Updates in the management of cancer therapy-related hypertension.

PURPOSE OF REVIEW: To provide a comprehensive review of hypertension among patients with cancer. Several cancer therapies cause hypertension which has resulted in a growing and vulnerable population of patients with difficult to control hypertension which has significant downstream effects. RECENT FINDINGS: Hypertension affects up to 50% of cancer patients and higher comorbidity when compared to the general population. Many anticancer therapies can cause hypertension through their treatment effect. Antihypertensive treatment is crucial given cardiovascular mortality is a leading cause of death among cancer patients. It is already known that hypertension is poorly controlled in the general population, and there are additional challenges in management among patients with cancer. Patients with cancer suffer from multimorbidity, are on multiple medications creating concern for drug interactions, and often have blood pressure lability, which can worsen clinical inertia among patients and their providers. It is crucial to effectively treat hypertension in cancer patients to mitigate downstream adverse cardiovascular events. SUMMARY: In recent years, there have been significant changes in management guidelines of hypertension and simultaneously as influx of new cancer therapeutics. We provide an update on hypertension treatment among patients with cancer on different chemotherapeutic agents.

Secondary analysis of electronic opt-out consent in pragmatic research: A study design method to diversify clinical trials?

We conducted a multi-center pragmatic trial of a low-risk intervention focused on medication adherence using an opt-out consent approach, where patients could opt out by letter and then electronically. We focus on the cohort after opt-out by mail. Here, we describe that 8% of patients opted out electronically, resulting in a 92% participation rate. Patients who self-identify as Black or Hispanic were less likely to opt out in the study, and half the study cohort was female. This demographic data is useful for planning future trials employing this approach.

Role of oxygen absorbers in food as packaging material, their characterization and applications.

To preserve the environment and to prevent the damage caused by packaging materials, the development of biodegradable, organic, and nano-active films for packaging is progressively being accentuated. As the demand for getting fresh and preservative-free food is increasing, an improved level of clarity and stability for consumers about the packaging is required. Presently, oxygen scavengers are used in the form of films, sachets, powders, or as part of the packaging material itself along with other means of preservation such as the use of chemicals, reduced water activity, pH, multilayer composite material, and or vacuum or modified packaging. Today's current demand increases their incorporation directly into the packaging material rather than being a part of the food itself. The present review, therefore, is based on the availability of types of natural sources of oxygen scavenging systems like antioxidants, and nano iron, and their possible scope of use in the food packaging industry.

Circadian rest-activity misalignment in critically ill medical intensive care unit patients.

Circadian alignment of rest-activity rhythms is an essential biological process that may be vulnerable to misalignment in critically ill patients. We evaluated circadian rest-activity rhythms in critically ill patients and their association with baseline (e.g. age) and clinical (e.g. mechanical ventilation status) variables, along with intensive care unit light-dark cycles. Using wrist actigraphy, we collected 48-hr activity and light exposure data from critically ill patients in a tertiary care medical intensive care unit. We evaluated circadian rest-activity rhythms using COSINOR and non-parametric circadian rhythm analysis models, and stratified these data across baseline and clinical variables. We used linear regression to evaluate the association of circadian rest-activity and light-dark exposure rhythms. In COSINOR and non-parametric circadian rhythm analysis analyses, the 34 medical intensive care unit patients completing 48-hr actigraphy recordings exhibited mean MESOR (mean activity levels of a fitted curve) and amplitudes of 0.50 ± 0.32 and 0.20 ± 0.19 movements per 30-s epoch, with high interdaily variability. Patients who were older, mechanically ventilated, sedated, restrained and with higher organ failure scores tended to exhibit greater circadian rest-activity misalignment, with three of 34 (9%) patients exhibiting no circadian rhythmicity. Circadian light-dark exposure misalignment was observed as well and was associated with rest-activity misalignment (p = 0.03). Critically ill patients in our MICU experienced profound circadian rest-activity misalignment, with mostly weak or absent rhythms, along with circadian light-dark exposure misalignment. Potentially modifiable factors contributing to rest-activity misalignment (i.e. mechanical ventilation, restraints, low daytime light levels) highlight possible targets for future improvement efforts.

Paraneoplastic cerebellar degeneration as the first evidence of malignancy: a case report.

