Patient and physician factors associated with symptomatic undiagnosed asthma or COPD.

BACKGROUND: It remains unclear why some symptomatic individuals with asthma or COPD remain undiagnosed. Here, we compare patient and physician characteristics between symptomatic individuals with obstructive lung disease (OLD) who are undiagnosed and individuals with physician-diagnosed OLD. METHODS: Using random-digit dialling and population-based case finding, we recruited 451 participants with symptomatic undiagnosed OLD and 205 symptomatic control participants with physician-diagnosed OLD. Data on symptoms, quality of life and healthcare utilisation were analysed. We surveyed family physicians of participants in both groups to elucidate differences in physician practices that could contribute to undiagnosed OLD. RESULTS: Participants with undiagnosed OLD had lower mean pre-bronchodilator forced expiratory volume in 1 s percentage predicted compared with those who were diagnosed (75.2% versus 80.8%; OR 0.975, 95% CI 0.963-0.987). They reported greater psychosocial impacts due to symptoms and worse energy and fatigue than those with diagnosed OLD. Undiagnosed OLD was more common in participants whose family physicians were practising for >15 years and in those whose physicians reported that they were likely to prescribe respiratory medications without doing spirometry. Undiagnosed OLD was more common among participants who had never undergone spirometry (OR 10.83, 95% CI 6.18-18.98) or who were never referred to a specialist (OR 5.92, 95% CI 3.58-9.77). Undiagnosed OLD was less common among participants who had required emergency department care (OR 0.44, 95% CI 0.20-0.97). CONCLUSIONS: Individuals with symptomatic undiagnosed OLD have worse pre-bronchodilator lung function and present with greater psychosocial impacts on quality of life compared with their diagnosed counterparts. They were less likely to have received appropriate investigations and specialist referral for their respiratory symptoms.

Typhoid vaccine does not impact feelings of social connection or social behavior in a randomized crossover trial among middle-aged female breast cancer survivors.

BACKGROUND: Inflammation can have social consequences, which may be relevant to inflammation's link with depression. The current study tests whether a typhoid vaccine increases feelings of social disconnection and avoidance behavior. METHOD: In two full-day visits at least three weeks apart, 172 postmenopausal breast cancer survivors (Stage I-IIIA) each received a typhoid capsular polysaccharide vaccination and a saline placebo injection in a random sequence. Blood was drawn prior to the injection, as well as every 90 min thereafter for 8 h to assess the inflammatory response (interleukin-6, IL-6; interleukin-1 receptor antagonist, IL-1Ra). At both visits, women completed the Social Connection Scale at 0 and 8.5 h post-vaccination as well as implicit and explicit social avoidance tasks at 7 h post-vaccination. RESULTS: The typhoid vaccine triggered rises in both inflammatory markers (ps < 0.01), but it did not impact feelings of social connection (p = .32), or performance on the implicit (p = .34) or explicit tasks (p = .37). Inflammatory rises did not predict feelings of social connection (ps > 0.64) or performance on explicit (ps > 0.73) or implicit (ps > 0.88) social avoidance tasks. CONCLUSION: Milder inflammatory stimuli may not affect social processes. Higher levels of inflammation or, relatedly, more sickness symptoms may be necessary to recapitulate prior findings of social avoidance.

Worry and Mindfulness Differentially Impact Symptom Burden Following Treatment Among Breast Cancer Survivors: Findings From a Randomized Crossover Trial.

