Danger Down Under: A Pediatric Case of Penile Trauma with a Saw.

Partial penile amputation in the pediatric age group is an emergency and occurs mainly due to iatrogenic trauma or road traffic accidents. Such lesions are incapacitating and have a devastating psychological impact. We present the case of a 16-year-old boy who presented with an accidental, near-total penile amputation, and highlight our management plan as a favorable one.

A Clinicopathological Study with Risk-Stratified Staging of Pediatric Hepatoblastoma: A 5-Year Experience from a Tertiary Cancer Center.

Background & Objective: Hepatoblastoma encompasses 1% of pediatric malignancies and is the most common liver malignancy in children. Ninety percent of cases are younger than 5 years of age. Clinical and pathological risk stratification forms a crucial role in determining the treatment strategy. This study aimed to assess the clinicopathological profile of hepatoblastoma with risk stratification and follow-up in children. Methods: A retrospective evaluation was performed on all pediatric patients diagnosed as hepatoblastoma between 2016 and 2020 in our institution. Clinical, radiological, biochemical, pathological, and treatment data were analyzed. Cases were stratified based on the SIOPEL protocol and compared with the outcome. Results: The median age of all children was 1 year, the male-to-female ratio was 2.3:1, and elevated α-fetoprotein (AFP) was observed in all cases. SIOPEL risk stratification showed that 50% of children were at high risk. The histopathological types were fetal (30%), embryonal (20%), and macrotrabecular (5%) patterns under epithelial type and mixed epithelial and mesenchymal type (45%) with 1 case showing teratoid features. During the follow-up period, 6 out of the 7 children who died, belonged to the high-risk SIOPEL category, and 5 presented a mixed epithelial and mesenchymal pattern. Conclusion: Our study found a significant correlation between clinicopathological data, histopathological patterns, and outcomes. Accordingly, histopathological patterns could be considered one of the criteria for risk stratification. Histopathological risk stratification indicators (such as SIOPEL and PRETEXT) have strong prognostic and predictive outcomes; hence, our study emphasizes such parameters to aid oncologists.

The presentation delay and differences of symptoms manifestation in Myocardial Infarction patients with and without Diabetes: a cross-sectional study.

Patients with diabetes have a higher risk of coronary artery disease (CAD). This study aims to evaluate the effect of diabetes on the symptoms and the delay it causes in seeking medical treatment. Methodology: This cross-sectional study was conducted from 1 January 2021 to 30 June 2022, in three major tertiary care hospitals in Karachi, Pakistan. Patients falling in the inclusion criteria included those who were diagnosed with ST-elevation myocardial infarction (STEMI) or Non-ST-elevation myocardial infarction (NSTEMI) and those that were clinically stable and answered the questions within 48 h of admission to the hospital with or without the help of their family members. The association of the demographic variables, symptoms, presentation delay, and distance from the hospital was determined between the diabetics and the nondiabetics using the χ 2-test. A P-value of less than 0.05 was considered significant. Results: Among the patients with diabetes, 147 (90.7%) were smokers, 148 (91.4%) had a history of hypertension, 102 (63.0%) had a history of ischemic heart disease, and 96 (59.3%) patient's family history is significant for CAD. The higher educational level, smoking, hypertension, history of ischemic heart disease, and family history of CAD were found to be significantly related to diabetes with a P-value of less than 0.05. Patients with diabetes did not believe they have myocardial infarction was the most common cause of delay. Conclusion: The findings of our study conclude that diabetes significantly causes a delay in myocardial infarction patients seeking medical help as compared to nondiabetics.

Nanoparticulate Silica Internalization and Its Effect on the Growth and Yield of Groundnut (Arachis hypogaea L.).

In recent years, foliar applications of nanoparticles are increasingly being employed in agricultural fields as fertilizers to enhance crop yields. However, limited studies are available on the foliar uptake of nanoscale nutrients and their interaction with plants. In this study, we reported the effects of foliar spray with varied concentrations of nanoscale silica (N-SiO2) and bulk tetraethyl orthosilicate (TEOS at 2000 ppm) on the growth and yield of groundnut. Nanosilica was prepared by a sol-gel method and characterized by transmission electron microscopy, dynamic light scattering, and X-ray diffraction. The size and zeta potential of N-SiO2 were found to be 28.7 nm and 32 mV, respectively. The plant height, number of branches, total dry weight, SPAD chlorophyll meter reading, photosynthetic rate, water use efficiency, number of nodules, and ascorbic acid content were increased significantly with the N-SiO2 foliar application at 400 ppm over control. The number of filled pods increased significantly by 38.78 and 58.60% with N-SiO2 at 400 ppm application over TEOS and control, respectively. The pod yield per plant in N-SiO2 at 400 ppm increased by 25.52 and 31.7% higher over TEOS and control, respectively. Antioxidant enzyme activities enhanced significantly in N-SiO2 at 200 and 400 ppm over control, indicating a stimulatory effect on the plant growth. In addition, confocal microscopy revealed that fluorescein isothiocyanate (FITC)-N-SiO2 entered through stomata and then transported to vascular bundles via apoplastic movement. Our study for the first time demonstrated that N-SiO2 can significantly modulate multiple complex traits in groundnut through an eco-friendly and sustainable approach.

