Histological risk score and its role in predicting recurrence in early-stage oral squamous cell carcinomas

Context: Oral squamous cell carcinoma (OSCC) comprises more than 90% of oral cancers and is the most common carcinoma affecting the oral cavity. Early stage T1/T2 OSCC have a heterogeneous prognosis and a significant number of patients develop loco regional recurrence (LRR) and have reduced disease free survival (DFS) with increased disease related mortality. Aims and Objectives: To assess the impact of the three parameters used in Brandwein-Gensler risk model along with lympho-vascular invasion (LVI), depth of invasion (DOI) and lymph node metastases in predicting LRR in early stage OSCC. Materials and Methods: This was a retrospective study on early stage T1/2 OSCC patients over a period of 2 years who received treatment by surgical resection and had follow-up data. LRR was assessed based on recurrence of OSCC at the initial site or in regional lymph nodes. Results: Out of 1135 OSCC cases during our study period a total of 207 cases befitted our inclusion criteria. Recurrence was noted in 113 (54.6%) cases. Univariate analysis identified LVI (P < 0.00001), DOI (P < 0.00001), nodal involvement (P < 0.00001), worst pattern of invasion (WPOI) (P < 0.00001), lymphocytic host response (LHR) (P = 0.004), perineural invasion (PNI) (P = 0.012) as strong statistically significant risk factors for LRR. Conclusion: Adequate assessment of simple parameters on routine H and E by incorporating Brandwein-Gensler histological risk scoring model at the initial presentation can help prognosticate and predict LRR and select patients for post-surgical adjuvant therapy.

To screen for obstructive sleep apnea in patients with type 2 diabetes mellitus and its association with microvascular complications

Objectives: The objectives of this study were to find the association between obstructive sleep apnea (OSA) and microvascualr complications in patients with type 2 diabetes mellitus (T2DM). Material and Methods: This study was conducted at Bangalore Medical College. One hundred patients fulfilling the inclusion criteria were enrolled for the study. The study group included outpatients and inpatients with T2DM in Victoria Hospital and Bowring and Lady Curzon Hospital. The data were collected according to the pro forma in terms of history, clinical examination, and the necessary investigations (HbA1c and urine microalbumin- creatinine ratio). To screen for OSA, STOP-BANG questionnaire was used. To assess microvascular complications, patients were subjected to fundoscopy, urine microalbumin-creatinine ratio, and Toronto clinical neuropathy scoring system. Based on STOP-BANG score, patients were divided into three groups: Low risk (0–2), intermediate risk (3–4), and high risk (5–8) for OSA. Mean values for the duration of diabetes, HbA1c, urine microalbumin- creatinine ratio, and Toronto neuropathy score were compared in each group using ANOVA variance analysis. To find the association between OSA and diabetic retinopathy, Kruskal–Wallis test was used. Results: Based on STOP-BANG score, 16% of patients were in the low-risk group, 68% in the intermediate-risk group, and 16% in the high-risk group. There was a significant difference in Toronto neuropathy scores, urine microalbumin-creatinine ratio, and diabetic retinopathy between low-, intermediate-, and high-risk OSA groups indicating higher neuropathy scores, higher values of UMCR, and more advanced diabetic retinopathy among the high-risk group as compared to other two groups. The association between STOP-BANG scores and UMCR, Toronto neuropathy score, and diabetic retinopathy was statistically significant with P values of 0.002, 0.029, and 0.03, respectively. Conclusion: All diabetic patients should be screened for OSA which is simple and inexpensive. Those who fall in intermediate-risk and high-risk categories showed more advanced microvascular complications. They should be subjected to polysomnography and treated for OSA for better glycemic control and to delay the progression of microvascular complications

Prevalence and risk factors for drug resistance in patients with lower respiratory infections in Healthcare Associated Infection: a single centre study from Eastern India

