Clinicopathological Profile and 2 Year Relapse Rates of Non-Hodgkin's Lymphoma in Tertiary Care Center.

The aim and objectives are to study clinicopathological profiles and 2-year relapse rates of Non-Hodgkin lymphoma,Material :This prospective observational study was conducted from Jan 2017 to May 2021. All newly diagnosed patients of NHL were enrolled and received a CHOP±R regimen for 6 cycles as per B-cell or T-cell lineage. The data was and analyzed using spss software. Observation: A total of 50 patients were enrolled and followed for 2 years. The median age of presentation was 44.62±15.92. Commonest clinical presentation was lymphadenopathy (46%), followed by B symptoms (32%). Commonest clinical sign was lymph node enlargement (52%). The commonest extranodal presentation was hepatomegaly (22%) and splenomegaly (22%). On peripheral blood smear, macrocytic hypochromic anemia (12%) was the commonest presentation. CT Scan showed, nodal involvement in 86% with generalized lymphadenopathy in (40%) cases. Extranodal involvement was seen in 50%. WB PET showed nodal involvement in (90%), and extranodal involvement in 70%. PET scan (90%) was a little more sensitive for detecting lymph node involvement over CT scan (86%). On lymph node biopsy, the most common subtype was B cell NHL (84.84%) and the commonest histopathological subtype was diffuse large cell B cell lymphoma. Biopsy from the extranodal site shown B cell NHL in (93.33%). The commonest histopathological subtype was DLBCL (18%). On marrow examination and biopsy, 88% were B cell type and the commonest type was DLBCL (62%). The commonest treatment-related toxicity was febrile neutropenia (44%). At 6 months, 30% were having clinical active disease and PET imaging revealed radiologic disease activity in 32 %. At 12 months, 14% were having clinical disease, and radiologic disease activity in 14%. At 18 months, 5% were having clinical disease, and radiologic disease activity in 10%. At 24 months, 14% were having clinical disease, and radiologic disease activity in 14%. At the end of the study period, 78 % were in remission, 10% cases in relapse, 6% cases had progressive disease and 6% of cases expired. Conclusion: This study found 02-year survival post standard chemotherapy in NHL cases was 88%. The relapse rate at 24 months was 14%. The B symptoms were seen less commonly, and bulky disease was noted in one-third of cases. The role of PET in diagnosing and follow up on these cases was good but it was comparable with CT scan.

The Safety and Long-Term Efficacy of Carotid Artery Stenting: An All-Comers Registry.

Background Carotid artery stenting (CAS) has emerged as a less invasive alternative to carotid endarterectomy (CEA) for the prevention of future cerebrovascular events in patients with carotid artery stenosis. Despite multiple randomized controlled trials (RCTs) comparing CAS and CEA for carotid disease, real-world data outside the rigorous environment of trials is scarce. Methods The present study is a prospective observational study conducted at a tertiary care center, wherein all patients who underwent CAS between January 2007 and December 2019 were included. All patients were followed up for one year of the last enrolled patient at an interval of one, six, and 12 months and then yearly thereafter. The primary composite outcome was defined as a combination of periprocedural (until 30 days of procedure) major adverse cardiac and cerebrovascular events (MACCEs) and the long-term incidence of ipsilateral stroke. The secondary outcome included the rate of restenosis. Results A total of 115 patients (86 males and 29 females) (147 lesions) who underwent CAS between 2007 and 2019 were followed up for a median of 80.5 months. Seventy-seven (67.27%) patients were symptomatic, and 38/115 (33%) were asymptomatic. Periprocedural MACCEs were noted in six patients, and four patients had ipsilateral stroke on long-term follow-up; hence, the primary composite outcome was observed in 10 (8.7%) patients. Higher age was found to be significantly associated with the primary composite outcome (p-value = 0.005). Five (4.34%) patients were lost to follow-up, while four (3.48%) patients developed restenosis. Conclusion CAS is a safe and less invasive intervention in patients with significant carotid artery stenosis and is equally effective in preventing future strokes. The incidence of primary outcome rises with an increase in age.

Association of ischemic electrocardiographic changes in high-altitude areas with coronary angiography.