Does Age Have a Role in Color and Whiteness Variations After Dehydration and Rehydration in Maxillary Anterior Teeth? An In Vivo Study.

OBJECTIVE: To determine the influence of in vivo dehydration and rehydration on color and whiteness variations in maxillary anterior teeth of younger, middle-aged, and older individuals. METHODS AND MATERIALS: The spectrophotometric shade of maxillary anterior teeth from younger (20 to 30 years, n=20), middle-aged (50 to 60 years, n=20) and older (65 to 80 years, n=20) participants were assessed at baseline and every 10 minutes for 30 minutes after rubber dam isolation (dehydration). The teeth were then allowed to rehydrate, and shade values were assessed every 10 minutes for 30 minutes, after 24 hours, and after 48 hours. Data were collected as International Commission on Illumination (CIE) L*a*b* color coordinates. Color differences (ΔE*ab) and whiteness differences (ΔWID) were evaluated. Statistical analysis was performed using one-way analysis of variance with the Tukey Honest Significant Difference test. RESULTS: The color and whiteness changes of maxillary anterior teeth in older individuals after dehydration for 30 minutes were significantly lower than that of younger and middle-aged individuals. In younger participants, after 10 minutes of dehydration, mean ΔE*ab values of maxillary anterior teeth were above the acceptability threshold (AT), while mean ΔWID values were above AT only in maxillary canines. In middle-aged participants, mean ΔE*ab values were above AT, and mean ΔWID values were above the perceptibility threshold (PT) and below AT after 10 minutes of dehydration. In older participants, mean ΔE*ab values were above PT and below AT at 20 minutes of dehydration, while mean ΔWID values were above PT at 10 minutes of dehydration, and both were above AT at 30 minutes of dehydration. The mean ΔE*ab values were above AT after 20 minutes of rehydration in younger and middle-aged participants, while they were below AT in older participants after 10 minutes of rehydration. Mean ΔWID values were below AT for older participants after 20 minutes of rehydration. All mean ΔWID values were below AT and above PT after 30 minutes of rehydration except central incisors of younger participants. After 24 hours of rehydration, mean ΔE*ab and mean ΔWID values of participants in all age groups were below AT. After 48 hours of rehydration, mean ΔE*ab and ΔWID values of participants in all age groups were below PT except mean ΔE*ab values of canines and mean ΔWID values of central incisors in younger participants. L*, a*, and b* values were significantly different between age groups at 30 minutes of dehydration and after 48 hours of rehydration (p<0.05). CONCLUSION: Color and whiteness changes due to dehydration were less pronounced in older participants. Dehydration for 10 minutes in most maxillary anterior teeth of younger and middle-aged participants led to perceptible and clinically unacceptable color and whiteness changes. Maxillary anterior teeth of older participants showed color and whiteness changes that were perceptible at 10 minutes of dehydration but clinically acceptable up to 30 minutes of dehydration. After 30 minutes of dehydration, a 10- and 20-minute rehydration was needed, respectively, for color and whiteness changes to be clinically acceptable in maxillary anterior teeth of older individuals, while a 30-minute rehydration was recommended for the middle aged group and for maxillary laterals and canines of the younger group. Color and whiteness changes in most maxillary anterior teeth were imperceptible only after 48 hours of rehydration.

Antibody-drug conjugate as targeted therapeutics against hepatocellular carcinoma: preclinical studies and clinical relevance.

An antibody-drug conjugate (ADC) is an advanced chemotherapeutic option with immense promises in treating many tumor. They are designed to selectively attack and kill neoplastic cells with minimal toxicity to normal tissues. ADCs are complex engineered immunoconjugates that comprise a monoclonal antibody for site-directed delivery and cytotoxic payload for targeted destruction of malignant cells. Therefore, it enables the reduction of off-target toxicities and enhances the therapeutic index of the drug. Hepatocellular carcinoma (HCC) is a solid tumor that shows high heterogeneity of molecular phenotypes and is considered the second most common cause of cancer-related death. Studies show enormous potential for ADCs targeting GPC3 and CD24 and other tumor-associated antigens in HCC with their high, selective expression and show potential outputs in preclinical evaluations. The review mainly highlights the preclinical evaluation of different antigen-targeted ADCs such as MetFab-DOX, Anti-c-Met IgG-OXA, Anti CD 24, ANC-HN-01, G7mab-DOX, hYP7-DCand hYP7-PC, Anti-CD147 ILs-DOX and AC133-vcMMAF against hepatocellular carcinoma and its future relevance.

