Risk factors associated with in-hospital mortality in critically ill elderly patients with venous thromboembolism

Background: Venous thromboembolism (VTE) is a major cause of morbidity and mortality for patients admitted to the intensive care unit (ICU). The present study aims to investigate the risk factors for in-hospital mortality among critically ill elderly patients with VTE. Methods: This was a retrospective cohort study utilizing data from the large medical information mart for intensive care IV (MIMIC-IV) database. All elderly patients diagnosed with VTE were included in the analysis. The analyses were conducted using SPSS version 26.0 software and MedCalc version 19.6. Univariable and multivariable logistic regression models were conducted to explore potential risk factors associated with in-hospital mortality. Results: The study population had a median age of 75 years, with a range from 69.0 to 82.0 years, and males represented 50.4% of the cohort. Among critically ill VTE patients, the in-hospital mortality rate was 18.5% (237 out of 1282). Multivariable regression analysis revealed that longer ICU stays [OR: 1.034; 95% CI: 1.010-1.059, p=0.005], higher Charlson comorbidity index (CCI) scores [OR: 1.090; 95% CI: 1.001-1.187, p=0.046], elevated simplified acute physiology score II (SAPS II scores) [OR: 1.039; 95% CI: 1.023-1.056, p<0.001], increased red blood cell distribution width (RDW) levels [OR: 1.088; 95% CI: 1.006-1.178, p=0.035], lower mean arterial pressure (MAP) [OR: 0.975; 95% CI: 0.957-0.994, p=0.011], presence of severe liver disease [OR: 2.036; 95% CI: 1.051-3.941, p=0.035], and the necessity for renal replacement therapy (RRT) [OR: 2.478; 95% CI: 1.315-4.671, p=0.005] were significantly associated with an increased risk of in-hospital mortality among elderly ICU patients with VTE. Conclusions: The study identifies numerous independent risk factors associated with in-hospital mortality among critically ill elderly patients with VT. These factors include prolonged length of ICU stay, elevated scores on the CCI and SAPS II, increased RDW, reduced MAP, the presence of severe liver disease, and the necessity for RRT.

Comparison of transvaginal versus transumbilical retrieval technique of laparoscopically removed surgical specimens

Background: Laparoscopy is a minimally invasive, safe, and acceptable technique for the removal of adnexal masses whereas specimen removal remains a big challenge due to the size and type of specimens. In this study, we have discussed the two different routes of specimen retrieval, transumbilical and transvaginal route. Methods: A prospective study was conducted on 34 women with adnexal mass who were admitted for laparoscopic removal of adnexal mass. Patients were randomized into two groups, Group A included 17 women who underwent transumbilical retrieval of specimens, and Group B included 17 patients who underwent transvaginal retrieval of specimens. Results: Basic demographic data were similar in both groups. None of our patients had intraoperative & postoperative complications. There was no significant difference in Specimen retrieval time, operative time, and blood loss. Two patients (N=2) in group A had spillage. Postoperative pain was significantly higher in group A and the cosmetic response was significantly higher in group B. Conclusions: Both transumbilical and transvaginal techniques of specimen retrieval in the laparoscopically resected specimen are safe, feasible, and easy, but the Transvaginal route has advantages over the transumbilical route because of better cosmesis and less postoperative pain.

Comparison of transvaginal versus transumbilical retrieval technique of laparoscopically removed surgical specimens

Background: Laparoscopy is a minimally invasive, safe, and acceptable technique for the removal of adnexal masses whereas specimen removal remains a big challenge due to the size and type of specimens. In this study, we have discussed the two different routes of specimen retrieval, transumbilical and transvaginal route. Methods: A prospective study was conducted on 34 women with adnexal mass who were admitted for laparoscopic removal of adnexal mass. Patients were randomized into two groups, Group A included 17 women who underwent transumbilical retrieval of specimens, and Group B included 17 patients who underwent transvaginal retrieval of specimens. Results: Basic demographic data were similar in both groups. None of our patients had intraoperative & postoperative complications. There was no significant difference in Specimen retrieval time, operative time, and blood loss. Two patients (N=2) in group A had spillage. Postoperative pain was significantly higher in group A and the cosmetic response was significantly higher in group B. Conclusions: Both transumbilical and transvaginal techniques of specimen retrieval in the laparoscopically resected specimen are safe, feasible, and easy, but the Transvaginal route has advantages over the transumbilical route because of better cosmesis and less postoperative pain.