BACKGROUND: Breast cancer survivors often experience many somatic and cognitive side effects resulting from their cancer diagnosis and treatment, including higher rates of pain, fatigue, and memory/concentration problems. Emotion regulation offers opportunities to either enhance or dampen physical health. PURPOSE: In a secondary analysis of a double-blind randomized controlled trial (RCT) using a typhoid vaccine to assess factors associated with breast cancer survivors' inflammatory responses, we assessed how two specific aspects of emotion regulation, mindfulness, and worry, corresponded to acute changes in focus problems, memory problems, and fatigue along with performance on pain sensitivity and cognitive tasks across two visits among breast cancer survivors. METHODS: Breast cancer survivors (N = 149) completed two 8.5-hr visits at a clinical research center. Survivors were randomized to either the vaccine/saline placebo or a placebo/vaccine sequence. Worry and mindfulness questionnaires provided data on trait-level emotion regulation abilities. Fatigue, memory problems, and focus difficulties were assessed via Likert scales six times-once before the injections and then every 90 min for 7.5 hr thereafter. Women also completed a pain sensitivity task and several cognitive tasks at each visit. RESULTS: Findings from this study showed that breast cancer survivors who worried more and were less mindful experienced subjective memory problems, focus problems, and cold pain sensitivity across two visits and irrespective of injection type. Lower mindfulness also corresponded to higher subjective fatigue and hot pain sensitivity and objective ratings. Emotion regulation skills did not predict objective pain sensitivity or cognitive problems. CONCLUSION: Results from this study highlight the benefits of adaptive emotion regulation in helping mitigate symptoms associated with breast cancer survivorship.

Breast cancer survivors experience side effects resulting from their cancer diagnosis and treatment, including higher rates of pain, fatigue, and memory/concentration problems. Emotion regulation offers the possibility to either better or worse physical health. This study assessed how two emotion regulation strategies, mindfulness and worry, corresponded to changes in focus problems, memory problems, and fatigue along with performance on pain sensitivity and cognitive tasks across two visits among breast cancer survivors. A total of 149 survivors completed 2 day-long visits in the laboratory where they rated their fatigue and memory problems six times across the day, completed cognitive tests, and a pain sensitivity test. Findings from this study showed that breast cancer survivors who worried more and were less mindful experienced subjective memory problems, focus problems, and cold pain sensitivity across two visits. Emotion regulation skills did not predict objective pain sensitivity or cognitive problems. Results from this study highlight the benefits of adaptive emotion regulation skills like mindfulness in helping improve the cognitive and physical symptoms commonly experienced by breast cancer survivorship.

Retrospective cohort study of CDK4/6-inhibitor-induced alopecia in breast cancer patients.

PURPOSE: Dermatologic adverse events commonly result in the interruption of oncologic treatment, and targeted therapies are the most frequently interrupted class of anticancer agents. Alopecia is a common cutaneous adverse event reported with CK4/6i therapy. Though the clinical characteristics and therapeutic response of EIA have been well documented, few studies have characterized alopecia in patients treated with CDK4/6i. METHODS: This study analyzed a retrospective cohort of 28 breast cancer patients diagnosed with endocrine-induced alopecia (EIA) or CDKiA. Comparative analysis of the clinical characteristics of alopecia and therapeutic response to minoxidil was conducted. Therapeutic response to minoxidil (LDOM or topical [5%] solution or foam) was assessed by both Dean Scale and qualitative clinical improvement by comparison of pretreatment and posttreatment clinical images by single-blinded, board-certified academic dermatologists (ST and BD). RESULTS: CDKiA was clinically similar to androgenetic alopecia and specific vertex involvement was more common in patients treated with CDK4/6i + ET than endocrine monotherapy (n = 7 [70.0%] vs n = 4 [36.4%]; p = 0.04), respectively. After 4-6 months of minoxidil, there was a moderate to significant qualitative alopecia improvement in 80% of CDKiA patients versus 94.4% of EIA patients. Additionally, superior improvement of mean Dean Score grade was observed in EIA (with change from pre- to posttreatment - 0.44; p = 0.0002). CONCLUSION: Compared to endocrine monotherapy, patients on combination CDK4/6i + ET had greater extent of vertex involvement and were more recalcitrant to minoxidil. The preferential vertex involvement observed in CDKiA suggests that combination therapy with minoxidil and topical antiandrogens with poor systemic absorption should be studied in this setting.

Distress Disorder Histories Relate to Greater Physical Symptoms Among Breast Cancer Patients and Survivors: Findings Across the Cancer Trajectory.