Doing More with Less: Fine Needle Aspiration Cytology in Pediatric Neoplasms.

BACKGROUND: Cancer is one of the leading causes of death in the pediatric age group following infections. Among the diagnostic modalities, fine needle aspiration cytology (FNAC) is increasingly recognized as it permits rapid diagnosis with low cost and complication. In this study, we emphasize the diagnostic value of FNAC and describe the cytomorphological spectrum of tumors diagnosed on FNAC in pediatric patients with or without the aid of ancillary tests. MATERIALS AND METHODS: This retrospective study included a total of 614 patients under the age of 15 years for whom fine needle aspiration (FNA) was done during a period of 3 years with or without guidance. The cytology smears were reviewed, and the morphological spectrum was analyzed with the ancillary studies. RESULTS: Aspirates from children constituted around 3.5% of the total FNAC performed in our Institute. Of the 614 cases, 336 were male, and 278 were female with age under 15 years. Neoplastic cases constituted around 72%, which included benign (2%) and malignant (98%) tumors. The spectrum include hematolymphoid neoplasms in 39.3%, small round cell tumors (SRCT) in 24.9%, Wilms tumor in 9.2%, germ cell tumors in 4.8%, spindle cell neoplasms in 4.8%, hepatoblastoma in 3.2%, and osteosarcoma in 3% of the cases. The metastatic lesions constituted 8.1% of the cases diagnosed by FNA. CONCLUSION: FNA proves to be a reliable and efficien modality in diagnosing pediatric neoplasms in the hands of a skilled cytopathologist.

Acute myeloid leukemia transforms the bone marrow niche into a leukemia-permissive microenvironment through exosome secretion.

Little is known about how leukemia cells alter the bone marrow (BM) niche to facilitate their own growth and evade chemotherapy. Here, we provide evidence that acute myeloid leukemia (AML) blasts remodel the BM niche into a leukemia growth-permissive and normal hematopoiesis-suppressive microenvironment through exosome secretion. Either engrafted AML cells or AML-derived exosomes increased mesenchymal stromal progenitors and blocked osteolineage development and bone formation in vivo. Preconditioning with AML-derived exosomes 'primed' the animals for accelerated AML growth. Conversely, disruption of exosome secretion in AML cells through targeting Rab27a, an important regulator involved in exosome release, significantly delayed leukemia development. In BM stromal cells, AML-derived exosomes induced the expression of DKK1, a suppressor of normal hematopoiesis and osteogenesis, thereby contributing to osteoblast loss. Conversely, treatment with a DKK1 inhibitor delayed AML progression and prolonged survival in AML-engrafted mice. In addition, AML-derived exosomes induced a broad downregulation of hematopoietic stem cell-supporting factors (for example, CXCL12, KITL and IGF1) in BM stromal cells and reduced their ability to support normal hematopoiesis. Altogether, this study uncovers novel features of AML pathogenesis and unveils how AML cells create a self-strengthening leukemic niche that promotes leukemic cell proliferation and survival, while suppressing normal hematopoiesis through exosome secretion.

Role of trabecular bone in visibility of laminadura: A cross-sectional radiographic study.

AIM: To determine the degree to which trabecular bone contributes to the radiographic visibility of laminadura (LD). STUDY DESIGN: Human dry mandibles were obtained, and a series of radiographs were acquired in the premolar region. Radiographs taken were: (1) Before removal of any bone, (2) After removal of small amount of cortical bone at the apex of tooth, (3) Removal of trabecular bone, (4) Smoothing of endosteal surface of cortical bone. The radiographs were projected to a panel of six oral radiologists, and they were asked to judge the visibility of LD. RESULTS: Chi-square analysis revealed a significant radiographic difference between radiographs made initially and after removal of trabecular bone, cortical bone and smoothing the endosteal surface of cortical bone. CONCLUSION: There was statistically significant difference in the visibility of loss of LD when trabecular bone is lost. LD can be visible only if the endosteal surface of the cortical bone and trabecular bone is intact.

Nasopharyngeal airway stenting devices for obstructive sleep apnoea: a systematic review and meta-analysis.

