PSMA Avidity in the Heterotropic Ossification-An Incidental Finding on PSMA PET/CT.

ABSTRACT: The upregulations of prostate-specific membrane antigen (PSMA) antigen are used for the presence of prostate cancer. However, published literature shows incidentally detected PSMA uptake in various nonprostatic benign and malignant conditions, which led to questioning the specificity of PSMA-targeted PET. In present case, we highlighted the abnormal PSMA expression in the benign bone abnormality.

FDG PET-CT in Clinical Management of a Rare Case of Primary Hepatic Lymphoma: Role and Challenges.

The common differential diagnoses for multiple space-occupying hepatic lesions (SOL) are metastases, multifocal hepatocellular carcinoma, and abscess. Primary hepatic lymphomas are rare entities that present many challenges with regard to their management. Fluorodeoxyglucose positron emission tomography-computed tomography is extensively used for the staging and response assessment of lymphomas but it can be challenging and difficult to interpret in cases with isolated liver involvement. We hereby present the case of an 82-year-old lady who presented with multiple liver SOL.

Challenges in Cervical Cancer Prevention: Real-World Scenario in India.

Satinder KaurIn spite of global falling trends, cervical cancer remains a major healthcare challenge for India, South Asia Association for Regional Cooperation region, and other low- and middle-income countries. Our survey was to document the real-world challenges that still exist in India. A total of 316 eligible and complete responses to the 21 questions were analyzed. Screening of mothers and vaccinating their daughters was considered as the most important strategy to prevent cervical cancer by 65.8% (208/316). Screening was offered to all asymptomatic eligible females by 79% (250/316). Improvement in screening rates requires promoting the national program (67.7%; 214/316), strengthening existing infrastructure (62%; 196/316), regular training of primary healthcare workers (57.6%; 182/316), and increasing awareness among schools and colleges (57.9%; 183/316). Almost all responders (93%; 294/316) wanted to have human papillomavirus (HPV) vaccination included in the national immunization schedule. Cost of vaccine was considered a major roadblock. If it became available at INR 250 per dose, 96.8% (306/316) respondents would recommend it for all eligible patients. With the impending availability of this indigenous tetravalent HPV vaccine jointly produced by Department of Biotechnology, Govt of India and Serum Institute of India, the war against cervical cancer just got easier.

How do patients and physicians perceive immune thrombocytopenia (ITP) as a disease? Results from Indian analysis of ITP World Impact Survey (I-WISh).

PURPOSE: Immune thrombocytopenia (ITP) is primarily considered a bleeding disorder; its impact on patients' health-related quality of life (HRQoL) is under-recognized. We aimed to assess how aligned patient and physician perceptions are regarding ITP-associated symptoms, HRQoL, and disease management in India. METHODS: Patients and physicians (hematologists/hemato-oncologists) from India who participated in the global ITP World Impact Survey (I-WISh) were included in this subgroup analysis (survey). Physicians were recruited via a local, third party recruiter in India. In addition to completing a survey themselves, physicians were asked to invite consulting patients on a consecutive basis to complete a survey. All surveys were completely independently by the respondents online in English. The respondents took 30 min to complete the questionnaire. Patients also completed the newly developed ITP Life Quality Index (ILQI) that included 10 questions on the impact of ITP on the following: work or studies, time taken off work or education, ability to concentrate, social life, sex life, energy levels, ability to undertake daily tasks, ability to provide support, hobbies, and capacity to exercise. RESULTS: A total of 65 patients and 21 physicians were included in this study. Average disease duration from diagnosis-to-survey-completion was 5.3 years. The most severe symptoms reported by patients at diagnosis were menorrhagia (15 of 19 patients [79%]), anxiety surrounding unstable platelet counts (17 of 28 patients [61%]), and fatigue (27 of 46 patients [59%]); these were also the key symptoms they wanted to be resolved. In contrast, physicians perceived petechiae (19 of 21 patients [90%]), bleeding-from-gums (8 of 21 patients [86%]), and purpura (16 of 21 patients [76%]) as the most common symptoms. While the important treatment goals for patients were healthy blood counts (42 of 65 patients [65%]), improved QoL (35 of 65 patients [54%]), and prevention of worsening of ITP (33 of 65 patients [51%]), physicians' goals were reduction in spontaneous bleeding (17 of 21 physicians [81%]), better QoL (14 of 21 physicians [67%]), and symptom improvement (9 of 21 physicians [43%]). More than half the patients reported that ITP affected their work life/studies, social life, and energy levels, thereby negatively impacting their QoL. Patients were almost entirely dependent on family and friends for support. CONCLUSIONS: This survey highlights the substantial discrepancy in patients' and physicians' perceptions regarding ITP-associated symptoms and treatment goals in India. Based on the identified gaps, educating physicians on aspects of ITP beyond bleeding, and highlighting patients' under-recognized symptoms/needs through support-systems should be prioritized in the future.

A Randomized, Placebo-Controlled Study to Evaluate the Effect of Bio-Enhanced Turmeric Formulation on Radiation-Induced Oral Mucositis.

