Prediction of response to radiotherapy in locally advanced carcinoma cervix using multiparametric MRI: A prospective, single-center, longitudinal study.

PURPOSE: To evaluate the possible role of a multiparametric magnetic resonance imaging (MRI) and semiquantitative fusion map for the prediction of response to radiotherapy in carcinoma cervix. METHODS: This was a prospective, single-center, longitudinal observational study performed on patients with locally advanced carcinoma cervix. Relative blood flow (rBF), relative blood volume (rBV), and apparent diffusion coefficient (ADC) values were obtained before and after the onset of radiotherapy. rBV, rBF, and ADC values were used to generate a semiquantitative pharmacokinetic model map to identify any hypoxic component of the tumor. The subjects were retrospectively classified as responders and nonresponders based on response to treatment. Prospective prediction of response status was done using pretreatment multiparametric MRI parameters (rBF, rBV, and ADC) and semiquantitative parametric map. RESULTS: In 32 patients (29 with parametrial involvement and 15 with lymphadenopathy), pretreatment ADC of the primary tumor was the most accurate measure for predicting response to treatment as well as for treatment-induced fractional volume reduction. Although rBV and rBF were insignificant metrics in isolation for predicting response status, a combination with ADC in the form of parametric map had a sensitivity of 86.4% and 77.2%, specificity of 70% and 70%, positive predictive value of 86.4% and 85%, and negative predictive value 70% and 59% respectively by two independent observers. CONCLUSION: ADC is the most accurate measure for predicting the response to treatment. A manual parametric map generated by an off-line fusion of the above map with those generated by pharmacokinetic modeling of perfusion-weighted MRI may be a useful tool for the prediction of response to radiotherapy.

Thoracic epidural Ewing sarcoma mimicking an epidural abscess: A case report.

INTRODUCTION AND IMPORTANCE: Ewing's sarcoma (ES) is a malignant mesenchymal tumor that is categorized as a primitive neuroectodermal tumor (PNET) and is a member of the "small round-cell tumor" family. Spinal extraosseous extradural lesions are highly uncommon in PNETs. There are few clinical studies and information on extra-osseous Ewing tumor outcomes. CASE PRESENTATION: A 19-year-old woman, with progressive dull aching low back pain of a duration of one month presented. Examination revealed, no knee or ankle reflexes and an MRC power of 0/5 across bilateral ankle and knee joints. The bilateral lower limb's pain, touch, and temperature all received a score of 0/2 on the sensory grading scale. An x-ray revealed radio-opacity at the 9th and 10th thoracic vertebra. The diagnosis of Pott's spine having a likely tubercular abscess was made after an MRI revealed a heterogeneously enhancing collection at T9-T10 communicating with the posterior epidural space. During surgery, an isolated epidural mass with no apparent bony extension was present. The diagnosis was changed to EES based on the results of the histopathology and CD 99 immunohistochemistry tests. Chemotherapy was started. Following up with the patient two months later revealed that her power and sensation in both lower limbs had improved. CLINICAL DISCUSSION: Usually, children and young adults are affected by Ewing's sarcoma. Due to the rarity of extradural thoracic Ewing sarcoma, its exact prevalence is unknown, Most EES have early distant metastases to the lungs and bones and are rapidly growing. It exhibits the compressive myelopathy symptom. It is challenging to distinguish EES from other spinal tumors and from the TB spine because no specific radiologic patterns for intra-spinal EES and PNETs have been described. Due to its rarity, the spinal epidural treatment protocol is not well established. However, the reported cases show that excision and combined radiotherapy have promising outcome. CONCLUSION: Epidural Ewing sarcoma should be one of the differentials even in the region with a high prevalence of Potts's spine in young patients presenting with back pain and myelopathy-like symptoms. Ewing sarcoma treatment plans are subject to significant, even month-to-month, changes.

Sleeve gastrectomy for multiple gastric perforations in a preterm: A case report.

Neonatal gastric perforation (NGP) is a rare life-threatening condition among preterm infants. NGP can occur secondary to necrotizing enterocolitis, distal obstruction, or as a result of gastric tube insertion. Sleeve gastrectomy can be a possible therapeutic option for multiple neonatal gastric perforations.

Splenic artery aneurysm with extrahepatic portal venous obstruction: A case report.