Artabotrys Hexapetalus (L. F.) Bhandari: A Plant With Enormous Biomedical Potential

This review is intended to investigate the published report regarding phytochemical, ethnomedicinal, and pharmacological activities and put forth the therapeutic potential of Artabotrys hexapetalus (L. f.) Bhandari. (A. hexapetalus). It belongs to the family Annonaceae, one of the therapeutically important plants, broadly distributed throughout the world. An extensive review of the literature available in various recognized databases including logical writing and scientific literature, search engines such as Springerlink, ScienceDirect, SciFinder, PubMed, Scopus, Google Scholar, and BioMed Central as well as relevant books, websites, scientific publications, and dissertations were utilized as a source of information that provided an up-to-date review. Phytochemical profiling of these species revealed the presence of some imperative phytochemicals alkaloids, terpenoids, anthraquinones, butyrolactones, flavonoids, neolignans, phenolic compounds, and leucoanthocyanins as the basis of its valuable therapeutic properties. The other imperative phytoconstituents which contribute to the therapeutic properties are isoamericanin A, isoamericanol, americanin, artabotricinol and artabotriol, β-unsaturated-β-butyrolactones, arapetaloside taxifolin, apigenin-7-O-apiosylglucoside, glucoluteolin, and artabotrine. The pharmacological activities exhibited by Artabotrys hexapetalus as antimicrobial, antileishmanial, antioxidant, antifungal, antifertility, and anthelmintic properties are attributed to the presence of valuable bioactive phytoconstituents. Considering these facts an effort was made to present a comprehensive review enlightening the taxonomical, phytochemical, and pharmacological activities of plant Artabotrys hexapetalus. Future research can be directed to an extensive investigation about phytochemistry, clinical trials, pharmacokinetics, and acquiring safety data to add new dimensions to the therapeutic utilization of Artabotrys hexapetalus and other Artabotrys species.

Clinicopathologic features of undifferentiated round cell sarcomas of bone & soft tissues: An attempt to unravel the BCOR-CCNB3- & CIC-DUX4-positive sarcomas

Background & objectives: Certain genetically defined undifferentiated round cell sarcomas, namely BCOR-CCNB3 and CIC-DUX4 positive, have been described. Here we present detailed clinicopathologic features and molecular results in such cases. Methods: Fifty one cases of undifferentiated round cell sarcomas, including 32 cases, tested for BCOR-CCNB3 and CIC-DUX4 fusions, by reverse transcription polymerase chain reaction technique and 44 tumours, for CCNB3 immunostaining, were analyzed. Results: Twenty seven (52.9%) tumours occurred in males and 24 (47%) in females; in soft tissues (38; 74.5%), commonly, trunk and extremities and bones (13; 25.4%), frequently, femur and tibia. Five of 32 (15.6%) tested cases were positive for BCOR-CCNB3 fusion and seven (21.8%) for CIC-DUX4 fusions. Histopathologically, CIC-DUX4-positive sarcomas comprised nodular aggregates of round to polygonal cells, containing hyperchromatic nuclei, prominent nucleoli and moderate cytoplasm, with focal myxoid stroma and variable necrosis, in certain cases. BCOR-CCNB3- positive sarcomas mostly comprised diffusely arranged, round to oval to short spindly cells with angulated nuclei, vesicular chromatin, inconspicuous nucleoli and interspersed vessels. Immunohistochemically, tumour cells were positive for MIC2 in 24 of 49 (48.9%) and CCNB3 in 12 of 44 (27.2%) cases. Four of five BCOR-CCNB3-positive sarcomas showed CCNB3 immunostaining and 6 of 7 CIC-DUX4-positive sarcomas displayed WT1 immunostaining. Most patients (27/37) (72.9%) underwent surgical resection and chemotherapy. Median overall survival was 12 months, and disease-free survival was seven months. Interpretation & conclusions: Undifferentiated round cell sarcomas are rare; mostly occur in soft tissues of extremities, with CIC-DUX4 positive, as these are relatively more frequent than BCOR-CCNB3 positive sarcomas. CCNB3 and WT1 are useful immunostains for triaging such cases for BCOR-CCNB3 and CIC-DUX4 fusion testing, respectively. Overall, these are relatively aggressive tumours, especially CIC-DUX4-positive sarcomas.