INTRODUCTION: Oral mucositis is the most common toxicity of chemoradiotherapy treatment of head and neck cancers. The present study was performed to evaluate the effect of a researched turmeric formulation on oral mucositis in patients receiving chemoradiotherapy for oral cancer. METHODS: This randomized double-blinded placebo-controlled trial included 60 patients with oral cancer who had undergone radical surgery. Patients were equally randomized into 3 arms. Bio-enhanced turmeric formulation (BTF) capsules (low dose [1 g/day] or high dose [1.5 g/day]) or placebo was administered daily for 6 weeks with concurrent chemoradiotherapy. Study endpoints included the impact of the treatment on chemoradiotherapy-induced oral mucositis along with dysphagia, oral pain, dermatitis, and weight loss. RESULTS: The incidence of grade 3 toxicity of oral mucositis, oral pain, dysphagia, and dermatitis was significantly lower in patients who received BTF than placebo. Twenty-five and 20% patients in BTF 1 g/day (p = 0.011) and 1.5 g/day (p = 0.004) arms, respectively, developed grade 3 oral mucositis compared to 65% patients in the placebo arm. Thirty-five and 30% patients in BTF 1 g/day (p = 0.027) and 1.5 g/day (p = 0.011) arms, respectively, developed grade 3 oral pain compared to 70% patients in the placebo arm. Twenty-five and 20% patients in BTF 1 g/day (p = 0.025) and 1.5 g/day (p = 0.010) arms, respectively, developed grade 3 dysphagia compared to 60% patients in the placebo arm. Ten and 5% patients in BTF 1 g/day (p = 0.114) and 1.5 g/day (p = 0.037) arms. respectively, developed grade 3 dermatitis compared to 30% patients in the placebo arm. Patients under BTF supplementation experienced significantly less weight loss and greater compliance with treatment than placebo. CONCLUSION: BTF (BCM-95®) can significantly reduce chemoradiotherapy-induced severe oral mucositis, dysphagia, oral pain, and dermatitis in oral cancer patients. TRIAL REGISTRATION: Clinical Trials Registry, India (Registration No. CTRI) (CTRI/2015/12/006413 dated December 4, 2015).

A randomized prospective study comparing acute toxicity, compliance and objective response rate between simultaneous integrated boost and sequential intensity-modulated radiotherapy for locally advanced head and neck cancer.

PURPOSE: Intensity-modulated radiotherapy (IMRT) provides higher dose to target volumes and limits the dose to normal tissues. IMRT may be applied using either simultaneous integrated boost (SIB-IMRT) or sequential boost (SEQ-IMRT) technique. The objectives of this study were to compare acute toxicity and objective response rates between SIB-IMRT and SEQ-IMRT in patients with locally advanced head and neck cancer. MATERIALS AND METHODS: Total 110 patients with locally advanced carcinoma of oropharynx, hypopharynx, and larynx were randomized equally into the two arms (SIB-IMRT vs. SEQ-IMRT). Patients in SIB-IMRT arm received dose of 66 Gy in 30 fractions, 5 days a week, over 6 weeks. SEQ-IMRT arm's patients received 70 Gy in 35 fractions over 7 weeks. Weekly concurrent cisplatin chemotherapy was given in both arms. Patients were assessed for acute toxicities during the treatment and for objective response at 3 months after the radiotherapy. RESULTS: Grade 3 dysphagia was significantly more with SIB-IMRT compared to SEQ-IMRT (72% vs. 41.2%; p = 0.006) but other toxicities including mucositis, dermatitis, xerostomia, weight-loss, incidence of nasogastric tube intubation and hospitalization for supportive management were similar in both the arms. Patients in SIB-IMRT arm showed better treatment-compliance and had significantly less treatment-interruption compared to SEQ-IMRT arm (p = 0.028). Objective response rates were similar in both the arms (p = 0.783). CONCLUSION: Concurrent chemoradiation with SIB-IMRT for locally advanced head and neck cancer is well-tolerated and results in better treatment-compliance, similar objective response rates, comparable incidence of mucositis and higher incidence of grade 3 dysphagia compared to SEQ-IMRT.

Farmer's participatory approach for breed improvement in Malpura sheep.