INTRODUCTION AND IMPORTANCE: Splenic artery aneurysm is one of the most common visceral aneurysms. Patients are usually asymptomatic. Splenic artery aneurysm if untreated has the potential for rupture and is therefore life-threatening. Its association with extrahepatic portal vein obstruction is rare. CASE PRESENTATION: A 25-year female was incidentally diagnosed with a splenic artery aneurysm with extrahepatic portal vein obstruction with splenomegaly 8 years back during the 5th month of her second pregnancy. No intervention was done back then. Recently, she presented to the surgical gastroenterology outpatient department with an increasing abdominal mass. On examination, the patient was pale and splenomegaly was present. Hematological reports were suggestive of hypersplenism. The patient underwent splenectomy and aneurysmal resection with a proximal splenorenal shunt as the best course of treatment. DISCUSSION: Due to the rarity of the disease, the management is still challenging and needs further study. Diagnosis can be made clinically with support from imaging modalities. Surgical treatment has a good outcome in such patients. Even with the availability of less invasive procedures such as endovascular treatment, open surgery is preferred. CONCLUSION: Proximal splenorenal shunt is a well-accepted surgical procedure for extrahepatic portal vein obstruction. Splenectomy and aneurysmal resection can relieve hypersplenism and treat splenic artery aneurysm in patients with isolated splenic artery aneurysm at the splenic hilum.

Clarifying Optimal Sodium InTake In Cardiovasular and Kidney (COSTICK) Diseases: a study protocol for two randomised controlled trials.

Background: While low sodium intake (<2.3g/day) is recommended for all, there is uncertainty about feasibility and net cardiovascular effects. In COSTICK, we evaluated the effects of a dietary counselling intervention (reduced sodium intake) on intermediate cardiorenal outcomes in patients with (STICK) and without (COSIP) mild/moderate kidney disease. Methods: This is a protocol for two phase IIb randomised, two-group, parallel, open-label, controlled, single centre trials. Participants were aged >40 years with stable blood pressure, unchanged anti-hypertensive medications, willing to modify diet and provided written informed consent. Participants were excluded for abnormal sodium handling, heart failure, high dose diuretics, immunosuppression, pregnancy/lactation, postural hypotension, cognitive impairment, high or low body mass index (BMI) or inclusion in another trial. STICK participants had estimated glomerular filtration rate (eGFR) 30-60ml/min/1.73m 2 and were excluded for acute kidney Injury, rapidly declining eGFR; known glomerular disease or current use of non-steroidal anti-inflammatory drugs. For COSIP, participants were excluded for known kidney or cardiovascular disease. Participants were randomized to usual care only (healthy eating) or an additional sodium lowering intervention (target <100mmol/day) through specific counseling (sodium use in foods, fresh over processed foods, sodium content of foods and eating outside of home). In STICK the primary outcome is change in 24-hour urinary creatinine clearance. In COSIP, the primary outcome is change in five biomarkers (renin, aldosterone, high sensitivity troponin T, pro-B-type natriuretic peptide and C-reactive protein). Our primary report (COSTICK), reports six biomarker outcome measures in the entire population at 2 years follow-up. Discussion: These Phase II trials will explore uncertainty about low sodium intake and cardiovascular and kidney biomarkers, and help determine the feasibility of low sodium intake. Trial results will also provide preliminary information to guide a future definitive clinical trial, if indicated. Trial registration: STICK: ClinicalTrials.gov NCT02738736 (04/04/2016); COSIP: ClinicalTrials.gov NCT02458248 (15/05/2016).

Awareness of medical students in a medical college in Mangalore, Karnataka, India concerning infection prevention practices.

BACKGROUND: Healthcare-associated infections (HCAIs) are an important public health problem. It is estimated that approximately 1 out of every 20 hospitalized patients will contract an HCAI. The risk is substantial not only to patients but also to healthcare workers, who may contract deadly blood-borne infectious diseases. Hence, it is essential for healthcare professionals to have adequate knowledge regarding infection prevention practices (IPPs) to reduce the burden of these illnesses among patients seeking care. METHODS: This cross-sectional study was conducted among 268 medical students at Kasturba Medical College, Mangalore. Information regarding important IPPs such as hand hygiene (HH), needle-stick injuries (NSIs), and standard precautions (SPs) was collected using a semi-structured questionnaire. The collected information was analyzed using SPSS v.11. Fisher's exact test was used to test the association between variables of interest. RESULTS: Overall, knowledge levels regarding HH were low in aspects such as healthcare workers' hands as sources of infection (40%) and the minimum time needed to apply hand rubs (45.7%), whereas knowledge levels were high in aspects such as indications for using HH. Regarding NSI prevention, knowledge levels were low in aspects such as activities with the highest NSI risk (56%). However, knowledge levels were high in relation to SPs. CONCLUSION: The knowledge levels regarding infection practices were not adequate among the participants, particularly in the case of hand hygiene methods. Other important aspects, such as needle-stick injuries and use of standard precautions, were better understood, although many aspects still require improvement. These findings suggest the need to consider strengthening the training related to IPPs as a separate entity in the existing curriculum.