BACKGROUND: Psychological disorders can substantially worsen physical symptoms associated with breast cancer diagnosis and treatment, reducing survivors' quality of life and increasing recurrence risk. Distress disorders may be particularly detrimental given their physical correlates. Across two studies, we examined the relationship between a distress disorder history and physical symptoms pre- and post-adjuvant treatment - two important periods of the cancer trajectory. METHODS: Breast cancer patients awaiting adjuvant treatment (n = 147; mean age = 52.54) in study 1 and survivors 1-10 years post-treatment (n = 183; mean age = 56.11) in study 2 completed a diagnostic interview assessing lifetime presence of psychological disorders. They also rated their pain, fatigue, physical functioning, and self-rated health. Covariates included body mass index, age, cancer stage, menopause status, and physical comorbidities. RESULTS: Results from both studies indicated that a distress disorder history was associated with higher pain, fatigue, and sleep difficulties as well as lower self-rated health compared to those without such a history. CONCLUSIONS: These findings suggest that breast cancer survivors with a distress disorder may be particularly at risk for more physical symptoms, poorer sleep, and worse self-rated health both prior to and following adjuvant treatment.

Conventional Rotary Technique and Piezosurgical Technique in the Removal of Impacted Mandibular Third Molar: A Comparative Study.

AIM: To compare the operating time, postoperative pain, edema, trismus, and patient acceptance following surgical removal of impacted third molar using piezosurgery and conventional rotary technique. MATERIALS AND METHODS: About 42 patients with impacted mesioangular mandibular third molars were included in this study. Subjects are divided into two groups: group I (treated with conventional rotary technique) and group II (treated with piezosurgery). Duration of surgery, pain, trismus, and swelling were assessed. The patients were evaluated on the 1st, 3rd, and 7th postoperative days. RESULTS: Postoperative pain, trismus, and edema were reduced with piezosurgery compared with conventional technique. Even though the duration of time was longer with piezosurgery, patient comfort was found to be better. CONCLUSION: Piezosurgery is a meticulous and innovative ultrasonic technique with selective bone cutting and better postoperative outcomes. However, it is expensive, and the operating time is prolonged. CLINICAL SIGNIFICANCE: Piezosurgery is an alternative in the surgical removal of third molars as it ensures precise and selective cutting, with no injury to the surrounding soft tissues. Postoperative outcome and patient acceptance are improved with piezosurgery.

Evaluation of Microbial Adherence on Antibacterial Suture Materials during Intraoral Wound Healing: A Prospective Comparative Study.

AIM: To assess the efficacy of antiseptic-coated silk sutures with triclosan-coated polyglactin 910 suture in reducing bacterial colonization after oral surgical procedures. MATERIALS AND METHODS: The patients who required multiple sutures after surgical procedures in the mandible were the study subjects. The sites of suturing were divided into three groups. Group A - surgical site receiving black-braided silk suture (control group). Group B - surgical site receiving triclosan-coated Polyglactin 910 suture (experimental group). Group C - surgical site receiving antiseptic-coated silk suture (experimental group). Evaluation was done on the 3rd postoperative and 7th postoperative day. Microbial adherence was evaluated by microbiological study. RESULTS: The mean comparison of microbial count between 3rd and 7th post-op day in the three groups shows an increased microbial colonization in the control group when compared with the experimental groups. The combined mean microbial adherence in the three groups showed microbial count in the uncoated silk suture (group A) as 10.35 ± 3.74, triclosan-coated suture (group B) as 6.28 ± 2.17 and iodoform + calendula oil-coated suture (group C) as 7.1 ± 2.02 which is statistically significant (p < 0.05). CONCLUSION: The present research concluded that the pomade-coated silk suture is as efficient as triclosan-coated VICRYL PLUS Polyglactin 910 sutures in reducing the bacterial colonization in intraoral wound healing. CLINICAL SIGNIFICANCE: The pomade (iodoform + calendula oil) may be advocated in the field of oral and maxillofacial surgery for impregnating the suture materials which act as an antiseptic agent and a promoter of wound healing which is easily accessible and also cost-effective.

