Assessment of symptomatic response to intravesical alkalinized lidocaine, bupivacaine, heparin and steroids in patients with bladder pain syndrome.

Bladder Pain Syndrome (BPS) is a puzzling and complicated disorder. 12 such patients, with a mean age 48.3 years, were treated with weekly intravesical instillation of admixture of alkalinized lidocaine, bupivacaine, heparin and steroids for six weeks. Evaluating the benefits of this therapy, patients experienced 82.2% & 90.9% relief at 3rd & 6th week of instillation. After completion of six cycles of therapy, patients experienced 68.7% & 65.3% relief at 3rd & 6th month follow up, concluding the early and long term relief of BPS.

Low-cost solutions incorporated in a standard surgical pathway for early breast cancer: A pilot study.

We present the results of incorporation of low-cost solutions to provide a standard surgical care for early breast cancer (EBC) patients. This surgical pathway consists of a low-cost vacuum-assisted core needle biopsy, sentinel lymph node biopsy (SLNB) using low-cost methylene blue and fluorescin dyes under local anesthesia and oncoplastic breast surgery. Patients assessed as clinically node-negative axilla underwent such treatment. SLNB using low-cost dyes was performed without any complication. Oncoplastic surgical techniques were opted for in 32 patients, and the lumps were all excised with a ∼1-cm all-around margin on the final histopathological examination. Standard breast cancer surgery can be provided in low-resource settings to eligible EBC patients with low-cost solutions.

The Role of Absolute Eosinophil Count as a Diagnostic and Prognostic Marker for Sepsis and Its Relation with Sequential Organ Failure Assessment/Quick Sequential Organ Failure Assessment Score.

AIMS AND BACKGROUND: Sepsis is a dysregulated host response to an infection that causes organ failure that poses a serious risk to life. Although culture results are not always available right away and the majority of patients continue to test culture negative, microbial culture is still the gold standard for diagnosing sepsis. Therefore, the objective of the current study was to assess absolute eosinophil count as a new marker for diagnosing sepsis and also to assess the prognosis of the patient in relation to Sequential Organ Failure Assessment (SOFA)/quick Sequential Organ Failure Assessment (qSOFA) score. Resources and procedures: In this cross-sectional study, 100 patients with sepsis were enrolled. The other 100 patients without any evidence of sepsis were taken as controls. Absolute eosinophil count (AEC), SOFA/qSOFA scores of all the patients were measured on the 1st, 3rd, and 7th day and data was analyzed statistically. RESULTS: The mean AEC on admission day in sepsis patients was 49.5. The mean AEC among survivors was >50 and nonsurvivors was <50. AEC and SOFA/qSOFA scores exhibit a statistically significant and inverse correlation on the 1st, 3rd, and 7th day of illness. CONCLUSION: Absolute eosinophil count (AEC) is a simple and cost-effective marker that may be helpful in diagnosis as well as in predicting the prognosis of sepsis as evidenced by its linear inverse correlation with SOFA/qSOFA score.

Assessment of the systemic toxicity of Laghu vishagarbha taila, an Ayurvedic medicated oil formulation after dermal exposure.

Laghu vishagarbha taila (LVT) is a medicated oil preparation used in the Ayurvedic system of medicine and applied topically for the treatment of painful musculoskeletal and inflammatory disorders. It contains some mildly poisonous phytoconstituents which may show untoward effects upon application. The present study evaluated the toxicity of LVT in the acute, subacute, and subchronic dermal toxicity study in Wistar rats. LVT was tested for its compliance using physicochemical and analytical parameters as per standard methods prescribed in Ayurvedic Pharmacopoeia of India, while acute, subacute, and subchronic toxicity studies were carried out as per OECD 402, 410, and 411 guidelines, respectively. In the acute dermal toxicity study, a single dose of LVT (2000 mg/kg) was applied topically to rats, while in subacute and subchronic dermal toxicity study, the rats were topically applied LVT (1000 mg/kg) up to 28 and 90 days, respectively. LVT did not cause any alterations in clinical signs and no mortality or moribund stage was observed. The change in weekly body weight was insignificant compared with the vehicle control group. In subacute and subchronic dermal toxicity study, there were no significant changes in behavior, body weight, feed consumption, biochemical and hematological parameters, organ weight, and histological parameters compared with vehicle control rats. Topical application of single and repeated doses of LVT in rats did not exhibit adverse effects and suggests that the LD50 of LVT is more than 2000 mg/kg in the acute dose and NOAEL is more than 1000 mg/kg/day in repeated dose application.