Paraneoplastic cerebellar degeneration (PCD) is an immune-mediated paraneoplastic disorder affecting the cerebellum. PCD associated with ovarian malignancy is a rare occurrence with fewer than 100 cases reported in published work. PCD patients express anti-Yo antibody, one of the anti-onconeuronal antibodies which is most likely associated with gynecologic or breast malignancies. In this report, we present the case of a 65-year-old postmenopausal woman presenting with acute symptoms of PCD as a first sign of ovarian malignancy.

Skin Colonization by Malassezia spp. in hospitalized neonates and infants in a tertiary care centre in North India.

Malassezia, a skin colonizer, is associated with multiple skin disorders in adults, and cephalic pustulosis and folliculitis in children. It can cause fungemia in infants and neonates. The time and pattern of colonization, risk factors associated with colonization and causing fungemia in children, are not well understood. The prospective cohort study was conducted to determine the rate of Malassezia species colonization and associated factors in hospitalized neonates and infants. Consecutive 50 neonates and infants admitted in neonatal and pediatric intensive care units were studied. The skin swabs were collected on the day of admission and every fifth day, thereafter, till the patient was discharged or died. Putative risk factors for the colonization of Malassezia species were recorded. Isolates were identified by phenotypic methods and sequencing of the D1 and D2 region of rDNA. Neonates were not colonized at the time of entry in neonatal ICU or at birth. Nineteen (38 %) neonates were colonized with Malassezia species during their hospital stay. Among the infants, three (6 %) came to ICU with Malassezia colonization and 26 (52 %) acquired Malassezia during ICU stay. Mechanical ventilation, duration of hospital stay, central venous catheterization, and antifungal therapy were the significantly associated factors for colonization. Malassezia furfur was the most common species isolated from the skin of infants and neonates. Colonization by Malassezia species in infants and neonates in a hospital is not uncommon and can be a potential source of nosocomial infection.

Decreased levels of circulating and tissue miR-107 in human esophageal cancer.

CONTEXT: Aberrant expression of miRNAs has emerged as an important hallmark of cancer. OBJECTIVES: We evaluated the clinical significance of circulating and tissue miR-107 expression in esophageal squamous cell carcinoma (ESCC) patients. MATERIALS AND METHODS: Quantitative real-time PCR was used to analyze the expression of miR-107 and its bioinformatically identified targets, PIM-1 and CDC42. RESULTS: Significant downregulation of miR-107 was observed in neoplastic and preneoplastic esophageal tissues (p = 0.004). Relative levels of circulating miR-107 significantly distinguished ESCC patients from normal subjects (p = 0.007). Significant inverse correlation was observed between miR-107 and PIM1 expression (r = -0.398; p = 0.015) suggesting PIM1 to be the downstream target of miR-107. DISCUSSION AND CONCLUSION: Our results, for the first time, document that the miR-107 levels may discriminate ESCC patients from healthy individuals emphasizing its diagnostic potential.

Enhanced Antibacterial and Photoluminescence Activities of ZnSe Nanostructures.

Microorganisms create various health issues; semiconductor nanostructures have raised interest because of antimicrobial properties for suppressing microbial growth. Herein, we report the synthesis of ZnSe nanostructures (NSs) using a green coprecipitation method, and the as-synthesized samples were annealed at 100, 150, and 200 °C temperatures. The synthesized samples were analyzed for structural, morphological, optical, and antibacterial properties. The growth of nanorods was confirmed by TEM micrographs and that of nanoparticles by FESEM and TEM micrographs. The cubic zinc blender phase of samples was confirmed by XRD. The high-intensity electron-phonon (e-ph) interactions and LO modes were confirmed by the Raman spectra. The UV-visible absorption spectra predicted the blue shift in optical band gaps of ZnSe NSs from their bulk counterparts. The PL spectra and associated CIE diagram indicated that the as-synthesized and annealed NSs produce blue color. The investigated antimicrobial activity against Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus implies the superior biological activity of the as-synthesized and annealed samples at 200 °C. The annealing enhances photoluminescence and antimicrobial activities of ZnSe NSs. The enhanced luminscence properties of ZnSe NSs make them suitable for preparing more efficient blue LEDs and lasers for medical applications. The as-synthesized and annealed ZnSe NSs are found effective against the growth of microorganisms, and sustaining this tendency for 1 week provides a strong basis for the development of new drugs against bacterial infections for supporting the pharmaceutical industry.

