Adding Evidence to Plasmacytoma: A Case Series.

Plasmacytoma is a rare tumor of plasma cells with two primary variants: solitary bone plasmacytoma (SBP) and extramedullary plasmacytoma (EMP). It poses diagnostic challenges at times. Radiotherapy (RT) is the curative modality in the majority of cases. We share a case series with the aim of adding evidence to the literature about plasmacytoma and its clinical presentation, diagnostic challenges, and outcome with RT.

Pongamia pinnata L. seed-derived karanjin as prominent antiviral agent against Newcastle disease virus.

Current study aim to explore Karanjin (Kar) isolated from the seeds of Pongamia pinnata as a potential antiviral polyphenol against Newcastle disease virus (NDV) through comprehensive investigations. For the in vitro study, plaque assays, gene and protein expression were used to analyse the inhibitory impact of Kar on NDV, where it reduced NDV replication as shown by a 13-fold suppression of the hemagglutinin-neuraminidase (HN) gene and decrease about 60% in virus activity. In ovo study showed that Kar mitigates NDV effects in chicken embryos. In silico studies involving molecular docking and molecular dynamics simulations showed strong binding between Kar and HN protein of NDV. Kar also influenced glucose metabolism, enhancing antiviral responses, as showed by the upregulation of GLUT1 and HEX genes through RT-qPCR and HPLC analyses. The study contributes valuable insights for future investigations into therapeutic applications of Kar against viral infections.

Compound Odontoma Associated with Multiple Odontogenic Abnormalities in the Mandible of a Child: A Case Report and Review of Literature.

Odontomas have been described as a dental abnormality that develops due to the overgrowth of certain components of the dental lamina, which eventually leads to the formation of a poorly structured calcified mass. The occurrence has been attributed to local trauma, infection, congenital defects, odontoblastic hyperactivity, or changes in the genetic material. Clinically, odontomas are largely asymptomatic and are diagnosed during routine examinations and procedures. However, they might frequently be associated with delayed eruption, impacted teeth, or missing teeth, warranting early diagnosis and management. This current paper describes the localization and management of a compound odontoma associated with multiple odontogenic abnormalities diagnosed in a 10-year-old girl. Eventually, surgical excision was planned and performed, and the defect was packed with PRF to promote healing and regeneration of the large defect. How to cite this article: Budia S, Rathi N, Patil L, et al. Compound Odontoma Associated with Multiple Odontogenic Abnormalities in the Mandible of a Child: A Case Report and Review of Literature. Int J Clin Pediatr Dent 2024;17(8):945-950.

Understanding the molecular basis of anti-fibrotic potential of intranasal curcumin and its association with mitochondrial homeostasis in silica-exposed mice.

Silicosis is an occupational disease of the lungs brought in by repeated silica dust exposures. Inhalation of crystalline silica leads to persistent lung inflammation characterized by lung lesions due to granuloma formation. The specific molecular mechanism has not yet been identified, though. The Present study investigated the impact of silica-exposed lung fibrosis and probable molecular mechanisms. Here, Curcumin, derived from Curcuma longa shown to be an effective anti-inflammatory and anti-fibrotic molecule has been taken to investigate its therapeutic efficacy in silica-induced lung fibrosis. An experimental model of silicosis was established in mice where curcumin was administered an hour before intranasal silica exposure every alternate day for 35 days. Intranasal Curcumin treatment reduced silica-induced oxidative stress, inflammation marked by inflammatory cell recruitment, and prominent granuloma nodules along with aberrant collagen repair. Its protective benefits were confirmed by reduced MMP9 activities along with EMT markers (Vimentin and α-SMA). It has restored autophagy and suppressed the deposition of damaged mitochondria after silica exposure. Intranasal Curcumin also inhibited oxidative stress by boosting antioxidant enzyme activities and enhanced Nrf2-Keap1 expressions. Higher levels of PINK1, PARKIN, Cyt-c, P62/SQSTM, and damaged mitochondria in the silicosis group were significantly lowered after curcumin and dexamethasone treatments. Curcumin-induced autophagy resulted in reduced silica-induced mitochondria-dependent apoptosis. We report that intranasal curcumin treatment showed protective properties on pathological features prompted by silica particles, suggesting that the compound may constitute a promising strategy for the treatment of silicosis in the near future.