OBJECTIVE: To systematically review outcomes of adults with obstructive sleep apnoea treated with nasopharyngeal airway stenting devices. METHODS: Medline, Scopus, Web of Science and the Cochrane Library databases were searched, and data on device use and tolerability, sleepiness, oxygen saturation, apnoea index, apnoea-hypopnoea index, and sleep quality were collected. RESULTS: Of 573 potential studies, 29 were retrieved for detailed evaluation and 16 met the study criteria. Polysomnography data for patients treated with nasal trumpets as an isolated therapy were pooled for meta-analysis. The mean apnoea index ± standard deviation, for 53 patients, decreased from 32.4 ± 15.9 to 9.0 ± 7.2 episodes per hour (p < 0.00001). The mean apnoea-hypopnoea index, for 193 patients, decreased from 44.1 ± 18.9 to 22.7 ± 19.3 episodes per hour (p < 0.00001). The mean lowest oxygen saturation, for 193 patients, increased from 66.5 ± 14.2 to 75.5 ± 13.9 per cent (p < 0.00001). CONCLUSION: Some studies have demonstrated limited effectiveness and low tolerability of nasopharyngeal airway stenting devices, while other studies have shown a significant benefit in treating obstructive sleep apnoea, with a high level of patient acceptance. Nasal trumpets have been successful in decreasing airway obstruction in the short term.

Radix entomolaris: 2 case reports and clinical guidelines for endodontic management.

Variations in dental anatomy and root canal systems are often reported in the dental literature. Among them, Radix entomolaris (RE) is the presence of an additional lingual root in mandibular molars. Though RE appears relatively infrequently, knowledge of the condition will aid in its management. This article presents 2 case reports of RE and clinical guidelines for endodontic management.

Application of artificial neural network, fuzzy logic and decision tree algorithms for modelling of streamflow at Kasol in India.

The prediction of streamflow is required in many activities associated with the planning and operation of the components of a water resources system. Soft computing techniques have proven to be an efficient alternative to traditional methods for modelling qualitative and quantitative water resource variables such as streamflow, etc. The focus of this paper is to present the development of models using multiple linear regression (MLR), artificial neural network (ANN), fuzzy logic and decision tree algorithms such as M5 and REPTree for predicting the streamflow at Kasol located at the upstream of Bhakra reservoir in Sutlej basin in northern India. The input vector to the various models using different algorithms was derived considering statistical properties such as auto-correlation function, partial auto-correlation and cross-correlation function of the time series. It was found that REPtree model performed well compared to other soft computing techniques such as MLR, ANN, fuzzy logic, and M5P investigated in this study and the results of the REPTree model indicate that the entire range of streamflow values were simulated fairly well. The performance of the naïve persistence model was compared with other models and the requirement of the development of the naïve persistence model was also analysed by persistence index.

Unusual causes of fungal rhinosinusitis: a study from a tertiary care centre in South India.

PURPOSE: The frequency of mycotic infections of the nose and paranasal sinuses has been increasing over the past three decades. Apart from the common causes of fungal rhinosinusitis such as Aspergillus species and Penicillium species, there have been reports of rare and unusual fungi isolated from India and other countries. OBJECTIVE: The objective of this study is to find out the prevalence of fungal infections of the nose and paranasal sinuses caused by unusual fungal isolates at a tertiary care teaching hospital in South India. MATERIALS AND METHODS: Duration of the study period was from April 2009 to March 2010. Specimens were collected from the nose and paranasal sinuses of all clinically and radiologically diagnosed cases of rhinosinusitis. All the clinical specimens were processed by standard methods for fungal culture. This included initial screening by 10% potassium hydroxide, inoculation of the specimen onto Sabouraud dextrose agar and incubation at 25°C and 37°C, followed by slide culture and other special techniques wherever necessary. Histopathological examination was also performed for the specimens. RESULTS: A total of 60 specimens were received for fungal culture from cases of rhinosinusitis during the period, out of which 45 showed no growth. There were nine cases of Aspergillus flavus, 1 each of Aspergillus fumigatus and Penicillium species. The rest four specimens grew rare fungal isolates, i.e. Acremonium sp., Scedosporium apiospermun, Cladosporium cladosporioides and Lasiodiplodia theobromae. Histopathological findings were also positive for these four cases. CONCLUSION: Apart from the common causes, unusual fungal pathogens were isolated from cases of rhinosinusitis during the study period, which is in accordance with similar reports from other parts of India and some other countries.

Transgenics in groundnut (Arachis hypogaea L.) expressing cry1AcF gene for resistance to Spodoptera litura (F.).

