Daily waiting time management for modern radiation oncology department in Indian perspective.

Introduction: Radiation therapy is one of the most technically sophisticated branch of medical sciences which caters to very ill patients, some of whom may be terminally ill. Since patients are treated on an outpatient basis which requires daily visit to hospital for a number of days, it can make them sensitive toward any increase in waiting time for their radiation treatment. This could be a source of stress for them. However, given the technical sophistication involved and varied clinical profile of patients, some amount of delay is inevitable. Aim & Objective: To compile and suggest strategies to manage patient waiting time in Radiation oncology department to achieve optimum patient' satisfaction. Method: The radiation oncologists in different institutes of the country were interviewed telephonically and were asked about the practices followed in their institutes/ departments in managing the patient waiting time during radiation treatment. The best practices being followed and the suggestions were compiled. Conclusion: Now it is being recognized that meticulous management of waiting time could go a long way in driving patient's satisfaction. Twoway communications are the best strategy. Apart from this many provisions could be made in waiting area as per institutional preferences and protocol to engage patient in waiting area of radiation treatment facility.

Antibodies against phosphorylcholine in hospitalized versus non-hospitalized obese subjects.

Obesity associates with reduced life expectancy, type 2 diabetes, hypertension and cardiovascular disease, and is characterized by chronic inflammation. Phosphorylcholine (PC) is an epitope on oxidized low-density lipoprotein, dead cells and some microorganisms. Antibodies against PC (anti-PC) have anti-inflammatory properties. Here, we explored the role of anti-PC in hospitalized versus non-hospitalized obese. One-hundred-and-twenty-eight obese (BMI ≥ 30 kg/m2) individuals (59.8 (± 5.5) years, 53.9% women) from the Malmö Diet and Cancer Cardiovascular Cohort were examined and IgM, IgG1 and IgG2 anti-PC were analyzed by ELISA. Individuals with at least one recorded history of hospitalization prior to study baseline were considered hospitalized obese (HO). Associations between IgM, IgG1 and IgG2 anti-PC and HO (n = 32)/non-hospitalized obese (NHO) (n = 96), but also with metabolic syndrome and diabetes were analysed using logistic regressions. Both IgM and IgG1 anti-PC were inversely associated with HO, also after controlling for age and sex. When further adjusted for waist circumference, systolic blood pressure, glucose levels and smoking status, only IgG1 anti-PC remained significantly associated with HO. In multivariate models, each 1 standard deviation of increment in anti-PC IgG1 levels was inversely associated with prevalence of HO (odds ratio 0.57; CI 95% 0.33-0.98; p = 0.044). IgG2 anti-PC did not show any associations with HO. Low levels of IgM and IgG1 anti-PC are associated with higher risk of being a HO individual independent of sex and age, IgG1 anti-PC also independently of diabetes and metabolic syndrome. The anti-inflammatory properties of these antibodies may be related to inflammation in obesity and its complications.

Haemorrhagic shock from solid tumours of the adrenal gland: a case of bleeding primary adrenal lymphoma.

Suprarenal or adrenal gland haemorrhage is an uncommon but potentially lethal condition if unrecognised. Adrenal masses rarely present with haemorrhage, but they remain an important differential aetiology for adrenal bleeding. We present a novel case of primary adrenal lymphoma with adrenal haemorrhage in a middle-aged woman who presented with right-sided abdominal pain and class 1 haemorrhagic shock. She was found to have spontaneous unilateral adrenal gland haemorrhage in the absence of any underlying previous pathology. Presenting features, diagnosis and subsequent oncological management are reported.

Anastomotic dehiscence following retroflexion in surveillance colonoscopy: a case report.

Anastomotic dehiscence following colonoscopy for routine surveillance after anterior resection for colorectal cancer is unreported in the English literature. It is a potentially fatal complication requiring awareness, quick recognition and management. We present the case of a 45-year-old woman who presented 12 hours after a routine follow-up colonoscopy with peritonitis due to anastomotic rupture diagnosed on computed tomography. The patient was taken to theatre for emergency laparotomy and formation of an end colostomy. Her postoperative recovery and follow-up were optimal.

