Assessment of Treatment Response after Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC) for Appendiceal Peritoneal Metastases.

Background The aim of this study was to analyse survival and surrogates for oncological response after PIPAC for appendiceal tumours. Methods This retrospective cohort study included consecutive patients with appendiceal peritoneal metastases (PM) treated in experienced PIPAC centers. Primary outcome measure was overall survival (OS) from the date of diagnosis of PM and from the start of PIPAC. Predefined secondary outcome included radiological response (RECIST criteria), repeat laparoscopy and peritoneal cancer index (PCI), histological response assessed by the Peritoneal regression grading system (PRGS) and clinical response. Results Final analysis included 77 consecutive patients (208 PIPAC procedures) from 15 centres. Median OS was 30 months (23.00-46.00) from time of diagnosis and 19 months (13.00-28.00) from start of PIPAC. 35/77 patients (45%) had ≥3 procedures (pp: per protocol). Objective response at PIPAC3 was as follows: RECIST: complete response 4 (11.4%), 11 (31.4%) partial/stable; mean PRGS at PIPAC3: 1.8 ± 0.9. Median PCI: 21 (IQR 18-27) vs. 22 (IQR 17-28) at baseline (p = 0.59); 21 (60%) and 18 (51%) patients were symptomatic at baseline and PIPAC3, respectively (p = 0.873). Median OS in the pp cohort was 22.00 months (19.00-NA) from 1st PIPAC. Conclusion Patients with PM of appendiceal origin had objective treatment response after PIPAC and encouraging survival curves call for further prospective evaluation.

Treatment Response After Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) for Peritoneal Metastases of Colorectal Originf.

The objective of this study is to analyze oncological outcomes of patients with peritoneal metastases (PM) of colorectal origin treated with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC). Background: PIPAC has been demonstrated to be a feasible and safe novel treatment for patients with PM of various origins. Only small series reports on survival after PIPAC by disease entity. Methods: International retrospective cohort study of consecutive patients with PM of colorectal origin. Outcome measures were overall survival (OS), radiological response according to Response Evaluation Criteria in Solid Tumors (RECIST), histological response (peritoneal regression grading score [PRGS]: complete response: 1-4: no response), change of peritoneal cancer index (PCI), and symptom control. Results: Seventeen eligible centers compiled 256 non-selected patients (mean age 61 [50.6-69.2], 43% female) and 606 procedures. Sixty-three percent were treated after 2 lines of chemotherapy, median PCI at PIPAC1 was 18 (interquartile range [IQR] = 10-27). Median OS was 19.00 months (IQR = 12.9-29.8) from diagnosis and 9.4 months (IQR = 4.5-16.8) from PIPAC1. One hundred and four of 256 patients (40.6%) had ≥3 procedures (per protocol [pp]) with the following outcomes at PIPAC3: RECIST: 59.3% partial response/stable, 40.7% progression; mean PRGS: 2.1 ± 0.9. Median PCI was 21 (IQR = 15-29) at baseline and 20 (IQR = 12-27) at PIPAC3 (P = 0.02). Fifty-six (54%) and 48 (46%) patients were symptomatic at baseline and PIPAC3, respectively (P = 0.267). Median OS for the pp cohort was 11.9 months (IQR = 10.7-15.0) from PIPAC1. Independent predictors for survival were radiological response (HR = 3.0; 95% CI = 1.6-5.7) and no symptoms (HR = 4.5, 95% CI = 2.2-9.1) at PIPAC3. Conclusions: Objective treatment response and encouraging survival were demonstrated after PIPAC for colorectal PM. Prospective registry data and comparative studies are now needed in to confirm these data.

Association of crossbite with vertical skeletal growth patterns: A retrospective study.