ß-Endorphin (an endogenous opioid) inhibits inflammation, oxidative stress and apoptosis via Nrf-2 in asthmatic murine model.

Asthma, a chronic respiratory disease is characterized by airway inflammation, remodelling, airflow limitation and hyperresponsiveness. At present, it is considered as an umbrella diagnosis consisting several variable clinical presentations (phenotypes) and distinct pathophysiological mechanisms (endotypes). Recent evidence suggests that oxidative stress participates in airway inflammation and remodelling in chronic asthma. Opioids resembled by group of regulatory peptides have proven to act as an immunomodulator. ß-Endorphin a natural and potent endogenous morphine produced in the anterior pituitary gland play role in pain modulation. Therapeutic strategy of many opioids including ß-Endorphin as an anti­inflammatory and antioxidative agent has not been yet explored despite its promising analgesic effects. This is the first study to reveal the role of ß-Endorphin in regulating airway inflammation, cellular apoptosis, and oxidative stress via Nrf-2 in an experimental asthmatic model. Asthma was generated in balb/c mice by sensitizing with 1% Toulene Diisocyanate on day 0, 7, 14 and 21 and challenging with 2.5% Toulene Diisocyanate from day 22 to 51 (on every alternate day) through intranasal route. ß-Endorphin (5 µg/kg) was administered through the nasal route 1 h prior to sensitization and challenge. The effect of ß-Endorphin on pulmonary inflammation and redox status along with parameters of oxidative stress were evaluated. We found that pre-treatment of ß-Endorphin significantly reduced inflammatory infiltration in lung tissue and cell counts in bronchoalveolar lavage fluid. Also, pre-treatment of ß-Endorphin reduced reactive oxygen species, Myeloperoxidase, Nitric Oxide, Protein and protein carbonylation, Glutathione Reductase, Malondialdehyde, IFN-γ, and TNF-α. Reversely, ß-Endorphin significantly increased Superoxide dismutase, Catalase, glutathione, Glutathione-S-Transferase, and activation of NF-E2-related factor 2 (Nrf-2) via Kelch-like ECH-associated protein 1 (Keap1), independent pathway in the lung restoring architectural alveolar and bronchial changes. The present findings reveal the therapeutic potency of ß-END in regulating asthma by Keap-1 independent regulation of Nrf-2 activity. The present findings reveal the therapeutic potency of ß-Endorphin in regulating asthma.

An antioxidant ameliorates allergic airway inflammation by inhibiting HDAC 1 via HIF-1α/VEGF axis suppression in mice.

Histone deacetylase inhibitors (HDACi) are novel class of drugs as they are involved in post translational modification of several proteins involved in signaling pathways related to asthma. HDACi have been reported to elicit protective effects on asthma but the signaling pathways associated with it have not been investigated much. Recently, we have demonstrated that intranasal administrations of Pan-HDAC inhibitors, sodium butyrate and curcumin, which have effectively reduced asthma severity via HDAC1 inhibition in Ovalbumin induced mouse model. Present study aimed to investigate possible pathways by which curcumin and sodium butyrate may minimize asthma pathogenesis via HDAC 1 inhibition. Balb/c mice were exposed (sensitized and challenged) with Ovalbumin to establish allergic asthma model followed by pretreatment of curcumin (5 mg/kg) and sodium butyrate (50 mg/kg) through intranasal route. Effects of curcumin and sodium butyrate on HIF-1α/VEGF signaling through activation of PI3K/Akt axis has been investigated using protein expressions followed by chromatin immunoprecipitation of BCL2 and CCL2 against HDAC1. Molecular docking analysis was also performed to investigate effects of curcumin and butyrate on mucus hypersecretion, goblet cell hyperplasia and airway hyperresponsiveness. Augmented expressions of HDAC-1, HIF-1α, VEGF, p-Akt and p-PI3K were observed in asthmatic group which was suppressed in both the treatments. NRF-2 level was significantly restored by curcumin and butyrate treatments. Protein expressions of p-p38, IL-5 and mRNA expressions of GATA-3 were also reduced in curcumin and butyrate treatment groups. Our findings suggest that curcumin and sodium butyrate may attenuate airway inflammation via down regulation of p-Akt/p-PI3K/HIF-1α/VEGF axis.