Spectrum of Glomerular Diseases in Adults: A Study from North Eastern India.

AIMS AND OBJECTIVES: To study the clinical profile of patients with glomerular diseases and to study pattern of glomerular diseases in adults. METHODOLOGY: A hospital based retrospective observational study from North Eastern India that includes biopsy proven glomerular disease (GD) in adults. Patients with inadequate biopsy sampling; incomplete medical data and biopsy of transplanted kidney were excluded. RESULTS AND OBSERVATIONS: A total of 102 patients were included of which 25 (24.5%) were male and 77(75.5%) were female with M: F ratio of 0.32:1. The mean age of presentation was 30.6 years. Nephrotic syndrome (57.8%) was the commonest clinical diagnosis followed by acute nephritic syndrome (31.4%), unexplained AKI (5.9%), unexplained CKD with normal kidney size (2.9%) and asymptomatic urine abnormality (1.9%). On histo-pathological analysis primary GD and secondary GD was diagnosed in 46(45.1%) and 53(52.0%) respectively. Overall Lupus nephritis (LN) was found to be the commonest (41.2%) GD. Among the primary GD, MCD (11.8%) was the most frequent followed by MPGN (10.8%), Membranous Nephropathy, (5.8%), IgA nephropathy (5.8%) and Focal segmental glomerulosclerosis (5.8%). Three (2.9%) patients did not have any specific diagnosis and were labelled as chronic glomerulo- nephritis.. CONCLUSIONS: As the pattern of glomerular disease varies from one region to another, the pattern of glomerular disease in the north eastern India also varies from the other regions of India. Nephrotic syndrome remains the most common indication of renal biopsy in this region similar to the other parts of India. Unlike other studies from outside North Eastern India, this study show that females are more commonly involved with majority of them having secondary GD and this is due to LN which was diagnosed as the most common GD in the present study.

Microsatellite Instability in Chronic Myeloid Leukemia using D17S261 and D3S643 markers: A Pilot Study in Gujarat Population.

CONTEXT: Tumor progresses through a series of genetic alterations that involve proto-oncogenes and tumor suppressor genes - the gatekeeper, caretakers, and landscaper genes. Microsatellites are short tandem repeat sequences, present over the span of human genome and are known to be variable at multiple loci due to errors in DNA Mismatch Repair machinery. AIM: The present study was aimed to evaluate the association between Microsatellite Instability (MSI) and evolution of Chronic Myeloid Leukemia (CML) - genetically a rare event but profound in this pilot study. SETTINGS AND DESIGNS: We explore the possibility of MSI in primary CML patients confirmed by t(9;22) using capillary electrophoresis. Fifteen CML patients and healthy individual samples, respectively, were used to study the markers D17S261 and D3S643. MATERIALS AND METHODS: The DNA was amplified using tagged and nontagged primers and further subjected to bioanalysis and fragment analysis. RESULTS: While the results from bioanalyzer fluctuated, fragment analysis indicated the presence of microsatellite variability in 80% of the patients' samples as compared to no MSI in normal individuals for both the markers. CONCLUSION: These findings suggest that MSI is a genetic event that may have a role in CML progression or evolution. Further studies are warranted to understand the plausible underlying causes.

Oral Submucous Fibrosis Secondary to Iron Deficiency Anemia: A Case Report, Etiopathogenesis and Management.

Oral submucous fibrosis (OSMF) is a premalignant condition that has received considerable attention in the recent past because of its chronic debilitating and resistant nature. Over the past decades, dental researchers have reported overwhelming evidence about various etiological factors of OSMF. It has been the subject of controversy ever since Schwartz first described the condition in 1952. Areca nut is considered the primary etiology along with other local irritants like capsaicin, pungent and spicy food, nutritional deficiency, defective iron metabolism, collagen metabolic disorder and genetic predisposition. Association of iron deficiency anemia and OSMF is very sparse in literature. Here, we present a case report of a 58 year old male patient where the patient presented with OSMF where iron deficiency anemia was found to be the main etiological factor.