An Observational Study on Cystic Alterations in Normal Dental Follicles Associated with Impacted Lower Third Molar for Early Intervention.

AIM: To evaluate the cystic changes in the radiographically normal dental follicle associated with impacted mandibular third molar. MATERIALS AND METHODS: This study was conducted on 80 patients. Samples were selected using a convenient sampling technique from the patients who had impacted mandibular third molars in Pell and Gregory's positions B and C, with follicular space less than 2.5 mm in diameter. After surgical removal of an impacted tooth, the dental follicle was sent for histopathologic evaluation. RESULTS: Pathologic alterations were found in 19% of cases out of 80 samples. Odontogenic keratocystic and dentigerous cystic changes were found in 7% of cases. A statistically significant cystic alteration was found in female patients and distoangular impacted teeth. CONCLUSION: This study shows a significant cystic alteration in the radiologically normal dental follicles. Clinical and radiographic features alone may not be a reliable indicator of the absence of pathology. Early intervention of impacted teeth will help to reduce morbidity due to the development of pathology. CLINICAL SIGNIFICANCE: This study will help educate patients on the risks of retaining impacted teeth, based on scientific facts, in order to minimize the risks and to assess the correlation of pathologic alterations with the depth of impaction and angular position of the impacted tooth.

A Study to Evaluate the Efficacy of Ultrasonography as a Diagnostic Screening Tool in Maxillofacial Fractures: A Prospective Study.

AIM: The aim of the study was to estimate the diagnostic efficacy of high-resolution ultrasonography (USG) in the diagnosis of maxillofacial fractures. MATERIALS AND METHODS: A descriptive diagnostic evaluation study was carried out on 30 patients with suspected maxillofacial fractures, out of which 26 were male (86.7%) and 4 were female (13.3%). After initial management, detailed clinical examinations were carried out and significant findings were noted. Computed tomography (CT) scans were performed in fracture-suspecting patients followed by USG examination which was done in a standardized pattern on both sides of the face. The result of USG was compared with the CT scan report. RESULT: Based on CT findings, 65 sites were found to be fractured, and this was considered the gold standard. Ultrasonography detected 58 fractures at these 780 sites, of which 54 were true fractures, while 4 were false-positive results. However, USG was not able to detect eleven fractures. The overall sensitivity and specificity of USG were 83.1% and 99%, respectively. The positive and negative predictive values were 93% and 98%, respectively. CONCLUSION: According to our study, it may be concluded that USG may be recommended as a diagnostic screening tool to detect superficial maxillofacial fractures. CLINICAL SIGNIFICANCE: Ultrasonography provides a safe, cost-effective, reliable, non-invasive, easily available, and portable imaging modality to screen for maxillofacial fractures.

Breast cancer survivors' typhoid vaccine responses: Chemotherapy, obesity, and fitness make a difference.

PURPOSE: To investigate breast cancer survivors' inflammatory responses to typhoid vaccine as a window into their innate immune response to novel pathogens. METHODS: This double-blind crossover trial randomized 158 breast cancer survivors to either the vaccine/saline placebo or the placebo/vaccine sequence. The relative contributions of age, cardiorespiratory fitness (VO2peak), type of cancer treatment, central obesity, and depression to interleukin (IL)-6, IL-1 receptor antagonist (IL-1Ra), and WBC vaccine responses were assessed pre-injection and 1.5, 3, 4.5, 6, and 7.5 h post-injection. RESULTS: The vaccine produced larger IL-6, IL-1Ra, and WBC responses than placebo, ps < 0.0001. Prior chemotherapy, higher central obesity, and lower VO2peak were associated with smaller vaccine responses after controlling for baseline inflammation. Vaccine response was summarized by the percent increase in area under the curve (IL-6, WBC) or average post-injection mean (IL-1Ra) for vaccine relative to placebo. Women who received chemotherapy had smaller vaccine responses than women who did not for both IL-6 (44% vs 78%, p <.001) and WBC (26% vs 40%, p <.001); IL-1ra response was not significantly moderated by chemotherapy. Women whose central adiposity was one standard deviation above the mean had smaller vaccine responses than women with average adiposity for IL-6 (33% vs 54%, p <.001), WBC (20% vs 30%, p <.001), and IL-1Ra (2.0% vs 3.2%, p <.001). Women with an average level of VO2peak had smaller vaccine responses than women whose VO2peak was one standard deviation above the mean for IL-6 (54% vs 73%, p <.001), WBC (30% vs 40%, p <.001), and IL-1Ra (3.2% vs. 4.1%, p = 0.01). Age and depression did not significantly moderate vaccine responses. CONCLUSIONS: This study provided novel data on chemotherapy's longer-term adverse immune consequences. The data also have an important public health message: even relatively low levels of fitness can benefit the innate immune response to a vaccine.