Projected Outcomes of Optimized Statin and Ezetimibe Therapy in US Military Veterans with Coronary Artery Disease.

Importance: Many patients with coronary artery disease (CAD) do not achieve the guideline-directed goals for low-density lipoprotein cholesterol (LDL-C) levels. Objective: To estimate reductions in the rates of adverse events associated with CAD in a large US military veteran population that may be achieved through use of optimized statin therapy alone or with ezetimibe compared with the prevailing lipid-lowering therapy (LLT). Design, Setting, and Participants: In this observational cohort study, US military veterans with CAD were identified by coronary angiography between June 2015 and September 2020 across 82 US Department of Veterans Affairs health care facilities. Exposures: The exposures were observed LLT, LLT with an optimized statin regimen, and LLT with optimized statin and ezetimibe. Main Outcomes and Measures: Observed rates of death, myocardial infarction, stroke, and coronary revascularization, and potential reductions in those outcomes with optimized LLT based on expected further reductions in LDL-C levels and application of formulas from The Cholesterol Treatment Trialists' Collaboration. Results: The analysis cohort comprised 111 954 veterans (mean [SD] age, 68.4 [8.8] years; 109 390 men [97.7%]; 91 589 White patients [81.8%]; 17 592 Black patients [15.7%]). The median (IQR) observation period for this study was 3.4 (2.1-4.0) years. At the time of index angiography, 66 877 patients (59.7%) were treated with statin therapy, and 623 patients (0.6%) were treated with ezetimibe. At 6 months, the number of patients with statin prescriptions increased to 74 400 (68.7%), but the number of patients with high-intensity statin prescriptions was only 57 297 (52.9%). At 6 months, ezetimibe use remained low (n = 1168 [1.1%]), and LDL-C levels were 70 mg/dL or more in 56 405 patients (52.1%). At 4 years, observed incidences of death, myocardial infarction, stroke, and coronary revascularization were 21.6% (95% CI, 21.3%-21.8%), 5.0% (95% CI, 4.9%-5.2%), 2.2% (95% CI, 2.1%-2.3%), and 15.4% (95% CI, 15.2%-15.7%), respectively. With optimized statin treatment, projected absolute reductions in these incidences were 1.3% (95% CI, 0.9%-1.7%), 0.8% (95% CI, 0.7%-1.0%), 0.2% (95% CI, 0.1%-0.3%), and 2.3% (95% CI, 2.0%-2.7%), respectively. With optimized statin and ezetimibe treatment, projected absolute reductions were 1.8% (95% CI, 1.2%-2.4%), 1.1% (95% CI, 0.9%-1.3%), 0.3% (95% CI, 0.2%-0.4%), and 3.1% (95% CI, 2.6%-3.6%), respectively. Conclusions and Relevance: In this cohort study of veterans with CAD, suboptimal LLT was prevalent in the clinical setting. Optimization of statin therapy was projected to produce clinically relevant reductions in the risks of death and cardiovascular events. Despite a lesser lipid-lowering efficacy of ezetimibe, its widespread use on a population level in conjunction with optimized statin therapy may be associated with further meaningful reductions in cardiovascular risk.

Correlation of body mass index with outcome of in vitro fertilization in a developing country.

AIMS AND OBJECTIVE: To correlate ovarian response to stimulation and IVF outcome according to the women's body mass index (BMI). MATERIALS AND METHODS: Records of all patients who underwent IVF cycle in our institution from January 2008 to October 2010 were reviewed retrospectively. Three hundred and twenty-eight patients underwent 342 in vitro fertilization (IVF) cycles or intra-cytoplasmic sperm injection (ICSI) and were divided into four subgroups according to BMI; underweight, BMI < 18.5; normal weight, 18.5-24.9; overweight, 25.0-29.9; and obese, >30.0. RESULTS: In our study, with increasing BMI negative co-relation was seen with clinical pregnancy rate (CPR) (P value = 0.040). Increased doses of gonadotropins were required with increase in patients BMI (P value = 0.045). In the present study, no difference was seen in the number of oocyte retrieved but a decreased fertilization and cleavage rate was seen with decreased number of cryo-preserved embryos with increasing BMI. This study shows that poorer oocyte quality is seen with increasing BMI which results in reduced CPR. In our study no deleterious effect of low BMI was seen on IVF outcome and CPR. CONCLUSION: Female obesity impairs IVF outcome potentially by impairing oocyte quality but does not affect ovarian response to stimulation.