Allogenic bone marrow-derived mesenchymal stem cells and its conditioned media for repairing acute and sub-acute peripheral nerve injuries in a rabbit model.

The present study evaluated healing potential of bone marrow-derived mesenchymal stem cells (BM-MSCs) and BM-MSCs-conditioned medium (BM-MSCs-CM) for acute and subacute injuries in the rabbit peripheral nerve injury model. The regenerative capacity of MSCs was evaluated in 40 rabbits divided into eight groups, four groups each for acute and subacute injury models. BM-MSCs and BM-MSCS-CM were prepared by isolating allogenic bone marrow from the iliac crest. After inducing sciatic nerve crush injury, different treatments consisting of PBS, Laminin, BM-MSCs + laminin, and BM-MSCS-CM + laminin were used on the day of injury in the acute injury model and after ten days of crush injury in the subacute groups. The parameters studied included: pain, total neurological score, gastrocnemius muscle weight and volume ratio, histopathology of the sciatic nerve and gastrocnemius muscle, and scanning electron microscopy (SEM). Findings indicate that BM-MSCs and BM-MSCS-CM have augmented the regenerative capacity in acute and subacute injury groups with a slightly better improvement in the subacute groups than the animals in acute injury groups. Histopathology data revealed different levels of regenerative process undergoing in the nerve. Neurological observations, gastrocnemius muscle evaluation, muscle histopathology, and the SEM results depicted better healing in animals treated with BM-MSCs and BM-MSCS-CM. With this data, it could be concluded that BM-MSCs support the healing of injured peripheral nerves, and the BM-MSCS-CM does accelerate the healing of acute and subacute peripheral nerve injuries in rabbits. However, stem cell therapy may be indicated during the subacute phase for better results.

Novel pyrimido-pyridazine derivatives: design, synthesis, anticancer evaluation and in silico studies.

Aim: A novel pyrimido-pyridazine derivative for developing anticancer agents was synthesized via Ullmann arylation using an efficient Cu(OAc)2 catalyst. Materials & methods: Compounds were investigated for their anticancer potential, against human breast adenocarcinoma cells, viz. MCF-7, MDA-MB-231 and normal cell line HEK-293. Further, an in vivo study was conducted on lymphoma-bearing mice while in silico analysis was carried out for molecular interactions. Results: Compound 2b displayed significant antitumor activity towards MDA-MB-231 cells through induction of apoptosis and arresting cells in S-phase in vitro, while it significantly increased the lifespan and reduced tumor growth in vivo. An in silico study revealed potent tyrosine-protein kinase inhibitors. Conclusion: Taken together the molecule has the potential to become an effective therapeutic treatment for breast cancer.

Community-based assessment of risk factors for cardiovascular diseases in a tribal population of Tharus in Bihar, India.

Background: The problems of cardiovascular diseases are on the rise and the tribal population are also not an exception to it. The present study aims to estimate the prevalence of risk factors of cardiovascular diseases and to find association of hypertension and diabetes with various risk factors among the Tharu tribe of Bihar, India. Methodology: The present study was an observational, cross-sectional study conducted on 252 individuals of 20-60 years age group. Risk factors related to cardiovascular diseases were assessed. Results: Among 252 participants, the prevalence of hypertension and diabetes was 32.5% and 4.8%, respectively. Around 30% of study participants were smokers, 39% were habitual of chewing tobacco, and about half of the population were not involved in active physical activities (49.2%). Raised blood glucose level was significantly associated with gender, age, smoking status, and tobacco chewing while hypertension was significantly associated with age, smoking status, and body mass index. Conclusions: Increased number of various risk factors among the tribal population makes them vulnerable to cardiovascular diseases and other complications.