Low-concentration Povidone-iodine and Normal Saline as Irrigant on Reducing Postoperative Complications after the Third-molar Surgery: A Comparative Study.

AIM: This study was conducted to compare the efficacy of using 0.5 mg/mL povidone-iodine solution as an irrigant and coolant in reducing postoperative sequelae like swelling, trismus, and pain with the conventional normal saline irrigation during the surgical removal of the impacted lower third molar. MATERIALS AND METHODS: The research was conducted out toward the MES Dental College in Perinthalmanna, Kerala, in the Department of Oral and Maxillofacial Surgery. After mandibular third-molar surgical removal, researchers studied 60 individuals, 30 of whom had normal saline irrigation (group I), and 30 of whom received 0.05% povidone-iodine irrigation (group II). The postoperative discomforts were measured on the second and seventh days after surgery, respectively. After that, the data were analyzed using SPSS. The data analysis considered p-values less than 0.05 to be significant. RESULTS: At the second postoperative visit, patients in the povidone-iodine group reported much less pain, swelling, and reduced mouth opening than those in the normal saline group. But on the seventh postoperative day, there was not much difference between either group. CONCLUSION: Following the surgical removal of teeth, it was revealed that povidone-iodine solution (0.5 mg/mL) was more effective as irrigation and cooling aid than regular saline solution. CLINICAL SIGNIFICANCE: Low-concentrated povidone-iodine is a better option in dentistry as irrigant.

The role of third-generation dual-source dual-energy computed tomography in characterizing the composition of renal stones with infrared spectroscopy as the reference standard.

Purpose: The aim of our study was to prospectively evaluate the role of third-generation, dual-source, dual-energy computed tomography (DECT) in the characterization of renal calculi, with ex vivo renal stone evaluation using Fourier transform infrared spectroscopy (IS) as the reference standard. Material and methods: In our study 50 patients with history suggestive of renal calculi were subjected to DECT using 100 kVp and Sn150 kVp. With DECT, renal stone attenuation at low and high kVp was attained, and the attenuation ratios were measured. The result of DECT was compared with IS to identify the chemical composition of the extracted renal stones. IBM SPSS version 22 was used for statistical analysis. Results: In our study, the mean attenuation ratio of the renal stone was 1.57 ± 0.25. Out of 50 patients, the stones of 39 patients were predicted as calcium-containing stones, in 4 patients as cystine stones, and in 7 as uric acid stones on DECT. In IS analysis, 43 patients had calcium-containing stones, and 7 patients had uric acid stones. The accuracy rate of DECT for detecting calcium and uric acid stones in our study were 90% and 100%, respectively. The positive predictive value for the DECT to assess the chemical composition of renal calculi was found to be 92%. Conclusions: Third-generation DECT scan had 100% accuracy in differentiating uric acid stones from non-uric acid stones in our study. Because the treatment is different for different chemical compositions of stones, identification of specific chemical components is very important, and it can be accurately done by DECT.

The role of ultra-low-dose computed tomography in the detection of pulmonary pathologies: a prospective observational study.

