An eco-epidemiological analysis of dengue outbreak in Port Blair, South Andaman Island, India.

BACKGROUND OBJECTIVES: In Port Blair, the capital of Andaman & Nicobar Islands, in the Bay of Bengal, India, there was a sudden increase in fever cases resembling the symptoms of dengue in the monsoon period of 2022. Hence, an investigation was carried out to find out epidemiological and entomological reasons behind the outbreak. METHODS: An entomological survey was carried out in 24 wards of Port Blair Municipal Council (PBMC) area, epidemiological data of last six years (January-December 2017-2021 and January-October 2022) and patient details of the year 2022 were collected. Both the epidemiological and entomological data were analyzed concerning time and place. RESULTS: During this outbreak period tyres (22.4%) came out as a major breeding habitat followed by small discarded materials (17.5%), metal drums (15.3%), and plastic drums (11.7%). In rainy season, peri-domestic breeding (55%) was more than the domestic breeding (45%) habitat. Ae. aegypti had a high preference for indoor large containers (100-1000 L) like plastic tank, metal drum and cement tank whereasAe. albopictus prefers to breed in medium sized plastic container (20-100 L) and outdoor water receptacles like tyres, flower pots, and domestic discarded materials. INTERPRETATION CONCLUSION: By source reduction, indoor space spray and outdoor fogging, vector density was controlled which curtailed the transmission and within eight weeks a decreasing trend of dengue cases was noticed. A regular entomological survey is crucial to know the seasonality and key breeding habitats of the vector for proper planning of vector control.

Quality Assurance in Radiotherapy (RT)-Specific Trials: Indian Scenario.

AIMS: There is evidence that proper radiotherapy trial quality assurance (RTTQA) translates into improved outcomes for patients. However, the practice of RTTQA is heterogeneous and implemented in a diverse manner across trials. In this paper, we review the RTTQA report for randomised trials (RCT) conducted in India and present our experience with RTTQA for various clinical trials and highlight the key achievements and challenges. MATERIALS AND METHODS: Search was performed using the keywords and the variations thereof for "radiotherapy" and author affiliations from India, its states and major metropolitan cities. Pubmed search filters were used to restrict results to RCT published in the past 5 years (2019-2024). Reporting of RTTQA procedures from publications and protocols was documented along with the protocol-specified dosimetric goals. We also evaluated a few clinical trials performed in the Department of Radiation Oncology at Tata Medical Center. The different RTTQA procedures and results for four representative clinical trials have been described. RESULTS: A formal RTTQA process was reported by only one out of 24 randomised controlled trials and formal dosimetric goals were pre-specified by 9 of 13 trials where IMRT was used as treatment. RTTQA requirements were tailored for each clinical trial at Tata Medical Center. For the HYPORT trial, the RTTQA process focused on ensuring the matchline doses were homogenous. HYPORT B trial commissioned the use of a simultaneous integrated boost technique which emphasised conformal avoidance of dose spillage to contralateral breast and lung. HYPORT Adjuvant and PROPARA trials are multicentre clinical trials. While HYPORT Adjuvant focussed on ensuring that the dose delivery met the predefined constraints, segmentation of the target volume was important for the PROPARA trial. CONCLUSION: We demonstrate different RTTQA procedures required for representative clinical trials and highlight key challenges encountered.

An eco-epidemiological analysis of Dengue outbreak in Port Blair, South Andaman Island, India, during 2022.