Sensing Host Health: Insights from Sensory Protein Signature of the Metagenome.

The human microbiota, which comprises an ensemble of taxonomically and functionally diverse but often mutually cooperating microorganisms, benefits its host by shaping the host immunity, energy harvesting, and digestion of complex carbohydrates as well as production of essential nutrients. Dysbiosis in the human microbiota, especially the gut microbiota, has been reported to be linked to several diseases and metabolic disorders. Recent studies have further indicated that tracking these dysbiotic variations could potentially be exploited as biomarkers of disease states. However, the human microbiota is not geography agnostic, and hence a taxonomy-based (microbiome) biomarker for disease diagnostics has certain limitations. In comparison, (microbiome) function-based biomarkers are expected to have a wider applicability. Given that (i) the host physiology undergoes certain changes in the course of a disease and (ii) host-associated microbial communities need to adapt to this changing microenvironment of their host, we hypothesized that signatures emanating from the abundance of bacterial proteins associated with the signal transduction system (herein referred to as sensory proteins [SPs]) might be able to distinguish between healthy and diseased states. To test this hypothesis, publicly available metagenomic data sets corresponding to three diverse health conditions, namely, colorectal cancer, type 2 diabetes mellitus, and schizophrenia, were analyzed. Results demonstrated that SP signatures (derived from host-associated metagenomic samples) indeed differentiated among healthy individual and patients suffering from diseases of various severities. Our finding was suggestive of the prospect of using SP signatures as early biomarkers for diagnosing the onset and progression of multiple diseases and metabolic disorders. IMPORTANCE The composition of the human microbiota, a collection of host-associated microbes, has been shown to differ among healthy and diseased individuals. Recent studies have investigated whether tracking these variations could be exploited for disease diagnostics. It has been noted that compared to microbial taxonomies, the ensemble of functional proteins encoded by microbial genes are less likely to be affected by changes in ethnicity and dietary preferences. These functions are expected to help the microbe adapt to changing environmental conditions. Thus, healthy individuals might harbor a different set of genes than diseased individuals. To test this hypothesis, we analyzed metagenomes from healthy and diseased individuals for signatures of a particular group of proteins called sensory proteins (SP), which enable the bacteria to sense and react to changes in their microenvironment. Results demonstrated that SP signatures indeed differentiate among healthy individuals and those suffering from diseases of various severities.

Intranasal curcumin and dexamethasone combination ameliorates inflammasome (NLRP3) activation in lipopolysachharide exposed asthma exacerbations.

The inflammasome NOD-like receptor (NLR) family, the pyrin domain containing 3 (NLRP3) is closely associated with exacerbation of asthma as endotoxin (lipopolysaccharide, LPS) is one of its activators present in the environment. Present study is undertaken to investigate anti-inflammatory effects of a well known phytochemical, curcumin, which might regulate LPS exposed asthma exacerbations by modulating NLRP3 activation if given through intranasal route. Balb/c mice were sensitized with intraperitoneal injection of OVA (Ovalbumin; 100 µg of OVA with alum) from day 1 to 8 and exposed to LPS with 1% OVA aerosol from day 9 to 15. LPS (0.1 µg) was given an hour before sensitization and OVA-aerosol challenge. Significant decrease in inflammatory cell recruitment and restoration of structural changes in lungs, alterations in mRNA and protein expressions of TLR-4, NF-κB, NLRP3, Caspase-1, IL-1ß, MMP-9, IL-5 and IL-17 in intranasal curcumin alone and corticosteroid combined pretreatment group.

Management of post appendicectomy intra-abdominal collections: A volumetric cut off for drainage?