BACKGROUND: Soldiers native to lowlands, while sojourning at high altitude (HA), are referred to tertiary care centers with electrocardiographic (ECG) abnormalities. Exposure to HA may precipitate myocardial ischemia in subjects with underlying coronary artery disease (CAD). Conversely, it may produce physiological ECG changes mimicking those of CAD, causing a diagnostic dilemma. This study sought to correlate the presence of CAD on coronary angiography (CAG) with a putative diagnosis of CAD based on clinical findings and ECG. METHODS: A prospective study was conducted on patient's from HA areas, referred for evaluation for CAD to a single center at near-sea-level. Thirty-five minimally symptomatic/asymptomatic soldiers with ECG changes suggestive of CAD, underwent CAG. Correlation was sought between ECG and CAG evidence of CAD. RESULTS: The association of CAD on CAG with clinical and ECG diagnosis of CAD was not significant, 4 of the 35 soldiers (11.4%) showing CAG evidence of CAD (chi square 3.849, p = 0.697). The association between symptoms and coronary artery lesions was, also, not significant, only four of twenty-three (17.4%) minimally symptomatic subjects having CAD on CAG. CONCLUSION: Insignificant numbers of previously healthy persons, who present with minimal symptoms and ECG changes suggestive of CAD while sojourning at HA, have coronary artery involvement on CAG. Those with incidental ECG changes, without symptomatology, do not have CAD on CAG.

Ecosystem health status and trophic modeling of an anthropogenically impacted small tropical estuary along India's west coast.

The tropical estuaries are characterized with high biological production and also impacted by anthropogenic activities. Describing these estuaries in terms of ecological data and trophic dynamics to reveal the ecological impacts is gaining attention recently. In this study, the ecological structure is analyzed for a heavily impacted small macrotidal tropical estuary, Ulhas river estuary (URE), situated near Mumbai megacity in the western coast of India, to delineate the impact of anthropogenic stressors on the ecosystem functioning. The URE is being exploited for sand and fisheries resources, and also faces risks from anthropogenic activities. The ecological data of URE were compiled for 2017-18 together with the most relevant literature estimates to construct an ecosystem model. A trophic organization in 20 functional groups was identified for URE using Ecopath modeling approach. The functional groups identified in the food web ranged from detritus and primary producers (trophic level (TL) = 1) to large pelagics (TL = 4.14). Detritivory: herbivory ratio (1.35) indicated that the detritus chain is dominant over the primary producer's chain. The total system throughput (TST) was estimated as 16 736.2 t km-2year-1. The indices such as net system production (NSP = 1 398.781 t km-2 year-1), total primary production/total biomass (TPP/TB = 25.17), biomass/total system throughput (TB/TST = 0.01), recycling index (Finn's Cycling Index = 13.94%), system omnivory index (0.3), relative ascendency (25.6%), and system overhead (74.4%) classified URE as an immature system. The eco-exergy index (30748.54 gm detritus equivalent m-2) showed that the ecosystem is a moderately stable and relatively less organized network. The estuarine fish community index (EFCI) yielded a value of 38 indicating the poor health status of the fish community in URE. The study delivers a comprehensive understanding of the ecosystem setting in URE and characterizes the prevailing condition. The ecological indicators analyzed here point towards a medium to a high level of impact in URE due to anthropogenic activities.

Comparative study of extended versus short term thromboprophylaxis in patients undergoing elective total hip and knee arthroplasty in Indian population.

BACKGROUND: Postoperative thromboprophylaxis with low molecular weight heparin (LMWH) for an extended period of 4 weeks is now preferred over short term thromboprophylaxis in patients undergoing total hip/knee arthroplasty (THA/TKA). However, most of the data demonstrating the efficacy and safety of extended thromboprophylaxis and short term thromboprophylaxis is from clinical trials done in the West. In India, the data of the incidence of venous thromboembolism (VTE) following THA/TKA has been conflicting and the duration has not been clearly defined. The aim of the study was to evaluate and compare the efficacy of extended thromboprophylaxis over short term thromboprophylaxis in Indian patients undergoing elective THA/TKA surgeries. MATERIALS AND METHODS: A prospective arm of 197 consecutive patients undergoing elective THA/TKA surgeries who were administered extended thromboprophylaxis for 4 weeks was compared with a historical group of 795 patients who were administered short term thromboprophylaxis for only 7-11 days. In both groups, LMWH (enoxaparin) was used in a dose of 40 mg subcutaneously, in addition to mechanical thromboprophylaxis. Primary efficacy endpoint was objectively confirmed venous thromboembolism (VTE). The presence of DVT was confirmed by a combination of pretest scoring, D-dimer, and Color Doppler Flow Imaging (CDFI) of deep veins of the legs, and pulmonary thromboembolism (PTE) was confirmed by ventilation perfusion (V/Q) scan or pulmonary angiography. Fisher's exact test and t test were used for the statistical analysis. The baseline confounding factors were compared between the two groups using t test for comparing the means for continuous data and Fisher's exact test for categorical data. RESULTS: In the prospective arm, only 1 patient developed symptomatic PTE compared to 26 (3.27%) cases of VTE (20 cases of PTE and 6 cases of DVT) in the retrospective group. CONCLUSION: Extended thromboprophylaxis (for 4 weeks) was found to be more effective than short term thromboprophylaxis in minimizing the risk of postoperative VTE in patients who underwent THA/TKA.