Background: Healthcare Associated Infections (HCAI) are associated with longer hospitalisations and increased morbidity and mortality. Lower respiratory infections including Pneumonia is an entity among healthcare associated infections mostly witnessed in nursing home residents, patients on long term care and patients receiving home or hospital based intravenous therapy and undergoing dialysis. Aim of the study to assess the prevalence and risk factors of resistance among the patients developing lower respiratory infections as a consequence of Healthcare Associated Infection.Methods: The study was conducted as a prospective cohort model. All the eligible patients were subjected to detailed history taking, clinical examination, laboratory and radiological investigations. All the categorical parameters were compared using Fisher’s exact test. Continuous parameters were compared using independent t-test. All the statistical analysis was carried out using the software Stata 15.1.Results: Majority of the patients were older than 60 yrs (73%). Death was significantly seen in persons under 60 years and associated pulmonary consolidation equal to or more than three zones (p<0.05). Klebsiella spp (20.95%), and Acinetobacter (6.1%) were most commonly isolated. Multi-drug and extensive drug resistance were encountered among these organisms. Male gender, immune-compromised patients, bilateral pulmonary involvement and hospitalisation for at least 48 hours in preceding 90 days were associated with isolation of MDR organism.Conclusions: Lower respiratory infection is an important component of healthcare associated infections. It needs targeted antibiotic therapy covering MDR organisms prevalent in the local population. Data from different institutions to corroborate findings regarding antibiotic resistance pattern of the microbes is recommended.

Comparative evaluation of subarachnoid block with low dose bupivacaine and fentanyl versus low dose bupivacaine and sufentanil in patients undergoing inguinal surgeries

Background:Fentanylis a phenylpiperidine derivative synthetic opioid agonist. As an analgesic fentanyl is 75-125 times more potent than morphine. Sufentanil is a semisynthetic thienyl analogue fentanyl with analgesic potency 5 to 10 times more than that of fentanyl. Recently there has been an interest in using analgesics and localanaesthetics in an attempt to decrease the local anaestheticdose enabling fasterrecovery.Methods:A double blinded randomised study was carried out with 50 patients of ASA grade I and II aged between 20 and 60 years undergoing elective inguinal and below inguinalregionsurgeriesunder low dose spinal anaesthesia. Patientsreceived 10 mg of 0.5% hyperbaric bupivacaine with 50 μg of fentanyl added to a total volume of 3 ml(group F),and with sufentanil 5 μg [diluted with 5% dextrose] and volume made to 3 ml(group S). Postoperative VAS score for pain, duration of motor block and complications postoperatively is noted.Results:Prolonged postoperative analgesia was observed in group F (216.7min) and group S(264.8)which was statistically significant among the groups (p<0.001) is higher in group S and also duration of motor block in group F(130.6) and group S (90.5) which was statistically significant among the groups (p<0.001) which is higher in group F than group S. Conclusions: When compared to intrathecalbupivacaine-fentanyl combination; intrathecal bupivacaine-sufentanil combination provided prolonged postoperative analgesia with a lesser duration of motor blockade thus allowing early post operative ambulation

Enhanced S-cone syndrome: Clinical spectrum in Indian population

Purpose: Enhanced S-cone syndrome (ESCS), a rare disorder, is often misdiagnosed as other forms of retinal degenerations, which have a poorer prognosis than ESCS. The aim of this study is to report the varied clinical features of ESCS and distinguish it from other similar disorders. Methods: We retrospectively scrutinized the records of patients with confirmed diagnosis of ESCS and analyzed the findings. Results: We included 14 patients (age range 4–39 years) who were confirmed to have ESCS according to pathognomonic electroretinography (ERG) showing reduced photopic, combined responses, and 30 Hz flicker with reduced L, M cone responses and supernormal S cone responses. The disease presented in the 1st decade with night blindness and was almost stationary or minimally progressive. Mid-peripheral fundus changes in form of nummular pigmentary alterations, yellow punctate lesions, and macular schisis were noted. The vision ranged from 6/6 to 6/36 with follow-up ranging from 1month to 22 years. Conclusion: ESCS shows varied clinical features ranging from unremarkable fundus to pigment clumping and atrophic lesions. It has good prognosis with patients mostly maintaining their vision. ERG is diagnostic. More awareness and knowledge about this entity can help to differentiate it from other forms of night blindness.