Development of interspecific Solanum lycopersicum and screening for Tospovirus resistance.

Tospovirus has emerged as a serious viral pathogen for several crops including tomato. The tomato production is being severely affected worldwide by Tospovirus. Some reports have been published about the association of plant virus and development of human disease either by direct or indirect consumption. Resistance to this virus has been identified as good source in wild tomato species (Lycopersicum peruvianum). But the introgression of resistance genes into cultivated tomato lines and the development of interspecific hybrid are hampered due to incompatibility, fertilization barriers and embryo abortion. But this barrier has been broken by applying the embryo rescue methods. This study describes the development of interspecific hybrid tomato plants by highly efficient embryo rescue method and screening for Tospovirus resistance. The interspecific hybrid tomato plants were developed by making a cross between wild tomato species (L. peruvianum) and cultivated tomato (Solanum lycopersicum). The immature embryos were cultured in standardized medium and interspecific hybrids were developed from embryogenic callus. The immature embryos excised from 7 to 35 days old fruits were used for embryo rescue and 31 days old embryos showed very good germination capabilities and produced the highest number of plants. Developed plants were hardened enough and shifted to green house. The hybrid nature of interspecific plants was further confirmed by comparing the morphological characters from their parents. The F1, F2 and F3 plants were found to have varying characters especially for leaf type, color of stem, fruits, size, shapes and they were further screened for virus resistance both in lab and open field followed by Enzyme linked Immunosorbant Assay confirmation. Finally, a total of 11 resistant plants were selected bearing red color fruits with desired shape and size.

Positive association between serum silicon levels and bone mineral density in female rats following oral silicon supplementation with monomethylsilanetriol.

UNLABELLED: Observational (epidemiological) studies suggest the positive association between dietary silicon intake and bone mineral density may be mediated by circulating estradiol level. Here, we report the results of a silicon supplementation study in rats that strongly support these observations and suggest an interaction between silicon and estradiol. INTRODUCTION: Epidemiological studies report strong positive associations between dietary silicon (Si) intake and bone mineral density (BMD) in premenopausal women and indicate that the association may be mediated by estradiol. We have tested this possibility in a mixed-gender rodent intervention study. METHODS: Tissue samples were obtained from three groups of 20-week-old Sprague Dawley rats (five males and five females per group) that had been supplemented ad libitum for 90 days in their drinking water with (i) <0.1 mg Si/L (vehicle control), (ii) 115 mg Si/L (moderate dose) or (iii) 575 mg Si/L (high dose). All rats received conventional laboratory feed, whilst supplemental Si was in the form of monomethylsilanetriol, increasing dietary Si intakes by 18 and 99 %, for the moderate- and high-dose groups, respectively. RESULTS: Fasting serum and tissue Si concentrations were increased with Si supplementation (p < 0.05), regardless of gender. However, only for female rats was there (i) a trend for a dose-responsive increase in serum osteocalcin concentration with Si intervention and (ii) strong significant associations between serum Si concentrations and measures of bone quality (p < 0.01). Correlations were weaker or insignificant for tibia Si levels and absent for other serum or tibia elemental concentrations and bone quality measures. CONCLUSIONS: Our findings support the epidemiological observations that dietary Si positively impacts BMD in younger females, and this may be due to a Si-estradiol interaction. Moreover, these data suggest that the Si effect is mediated systemically, rather than through its incorporation into bone.

Gender-specific brain regional variation of neurons, endogenous estrogen, neuroinflammation and glial cells during rotenone-induced mouse model of Parkinson's disease.

