Ewing's sarcoma in adolescents and adults - 10-year experience from a tertiary cancer center in India.

BACKGROUND: Ewing's sarcoma (EWS) is an aggressive small round cell tumor, affecting bone and soft tissues and is mostly seen in childhood and second decade of life. EWS accounts for 10-12% of bone tumors in more than 15 years age group and is even rarer after 40 years of age. MATERIALS AND METHODS: This retrospective analysis was conducted among patients aged more than 15 years with histologically proven EWS. RESULTS: Among 240 cases of EWS treated at our center during 2001-2010, 130 (54%) were more than 15 years of age. The median age was 20 years with a male: female ratio of 2.4:1. Ninety percent had skeletal EWS, 10% had extra skeletal EWS, and 37% patients were metastatic at presentation. Eighty-two received curative treatment with chemotherapy (vincristine, doxorubicin, cyclophosphamide, ifosfamide, etoposide (VAC/IE)) along with local treatment, radiotherapy (RT) in 61, surgery alone in seven, and RT plus surgery in 14. Two- and 5-year overall survival (OS) was 43.3% and 25.5%, respectively, for the entire series. The OS for the non-metastatic group was 63.2% at 2 years and 36.5% at 5 years, and the progression free survival was 53.7% at 2 years and 37.8% at 5 years. High lactate dehydrogenase was found to be a significant poor prognostic factor (P = 0.001). Median OS for localized central EWS was 49.2 months and that for peripheral EWS was 24 months. Patients more than 20 years of age with non-metastatic disease had better OS compared to those with 15-20 years of age. CONCLUSION: Treatment of EWS requires a multidisciplinary approach with radical surgery and/or radiation to control local disease and multiagent chemotherapy to control systemic disease. Long-term follow-up is essential because of disease relapse and treatment-related complications.

Are Mindfulness and Mind-Wandering Opposite Constructs? It Depends on How Mindfulness is Conceptualised.

This study investigated if trait mindfulness and its components, mindful attention, acceptance, and non-judging correlate negatively with self-reported and indirect markers of mind-wandering. The 552 participants of the study completed an anonymous online questionnaire consisting of trait mindfulness and mind-wandering scales. They also completed the computer-based Sustained Attention to Response Task (SART), an objective measure of mind-wandering. The total mindfulness score and acceptance and non-judging subscale scores were strongly negatively correlated with both self-reported trait mind-wandering (TMW) and SART indices of mind-wandering. In contrast, attention was significantly positively correlated with both. These findings suggest that trait mindfulness conceptualised as a multi-component construct, but not a uni-component one, is probably an opposing construct to trait mind-wandering. Furthermore, mindfulness and its components, acceptance and non-judging, are associated with a reduction in the more common form of SART errors. However, only the acceptance component made a unique contribution to the variance in TMW and SART performance. Therefore, it is advisable for researchers to specify whether they investigated mindfulness as a uni-component or multi-component construct. Furthermore, it would be beneficial if future research investigates the relationship of mindfulness and its components with mind-wandering further by also incorporating a measure of state mindfulness.

Effective control of Leptosphaeria maculans increases importance of L. biglobosa as a cause of phoma stem canker epidemics on oilseed rape.

BACKGROUND: Phoma stem canker is a damaging disease of oilseed rape caused by two related fungal species, Leptosphaeria maculans and L. biglobosa. However, previous work has mainly focused on L. maculans and there has been little work on L. biglobosa. This work provides evidence of the importance of L. biglobosa to stem canker epidemics in the UK. RESULTS: Quantification of L. maculans and L. biglobosa DNA using species-specific quantitative PCR showed that L. biglobosa caused both upper stem lesions and stem base cankers on nine oilseed rape cultivars in the UK. Upper stem lesions were mainly caused by L. biglobosa. For stem base cankers, there was more L. maculans DNA than L. biglobosa DNA in the susceptible cultivar Drakkar, while there was more L. biglobosa DNA than L. maculans DNA in cultivars with the resistance gene Rlm7 against L. maculans. The frequency of L. biglobosa detected in stem base cankers increased from 14% in 2000 to 95% in 2013. Ascospores of L. biglobosa and L. maculans were mostly released on the same days and the number of L. biglobosa ascospores in air samples increased from the 2010/2011 to 2012/2013 growing seasons. CONCLUSION: Effective control of L. maculans increased infection by L. biglobosa, causing severe upper stem lesions and stem base cankers, leading to yield losses. The importance of L. biglobosa to phoma stem canker epidemics can no longer be ignored. Effective control of phoma stem canker epidemics needs to target both L. maculans and L. biglobosa. © 2022 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Assessment of Out of Pocket Expenditure and associated factors for availing COVID-19 vaccination by the beneficiaries in Bengaluru: South India