Geographical distribution of primary & secondary dengue cases in India – 2017: A cross-sectional multicentric study

Background & objectives: Dengue virus infection is endemic in India with all the four serotypes of dengue virus in circulation. This study was aimed to determine the geographic distribution of the primary and secondary dengue cases in India. Methods: A multicentre cross-sectional study was conducted at Department of Health Research / Indian Council of Medical Research (DHR)/(ICMR) viral research and diagnostic laboratories (VRDLs) and selected ICMR institutes located in India. Only laboratory-confirmed dengue cases with date of onset of illness less than or equal to seven days were included between September and October 2017. Dengue NS1 antigen ELISA and anti-dengue IgM capture ELISA were used to diagnose dengue cases while anti-dengue IgG capture ELISA was used for identifying the secondary dengue cases. Results: Of the 1372 dengue cases, 897 (65%) were classified as primary dengue and 475 (35%) as secondary dengue cases. However, the proportion varied widely geographically, with Theni, Tamil Nadu; Tirupati, Andhra Pradesh and Udupi-Manipal, Karnataka reporting more than 65 per cent secondary dengue cases while Srinagar, Jammu and Kashmir reporting as low as 10 per cent of the same. The median age of primary dengue cases was 25 yr [interquartile range (IQR 17-35] while that of secondary dengue cases was 23 yr (IQR 13.5-34). Secondary dengue was around 50 per cent among the children belonging to the age group 6-10 yr while it ranged between 20-43 per cent among other age groups. Interpretation & conclusions: Our findings showed a wide geographical variation in the distribution of primary and secondary dengue cases in India. It would prove beneficial to include primary and secondary dengue differentiation protocol in the national dengue surveillance programme.

Clinical profile of uveitis patients developing central serous chorioretinopathy: An experience at a tertiary eye care center in India

Purpose: To evaluate clinical profile of patients with uveitis who developed central serous chorioretinopathy (CSC). Methods: Retrospective case series of consecutive patients of uveitis with CSC managed at a tertiary eye care center in India between 1994 and 2014. The data about clinical features, investigations, treatment, and outcomes were obtained from their medical records. Results: A total of 31 eyes of 26 patients with uveitis with a diagnosis of CSC between June 1994 and May 2014 were included in the study. The mean age of presentation was 42.8 � 9.2 years, and 88.4% of the patients were male. CSC was bilateral in 19.2% of the patients, and in 38.4% patients uveitis was because of infectious etiology. CSC developed in 23 (88.5%) patients when they were on oral corticosteroid. The most common cause of uveitis in our study was choroiditis (48.4%), followed by retinal vasculitis (12.9%). The mean time for resolution of CSC was relatively less in patients with uveitis because of infectious etiology. In 10% eyes vision remained the same and deterioration of vision was noted in 19% eyes. Best corrected visual acuity of the patients at the time of presentation with CSC was 0.56 � 0.34 and after the resolution of CSC was 0.48 � 0.5 (P < 0.0005). Conclusion: Patients with choroidal inflammations are more prone to develop CSC compared with other subtypes of uveitis. Management of CSC in uveitis can be challenging.

Isolation And Characterisation Of Rapamycin, Temsirolimus Regio Isomer (MONOESTER) And Temsirolimus Diester In Temsirolimus Drug

Objective: Separation and identification of the process impurities in the manufacture of temsirolimus drug viz., rapamycin, temsirolimus regioisomer (monoester) (TS monoester), and temsirolimus diester (TS diester). Methods: During the process development of temsirolimus (TS), three process impurities-rapamycin, temsirolimus regioisomer (monoester) and temsirolimus diester-were detected by high-performance liquid chromatography (HPLC). Impurities were isolated by medium pressure liquid Chromatography (MPLC) and characterized by ESI-MS/MS, 1H NMR, FT-IR spectral data. Results: These impurities are characterised with the help of ESI MS/MS, 1H NMR, and FT-IR data. The impurities are identified and characterised as the process impurities. One of them is the starting material i.e. rapamycin and the other two are formed during the manufacture of the drug. This method offers advantages over using photodiode-array UV detection (LC-PDA) for the determination of peak purity, viz. components with similar UV spectra can be distinguished. Conclusion: The structures of these impurities were characterized as rapamycin, TS Monoester, and TS Diester. Out of these process impurities, rapamycin has been previously identified while the other two are previously unreported.