Rotenone (RT) produces reactive oxygen species (ROS) by inhibiting the mitochondrial electron transport chain; causing dopaminergic (DA) cell death in the substantia nigra (SN) and simulates other models of induced Parkinson's disease (PD). There is a sincere dearth of knowledge regarding the status of glial cells, neuroprotective estrogen and the status of neuroinflammatory TNF-α in the different brain regions in either sex during healthy, as well as during PD conditions. In the present study of RT-induced mouse model of PD, we have selected the frontal cortex (FC), hippocampus (HC) and SN from either sex of Swiss albino mice as these are the major regions involved during PD pathogenesis. During non pathogenic conditions, the ROS-scavenging enzyme activity varied among the brain regions and also in between genders. The number of DOPA decarboxylase-positive cells, astrocytes and microglia was similar in the respective regions of the brain in both the sexes. The level of proinflammatory cytokine TNF-α was same in the respective FC and HC in either sex except that of SN. The expression level of estrogen and its receptors varied among the three brain regions. During RT treatment, ROS-scavenging enzyme activities increased, DOPA decarboxylase-positive neurons and fibers in DA as well as in norepinephrinergic (NE) systems become degenerated, number of astrocytes decreased and microglial cells increased in those specific brain regions in either of the sexes except in the SN region of males where astrocyte number remained unaltered and microglial cell percentage decreased. TNF-α increased in the FC and SN but remained unaltered in the HC of both sexes. Estradiol level decreased in the HC and SN but the level unevenly varied in the FC. Similarly, the estrogen bound and nuclear-cytosolic receptor α and ß also varied differentially among the brain regions of the two sexes. Therefore our present study depicts that there exists a clear variation of neuronal and astroglial cell population, estrogen and its receptor levels in different brain regions of both the sexes during control and RT-treated pathogenic condition and these variations have major implication in PD pathogenesis and progression.

Scrub typhus meningoencephalitis, a diagnostic challenge for clinicians: A hospital based study from North-East India.

UNLABELLED: Central nervous system (CNS) involvement is a known complication of scrub typhus which range from mild meningitis to frank meninigoencephalitis. AIMS AND OBJECTIVES: To study the clinical feature, laboratory parameters and response to treatment of scrub typhus meningitis/meningoencephalitis. METHODS AND MATERIALS: This is a hospital based prospective observational study from North Eastern India. Diagnosis was based on clinical features and positive serological test (Weil's Felix test and IgM antibody card test). RESULTS: 13 patients of scrub typhus with features of meningitis/meningoencephalitis were included. The mean duration of fever before presentation was 5.61±3.08 days and 4 (30.76 %) patients had eschar. Altered sensorium, headache, seizure and meningeal sign were present in 13 (100%), 13 (100%), 6 (46.15%) and 10 (76.92%) patients respectively. Mean CSF protein, glucose and Adenosine deaminase was 152.16±16.88mg/dl, 55.23±21.7mg/dl, and 16.98±7.37U/L respectively. Mean total count of CSF leukocyte and lymphocyte percentage was 46.07±131 cell/cumm and 98.66±3.09% respectively. Tablet doxycycline with or without injection azithromycin was used and that shows good response 15.38% of patients died and all of them had multi organ dysfunction. CONCLUSION: Meningoencephalitis is a common manifestation of scrub typhus and diagnosis requires high degree of clinical suspicion which if diagnosed early and specific treatment started, patients usually recover completely with few complications.

In vivo magnetic resonance imaging of hyperpolarized silicon particles.

Silicon-based micro- and nanoparticles have gained popularity in a wide range of biomedical applications due to their biocompatibility and biodegradability in vivo, as well as their flexible surface chemistry, which allows drug loading, functionalization and targeting. Here, we report direct in vivo imaging of hyperpolarized (29)Si nuclei in silicon particles by magnetic resonance imaging. Natural physical properties of silicon provide surface electronic states for dynamic nuclear polarization, extremely long depolarization times, insensitivity to the in vivo environment or particle tumbling, and surfaces favourable for functionalization. Potential applications to gastrointestinal, intravascular and tumour perfusion imaging at subpicomolar concentrations are presented. These results demonstrate a new background-free imaging modality applicable to a range of inexpensive, readily available and biocompatible silicon particles.

Laparoscopic slit mesh repair of parastomal hernia using a designated mesh: long-term results.