Purpose: The aim of the study was to compare the image noise, radiation dose, and image quality of ultra-low-dose computed tomography (CT) and standard CT in the imaging of pulmonary pathologies. Material and methods: This observational study was performed between July 2020 and August 2021. All enrolled patients underwent both ultra-low-dose and standard CTs. The image noise, image quality for normal pulmonary structures, presence or absence of various pulmonary lesions, and radiation dose were recorded for each of the scans. The findings of standard-dose CT were regarded as the gold standard and compared with that of ultra-low-dose CT. Results: A total of 124 patients were included in the study. The image noise was higher in the ultra-low-dose CT compared to standard-dose CT. The overall image quality was determined to be diagnostic in 100% of standard CT images and in 96.77% of ultra-low-dose CT images with proportional worsening of the image quality as the body mass index (BMI) range was increased. Ultra-low-dose CT offered higher (> 90%) sensitivity for lesions like consolidation (97%), pleural effusion (95%), fibrosis (92%), and solid pulmonary nodules (91%). The effective radiation dose (mSv) was many times lower in ultra-low-dose CT when compared to standard-dose CT (mean ± SD: 0.50 ± 0.005 vs. 3.99 ± 1.57). Conclusions: The radiation dose of ultra-low-dose chest CT was almost equal to that of a chest X-ray. It could be used for the screening and/or follow-up of patients with solid pulmonary nodules (> 3 mm) and consolidation.

Patient preferences and adherence to adjuvant GnRH analogs among premenopausal women with hormone receptor positive breast cancer.

PURPOSE: Adjuvant ovarian function suppression (OFS) in premenopausal hormone receptor (HR) positive breast cancer (BC) improves survival. Adherence to adjuvant gonadotropin-releasing hormone analogs (GnRHa) remains a challenge and is associated with toxicities and inconvenient parenteral administration. The goal of this study was to describe real-world adherence patterns and patient preferences surrounding adjuvant GnRHa. METHODS: We analyzed the medical records of premenopausal women with non-metastatic HR positive BC from January 2000 to December 2017; participants received adjuvant monthly goserelin or leuprolide at The Ohio State University. Data collected included demographics, clinicopathologic characteristics, and OFS adherence/side effects. We defined non-adherence as discontinuation of GnRHa within 3 years for a reason other than switching to an alternate OFS, delay > 7 days from a dose, or a missed dose. Chi-square tests assessed associations between clinical characteristics and outcomes. RESULTS: A total of 325 patients met eligibility. Of these, 119 (37%) patients were non-adherent to GnRHa; 137 (42%) underwent elective bilateral salpingo-oophorectomy after initial GnRHa. Those opting for surgery reported significantly more hot flashes (74% vs 48%, p < 0.001), arthralgias (46% vs 30%, p = 0.003), and vaginal dryness (37% vs 21%, p = 0.001) compared with patients remaining on GnRHa. CONCLUSION: Non-adherence to adjuvant GnRHa occurred in over a third of patients and almost half the patients initiating GnRHa underwent subsequent surgical ablation. These high frequencies highlight real-world patterns of OFS. Additionally, treatment toxicities may impact personal preference of OFS modality. Personalized practices to target predictors of adjuvant GnRHa non-adherence are critical to optimize symptoms, adherence, and survivorship.

Genomic features of rapid versus late relapse in triple negative breast cancer.