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: A distinct clinicopathologic entity

Objective: The objective of this study is to retrospectively evaluate follicular variant of papillary thyroid carcinoma (FVPTC) and reclassify encapsulated FVPTC as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) according to the criteria proposed by The Endocrine Pathology Society working group in 2015 to correlate with outcome. Materials and Methods: Retrospective review of case records of all patients diagnosed as carcinoma of thyroid between 2015 and 2016 was done for the histologic subtype. Gross and microscopic features on resected specimens of FVPTC were reviewed and subtyped as invasive and encapsulated based on capsular/vascular invasion; the encapsulated forms were further studied for size, number, follicular architecture, nuclear features, presence of psammoma bodies, stromal fibrosis, necrosis, mitoses, and lymph node status. Results: Out of the 383 patients with thyroid carcinomas in the study period, 349 were PTC which included 106 FVPTC. Thirty-three patients fulfilled the criteria to be labeled as NIFTP. Total thyroidectomy was performed in 8 patients and hemithyroidectomy in 25 patients. Lymph node dissection along with total thyroidectomy was done in 3 and completion thyroidectomy following hemithyroidectomy was done in 9. There were 29 single and 4 multiple lesions with size varying from 0.2 to 7 cm including 5 lesions measuring <1 cm. The involvement was confined to one lobe in 31 and both lobes in 2 specimens. Patients are on follow-up with no recurrence till date. Conclusion: Thyroid carcinomas currently diagnosed as FVPTC should be evaluated for criteria of NIFTP to avoid overtreatment as they have an indolent behavior.

Catechin, an active constituent of green tea, preserves skeletal muscle activity in dexamethasone induced cachexia by increasing acetylcholine sensitivity in muscles of Wistar rats

Chronic administration of glucocorticoids produces cachexia like symptoms such as muscular dystrophy, weight loss and skeletal muscle dysfunction. However, only limited options are available for treatment of this disease. One of the tea catechins, epigallocatechin-3-gallate attenuated skeletal muscle atrophy in cancer cachexia. In this context, we explored here (+)-catechin hydrate (catechin) for of its anticachectic activity in dexamethasone induced muscle dystrophy. Dosing of catechin at 100 mg/kg p.o. was continued for 5 days along with a daily dosing of dexamethasone at 0.6 mg/kg i.p. On the 6th day, animals were assessed for cachectic condition using changes in body weight, functional aspect of skeletal muscle such as muscle integrity, locomotor activity, handgrip strength, glucose uptake, responsiveness of skeletal muscle to acetylcholine, by estimating inflammatory parameters such as nitrite, myeloperoxidase in the gastrocnemius muscle and by evaluating plasma biochemical parameters such as triglycerides, total protein, albumin, creatinine, urea and IL-6 levels. Except for a few parameters, such as body weight, glucose uptake by hemi-diaphragm and triglyceride level, remaining parameters were significantly reversed by catechin treatment. The underlying mechanism of the myoprotective action of catechin has been postulated by the increased sensitivity of muscle to acetylcholine as demonstrated in this study, which might be responsible for prevention of muscle inflammation.

A Study of Clinical Outcome of Double Folded Rectosigmoid Bladder with Extramural Subserous Tunneled Ureterocolonic Anastomosis (Abol-Enein and Ghoneim) for Urinary Diversion.

Background: To study and analyze the clinical outcome of double folded rectosigmoid bladder with extramural subserous tunnels done in various cases for urinary diversion after cystectomy. Method: Analysis and follow up of 18 cases of double - folded rectosigmoid urinary diversions done in various patients following cystectomy for various indications in Department of urology, King George Hospital, Vishakapatnam during the period between 2008 - 2009. Results: There was no deaths or deterioration of the upper tracts recorded in the study group. In early post-operative period wound infection developed in 4 cases, prolonged ileus was seen in 3 cases, Electrolyte imbalance was seen in 4 cases. Late complications noted, were pyelonephritis in 3 cases, acidosis in 2 cases and hypokalemia in 3 cases. All the early and late postoperative complications were successfully treated conservatively. Conclusion: Our study has shown that the double folded rectosigmoid bladder reconstruction is an easier procedure with an easier technique of reimplantation suited even for dilated ureters with a short operating time and has shown better continence rate with postoperative complications less in number and severity.

An Unusual Cause of Calcific Thoracic Metastases.

Clinical Summary: An 18-year-old male presented with progressive breathlessness and cough of two months duration. He also complained of generalised body pains, low grade intermittent fever, anorexia and weight loss. He was started on empiric daily anti-tuberculosis treatment with rifampicin, isoniazid, pyrazianmide and ethambutol from elsewhere for right-sided pleural effusion one month ago. He presented to us as he did not experience improvement in his condition. There was no other significant medical history. Physical examination showed a 10cm x 8cm, non-tender hard bony mass with ill-defined margins over the upper third of left arm. There was no evidence of digital clubbing or peripheral lymphadenopathy. Respiratory system examination showed features of a right-sided pleural effusion.