Chronic disfiguring facial lesions in an immunocompetent patient due to Exophiala spinifera: a case report and review of literature.

Exophiala spinifera is a rare fungus causing chromoblastomycosis or different types of phaeohyphomycosis (cutaneous, subcutaneous, disseminated and cyst phaeohyphomycosis). We report a case of a young male with phaeohyphomycosis due to E. spinifera, who had multiple itchy painful papular lesions disfiguring his face for 4 years. His diagnosis was delayed and had received antibacterial and antileishmanial therapy elsewhere without any improvement. While he reported to our hospital, the histopathology of the biopsy collected from the lesion demonstrated acute on chronic inflammation with granuloma formation and darkly pigmented fungal elements. The isolate grown on culture was identified as E. spinifera on the basis of morphological characters. The identification of the isolate was further confirmed by sequencing of the ITS region of ribosomal DNA. After treatment with oral itraconazole, he had marked clinical improvement.

Anthropometric assessment of human auricle in North Indian population.

Introduction: Morphometric studies of the auricle find its place in many areas, such as esthetics, forensic medicine, biology, anthropology, mythology, arts, and acupuncture. Aims and Objective: This study aims at establishing the anatomical variations in the auricular dimensions in North Indian population. The objectives of this study were to measure auricle height in males and females, to measure auricle width in both sexes, to measure lobular height (LH) in both sexes, to measure lobular width (LW) in both sexes, to calculate the auricle index in both sexes, and to calculate lobular index in both sexes. Materials and Methods: This study was conducted on 130 subjects (78 males and 52 females), in the age group of 18-25 years, without history of genetic disorders, injuries, or any disease of the auricle. Results: The average length of the auricle was 6.28 cm (right) and 6.23 cm (left), and the average width was 3.21 cm (right) and 3.28 cm (left). The average height of the lobule was 1.76 cm and 1.77 cm on the right and left sides, respectively, while the lobule width was 1.90 cm on the right side and 2.01 cm on the left side. Conclusion: Total right auricle height and total auricle width of both the right and left ears are more in males as compared to females, and the difference between both the sides was significant. Both right- and left-side LH and LW were higher in males as compared to females.

Antenatal ultrasound and MRI findings of Pena-Shokeir syndrome.

INTRODUCTION: Pena-Shokeir syndrome is an autosomal recessive disorder characterized by arthrogryposis, facial anomalies (micrognathia), camptodactyly, polyhydramnios and lung hypoplasia. CASE REPORT: We report prenatal ultrasonographic, antenatal MR and postnatal examination findings of a fetus with Pena-Shokeir syndrome. CONCLUSION: Pena-Shokeir syndrome is a potentially lethal condition and most cases are diagnosed prenatally by ultrasound. Fetal MR can be performed to look associated neurological malformation.

Extensive white piedra of the scalp caused by Trichosporon inkin: A case report and review of literature.

Trichosporon species cause wide varieties of fungal infections. White piedra, a superficial fungal infection on the hair shaft, is caused by Trichosporon species. We report here a case of white piedra over the scalp due to T. inkin, a rarely isolated pathogen from such a lesion. The identification of the fungus was confirmed on the basis of morphology, carbohydrate assimilation tests, and sequencing of the ITS region of rDNA. The available literature on infections due to T. inkin is also reviewed.

Utility of special drive campaign on substance use disorders in hard-to-reach communities in the fast urbanizing town of Solan, India.