Validation sentinel lymph node biopsy study in cN0 axilla using low-cost dual dye technique: potential solution for resource poor settings.

BACKGROUND: Sentinel lymph node biopsy (SLNB) using radio-pharmaceutical and a blue dye is gold standard for axillary staging in clinically node-negative breast cancer. High costs and limited availability of radio-pharmaceutical and/or gamma probe are major deterrents in performing SLNB in developing countries. In this study, we evaluated feasibility of SLN identification (SLN-IR) of fluorescein-guided (FG) SLNB in combination with methylene blue dye (MBD). METHODS: This was a prospective cross-sectional non-randomized validation study in patients with clinically node-negative axilla. Patients underwent validation SLNB using fluorescein (and blue LED light) and MBD. Axillary dissection was performed irrespective of SLNB histology. SLIN-IR and False Negative Rate (FNR) were assessed for both groups. RESULTS: The SLNs were identified in 29 (96.6%) pre-chemotherapy patients and 23 (82%) post Neoadjuvant Chemotherapy (NACT) patients. The median number of sentinel lymph nodes identified was 3 (range of 1-5) in pre-chemotherapy patients and 1 (range of 1-3) in post NACT patients. The SLN-IR using MBD was 90%, FD was 86.7% and combined MBD FD was 96.7% in pre-chemotherapy patients. The SLN-IR using MBD was 82%, FD was 71% and combined MBD FD was 82% in in post NACT patients. The false negative rate (FNR) in pre-chemotherapy group was 8.0% (MBD), 8.3% (FD) and 7.4% (MBD + FD). The FNR in post NACT group was 8.7% (MBD), 10% (FD) and 8.7% (MBD + FD). CONCLUSION: This prospective validation study showed adequate SLN-IR and FNR using low-cost dual dyes in early breast cancer patients and can be used in low resource settings. However, SLNB in post NACT axilla though viable along with a satisfactory FNR, is associated with low identification rate and needs further evaluation.

Assessment of clean cooking technologies under different fuel use conditions in rural areas of Northern India.

The study was conducted to assess the performance of improved and traditional cookstoves using wood as a fuel and three combinations of other fuel mixes - (i) wood and cow dung, (ii) wood and mustard stalks, and (iii) cow dung and mustard stalks). Energy and emission parameters such as specific energy consumption (SEC), emission factors (EFs) of carbon monoxide (CO), particulate matter (PM) and black carbon (BC) were used to compare four different types of cookstoves. These included top-feed forced draft (TF-FD), top-feed natural draft (TF-ND), front-feed natural draft (FF-ND) and front-feed traditional (FF-TR) cookstoves. Controlled cooking test (CCT) was used as the test protocol. The results showed the performance of improved cookstove technologies can vary based on the fuel used for cooking. It was observed that emission factors for PM and CO increased by 67-96% and 45-90% respectively when all three improved cookstoves were tested with three fuel combinations against wood as cooking fuel. Among the tested cookstoves, a marked difference was observed between performance of forced draft and natural draft cookstoves. Forced draft cookstoves emitted higher amount of all pollutant emissions compared to natural draft cookstoves when used with mustard stalks in combination with either wood or cowdung. The results are of critical importance given that forced draft cookstoves have been promoted in geographical regions where fuel mix use is prevalent. Therefore, forced draft cookstove might not be the right choice when the goal is climate mitigation and reduction in impact on human health. It is imperative to study comprehensively the influence of various field variables on performance of cookstoves, which have severe implications on the performance of cookstoves.

A Prediction Model for Preoperative Risk Assessment in Endometrial Cancer Utilizing Clinical and Molecular Variables.

The utility of comprehensive surgical staging in patients with low risk disease has been questioned. Thus, a reliable means of determining risk would be quite useful. The aim of our study was to create the best performing prediction model to classify endometrioid endometrial cancer (EEC) patients into low or high risk using a combination of molecular and clinical-pathological variables. We then validated these models with publicly available datasets. Analyses between low and high risk EEC were performed using clinical and pathological data, gene and miRNA expression data, gene copy number variation and somatic mutation data. Variables were selected to be included in the prediction model of risk using cross-validation analysis; prediction models were then constructed using these variables. Model performance was assessed by area under the curve (AUC). Prediction models were validated using appropriate datasets in The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases. A prediction model with only clinical variables performed at 88%. Integrating clinical and molecular data improved prediction performance up to 97%. The best prediction models included clinical, miRNA expression and/or somatic mutation data, and stratified pre-operative risk in EEC patients. Integrating molecular and clinical data improved the performance of prediction models to over 95%, resulting in potentially useful clinical tests.