BACKGROUND: Triple-negative breast cancer (TNBC) is a heterogeneous disease and we have previously shown that rapid relapse of TNBC is associated with distinct sociodemographic features. We hypothesized that rapid versus late relapse in TNBC is also defined by distinct clinical and genomic features of primary tumors. METHODS: Using three publicly-available datasets, we identified 453 patients diagnosed with primary TNBC with adequate follow-up to be characterized as 'rapid relapse' (rrTNBC; distant relapse or death ≤2 years of diagnosis), 'late relapse' (lrTNBC; > 2 years) or 'no relapse' (nrTNBC: > 5 years no relapse/death). We explored basic clinical and primary tumor multi-omic data, including whole transcriptome (n = 453), and whole genome copy number and mutation data for 171 cancer-related genes (n = 317). Association of rapid relapse with clinical and genomic features were assessed using Pearson chi-squared tests, t-tests, ANOVA, and Fisher exact tests. We evaluated logistic regression models of clinical features with subtype versus two models that integrated significant genomic features. RESULTS: Relative to nrTNBC, both rrTNBC and lrTNBC had significantly lower immune signatures and immune signatures were highly correlated to anti-tumor CD8 T-cell, M1 macrophage, and gamma-delta T-cell CIBERSORT inferred immune subsets. Intriguingly, lrTNBCs were enriched for luminal signatures. There was no difference in tumor mutation burden or percent genome altered across groups. Logistic regression mModels that incorporate genomic features significantly outperformed standard clinical/subtype models in training (n = 63 patients), testing (n = 63) and independent validation (n = 34) cohorts, although performance of all models were overall modest. CONCLUSIONS: We identify clinical and genomic features associated with rapid relapse TNBC for further study of this aggressive TNBC subset.

Differential risk factor profile of diabetes and atherosclerosis in rural, sub-urban and urban regions of South India: The KMCH-Non-communicable disease studies.

AIMS: South Asia has emerged rapidly as an epicentre of non-communicable diseases (NCDs) specifically diabetes and cardiovascular diseases. The prevalence rate, risk factors and aetiology of NCDs in different socio-demographic settings are not clearly understood. This study was performed to assess the prevalence of diabetes and atherosclerosis and their risk factors in urban, sub-urban and rural communities of South India. METHODS: Three communities [Nallampatti (rural), Thadagam (sub-urban) and Kalapatti (urban)] in South India were selected for participation in the KMCH-NCD Studies. Study volunteers were administered a detailed questionnaire, underwent anthropometric measurements, clinical measurements including blood pressure, glycated haemoglobin (HbA1c ), non-fasting lipid profile and serum creatinine. Carotid intima-media thickness was measured using B-mode ultrasound. Multiple logistic regression analyses were performed to understand the association of risk factors with diabetes and atherosclerosis. RESULTS: A total of 2976 native participants, ≥20 years of age were screened. The prevalence of diabetes was 16%, 26% and 23% respectively in the rural, sub-urban and urban study populations. Association of obesity with diabetes was observed in only urban population while hypertension and dyslipidaemia showed association in both urban and semi-urban populations. Association of diabetes with atherosclerosis was observed in urban and semi-urban populations. Hypertension in semi-urban and obesity and dyslipidaemia in urban population showed association with atherosclerosis. CONCLUSIONS: Diabetes and atherosclerosis burden reported in the three different communities were higher than previous reports, especially in rural and sub-urban regions. No traditional risk factor is identified to be associated with prevalence of diabetes and atherosclerosis in rural population. These findings suggest an urgent need for investigation into the role of non-traditional risk factors like environmental or occupational exposures may help to better understand the aetiology of diseases in non-urbanized communities.

Pseudoaneurysm of Cavernosal Artery Presenting as Priapism in a 7-Year-Old Boy.

Priapism due to pseudoaneurysm of the cavernosal artery is very rare. Herein, we describe the magnetic resonance imaging and digital subtraction angiographic findings of pseudoaneurysm in the right corpus cavernosum in a 7-year-old boy who presented with pain in the penis and lower abdomen and priapism with an obscure history of trauma. This was managed by endovascular embolization of the aneurysm. One-year follow-up has shown him to be normal without any symptoms and normal erection.

Elastography: a surrogate marker of renal allograft fibrosis - quantification by shear-wave technique.