BACKGROUND OBJECTIVES: In Port Blair, the capital of Andaman & Nicobar Islands, in the Bay of Bengal, there was a sudden increase in fever cases resembling the symptoms of dengue in the monsoon period of 2022. Hence, an investigation was carried out to find out both epidemiological and entomological reasons behind the outbreak. METHODS: An Entomological survey was carried out in 24 wards of Port Blair Municipal Council (PBMC) area, epidemiological data of last six years (January to December of 2017-2021 & January to October of 2022) and patient details of the year 2022 were collected. Both the epidemiological and entomological data were analyzed concerning time and place. RESULTS: During this outbreak period tyres (22.4%) came out as a major breeding habitat followed by small discarded materials (17.5%), metal drums (15.3%), and plastic drums (11.7%). In rainy season peri-domestic breeding (55%) was more than the domestic breeding (45%) habitat. Ae. aegypti had a high preference for indoor large containers (100-1000 L) like plastic tank, metal drum and cement tank whereas Ae. albopictus prefers to breed in medium sized plastic container (20-100 L) and outdoor water receptacles like tyres, flower pots, domestic discarded materials etc. INTERPRETATION CONCLUSION: By source reduction, indoor space spray and outdoor fogging vector density was controlled which curtailed the transmission and within 8 weeks decreasing trend of dengue cases were noticed. A regular entomological survey is very important to know the seasonality and key breeding habitats of the vector for proper planning of vector control.

Normal and Delayed Fracture Healing: Symphony and Cacophony.

The incidence of any fracture in the US is estimated to be 2 704 fractures per 100,000 person-years. Approximately 10 percent of these fractures develop complications of healing. The processes that occur during fracture healing mimic the processes that take place in the growth plate during development. The study of fracture healing represents a window to enhance our understanding of the processes of growth and development of bones and its reparative biology. This review is aimed for clinicians evaluating non-unions as an overview of different factors that inhibit fracture healing.

Note: control of liquid helium supply to cryopanels of Kolkata superconducting cyclotron.

The Kolkata superconducting cyclotron utilises liquid helium to cool the main magnet niobium-titanium (NbTi) coil and the cryopanels. Three liquid helium cooled cryopanels, placed inside the dees of the radio-frequency system, maintain the high vacuum in the acceleration region of the superconducting cyclotron. The small cryostat placed inside the cryogenic distribution manifold located at the basement of the superconducting cyclotron building supplies liquid helium in parallel branches to three cold heads, used for cooling their associated cryopanels. The level in the cryostat has to be maintained at an optimum value to ensure uninterrupted flow of liquid helium to these three cold heads. This paper describes the transfer function of the overall system, its tuning parameters, and discusses the actual control of cryostat level by using these parameters.

Efficacy of radical radiotherapy alone for functional preservation of larynx in laryngeal carcinoma: a retrospective analysis.

PURPOSE: Concurrent chemoradiation is the current standard of care in locally advanced head and neck cancer. But, in our setup, many patients of carcinoma larynx are treated with only radical radiotherapy because of poor general condition of the patients. This study was performed to assess the influence radical radiotherapy alone on functional preservation of larynx. MATERIALS AND METHODS: 110 previously untreated patients with invasive squamous cell carcinoma of larynx were treated with radical radiotherapy alone between January 2006 and June 2009. Conventional one daily fraction of 2 Gy with total doses of 60-66 Gy was used. Voice preservation and local control at median follow-up period of 2 years were analyzed. Several host, tumor, and treatment parameters were also analyzed. RESULTS: Among 110 patients, preservation of larynx was possible in 78 patients (71%). With radical radiotherapy alone, excellent preservation of larynx was achieved in stage I (88.9%) and stage II (75%) disease, while in advanced stages, results were not so encouraging. In stage III and stage IVA, larynx preservation was only 72.4% and 65.3%, respectively. Patients without any cartilage invasion had significantly better laryngeal preservation rate as compared to patients with cartilage invasion. (78.9% vs. 35.3%; P = 0.008). CONCLUSION: Though concurrent chemoradiation is the standard of care in preservation of voice in laryngeal cancer, definitive radiotherapy alone may also be a good option in terms of preservation of larynx in patients of laryngeal cancer in community practice in the developing world where most of the patients cannot tolerate concurrent chemoradiation.

Adherence to oral bisphosphonates and the risk of subtrochanteric and femoral shaft fractures among female medicare beneficiaries.