AIMS: Special drive campaigns on substance use disorders (SUDs) in India are usually organized in educational institutes, non-governmental organizations, or few selected localities. Hard to reach communities of construction, prison, and industrial sites quite often remain uncovered. MATERIALS AND METHODS: During a month-long special drive in 2019, under a cross-sectional study, we reached these communities of Solan town through awareness camps and incorporated standardized screening tools for evaluating morbidity patterns of SUDs. RESULTS: Statistically significant relationship existed between 360 participants (90.8% males, 9.2% females; mean age of 33 years) and their educational levels with χ2 (1, n = 360) =130.59, P = 0.000. Fagerstrom's scale inferred very high nicotine dependence in 10.6%, 7.9%, and 2.4% of prisoners, industrial workers, and laborers, respectively. Whereas, Fagerstrom scale for smokeless tobacco revealed 31% of significant dependence potential amongst laborers. Alcohol use disorder identification test revealed 28 persons with harmful alcohol dependence. Drug abuse screening test revealed 13.6% of prisoners having moderate level drug abuse potential. The Kruskal-Wallis test showed a statistically significant difference, in levels and potential of substance use in construction, prison, and industrial sites. CONCLUSION: The study proved the utility of special drives in evaluating SUDs morbidity patterns in hard-to-reach communities.

Role of MRI in fetal abdominal cystic masses detected on prenatal sonography.

OBJECTIVE: Our aim was to determine the role of fetal MRI in sonographically detected abdominal cystic masses. MATERIALS AND METHODS: Fifty-six fetuses in 56 women with fetal malformation underwent sonography and MRI. Out of the 56 fetuses, 6 had intra-abdominal cystic masses and formed our study group. MRI findings were compared with ultrasonographic findings regarding detection, anatomical localization and tissue characterization. MR findings were considered to have affected management if subsequent treatment was influenced by the MR findings and diagnosis. RESULTS: Final individual diagnoses were: meconium pseudocyst (n = 2), mesenteric cyst, hydrometrocolpos, chylous ascitis, and gross hydronephrosis with pelvic-ureteric junction obstruction (n = 1 each). MRI was superior to sonography and had supplemental value because of better anatomical localization in five cases. MRI better characterized the nature of cystic masses in two fetuses (Chylous ascitis, and hydrometrocolpos). In two patients with meconium pseudocyst, tissue characterization was inferior with MRI. Overall, addition of MRI changed the diagnosis and management in four cases. CONCLUSION: Our preliminary results suggest that because of its excellent anatomical localization and contrast resolution, MRI has a supplemental value to antenatal sonography in delineation and characterization of abdominal cystic masses.

Use of actigraphy to characterize inactivity and activity in patients in a medical ICU.

BACKGROUND: In the intensive care unit (ICU), inactivity is common, contributing to ICU-acquired weakness and poor outcomes. Actigraphy may be useful for measuring activity in the ICU. OBJECTIVES: To use actigraphy to characterize inactivity and activity in critically ill patients. METHODS: This prospective observational study involved 48-h wrist actigraphy in medical ICU (MICU) patients, with activity data captured across 30-s epochs. Inactivity (zero-activity epochs) and activity (levels of non-zero activity) were summarized across key patient (e.g., age) and clinical (e.g., mechanical ventilation status) variables, and compared using multivariable regression. RESULTS: Overall, 189,595 30-s epochs were collected in 34 MICU patients. Zero-activity (inactivity) comprised 122,865 (65%) of epochs; these epochs were 24% and 13% more prevalent, respectively, in patients receiving mechanical ventilation (versus none, p < 0.001) and in the highest (versus lowest) organ failure score tertile (p = 0.03). Ambulatory (versus non-ambulatory) patients exhibited more non-zero activity (35 more movements per epoch, p < 0.001), while those in the highest (versus lowest) organ failure score tertile exhibited less activity (22 fewer movements per epoch, p = 0.03). Significant inactivity/activity differences were not observed when evaluated based on age, sedation, or restraint status. CONCLUSIONS: Actigraphy demonstrated that MICU patients are profoundly inactive, including those who are young, non-sedated and non-restrained. Hence, ICU-specific, non-patient-related factors may contribute to inactivity, an issue requiring further investigation.

Esophageal carcinoma during pregnancy: a case report.

Association of pregnancy with esophageal cancer is an extremely rare event. The symptoms are frequently masked by factors related to normal pregnancy and diagnostic approaches are restricted by physical and psychological clinical events. Hence, the cancer stage is usually advanced at the time of diagnosis. The approach to cancer surgery and chemotherapy must be modified in pregnant patients to minimize fetal and maternal risks. We present an extremely rare case of carcinoma esophagus during pregnancy.