Epidemiological data and case load spectrum of patients presenting to bone and soft tissue disease management group at a tertiary cancer center.

INTRODUCTION AND BACKGROUND: This study was conducted to know the spectrum and number of bone and soft tissue (BST) tumors presenting to our institute. We needed to assess the gap between the number of patients seen and infrastructure available, and based on this information, help formulate guidelines for optimum utilization of resources and to provide best possible evidence‑based cancer care. SETTINGS AND DESIGNS: This is a prospective observational study (epidemiological). MATERIALS AND METHODS: This study included all new patients seen in BST‑disease management group (DMG) in the year 2010. An audit form was devised to capture all the relevant information. A comparison of our data with other national and international studies was also done. RESULTS: Out of total 31,951 new patients registered at our institute, 2007 patients availed BST‑DMG services. Sixty percent were bone tumors and 36% were soft tissue tumors. In bone tumor, 66% were malignant, 15% were benign, and 19% were non-neoplastic. Osteosarcoma (43%) was the most common malignant tumor followed by primitive neuroectodermal tumor/Ewing’s (27%) and chondrosarcoma (11%). Giant cell tumor was the most common benign bone tumor. Eighty‑one percent of all soft tissue lesions were malignant, of which 75% were of mesenchymal origin and 25% were of cutaneous origin. CONCLUSION: This is an attempt to document the epidemiology of musculoskeletal tumors presenting to our institution while guiding the institute to frame and implement disease‑specific protocols and generate further research questions. Continued data collection and follow‑up can provide valuable information on long‑term survival and treatment‑related toxicities. This data (within limitations) may be extrapolated to national level to identify the need for infrastructure and human resources.

The Onset and Duration of Action of 0.2% Lidocaine in a One-per-Mil Tumescent Solution for Hand Surgery

BACKGROUND: One-per-mil tumescent solution, which contains 0.2% lidocaine with 1:1,000,000 epinephrine, has been reported to be clinically effective for hand surgery under local anesthesia. However, it was lacking in its basic pharmacokinetics profile in regard to the onset of action (OOA) and duration of action (DOA). METHODS: A randomized, double-blind study was conducted on 12 volunteers who met the inclusion criteria from October to November 2014. All volunteers had their right and left ring finger pulps injected with either one-per-mil solution or 2% lidocaine. Semmes-Weinstein and two-point discrimination tests were used to test sensation. Visual analogue scale was recorded at the time when the finger lost its sensation and when it regained normal sensation to measure the OOA and DOA. The data were then analyzed with a paired t-test and a Wilcoxon signed-rank test. RESULTS: The OOA and DOA of 2% plain lidocaine were 1 minute and 99.67 minutes, respectively. Meanwhile, 0.2% lidocaine in a one-per-mil tumescent solution showed an OOA of 5 minutes and a DOA of 186.83 minutes. The OOA of 0.2% lidocaine in a one-per-mil tumescent solution is statistically shorter than 2% plain lidocaine (P=0.04); while its DOA is statistically longer than 2% plain lidocaine (P<0.001). CONCLUSIONS: The 0.2% lidocaine in a one-per-mil tumescent solution is statistically and clinically superior to 2% plain lidocaine in achieving longer duration of local anesthesia.

Colorectal carcinoma up to the second decade of life: An 8‑year experience in a tertiary care center.