Crossbite is a type of malocclusion in which teeth are positioned more buccally or lingually than their corresponding opposing tooth in the upper or lower dental arch, resulting in a lateral mismatch of the teeth in the dental arches. Crossbite can be unilateral or bilateral, and it can be anterior or posterior. The link between crossbite and skeletal growth pattern remains uncertain. The current study aimed to find the prevalence of crossbite in subjects visiting a private dental hospital and evaluate if there is any association between crossbite and skeletal growth pattern. Data required for the study were procured from the dental information archiving software. The data were sorted and entered into an Excel spreadsheet. IBM SPSS software version 23 was used to conduct the statistical analysis. Graphs and tables were used to interpret the findings. the prevalence of crossbite was found to be 6.4%. Subjects with horizontal growth pattern commonly had crossbite, but no statistical significance (P = 0.07), standard deviation (1.011), was noted. There was no statistically significant association between different skeletal growth patterns however subjects with horizontal growth pattern reported more commonly with crossbite.

Drug utilization pattern and factors associated with polypharmacy and excessive polypharmacy in geriatric medical out-patients at a rural health training centre in India.

CONTEXT: Multiple chronic illnesses associated with ageing population demands the role of polypharmacy. Drug utilization study in terms of description of drug use pattern in the geriatric patients aids in monitoring polypharmacy as well as to determine the factors contributing to it. OBJECTIVES: To analyse the drug utilization pattern in geriatric patients at a rural health training centre. SUBJECTS AND METHODS: A cross-sectional study was conducted in a rural health centre to assess the drug utilization pattern using the WHO core drug prescribing indicators. Polypharmacy was defined as usage of 5-8 drugs and excessive polypharmacy as intake of 10 or more drugs. The drugs were coded using Anatomical Therapeutical Chemical classification. Univariate and bivariate analysis were done using SPSS to present the data. RESULTS: Among 207 patients, 29.5% were on polypharmacy and 1.5% patients on excessive polypharmacy. About 75% of patients had one or more comorbid medical condition. A total number of 829 drugs were prescribed and the average number of drugs per prescription was 4.02. CONCLUSION: The drug utilization pattern analysis in the geriatric patients reveals deviation of the average number of drugs per prescription from the WHO standard recommendation. The most common comorbid condition among the geriatric patients was diabetes mellitus. This drug utilization study imparts knowledge about the use of polypharmacy, comorbidities and the pattern of commonly used drugs among the geriatric patients in rural area. Periodic assessment of the pattern of drug utilization in the elderly aids to improve the prescribing pattern and minimize patient harm.

Comparison of i-gel™ and laryngeal mask airway Classic™ in terms of ease of insertion and hemodynamic response: A randomized observational study.

CONTEXT: Laryngeal mask airway (LMA) Classic™ has an inflatable cuff while i-gel™ has a noninflatable cuff made of thermoplastic elastomer. AIMS: To compare ease of insertion, number, and duration of insertion attempts among the two device. Secondary objectives were to evaluate the hemodynamic response and SpO2 during device insertion and during maintenance of general anesthesia. SETTINGS AND DESIGN: This study was conducted as randomized observational study in a teaching hospital. SUBJECTS AND METHODS: One hundred American Society of Anesthesiologists I and II, patients posted for surgery under general anesthesia were divided in two groups of fifty each. LMA Classic™ and i-gel™. Ease of insertion, duration of insertion, hemodynamic data, and episodes of hypoxia during insertion, 1, 3 and 5 min for 30 min, during removal and 1 min after removal. STATISTICAL ANALYSIS USED: Descriptive analyses were expressed as a mean ± standard deviation. Independent t-test used for parametric data, Chi-square test for nonparametric data and hemodynamic data were analyzed using repeated measures ANOVA to find statistical difference within the groups. RESULTS: Devices were easy to insert, the mean duration of insertion attempts was 15.92 ± 1.62 s in the i-gel™ group, while it was 26.06 ± 5.12 s in the LMA Classic™ group, was statistically significant (P = 0.0001). CONCLUSIONS: Successful and shorter duration of insertion, with less hemodynamic response makes i-gel™ a suitable alternative to LMA Classic™ during general anesthesia.