BACKGROUND: Intra-abdominal collections (IAC) are a common complication following appendicectomy, one of the most commonly performed emergency abdominal procedures in childhood. The option to drain a collection is frequently available but not always required. AIM: The aim of this study was to compare the outcomes of medically and procedurally-managed post appendicectomy IACs and suggest a method of standardising the need for intervention. METHODS: A single centre, retrospective review of children aged ≤ 16 years presenting between 2014 and 2019 was performed. Patient demographics, management, and outcome data were collected. IAC volume and surface area were calculated assuming a prolate spheroid or true ellipsoid depending on the number of dimensions reported. RESULTS: 60 patients (18%) of 334 patients developed an IAC post appendicectomy. Medical management was undertaken in 44 (73%), drainage in 12 (20%), and surgical washout in 4 (7%). Collection size was associated with failure of medical management: maximum diameter (p = 0.028), volume (p = 0.002), and surface area (p = 0.001). Collections with a volume of 2 ml/kg were significantly less likely to fail medical management than larger collections (0/33 vs 6/11; p < 0.0001). DISCUSSION: Not all post appendicectomy IACs require drainage. The relationship between collection volume and need for drainage is more closely assessed using a volume calculation rather than a single dimension measurement, particularly when adjusted for weight of the child. A cut off of 2 ml/kg appears to be a good objective measure for intervention and provides a communication tool for discussion amongst the multidisciplinary team. Prospectively collected multicentre data on this subject would be timely. LEVEL OF EVIDENCE: III.

Intranasal curcumin and sodium butyrate modulates airway inflammation and fibrosis via HDAC inhibition in allergic asthma.

Asthma being an inflammatory disease of the airways lead to structural alterations in lungs which often results in the severity of the disease. Curcumin, diferuloylmethane, is well known for its medicinal properties but its anti-inflammatory potential via Histone deacetylase inhibition (HDACi) has not been revealed yet. Therefore, we have explored here, anti-inflammatory and anti-fibrotic potential of intranasal curcumin via HDAC inhibition and compared its potential with Sodium butyrate (SoB), a known histone deacetylase inhibitor of Class I and II series. Anti-inflammatory potential of SoB, has been investigated in cancer but not been studied in asthma before. MATERIALS AND METHODS: In present study, ovalbumin (OVA) was used to sensitize Balb/c mice and later exposed to (1%) OVA aerosol. Curcumin (5 mg/kg) and Sodium butyrate (50 mg/kg) was administered through intranasal route an hour before OVA aerosol challenge. Efficacies of SoB and Curcumin as HDAC inhibitors were evaluated in terms of different inflammatory parameters like, total inflammatory cell count, reactive oxygen species (ROS), histamine release, nitric oxide and serum IgE levels. Inflammatory cell recruitment was analyzed by H&E staining and structural alterations were revealed by Masson's Trichrome staining of lung sections. RESULTS: Enhanced Matrix Metalloproteinase-2 and 9 (MMP-2 and MMP-9) activities were observed in bronchoalveolar lavage fluid (BALF) of asthmatic mice by gelatin zymography which was inhibited in both treatment groups. Protein expressions of MMP-9, HDAC 1, H3acK9 and NF-kB p65 were modulated in intranasal curcumin and SoB pretreatment groups. CONCLUSION: This is the first report where intranasal curcumin inhibited asthma severity via affecting HDAC 1 (H3acK9) leading to NF-kB suppression in mouse model of allergic asthma.

Identifying the natural compound Catechin from tropical mangrove plants as a potential lead candidate against 3CLpro from SARS-CoV-2: An integrated in silico approach.