AIMS AND OBJECTIVES: To evaluate the demographic pattern, incidence, and histological characteristics of colorectal carcinomas (CRCs) in very young adults diagnosed in the center. MATERIALS AND METHODS: We retrieved and reviewed slides and data pertaining to all the cases of CRCs and “segregated into decade wise age‑groups” from the archives of Department of Pathology. Patients with age ≤20 years diagnosed during the last 8 years (2006–2013) were further evaluated. RESULTS: Totally, 590 cases of CRCs diagnosed over last 8‑year period, of which 4.2% (25 cases) presented in the study group (age ≤20 years) with a mean age of 17 years. About 50% of the tumors were either signet ring cell, mucin‑secreting or poorly differentiated carcinomas. Four cases occurred in a background of familial adenomatous polyposis (FAP), three of which showed high‑grade dysplasia, while in one case, carcinoma‑in‑situ was diagnosed. In all but two cases, rectum was the site of involvement except FAP cases in which colorectal location was noted. CRCs show a sharp rise in earlier age onset (≤40 years) and an increasing trend was followed in patients between age groups third, fourth, and fifth decades of life over the last 8 years. CONCLUSION: Colorectal carcinomas show an increasing trend in young age (≤40 years). This change may be attributed to dietary, lifestyle changes, and newer genetic alterations in developing countries. In very young age group (≤20 years), a higher grade and stage at the time of diagnosis and predominantly rectal involvements are the distinct features.

Topical Application of Honey in The Treatment of Wound Healing: A Metaanalysis.

Honey has been extensively studied in the treatment of wound but efficacy in clinical practice is not fully established. The aim of the present study was to evaluate the efficacy of topical application honey in observational studies as well as in controlled clinical trials in the treatment of wound healing. A systematic literature search was carried out from 1966 to 31 July 2008 in Pubmed, Medline, Embase, Cochrane database using the appropriate search key words. We found 5 observational studies with 160 patients while 963 cases in 10 controlled clinical trials where 511 patients were treated with honey. Efficacy was found highly efficacious in observational studies but in controlled clinical trial showed its modest efficacy. Most of the patients reported with complete healing of 99% within 2-9 weeks in observational and 56 % in controlled trials and healing was observed within 4-12 weeks time in controlled clinical trials however some of the recent double blind trial showed no superior benefit of honey compare to control. So base on above trials it can be concluded that topical application of honey is useful for the treatment for wound healing but to fully established its efficacy, larger prospective double blind study is required in near future.

A t(X; 18) SYT-SSX2 positive synovial sarcoma in the pelvis of a young adult male: A rare case report with review of literature.

Synovial sarcoma is uncommonly documented in the pelvis. Rarely, such cases have dealt with molecular analysis. A 19-year-old boy presented with pain and swelling in his left lower limb of two months duration. He developed acute urinary retention four days prior to his hospital admission, wherein radiological examination unraveled a large soft tissue mass, displacing his pelvic muscles, along with a lytic lesion involving his right pubic bone. Biopsy showed a cellular spindle cell sarcoma, exhibiting hemangiopericytoma-like vascular pattern with focal necrosis. Immunohistochemistry (IHC) showed positivity for vimentin, BCL-2, calponin and MIC 2. Cytokeratin (CK) and epithelial membrane antigen (EMA) were negative. MIB 1 count was 70% (high). P53 was positive. Diagnosis of a poorly differentiated synovial sarcoma was offered and confirmed with a positive t(X; 18) SYT-SSX2 translocation. This case highlights the value of molecular analysis in diagnosis of a synovial sarcoma at rare sites, especially when IHC results are equivocal and the biopsy material is limited.

Effect of propofol in altering pentylenetetrazol induced seizure threshold in rats.

The present study was undertaken to evaluate the role of propofol in altering pentylenetetrazol induced seizure threshold in rats. Total 42 Wistar rats were used to evaluate different parameters (onset of action, duration of seizure, seizure severity score and number of seizure) following propofol injection. The present results showed that there was significant reduction in the time required for onset of seizure in propofol treated groups following PTZ treatment. If treated with propofol alone (2 and 5 mg/kg), there was no significant difference as compared to controls. In seizure severity score assessment, there was no significant difference with various doses of propofol alone treated groups, but the difference was observed in propofol (2 and 5 mg/kg) treated groups following PTZ treatment. Duration of seizure also significantly increased in propofol (5 mg/kg) treated group, but at 2 mg/kg of propofol treatment, no significant difference was observed. The present results showed that propofol ameliorate seizure threshold and caused prolongation of duration of seizure. However, further study and trials are needed to confirm the present results.