PURPOSE: Renal fibrosis is the most common cause of allograft failure in kidney transplantations. Evaluation of renal abnormalities has progressed considerably over the past years. Currently, the diagnosis of intrarenal fibrosis and quantification of its development with non-invasive assessment tools is possible. This may help in early detection of renal allograft dysfunction. This study sought to assess the efficacy of 2D real-time shear-wave elastography (SWE) in the quantitative measurement of renal allograft dysfunction. METHODS: A total of 172 patients were included in our study. SWE was performed in all these patients just before renal allograft biopsy. The cortical elasticity was assessed and described in terms of Young's modulus (kPa). Banff histopathological grading obtained from transplant kidney tissue biopsy was taken as the reference standard. The potential correlation between SWE scores and Banff classification was performed. RESULTS: There was a significant correlation between the Banff grade and mean SWE score, with a correlation coefficient of 0.665 (p < 0.001). The individual correlation coefficients of interstitial fibrosis and tubular atrophy with mean SWE score stood at 0.667 and 0.649 respectively (p < 0.001). The correlation of resistive indices was insignificant when compared to mean polar SWE score in respective poles and the Banff grading of fibrosis. CONCLUSIONS: Renal stiffness quantified by 2D SWE showed significant correlation with histopathological renal fibrosis. Thus, the study suggests that shear-wave elastography could be used as a surrogate marker for early detection of renal fibrosis.

Comparison of T2 relaxometry and PET CT in the evaluation of patients with mesial temporal lobe epilepsy using video EEG as the reference standard.

PURPOSE: Our study aimed to compare the sensitivity of T2 relaxometry and positron emission tomography - computed tomography (PET/CT) in patients with a history suggestive of mesial temporal lobe epilepsy using video electroencephalography (EEG) as the reference standard. MATERIAL AND METHODS: In our study, 35 patients with a history suggestive of mesial temporal lobe epilepsy were subjected to conventional magnetic resonance imaging (MRI), T2 relaxometry, and PET/CT. The results of each of the studies were compared with video EEG findings. Analyses were performed by using statistical software (SPSS version 20.0 for windows), and the sensitivity of conventional MRI, T2 relaxometry, and PET/CT were calculated. RESULTS: The sensitivity of qualitative MRI (atrophy and T2 hyperintensity), quantitative MRI (T2 relaxometry), and PET/CT in lateralizing the seizure focus were 68.6% (n = 24), 85.7% (n = 30), and 88.6% (n = 31), respectively. CONCLUSIONS: The sensitivity of MRI in lateralization and localization of seizure focus in temporal lobe epilepsy can be increased by adding the quantitative parameter (T2 relaxometry) with the conventional sequences. T2 Relaxometry is comparable to PET/CT for localization and lateralization of seizure focus and is a useful tool in the workup of TLE patients.

Efficacy of different dosing schedules of capecitabine for metastatic breast cancer: a single-institution experience.

Purpose Capecitabine is widely used as a single agent on a 21-day cycle in the management of metastatic breast cancer (MBC). Our primary objective was to compare the standard dosing of capecitabine (Arm A: days 1-14 on 21-day cycle) to biweekly dosing (Arm B: days 1-7 and 15-21 on 28-day cycle) using retrospective data analysis. Methods 166 patients with MBC treated with single agent capecitabine at The Ohio State University from 2002 to 2014 were considered eligible. Median time to treatment failure (TTF) and overall survival (OS) were estimated using Kaplan-Meier (KM) methods. KM curves were compared using log-rank tests with Holm's correction for multiplicity. Results Patients were grouped by dose schedule into one of three arms: Arm A (21-day cycle; capecitabine given at 1000 mg/m2 orally, twice daily on days 1-14 of 21-day cycle); Arm B (28-day cycle; capecitabine given at 1000 mg/m2 orally, twice daily on days 1-7 and 15-21 of 28-day cycle); and Arm C (changeover regimen where patients started on the 21-day cycle, but changed to a 28-day cycle for tolerability). No difference was found in TTF or OS for patients with MBC between those who received capecitabine on either standard dosing (Arm A) and those on a biweekly cycle (Arm B or C). Overall, 41% of patients required dose reduction. Conclusions Our single institution experience showed that alternate dosing of capecitabine (biweekly, 28-day cycle) may be a reasonable alternative to standard 21-day cycle with similar efficacy and fewer dose reductions.