SARS-CoV-2, a member of beta coronaviruses, is a single-stranded, positive-sense RNA virus responsible for the COVID-19 pandemic. With global fatalities of the pandemic exceeding 4.57 million, it becomes crucial to identify effective therapeutics against the virus. A protease, 3CLpro, is responsible for the proteolysis of viral polypeptides into functional proteins, which is essential for viral pathogenesis. This indispensable activity of 3CLpro makes it an attractive target for inhibition studies. The current study aimed to identify potential lead molecules against 3CLpro of SARS-CoV-2 using a manually curated in-house library of antiviral compounds from mangrove plants. This study employed the structure-based virtual screening technique to evaluate an in-house library of antiviral compounds against 3CLpro of SARS-CoV-2. The library was comprised of thirty-three experimentally proven antiviral molecules extracted from different species of tropical mangrove plants. The molecules in the library were virtually screened using AutoDock Vina, and subsequently, the top five promising 3CLpro-ligand complexes along with 3CLpro-N3 (control molecule) complex were subjected to MD simulations to comprehend their dynamic behaviour and structural stabilities. Finally, the MM/PBSA approach was used to calculate the binding free energies of 3CLpro complexes. Among all the studied compounds, Catechin achieved the most significant binding free energy (-40.3 ± 3.1 kcal/mol), and was closest to the control molecule (-42.8 ± 5.1 kcal/mol), and its complex with 3CLpro exhibited the highest structural stability. Through extensive computational investigations, we propose Catechin as a potential therapeutic agent against SARS-CoV-2. Communicated by Ramaswamy H. Sarma.

Evaluation of Non-infectious Pulmonary Complications in Hematological Malignancies on MDCT: Decoding Imaging Markers.

Patients with hematological malignancies are at risk of developing of various infectious and non-infectious pulmonary complications. Common non-infectious pulmonary complications include pulmonary edema, leukostasis, diffuse alveolar haemorrhage (DAH) and differentiation syndrome. The overlapping imaging features pose diagnostic dilemma. We retrospectively analysed the CT findings in identifying differentiating imaging markers and developing an algorithm. 46 diagnosed patients of non-infectious pulmonary complications who underwent CT chest between February 2017 to March 2020 were included. The CT findings were recorded as parenchymal (GGO, consolidation, septal thickening, peribronchovascular interstitial thickening, and nodules), pleural effusion, and mediastinal lymphadenopathy. We categorized non-infectious pulmonary complications as: differentiation syndrome (Group1, n = 6), DAH (Group 2, n = 8), leukostasis (Group 3, n = 14),leukemic infiltrate (Group 4, n = 5), and pulmonary edema(Group 5, n = 13). Chi-square or Fisher exact test were used with p value < 0.05 as statistically significant.Absence of diffuse GGO in Group 4, interlobular septal thickening in Group 2 and Group 3, nodules in Group 5, and peribronchovascular interstitial thickening in Group 2 were statistically significant. Presence of interlobular septal thickening in Group 5, nodules in Group 4, and peribronchovascular interstitial thickening in Group 5 were statistically significant. Based on the results, an algorithm was developed which may suggest a possible diagnosis in an appropriate clinical scenario.

Magnetic resonance imaging in response assessment of mediastinal tuberculous lymphadenopathy: Going beyond size.

BACKGROUND: Assessment of response to antitubercular treatment (ATT) in mediastinal tuberculous lymph nodes (LNs) is challenging. Gold standard techniques such as biopsy and culture involve invasive procedures. Radiographic persistence of mediastinal LNs even after completion of ATT poses a treatment dilemma. In this study, we evaluated the changes in signal intensity (SI) and apparent diffusion coefficient (ADC) values of mediastinal LNs on magnetic resonance imaging (MRI), for response assessment to ATT. MATERIALS AND METHODS: After institute ethics approval, a retrospective analysis of MRI images of 22 patients with 55 mediastinal tuberculous LNs was done. Clinically responsive patients of mediastinal tuberculous LNs who underwent chest MRI prior to ATT, or within 1 month of starting ATT, and second MRI performed at least after 2 months of start of the treatment were included. LN size, T1 and T2 signal characteristics (homogenously/heterogeneously and hyperintense or hypointense), T2 and T1 SI ratio, ADC values, and contrast enhancement characteristics were compared. Paired t-test and McNemar test were performed at a significance level of α =0.05. RESULTS: Size of LN reduced, but 45 LNs measured >8 mm in second MRI. There was statistically significant decrease in the T2 and T1 SI ratios in second MRI, P = 0.026 and 0.008, respectively. No statistically significant difference was found in ADC values, P = 0.31. CONCLUSIONS: Decrease in T2 and T1 SI ratios of mediastinal tuberculous LNs can be used as a noninvasive imaging parameter to suggest response to ATT. However, ADC value is not a useful indicator of treatment response.