The objective of the study was to propose a model for a community-based breeding programme (CBBP) in Malpura sheep. The study was carried out for nine years (2012-2018) in 31 villages covering 77 flocks. The average flock size was 54.39 ± 0.65. The study revealed that the Malpura sheep is a long-day breeder with 72.1% of lambing during August to January. The higher concentration of lambing in this period is to avoid the stress of harsh summer and scarcity of feed. The disposal pattern of male lambs was stringent due to selection. Only 3.1% of male lambs reach to adult stage. For females, the replacement rate was 34.11%. The live weights (kg) from 8,263 lambs were 3.34 ± 0.01, 14.61 ± 0.04, 20.48 ± 0.07 and 30.01 ± 0.16, for birth, three-, six- and 12-month age, respectively. Non-genetic factors such as sex, season and year of birth and flock significantly influenced growth. The heritability was 0.20 ± 0.03, 0.20 ± 0.008, 0.23 ± 0.004 and 0.17 ± 0.009 for birth, three-, six- and 12-month weight, respectively. This indicated scope for genetic improvement, given a systematic breeding programme, is in place. The present model followed by sheep breeders is highly dependent upon the Government aided Central Sheep and Wool Research Institute (CSWRI) for supply of breeding rams, data collection and health care. Alternate self-sustainable model of CBBP is proposed wherein a breeder's organization leads the way to establish a ram-rearing centre (RRC), teams of experts for ram selection, data collection and market linkage. CSWRI will continue to assist for selection decisions and real-time data entry using a cloud-based "Avimegh" platform. The early selection of 5% male lambs at weaning and rearing them at RRC until final selection at 12-month will provide unbiased selection of rams under CBBP. The surplus rams will be sold by RRC for profit. Several key measures such as micro-finance, co-ordination between stakeholders, market linkage and technical input for data collection and selection have been suggested to make the CBBP self-sustainable.

A prospective, comparative analysis of acute toxicity profile between three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) in locally advanced head and neck cancer patients.

INTRODUCTION: The advances of modern radiotherapy have emerged with the development of conformal radiotherapy techniques, such as the three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT). We prospectively compared acute toxicities and treatment-compliance between IMRT and 3DCRT in patients with locally advanced head and neck carcinoma. METHOD: 80 patients were enrolled in this comparative prospective non-randomized study. Inclusion criteria were patients with locally advanced carcinoma of hypopharynx, oropharynx and larynx. 40 patients were treated with IMRT and 40 patients with 3DCRT to dose of 70 Gy in 35 fractions, along with concurrent cisplatin weekly chemotherapy. All patients were assessed weekly during chemoradiotherapy treatment and after 3 months of the treatment. RESULTS: 15 patients (38.4%) versus 8 patients (20.51%) developed grade 3 mucositis in the 3DCRT and IMRT group respectively (p= <0.001). At three months post chemo-radiotherapy treatment, 17 patients (43.6%) versus 7 patients (17.9%) had grade 2 dysphagia in 3DCRT and IMRT group respectively (p = 0.029). At three months post radiotherapy, grade 3 xerostomia was seen in 3 patients (7.6%) in 3DCRT group versus no patient (0%) in IMRT group (p = 0.006). IMRT group had lower incidence of grade 3 dermatitis (p = 0.043), weight loss of the patients during the treatment (p = 0.126), lesser requirement of nasogastric intubation (p = 0.003) and better treatment-compliance (p = 0.336) compared to 3DCRT. CONCLUSION: IMRT reduced the incidence of severe mucositis, dysphagia, xerostomia, weight-loss of the patients, requirements for nasogastric tube and it improved the treatment-compliance compared to 3DCRT in locally advanced head neck cancer patients treated by chemo-radiotherapy.

Retrovesical malignant fibrous histiocytoma: a rare tumor.

Malignant fibrous histiocytoma (MFH) originating from the retrovesical space is a very rare tumour. A 61-year-old man presented to our hospital with complaints of retention of urine and burning sensation during micturition since 6 months. CT scan abdomen showed a large retrovesical mass between the urinary bladder and rectum, measuring 11×9×12 cm, displacing the urinary bladder. Serum PSA (Prostate Specific Antigen) value was within normal range. Biopsy from retrovesical mass and immunohistochemistry was suggestive of MFH. Wide excision of the retrovesical mass was done. Histopathology confirmed the diagnosis of MFH. He received adjuvant radiotherapy. He is on regular follow-up since the last 2 years after radiotherapy with no signs and symptoms of disease recurrence.

Combined occurrence of von Willebrand's disease and factor XIII deficiency: a case report.

We report the case of a three year old female child with combined occurrence of von Willebrand's disease and factor XIII deficiency, an extremely rare combination. The patient presented with prolonged bleeding following cuts and wounds. Clot solubility test using 5M urea was positive. Platelet aggregation using ristocetin was reduced, which corrected on adding normal plasma. Aggregation with other agonists was normal. We discuss the clinico- hematological profile of the case. Only one such case has been reported in literature in the past to the best of our knowledge.

Selective recovery of gold from secondary sources by Dowex-50-X8 sorbed Rhodamine-B resin.

Gold recovery from spent materials has been performed on modified cation-exchange resin. The modified resin was prepared by sorption of Rhodamine-B on Dowex-50-X8 (Na+) resin at pH 2.0. Distribution coefficients of gold ion have been determined with 15% (w/v) potassium chloride in different concentrations of hydrochloric acid. On the basis of Kd values quantitative separation of gold from secondary sources has been achieved. Gold(III) has been selectively separated from gold containing spent materials by column chromatography using modified ionexchange resin and the recovery was more than 92% compared to conventional cyanidation process. The results of the proposed method are suggestive of its applicability to other gold containing secondary sources.