BackgroundGovernment of India has introduced COVID 19 vaccination in Jan 2021. There are no studies on out of pocket expenditure in COVID-19 vaccination in India, hence this study was undertaken to estimate the out of pocket expenditure for availing COVID 19 vaccine, to assess the factors associated with out of pocket expenditure for COVID vaccination and adverse events following immunisation. MethodsThis is a cross-sectional study conducted during Sep 2021-Dec 2021 of a medical college. A total of 438 study subjects above 18 years fulfilling inclusion and exclusion criteria were studied using probability proportional to population size. Data was collected using interview method by pre-tested semi structured proforma and analysed using descriptive & inferential statistics. ResultsThe mean direct cost in Government vaccination centre was 3.24{+/-} 6.74 INR, indirect cost 809.10{+/-}1076.35 INR, total cost was 812.34 {+/-}1079.49 INR.The mean direct cost in private vaccination centre was 1446.9{+/-}1845.65 INR, indirect cost 1140{+/-}1398 INR and total cost was 2586.90{+/-}2241.54 INR. The mean total cost was OOPE for COVID 19 vaccination was 852.80 {+/-}1128.512 INR, out of which direct cost was only 36.17({+/-}359.20). The higher mean OOPE was found in loss of wages 670.02 INR. The factors associated with higher out of pocket expenditure was type of vaccine (P=0.031, OR=2.141, 95% CI=1.07-4.24) occupation of the study subject (P=0.000, OR=2.043, 95% CI= 1.37-3.03), reported stress following vaccination (P= 0.018, OR=1.72, 95%CI=1.098-2.703), adverse event within 48hrs (P=0.006, OR=2.125, 95% CI= 1.248-3.62), received any medication for adverse event (P=0.041, OR= 1.721, 95% CI= 1.022-2.84) ConclusionMajority of the study subjects utilized public facility. The higher mean out of pocket expenditure was for indirect cost loss of wages. This study shows that type of vaccine, occupation of the study subject and adverse event within 48 hrs, had 2 times higher out of pocket expenditure compared to other factors. Among the AEFI, fever was the most common, followed by pain at the injection site and myalgia.

Cardiac involvement in hospitalized patients with COVID-19 and its incremental value in outcomes prediction.

Recent reports linked acute COVID-19 infection in hospitalized patients to cardiac abnormalities. Studies have not evaluated presence of abnormal cardiac structure and function before scanning in setting of COVD-19 infection. We sought to examine cardiac abnormalities in consecutive group of patients with acute COVID-19 infection according to the presence or absence of cardiac disease based on review of health records and cardiovascular imaging studies. We looked at independent contribution of imaging findings to clinical outcomes. After excluding patients with previous left ventricular (LV) systolic dysfunction (global and/or segmental), 724 patients were included. Machine learning identified predictors of in-hospital mortality and in-hospital mortality + ECMO. In patients without previous cardiovascular disease, LV EF < 50% occurred in 3.4%, abnormal LV global longitudinal strain (< 16%) in 24%, and diastolic dysfunction in 20%. Right ventricular systolic dysfunction (RV free wall strain < 20%) was noted in 18%. Moderate and large pericardial effusion were uncommon with an incidence of 0.4% for each category. Forty patients received ECMO support, and 79 died (10.9%). A stepwise increase in AUC was observed with addition of vital signs and laboratory measurements to baseline clinical characteristics, and a further significant increase (AUC 0.91) was observed when echocardiographic measurements were added. The performance of an optimized prediction model was similar to the model including baseline characteristics + vital signs and laboratory results + echocardiographic measurements.

Spotlight on itolizumab in the treatment of psoriasis - current perspectives from India.

Psoriasis is a chronic, debilitating, immune-mediated, systemic inflammatory disease affecting mainly skin, nails, and joints. Several therapeutic modalities are available depending on the severity of the disease. Long-term use of these drugs results in unwanted effects and toxicities. Recently, itolizumab, a humanized monoclonal immunoglobulin G1 antibody to CD6, has shown appreciable clinical effects and safety profile in patients with moderate-to-severe chronic plaque psoriasis. A literature search was conducted using the keywords "anti-CD6", "psoriasis", "phase trials", "case series", and "case reports". The data from all studies conducted in India on efficacy of itolizumab in psoriasis and published before September 2017 were collected. This article provides an overview of the clinical data obtained in these published articles. Itolizumab has immunomodulatory and anti-inflammatory effects. It is efficacious and provides a good duration of remission, and hence represents a new biological agent that could be added to the therapeutic armamentarium of psoriasis.