UNLABELLED: Previous studies have shown an association between duration of bisphosphonate use and atypical femur fractures. This cohort study showed an increasingly higher risk of subtrochanteric and femoral shaft fractures among those who were more adherent to oral bisphosphonates. INTRODUCTION: Long-term use of oral bisphosphonates has been implicated in an increased risk of atypical femur fractures located in subtrochanteric and femoral shaft regions. Another measure of drug exposure, medication adherence, however, has not been investigated. METHODS: Among all Medicare fee-for-service female beneficiaries from 2006-2010, we followed 522,287 new bisphosphonate users from their index prescription until being censored or having a primary diagnosis of closed subtrochanteric/femoral shaft or intertrochanteric/femoral neck fractures. Data about radiographs of fracture site and features were not available. Adherence was classified according to the medication possession ratio (MPR) as the following: MPR < 1/3 as less compliant, MPR ≥ 1/3- < 2/3 as compliant, and MPR ≥ 2/3 as highly compliant. Alternative cutoff points at 50 and 80% were also used. Survival analysis was used to determine the cumulative incidence and hazard of subtrochanteric/femoral shaft or intertrochanteric/femoral neck fractures. RESULTS: There was a graded increase in incidence of subtrochanteric/femoral shaft fractures as the level of adherence increased (Gray's test, P < 0.001). The adjusted hazard ratio (HR) for the highly compliant vs. the less compliant was 1.23 (95% Confidence Interval [CI] 1.06-1.43) overall, became significant after 2 years of follow-up (HR = 1.51, 95% CI 1.06-2.15) and reached the highest risk in the fifth year (HR = 4.06, 95% CI 1.47-11.19). However, age-adjusted incidence rates of intertrochanteric/femoral neck fractures were significantly lower among highly compliant beneficiaries, compared to less compliant users (HR = 0.69, 95% CI 0.66-0.73). Similar results were obtained when the cutoff points for being compliant and highly compliant were set at 50 and 80 %, respectively. CONCLUSIONS: Subtrochanteric/femoral shaft fractures, unlike intertrochanteric/femoral neck fractures, are positively associated with higher adherence to long-term (≥3 years) oral bisphosphonates in the elderly female Medicare population.

Competing risk: An illustration with aspiration pneumonia in head and neck cancer patients undergoing radical radiotherapy: A biostatistician's perspective.

Interest in survival analysis is to look and capture the information about the occurrence of events, i.e., death. In human life different types of events may happen at the same time. Sometimes, few events completely interrupt or make subtle changes on the occurrence of an event of interest. The method to capture information about the specific event of interest along with other events is known as competing risk modeling. This paper is dedicated to explore the application of competing risk model in oncology practice. It is aimed in near future that more and more survival analysis will be performed through application of competing risk modeling instead of traditional survival analysis to generate robust statistical inference.

Factor inhibiting HIF (FIH-1) promotes renal cancer cell survival by protecting cells from HIF-1α-mediated apoptosis.

BACKGROUND: Clear cell renal cell carcinoma (CCRCC) is the commonest form of kidney cancer. Up to 91% have biallelic inactivation of VHL, resulting in stabilisation of HIF-α subunits. Factor inhibiting HIF-1 is an enzyme that hydroxylates HIF-α subunits and prevents recruitment of the co-activator CBP/P300. An important question is whether FIH-1 controls HIF activity in CCRCC. METHODS: Human VHL defective CCRCC lines RCC10, RCC4 and 786-O were used to determine the role of FIH-1 in modulating HIF activity, using small interfering RNA knockdown, retroviral gene expression, quantitative RT-PCR, western blot analysis, Annexin V and propidium iodide labelling. RESULTS: Although it was previously suggested that FIH-1 is suppressed in CCRCC, we found that FIH-1 mRNA and protein are actually present at similar levels in CCRCC and normal kidney. The FIH-1 inhibition or knockdown in the VHL defective CCRCC lines RCC10 and RCC4 (which express both HIF-1α and HIF-2α) resulted in increased expression of HIF target genes. In the 786-O CCRCC cell line, which expresses only HIF-2α, FIH-1 attenuation showed no significant effect on expression of these genes; introduction of HIF-1α resulted in sensitivity of HIF targets to FIH-1 knockdown. In RCC4 and RCC10, knockdown of FIH-1 increased apoptosis. Suppressing HIF-1α expression in RCC10 prevented FIH-1 knockdown from increasing apoptosis. CONCLUSION: Our results support a unifying model in which HIF-1α has a tumour suppressor action in CCRCC, held in check by FIH-1. Inhibiting FIH-1 in CCRCC could be used to bias the HIF response towards HIF-1α and decrease tumour cell viability.