Giant solitary fibrous tumour of the pleura.

Solitary fibrous tumour of the pleura is a rare primary pleural neoplasm. These tumours are usually asymptomatic and are incidentally detected. Majority of these neoplasms are benign and surgical excision provides excellent results. With the widespread use of imaging and better diagnostic criteria, this tumour is likely to be detected more frequently. We encountered a patient with a giant solitary fibrous tumour of the pleura. In this report, we describe the case of a patient with a giant solitary fibrous tumour of the pleura, review the literature and present the details of management of this patient.

Determination of multiclass pesticide residues in mangoes by liquid chromatography –tandem mass spectrometry.

The Development of an analytical method for the determination of 24 multiclass pesticides in mango at the ≤10 ng g-1 level. The method involves extraction of 10 g of homogenized mango samples (2 g of Sodium chloride- +8g of Magnesium sulfate) with 10 mL of Acetonitrile; Clean up by Dispersive solid phase extraction with a combination of primary secondary amine (PSA), graphitized carbon black (GCB) and anhydrous Magnesium sulfate and final estimation by LC-MS/MS with multiple reaction monitoring (MRM) mode. The mean recoveries were in the range 80-120%. The method quantifies over a linear dynamic range of 10-100 μg/kg. The methodology has been proven to be highly efficient and robust and thus the method is suitable for monitoring the Maximum Residue Limits (MRL) compliance of a wide range of pesticides combinations.

Orofacial rehabilitation of patients with post-cancer treatment-An overview and report of three cases.

According to World Health Organisation statistics, individuals of the Indian subcontinent have the highest prevalence of orofacial cancer. Surgery, radiation, chemotherapy or combination therapies are commonly administered treatment modalities for treatment of oral cancer. Surgical resection can be mutilating, disfiguring and may deeply affect self-image of patients. Orofacial defects have unique limitations and challenges. A coordinated effort from the surgeon, oral physician and the maxillofacial prosthodontist to treat such patients is the need of the hour. This article presents an overview of the orofacial rehabilitation of postcancer treatments along with case reports.

Interstitial cells of Cajal and intestinal function in Trinidadian children / Células intersticiales de Cajal y función intestinal en niños trinitenses

OBJECTIVE: This study was carried out to compare the density of the interstitial cells of Cajal (ICCs) in the bowel wall of children with Hirschsprung's disease (HD), anorectal malformations (ARM) and normal controls in Trinidad and Tobago. SUBJECTS AND METHOD: Segments of bowel wall excised from eight children with HD, three controls and two children with ARM were immunostained with c-Kit primary antibody. Cells with features of ICCs were counted. RESULTS: All three controls and the two children with ARM had dense distribution of ICCs. Most children (6/8;75%) with HD had markedly reduced counts in aganglionic bowel. Two (25%) also had a decrease in ganglionic bowel. Possible influences were patient age and gender and the level of bowel sectioned. CONCLUSION: Analysis of this sample suggests that immunostaining for c-Kit positive cells might be a useful screening test in the assessment of bowel motility disorders. The possible effects of age, gender and the level of bowel sampled await determination.

OBJETIVO: Este estudio se llevó a cabo con el propósito de comparar la densidad de las células intersticiales de Cajal (CIC) en las paredes intestinales de niños con la enfermedad de Hirschprung (EH), y malformaciones anorectales (MAR), frente a controles normales en Trinidad Tobago. SUJETOS Y MÉTODOS: Segmentos de las paredes intestinales les fueron extirpados a ocho niños con EH; tres controles y dos niños con MAR fueron inmunoteñidos con anticuerpo primario c-kit. Se contaron las células con características de CIC. RESULTADOS: Los tres controles y los dos niños con MAR presentaban una distribución densa de CICs. La mayor parte de los niños (6/8; 75%) con EH tuvieron conteos marcadamente reducidos de intestino agangliónico. Dos niños (25%) también tuvieron una disminución de intestino gangliónico. Entre las influencias posibles se cuentan la edad y el género del paciente así como el nivel de intestino seccionado. CONCLUSIÓN: El análisis de esta muestra sugiere que la inmunotinción para células c-kit positivas podría ser un útil test de pesquisaje a la hora de evaluar desórdenes en la motilidad intestinal. Los efectos posibles de la edad, el género y el nivel de intestino muestreado, están pendientes de determinación.