%] case uncertain. A total of 5 [11.6%] cases had past history of ADRs. Three patients [9%] had secondary bacterial infection over ADR lesions and required antimicrobial treatment. The clinical pattern of ADRs and the drugs causing cutaneous ADRs was largely similar to that observed in other countries

Histological study of preventive role of cyanacobalamin [vitamin B-12] on heat induced testicular injury

The purpose of this study was to investigate the possible role of Cyanacobalamin [Vitamin B-12] in reducing the hazardous effects of heat on seminiferous tubules of testes in albino rats. Experimental Study. This study was conducted in the Department of Anatomy, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi, for 6 weeks from October 2010 to November 2010. Thirty adult albino rats of 200-250 grams of weight and 90-120 days of age were taken for this study. They were divided into three groups A [control], B [heat treated], and C [heat plus Cyanocobalamin treated]. They were further subdivided into A1 and A2, B1 and B2 and C1 and C2, based on duration of treatment of 4 weeks and 6 weeks respectfully. At the end of study histological examination of seminiferous tubules of testes were seen by applying Periodic Acid Schiff Iron Hematoxylin stain. There was marked damaging effects of heat [42°C] on seminiferous tubules of testes with disorganized germinal epithelium and vacuolation. This damage to spermatogenic cell series was well protected with concomitant treatment with Cyanacobalamin [vitamin B-12]. There was restoration of germinal epithelium and marked decrease in vacuolation. This study proved protective role of Cyanacobalmin [Vitamin B-12] in heat induced damage in testes of albino rats

Preliminary studies on CD36 gene in type 2 diabetic patients from north India.

Background & objectives: The greater tendency to diabetes in Indians may be due to genetic factors in addition to environment and diet. CD36, a class B scavenger cell surface receptor mediates internalization of oxidized low density lipoprotein (Ox-LDL) leading to the formation of macrophage foam cells. CD36 deficiency is related to phenotypic expression of the metabolic syndrome, frequently associated with atherosclerotic cardiovascular diseases resulting in raised levels of glucose thereby contributing to type 2 diabetes (T2DM). Therefore, the association of human CD36 gene mutation to T2DM needs investigation. We undertook this study to investigate CD36 gene status in north Indian subjects by screening for the deletion of exons 3, 4 and 5 and certain polymorphisms. Methods: Clinical characteristics were compared between 300 T2DM patients and 100 healthy controls. Deletion analysis was carried out for exons 3, 4 and 5 of CD36 gene in 300 T2DM patients using PCR and agarose gel electrophoresis. Genotype analysis for two polymorphisms 478C>T and delAC in exons 4 and 5 respectively was carried out using PCR-RFLP method. Results: Biochemical parameters such as fasting and post-prandial glucose levels, total cholesterol, LDL-cholesterol and blood pressure were slightly raised in the T2DM patients when compared with controls with lowered HDL-cholesterol. No exonic deletion was observed in the 300 patients and 100 controls screened. All individuals were found to be homozygous (CC and -/-) for the two polymorphisms studied. Interpretation & conclusions: Although no exonic deletion was found in T2DM patients, our study suggests that all 15 exons need to be screened for mutations which lead to CD36 deficiency. Genotyping studies of the two SNPs in the CD36 gene confirmed the absence of exons 4 and 5 deletion. This is perhaps the first report from India suggesting that CD36 is one of the several important genes that need to be explored in relation to T2DM.

A partner monoclonal antibody to Moab 730 kills 100% of DU145 and PC3 androgen-independent cancer cells.

A number of therapeutic options are available for patients with prostate carcinoma till the time that the tumour is hormone dependent. However, no fully effective therapy is available for the treatment of androgen-independent prostate carcinomas. Antibodies directed at epitopes unique to or overexpressed on the cancer cells could be of therapeutic utility. A monoclonal antibody (Moab) 2C4 has been generated, which binds with cells of two androgenindependent prostate cancers, DU145 and PC3, and does not bind to peripheral blood leukocytes (PBLs) of healthy donors. This antibody, along with the previously developed Moab 730, kills 100% of both DU145 and PC3 cells in the presence of complement and does not have a deleterious effect on PBLs of healthy males. The anti-tumour action of the two antibodies prevents the establishment of DU145 cell tumour in nude mice in vivo. Moab 2C4 in combination with 730 has potential for use as therapy for androgen-independent cancers.

Vitamin D receptor (FokI, BsmI and TaqI) gene polymorphisms and type 2 diabetes mellitus : A North Indian study.

Background : The vitamin D receptor (VDR) gene is a candidate gene for susceptibility to several diseases. Studies on association between VDR polymorphisms and risk of type 2 diabetes (T2DM) in different ethnic populations are yet inconclusive. Aims : This study was conducted to evaluate association between VDR polymorphisms and genetic susceptibility to T2DM in the north Indian population. Settings and Design : One hundred clinically diagnosed T2DM patients and 160 healthy controls from the north Indian population were recruited for genetic association study. Materials and Methods : Genomic DNA was extracted from blood and genotyped for the single nucleotide polymorphism SNPs of FokI (T/C) [rs2228570], BsmI (A/G) [rs1544410] and TaqI (C/T) [rs731236] by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) analysis. Statistical Analysis Used : Genotype distribution and allelic frequencies were compared between patients and controls. Mean values and odds ratios (ORs) with 95% confidence interval (CI) were calculated using SPSS software (version 15.0). Results : The genotype distribution, allele and haplotype frequencies of VDR polymorphism did not differ significantly between patients and controls. Mean age and waist-hip ratio of patients were found to be associated with VDR polymorphism. Combination studies showed FFBbtt increased the risk of T2DM in north Indians. Conclusions : Our data suggest that VDR gene polymorphism in combination of genotypes is associated with the risk of T2DM and thus requires further studies as a probable genetic risk marker for T2DM.

Effects of heat on testicular tissue with protective role of cyancobalamin [vitamin B12] in albino rats

The effects of heat on all tissues of the body are very well known but enough literature is not available on the effects of heat on testicular tissue. So this study was undertaken to see the effects of heat on testicular tissue with protection provided by Cyanocobalamin [vitamin B12]. Anatomy department BMSI, JPMC, Karachi. October 2008 to November 2008. This experimental study was done at Anatomy department, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. Thirty male healthy Albino rats of 90-120 days of age and 200-250 grams of weight were selected and divided into three groups comprising of ten rats each. Group A served as control. Group B was given heat of 40-45 °C for six hours daily for six weeks with room heater and maintained on room thermometer. Group C received heat and Cyanocobalamin, at a dose of 1.4 mcg / 100 g body weight. At the end of six weeks, weight of all animals, gross changes of testes and weight of testes were recorded. Group B showed decrease in weights of all animals, gross changes in testicular tissue [i.e. dilatation of blood vessels and bleeding spots] and reduction in testicular weight. Group C which was protected with Cyanocobalamin, showed increase in body weight, slight dilatation of blood vessels and increase in testicular weight as compared to Group B. Present study concluded that Cyanocobalamin [vitamin B12] reduced the damaging effects of heat on testicular tissue