Effect of DENA induced hepatocarcinogenesis on neuroendocrine levels in male rats.

Hepatocarcinogenesis was induced in Sprague Dawley rats by injecting diethylnitrosamine (DENA); 150 mg/kg body weight, ip, a well known liver carcinogen and a mutagenic agent. Concurrent with the induction of hepatocarcinoma, psychological stress was also elicited from the changes in brain neurotransmitters. Noradrenaline and dopamine, the neurotransmitters of sympathetic system were estimated from the whole brain and corresponding hormones T3, T4 and prolactin were estimated from the blood of such rats. The neuroendocrine cascade and the marker enzyme gamma glutamyl transferase were estimated at 7, 14, 21 and 30 weeks. A direct relationship between noradrenaline, T3 and T4 and a reciprocal relationship between dopamine and prolactin were observed, which may be correlated to the carcinogenic effect of DENA.

Admission Cardiotocography Screening of High Risk Obstetric Patients.

BACKGROUND: To predict the neonatal outcome in high risk obstetric cases by admission cardiotocography (CTG) testing. METHODS: A total of 150 consecutive high risk obstetric patients meeting the inclusion criteria were subjected to admission CTG testing in this prospective study. The CTG tracing was categorized based on Royal College of Obstetricians and Gynaecologists (RCOG) criteria. Specific foetal and neonatal outcome measures were studied and correlated with the admission CTG testing. RESULT: Foetal distress during labour developed in 15% of patients with a normal test and in 73% of patients with an abnormal test. The admission test had a sensitivity of 66.7%, specificity of 93.3% and a positive predictive value of 53.3% for predicting an Apgar score < 5 at birth. Neonatal admission to neonatal intensive care unit was required in 1% of patients with a normal test and 33% of patients with an abnormal test (p <0.01). CONCLUSION: The result of admission cardiotocography testing could be used to identify patients likely to develop adverse foetal outcomes and help in optimal utilization of labour room resources.

A study on the effects of diclofenac sodium and etoricoxib in the treatment of osteoarthritis.

Diclofenac sodium, a non-selective cyclo-oxygenase inhibitor and etoricoxib, a selective cyclo-oxygenase-2 inhibitor have been widely used in treatment of patients with osteo-arthritis. Five hundred and eighty-five patients with uncomplicated knee osteo-arthritis were randomly allocated into 3 equal groups and received either diclofenac sodium, etoricoxib or placebo in a double-blind manner. The response in both the drug groups was comparable and much more than placebo group. The study shows that etoricoxib provides better clinical efficacy and gastro-intestinal tolerability in osteo-arthritis in comparison to diclofenac sodium presumably due to the selective inhibition of cyclo-oxygenase-2 by etoricoxib.

Biocompatibility of diamond-like nanocomposite thin films.

Diamond-like nanocomposite (DLN) films consist of network structure of amorphous carbon and quartz like silicon. In the present work, DLN films have been synthesized on pyrex glass and subsequently, their biocompatibility have been investigated through primary and secondary cell adhesion, cytotoxicity, protein adsorption and murine peritoneal macrophage activation experiments. Variable degree of cell and protein response have been found based on variable film synthesis parameters but in overall, required biocompatibility has been established for all types of film-coating.

Management of Rh-isoimmunised Pregnancies : Our Experience.