BACKGROUND: Parastomal hernia (PH) is a frequent complication of colorectal surgery, which incidence reaches 55% of all stoma formation. Currently, there is no definitive strategy for its repair. This study was designed to assess the outcome in patients who underwent laparoscopic PH repair using a slit mesh/keyhole technique. METHODS: We undertook a retrospective case review of all patients who underwent laparoscopic PH repair with a designed slit mesh/keyhole between 2005 and 2010. Three ports were placed opposite the stoma site, and careful adhesiolysis and hernia content reduction were performed. The parastomal fascial defect was measured and covered with a designated mesh. Fixation of the mesh was achieved with concentric tacks and transcutaneous Prolene suture. Recurrence was diagnosed after examination of patients by two surgeons or by imaging demonstrating an indolent hernia. RESULTS: Twenty-nine laparoscopic PH mesh repairs were performed with an average age of 63.5 (range 42-81, median 64) years to treat paracolostomy hernia in 18 of 29 cases (62.1%), para-ileostomy hernia in 10 of 29 cases (34.5%), and for an ileal conduit site hernia in 1 of 29 cases (3.4%). The average operative time was 179 (range, 80-300; median, 180) min. Two operations (6.9%) were converted to an open approach. Early postoperative complications were documented in four patients (13.8%), including one elderly patient with severe comorbidities who died from postoperative sepsis (mortality rate, 3.4%). Only one late complication was recorded (3.4%). The average hospital stay was 4.7 (range, 1-19; median, 3) days. Average follow-up time was 28 (range, 12-53; median, 30) months. Recurrence of the hernia was found in 13 of 28 patients (46.4%). CONCLUSIONS: Laparoscopic slit mesh/keyhole repair is feasible, although it is a complex surgery reflected by extended operative time. The high recurrence rate suggests that technical improvement of the method is essential.

An integrated and interactive decision support system for automated melanoma recognition of dermoscopic images.

This paper presents an integrated and interactive decision support system for the automated melanoma recognition of the dermoscopic images based on image retrieval by content and multiple expert fusion. In this context, the ultimate aim is to support the decision making by retrieving and displaying the relevant past cases as well as predicting the image categories (e.g., melanoma, benign and dysplastic nevi) by combining outputs from different classifiers. However, the most challenging aspect in this domain is to detect the lesion from the healthy background skin and extract the lesion-specific local image features. A thresholding-based segmentation method is applied on the intensity images generated from two different schemes to detect the lesion. For the fusion-based image retrieval and classification, the lesion-specific local color and texture features are extracted and represented in the form of the mean and variance-covariance of color channels and in a combined feature space. The performance is evaluated by using both the precision-recall and classification accuracies. Experimental results on a dermoscopic image collection demonstrate the effectiveness of the proposed system and show the viability of a real-time clinical application.

Unilateral paravertebral block: an alternative to conventional spinal anaesthesia for inguinal hernia repair.

BACKGROUND: Inguinal herniorrhaphy can be successfully performed using general, regional or local anaesthesia. Paravertebral block (PVB) has been used for unilateral procedures such as thoracotomy, breast surgery, chest wall trauma, hernia repair or renal surgery. METHODS: We compared unilateral lumbar PVB with conventional spinal anaesthesia (SA) in 60 consenting ASA I and II males aged 18-65 years, scheduled for unilateral inguinal hernia repair. Patients were randomly assigned into two groups, P (n=30) or S (n=30) to receive either PVB or SA, respectively. Two patients (7%) in group P had to be converted to general anaesthesia due to block failure. During surgery, patients of both groups received intravenous infusion of propofol titrated to light sedation. RESULTS: The time to first post-operative analgesic requirement (primary outcome measure) as 342 +/- 73 min in group P and 222 +/- 22 min in group S (P<0.0001). Time to ambulation was 234 +/- 111 min in group P and 361 +/- 32 min in group S (P<0.0001). Urinary retention requiring catheterization were found in zero (0%) patients in group P compared with five (16%) in group S (P=0.024). CONCLUSION: It can be concluded that unilateral PVB is more efficacious than conventional SA in terms of prolonging post-operative analgesia and reducing morbidities in patients undergoing elective unilateral inguinal hernia repair.

Hyperpolarized MR imaging: neurologic applications of hyperpolarized metabolism.