DENVirDB: a web portal of dengue virus sequence information on Asian isolates.

DENVirDB is a web portal that provides the sequence information and computationally curated information of dengue viral proteins. The advent of genomic technology has increased the sequences available in the public databases. In order to create relevant concise information on Dengue Virus (DENV), the genomic sequences were collected, analysed with the bioinformatics tools and presented as DENVirDB. It provides the comprehensive information of complete genome sequences of dengue virus isolates of Southeast Asia, viz. India, Bangladesh, Sri Lanka, East Timor, Philippines, Malaysia, Papua New Guinea, Brunei and China. DENVirDB also includes the structural and non-structural protein sequences of DENV. It intends to provide the integrated information on the physicochemical properties, topology, secondary structure, domain and structural properties for each protein sequences. It contains over 99 entries in complete genome sequences and 990 entries in protein sequences, respectively. Therefore, DENVirDB could serve as a user friendly database for researchers in acquiring sequences and proteomic information in one platform.

Vitamin B12 deficiency & levels of metabolites in an apparently normal urban south Indian elderly population.

BACKGROUND & OBJECTIVES: There is no published literature on the extent of vitamin B12 deficiency in elderly Indians as determined by plasma vitamin B12 levels and methylmalonic acid (MMA) levels. Vitamin B12 deficiency is expected to be higher in elderly Indians due to vegetarianism, varied socio-economic strata and high prevalence of Helicobacter pylori infection. We therefore, studied the dietary habits of south Indian urban elderly population and measured vitamin B12, MMA red cell folate and homocysteine (Hcy) levels. METHODS: Healthy elderly urban subjects (175, >60 yr) were recruited. Detailed history, physical examination and neurological assessment were carried out. Food Frequency Questionnaire (FFQ) for dietary analysis for daily intake of calories, vitamin B12, folate and detailed psychological assessment for cognitive functions was carried out. Blood samples were analyzed for routine haematology and biochemistry, vitamin B12, red cell folate, MMA and Hcy. RESULTS: The mean age of the study population was 66.3 yr. Median values for daily dietary intake of vitamin B12 and folate were 2.4 and 349.2 µg/day respectively. Sixty two (35%) participants consumed multivitamin supplements. Plasma vitamin B12 level and the dietary intake of vitamin B12 was significantly correlated (P=0.157). Plasma vitamin B12 and Hcy were inversely correlated (P= -0.509). Red cell folate was inversely correlated with Hcy (P= -0.550). Significant negative correlation was observed between plasma vitamin B12 and MMA in the entire study population (P= -0.220). Subjects consuming vitamin supplements (n=62) had significantly higher plasma vitamin B12 levels, lower MMA levels and lower Hcy levels. There was no significant correlation between plasma vitamin B12, MMA, Hcy and red cell folate and any of the 10 cognitive tests including Hindi Mental Status Examination (HMSE). INTERPRETATION & CONCLUSIONS: Our study is indicative of higher vitamin B12 (2.4 µg/day) intakes in urban south Indian population. Thirty five per cent of the study population consumed multivitamin supplements and therefore, low plasma vitamin B12 levels were seen only in 16 per cent of the study subjects. However, MMA was elevated in 55 per cent and Hcy in 13 per cent of the subjects.

Evaluation of psychopharmacological effects of Clerodendrum phlomidis Linn. extract.

The methanolic extract of Clerodendrum phlomidis Linn. (MECP) leaves was evaluated for its psychopharmacological activities in several experimental models using Swiss albino mice and Wistar albino rats. The MECP was found to cause significant reduction in spontaneous activity, and decreases in exploratory behavioral profiles by the Y-maze and head dip test. It also showed reduction in muscle relaxant activity by rotarod, 30 degrees inclined screen and traction tests, as well as significantly potentiated the phenobarbitone sodium-induced sleeping time in the doses examined (200, 400 and 600 mg/kg body wt.). All the results were compared with respective controls for the evaluation of significance.