BACKGROUND: The aim of this study was to assess the role of middle cerebral artery peak systolic velocity (MCA-PSV), as measured by doppler ultrasound, in detecting foetal anaemia in Rh- isoimmunised pregnancies. Intra-uterine foetal blood transfusion was performed in such anaemic foetuses to tide over the crisis of foetal immaturity till considered fit for extra-uterine survival. METHODS: Rh-isoimmunised pregnancies reporting to a tertiary institute from 2003 to 2005, were screened by doppler ultrasound to estimate MCA-PSV to detect foetal anaemia. If the foetus developed MCA-PSV of more than 1.5 multiple of median (MoM) for the gestational age, foetal blood sampling through cordocentesis was performed to confirm foetal anaemia, followed by intrauterine foetal blood transfusion to all anaemic foetuses at the same sitting. Neonatal outcome was evaluated by recording gestational age at the time of delivery, duration of gestational time gained and need for blood transfusion in the neonatal period. RESULTS: A total of thirteen isoimmunised pregnancies were evaluated. Three pregnancies did not require in-utero foetal blood transfusion. Twenty-one intrauterine foetal blood transfusions were performed in the remaining ten patients. Five received blood transfusion in the neonatal period. Intra uterine foetal death occurred in one grossly hydropic foetus and favourable neonatal outcome was recorded in the rest. CONCLUSION: The clinical outcome of these pregnancies justifies the use of doppler studies of MCA-PSV in detecting foetal anaemia and intra uterine foetal blood transfusion is the only hope of prolonging pregnancy and salvaging such foetuses.

Acute Abdomen in Gynaecological Practice.

Acute abdomen in pregnancy is due to consequence of pregnancy itself or is totally unrelated to pregnancy. During pregnancy, a woman is at an increased risk of acute abdomen due to various physiological changes. The article discusses the various conditions which can present as acute abdomen in women during pregnancy and in non-pregnant state. The clinician often has a difficult task in diagnosing and managing acute abdomen in pregnancy. Clinical evaluation is further confounded by various anatomical and physiological changes occurring in pregnancy. The growing gravid uterus too causes difficulty in detailed examination. The general reluctance to use conventional X-rays because of pregnancy should be set aside when faced with a seriously ill mother. A reluctance to operate during pregnancy adds unnecessary delay, which increases morbidity for both the mother and the fetus. Adnexal accidents should always be kept in mind in a woman with acute abdomen even if she is not pregnant. Such mistakes should be avoided as prompt diagnosis and appropriate therapy are crucial. A general approach to acute abdominal conditions in pregnancy is to manage these problems considering the risk to mother regardless of the pregnancy.

Synonymous codon usage in Lactococcus lactis: mutational bias versus translational selection.

In this study codon usage bias of all experimentally known genes of Lactococcus lactis has been analyzed. Since Lactococcus lactis is an AT rich organism, it is expected to occur A and/or T at the third position of codons and detailed analysis of overall codon usage data indicates that A and/or T ending codons are predominant in this organism. However, multivariate statistical analyses based both on codon count and on relative synonymous codon usage (RSCU) detect a large number of genes, which are supposed to be highly expressed are clustered at one end of the first major axis, while majority of the putatively lowly expressed genes are clustered at the other end of the first major axis. It was observed that in the highly expressed genes C and T ending codons are significantly higher than the lowly expressed genes and also it was observed that C ending codons are predominant in the duets of highly expressed genes, whereas the T endings codons are abundant in the quartets. Abundance of C and T ending codons in the highly expressed genes suggest that, besides, compositional biases, translational selection are also operating in shaping the codon usage variation among the genes in this organism as observed in other compositionally skewed organisms. The second major axis generated by correspondence analysis on simple codon counts differentiates the genes into two distinct groups according to their hydrophobicity values, but the same analysis computed with relative synonymous codon usage values could not discriminate the genes according to the hydropathy values. This suggests that amino acid composition exerts constraints on codon usage in this organism. On the other hand the second major axis produced by correspondence analysis on RSCU values differentiates the genes into two groups according to the synonymous codon usage for cysteine residues (rarest amino acids in this organism), which is nothing but a artifactual effect induced by the RSCU values. Other factors such as length of the genes and the positions of the genes in the leading and lagging strand of replication have practically no influence in the codon usage variation among the genes in this organism.