Hyperpolarization is the general term for a method of enhancing the spin-polarization difference of populations of nuclei in a magnetic field. No less than 5 distinct techniques (dynamic nuclear polarization [DNP]; parahydrogen-induced polarization-parahydrogen and synthesis allow dramatically enhanced nuclear alignment [PHIP-PASADENA]; xenon/helium polarization transfer; Brute Force; (1)H hyperpolarized water) are currently under exhaustive investigation as means of amplifying the intrinsically (a few parts per million) weak signal intensity used in conventional MR neuroimaging and spectroscopy. HD-MR imaging in vivo is a metabolic imaging tool causing much of the interest in HD-MR imaging. The most successful to date has been DNP, in which carbon-13 ((13)C) pyruvic acid has shown many. PHIP-PASADENA with (13)C succinate has shown HD-MR metabolism in vivo in tumor-bearing mice of several types, entering the Krebs-tricarboxylic acid cycle for ultrafast detection with (13)C MR imaging, MR spectroscopy, and chemical shift imaging. We will discuss 5 promising preclinical studies: (13)C succinate PHIP in brain tumor; (13)C ethylpyruvate DNP and (13)C acetate; DNP in rodent brain; (13)C succinate PHIP versus gadolinium imaging of stroke; and (1)H hyperpolarized imaging. Recent developments in clinical (13)C neurospectroscopy encourage us to overcome the remaining barriers to clinical HD-MR imaging.

Metastatic angiosarcoma presenting as diffuse alveolar hemorrhage.

Angiosarcoma is a rare malignant neoplasm of the vascular or lymphatic endothelium. Diffuse alveolar hemorrhage is a rare presenting manifestation of angiosarcoma. We describe a case of pulmonary metastasis of angiosarcoma who presented with diffuse alveolar hemorrhage as initial manifestation.

Predisposition to HPV16/18-related cervical cancer because of proline homozygosity at codon 72 of p53 among Indian women is influenced by HLA-B*07 and homozygosity of HLA-DQB1*03.

This study was undertaken to examine whether predisposition to human papillomavirus (HPV)16/18-related cervical cancer (CaCx) because of p53 proline homozygosity (Pro72Pro) among Indian women was mediated singly or jointly with immunogenetic risk factors such as HLA-B*07 or homozygosity of HLA-DQB1*03. Molecular detection of all three genetic factors was performed by polymerase chain reaction-restriction fragment length polymorphism using DNA from (i) 114 CaCx samples (78 HPV16/18 positive) and (ii) 195 cytologically normal cervical scrapes (116 HPV-negative and 79 HPV16/18-positive samples). Multiple logistic regression analyses were performed to examine independent effects of the three factors and to determine age-adjusted odds ratio (OR) [95% confidence interval (CI)] and P-values. HLA-B*07 was observed to be significantly associated with HPV16/18 infection in asymptomatic controls (OR(age-adjusted) = 4.73; 95% CI: 1.55-14.45; P = 0.006) and CaCx (OR(age-adjusted) = 6.14; 95% CI: 2.15-17.53; P < 0.001) in this enhanced sample set of CaCx cases. There was a lack of association between HLA-B*07 and HLA-DQB1*03 in our study samples. The association of p53Pro72Pro with CaCx was non-significant in the absence of HLA-B*07 in HPV16/18-positive women. In this group, prevalence of p53Pro72Pro and HLA-B*07 together was significantly higher (7.0%) among CaCx cases (OR(age-adjusted) = 14.05; 95% CI: 1.11-177.30; P = 0.04), compared with controls (1.3%) lacking both factors. HLA-DQB1*03 homozygosity (OR(age-adjusted) = 4.75; 95% CI: 1.17-19.30; P = 0.03) or p53Pro72Pro (OR(age-adjusted) = 5.84; 95% CI: 1.18-28.99; P = 0.03) was found to be significantly associated with CaCx, each in the absence of the other in this group but not when present jointly in contrast to those lacking both factors (P = 0.214). Thus, modulation of p53Pro72Pro-mediated susceptibility to CaCx by immunogenetic factors could possibly be mediated through cross talk between HPV16/18-induced immune evasion and cell transformation.