Image-Guided Breast Interventions: Biopsy and Beyond.

Breast interventions primarily comprise of biopsy of the suspicious breast lesions to obtain accurate pathological diagnosis. Generally, image-guided breast biopsy is required for nonpalpable lesions, however, even in palpable lesions, image-guided biopsy should be performed as it improves the accuracy of diagnosis. Image-guided breast interventions have progressed well beyond biopsy, making the radiologist an important part of the multidisciplinary management of breast cancer. Preoperative localization of nonpalpable abnormalities guides optimal surgical excision to obtain negative margins without sacrificing the normal tissue. Ablative procedures for breast cancer treatment such as radiofrequency ablation (RFA) and high-intensity focused ultrasound ablation can sometimes replace surgery in older patients with comorbidities. This article enumerates and describes the expanding spectrum of image-guided interventions performed by breast radiologist.

Erdheim-Chester disease: an unusual aetiology of bilateral lipomatous perinephric masses.

A 53-year-old man presented with a history of progressive abdominal distention for 1 year. Physical examination revealed large palpable masses in the bilateral flank regions. Contrast-enhanced CT of the abdomen showed bilateral, symmetrical large perinephric masses with fat attenuating areas, which was further confirmed on MRI. CT of the paranasal sinuses revealed circumscribed extraconal soft tissue mass in the left orbit, causing scalloping and erosion of the left orbital roof. Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography/CT showed FDG uptake in the bilateral perinephric masses. Based on imaging appearance, a diagnosis of Erdheim-Chester disease (ECD) was suggested. Ultrasound-guided biopsy from perinephric masses revealed a sheet of histiocytes with sprinkled lymphocytes and plasma cells in the background. The histiocytes were immunopositive for CD68, S100 and immunonegative for CD1a, which confirmed the diagnosis of ECD. The patient was started on interferon-α-2a and showed symptomatic improvement.

Successful primary repair of oesophageal atresia and distal tracheo-oesophageal fistula in a 525 g neonate, the smallest reported in literature.

Advances in neonatal intensive care have meant improved survival of the extremely low birth weight neonate. We report the successful primary repair of a preterm neonate born with an oesophageal atresia and tracheo-oesophageal fistula with a birth weight of just 525 g, on day 1 of life, the smallest survivor so far reported in the literature, now followed up for 5 years.

Dose-volume analysis of acute gastrointestinal complications in cervical cancer undergoing definitive concurrent chemoradiation.

CONTEXT: Definitive concurrent chemoradiation with brachytherapy is the prime modality of treatment of cervical cancer. The small bowel is one of the critical organs responsible for gastrointestinal complications. AIMS: This study aims to analyze the relation of small bowel dosimetric parameters with the incidence of acute gastrointestinal complications. SUBJECTS AND METHODS: The study analyzed 40 patients of stage IIB-IVA who underwent concurrent chemoradiation with three-dimensional conformal radiotherapy and weekly cisplatin from June 2017 to June 2018. The small bowel was contoured as the organ of risk. Dose-volume histogram parameters of the small bowel subjected to analysis were mean dose, maximum dose, the total volume of organ receiving 20 Gy, 40 Gy, and 45 Gy (V20-45), and the volume of V20-45 to total volume (V20-45 ratio). Gastrointestinal toxicity was graded using CTCAE version 5.0 criteria. Association between dosimetric parameters and incidence of 1-2 gastrointestinal complications were evaluated. RESULTS: A total of forty patients treated with concurrent chemoradiation were analyzed. Seven patients reported Grade 1, whereas three patients reported Grade 2 gastrointestinal complications. None of the patients reported Grade 3 or higher gastrointestinal complication. Patients with gastrointestinal complications had greater V30-45 and mean dose as compared to those without gastrointestinal complication. CONCLUSIONS: Dosimetric parameters of small bowel should be evaluated to reduce the incidence of gastrointestinal complications.