Large number of primary transgenic events were generated in groundnut by an Agrobacterium mediated, in planta transformation method to assess the efficacy of cry1AcF against the Spodoptera litura. The amplification of required size fragment of 750 bp with npt II primers and 901 bp with cry1AcF gene primers confirmed the integration of the gene. The expression of the cry gene was ascertained by ELISA in T2 generation, and the maximum concentration of cry protein in transgenic plants reached approximately 0.82 µg/g FW. Further, Southern blot analysis of ten T2 transgenic plants proved that transgene had been integrated in the genome of all the plants and Northern analysis of the same plants demonstrated the active expression of cry1AcF gene. The highest mean % larval mortalities 80.0 and 85.0 with an average mean % larval mortalities 16.25 (n = 369) and 26.0 (n = 80) were recorded in T1 and T2 generations, respectively. Segregation analysis of the selected lines in the T3 generation demonstrated homozygous nature. This clearly proved that though there is considerable improvement in average mean % larval mortality in T2 generation, the cry1AcF gene was effective against S. litura only to some extent.

Assessment of correlation between CT angiographic clot load score, pulmonary perfusion defect score and global right ventricular function with dual-source CT for acute pulmonary embolism.

OBJECTIVE: The purpose of this study was to prospectively investigate the correlation between CT angiographic clot load (CTACL) score, pulmonary perfusion defect (PPD) score and the global right ventricular function in the assessment of pulmonary embolism (PE) severity. METHODS: 49 patients with acute PE, who underwent dual-source CT scan, were included in the study. CT angiography and perfusion imaging were performed. Data from electrocardiogram-gated coronary angiography scanning protocol were used for right ventricular function analysis. Two readers evaluated the CTACL and PPD scores using the Qanadli and Chae methods, respectively. RESULTS: The PPD score had a strong positive correlation with the CTACL score (r=0.72, p<0.001) and both scores in turn had a strong positive correlation with the right ventricular/left ventricular (RV/LV) diameter ratio (r=0.60, r=0.62, p<0.001). However, the PPD score had a strong negative correlation with ejection fraction (EF) (r=-0.63, p<0.001) while the CTACL score had a low negative correlation with EF (r=-0.33, p=0.02). Between the RV/LV<1 group (n=35) and the RV/LV >1 group (n=14), the PPD score, CTACL score, pulmonary artery trunk diameter, EF and reflux of inferior vena cava were significantly different, all with p<0.001. The end-systolic volume (p=0.01) was significantly different but the end-diastolic volume (p=0.11) and stroke volume (p=0.08) showed no statistically significant difference between the two groups. CONCLUSION: Therefore, considering PPD scores, CTACL scores and cardiovascular manifestations together may be helpful in the evaluation of PE severity.

Impact of nutrition education on knowledge and haemoglobin status of hill women in Uttarakhand State of India.

INTRODUCTION: This study aimed to examine the impact of the use of single vs. combination of media on nutritional knowledge and haemoglobin status of women in a rural hill area in Uttarakhand State, India. METHODS: Women from three villages were selected randomly and divided into three groups namely, print media group (n = 59), multimedia group (n = 53) and control group (n = 111). The print media group was exposed to nutrition education through the use of calendars on anaemia for 60 days; the multimedia group was given nutrition education through a combination of media including calendars, video films, and group discussions for 60 days. RESULTS: At pre-exposure stage, 62.7% of the women in the print media group, 67.9% of the multimedia group, and 66.7% of the control group had a low nutrition knowledge level. After exposure, the print media group and the multimedia group showed a significant rise in nutrition knowledge, with the multimedia group scoring significantly higher than the print media group. Overall, 69.1% of the women were anaemic with mean haemoglobin concentration of 10.74 +/- 0.86 g/dl. A non-significant rise in mean haemoglobin concentrations in the experimental groups was found at post-exposure stage. CONCLUSION: Calendars and video films are effective in increasing nutrition knowledge of illiterate hill women. Use of mass media programmes of longer duration should be encouraged to combat the nutritional problems of rural communities.

Simultaneous pedicled flaps for coverage of complex blast injuries to the forearm and hand (with supplemental external fixation to the iliac crest for immobilization).

The technique of two simultaneous pedicled flaps to a single extremity has recently proven useful in the care of war-injured military personnel. We present two cases of combat-injured Marines who underwent upper extremity reconstruction using simultaneous pedicled flaps. These cases illustrate a simple and successful alternative to free tissue transfer in providing coverage to complex soft tissue defects of the hand and forearm. Good outcomes were obtained in circumstances where free tissue transfer was not indicated.