Coronary Artery Fistula.

Coronary artery fistulae are rare abnormalities of the coronary arteries that are usually discovered incidentally on coronary angiogram. Most patients remain asymptomatic, and significant hemodynamic consequences are rarely observed. The following report describes the case of a patient presenting with symptoms of congestive cardiac failure due to multiple coronary artery fistulae.

Doppler Echocardiography for the Estimation of LV Filling Pressure in Patients With Mitral Annular Calcification.

OBJECTIVES: This study sought to identify Doppler parameters useful for the assessment of left ventricular filling pressure (LVFP) in patients with mitral annular calcification (MAC) and to develop and validate a decision algorithm for assessing LVFP in such patients. BACKGROUND: Predicting LVFP in the presence of MAC is problematic. METHODS: Prospectively, 50 patients with MAC (mean 72 ± 11 years of age) underwent a complete Doppler echocardiographic study and right or left heart catheterization. Standard and nonstandard parameters of ventricular filling and relaxation were correlated with LVFP. Classification and regression tree analysis was used to develop a decision tree for prediction of LVFP. Validation was performed prospectively using an additional cohort with MAC and invasive hemodynamics (n = 21). RESULTS: In the initial study group, 26 patients had mild MAC, and 24 had moderate or severe MAC. Mean LVFP was 17.0 ± 8.1 mm Hg (range 4 to 50 mm Hg). Of the variables tested, the best predictor of LVFP was the ratio of early-to-late diastolic filling velocity (mitral E/A) (r = 0.66; p < 0.001). This finding was observed in subjects with mild as well as moderate-to-severe MAC. Importantly, the ratio of early diastolic filling velocity-to-mitral annulus velocity (E/e') demonstrated weak correlation (r = 0.42; p = 0.003). A clinical algorithm using mitral E/A and isovolumic relaxation time (IVRT) was associated with good specificity (100%) and positive predictive value (100%), and moderate sensitivity (81%) and negative predictive value (67%) for high LVFP. Validation of the clinical algorithm in a separate prospective cohort yielded a diagnostic accuracy of 94%. CONCLUSIONS: The E/e' ratio should not be used to estimate LVFP in subjects with significant MAC. However, mitral E/A ratio and IVRT are useful predictors of LVFP in this patient population. The proposed decision algorithm combining these Doppler parameters is accurate in estimating LVFP in patients with MAC.

Noncompaction cardiomyopathy: The role of advanced multimodality imaging techniques in diagnosis and assessment.

Noncompaction cardiomyopathy (NCCM) is a unique cardiomyopathy with a diverse array of genotypic and phenotypic manifestations. Its hallmark morphology consists of a bilayered myocardium with a compact epicardial layer and prominent trabeculations that comprise the noncompacted endocardial layer. The controversial diagnostic criteria for NCCM have been frequently discussed in the literature. This review touches on those diagnostic criteria, delves further into the evolving use of advanced imaging techniques within the major imaging modalities (echocardiography, computed tomography, and cardiac magnetic resonance imaging), and proposes an alternative algorithm incorporating these techniques for aiding with the diagnosis of NCCM.

Biomechanical characteristics of microimplant for anchorage in orthodontics: a 3D finite element model study.

In orthodontic treatment, anchorage control is essential for success. A recent development, stationary anchorage (micro- implants) eliminates one of the uncertainties of orthodontic tooth movement by offering absolute control over potentially undesirable counter movements. The objective of this study was to establish a 3D finite element model for microimplant and to analyze the influence of different angulations to the long axis of the teeth (30-90°) on the biomechanical characteristics of orthodontic anchorage implant-bone interface. Results of this study showed that largest stress and deformation was seen in the cortical bone and upper region of trabecular bone. Stress and deformation increased as the angulations of the implant to the long axis of the tooth increased. As the angulation of the implant to the long axis of maxillary 1st molar increased, stress and deformation also decreased. Maximum stress and displacement were recorded when implant was placed perpendicular to the long axis of maxillary 1st molar.