Unresectable Primary Tracheal Synovial Sarcoma.

Synovial sarcoma (SS) comprises less than 1% of head and neck cancers, and less than five cases of adult primary tracheal SS have been described. This case describes a patient encountered at a community-based academic hospital, and retrospective chart review was performed for data collection. A woman in her forties presented with shortness of breath due to a superior mediastinal mass found to be an unresectable primary tracheal SS. Primary treatment resorted to curative-intent radiation therapy. Subsequent metastasis required systemic chemotherapy with pazopanib. To the best of our knowledge, this is the first reported case of this nature and adds to understanding the presentation, diagnosis, natural history, and treatment outcomes of primary tracheal SS. This case was exempt from review by the institutional review board and complied with privacy policy standards.

Biomonitoring of metallic air pollutants in unique habitations of the Brahmaputra Valley using moss species-Atrichum angustatum: spatiotemporal deposition patterns and sources.

In this paper, we have evaluated the bioaccumulation of metals by Atrichum angustatum, which is a readily available moss species in the Brahmaputra valley, India. A systematic investigation of metallic pollutants in the atmosphere was carried out using A. angustatum as a biomonitor collected from representative locations during three seasons viz. winter, pre-monsoon, and monsoon (n = 99) during the year 2018. The study was done in four unique habitations of the Brahmaputra Valley, which were further divided into three landuse areas: residential, roadside, and industrial. The highest accumulations were seen against Ca, Mg, Zn, and Fe. The calculated contaminant factors and ecological risk indices suggest that the Brahmaputra Valley is mostly contaminated by Cr, Zn, Cu, Ni, and Pb, and these metals pose a maximum ecological risk. The accumulation trend of metallic pollutants was site-specific, but most metals showed positive seasonal accumulation. A significant difference in spatial and seasonal accumulation patterns was specific to metal species. Principal component analysis (PCA) and inter-species correlations revealed that the air quality of Brahmaputra valley was greatly affected by coal burning, vehicular emission, biomass burning, road dust, and crustal dust. Finally, the study led us to the conclusion that A. angustatum can serve as a potential biomonitor for metallic pollutants.

Seven-year study of monsoonal rainwater chemistry over the mid-Brahmaputra plain, India: assessment of trends and source regions of soluble ions.

This work is a 7-year study of monsoonal rainwater chemistry (n = 302), over mid-Brahmaputra plain during 2012 to 2018. The samples were analyzed for major chemical parameters viz. pH, electrical conductivity (EC), and ions (SO42-, NO3-, Br-, Cl-, F-, Mg2+, Ca2+, K+, NH4+, Na+, and Li+) to assess the chemistry. The mean pH of rainwater varied among the years, which was maximum in 2018 (6.18 ± 0.72) and minimum in the year 2014 (5.39 ± 0.54), and the variations were significant at p < 0.0001. Ridgeline plots were drawn to visualize interannual variations, which revealed that Ca2+ was the dominant cation in the early years, whereas NH4+ prevailed in the latter years. Mann-Kendall analysis and Sen's slope statistical tests were employed, and it was found that all the ions showed positive S values indicating increasing trends. Enrichment factors (EF) of K+, SO42-, and NO3- were found to be high with respect to both soil and seawater suggesting the influence of emissions from fossil fuel and biomass burning in the chemistry of rainwater. Principal component analysis (PCA) was applied to identify the sources of rain constituents, and five factors were obtained explaining crustal dust, biomass burning, fossil fuel combustion, agricultural emissions, and coal burning as possible sources. Airmass back trajectory clusters and Potential Source Contribution Function (PSCF) were computed by application of HYbrid Single-Particle Lagrangian Integrated Trajectory model to appreciate the terrestrial influence on the chemistry. The results indicated inputs from both local and regional dust and anthropogenic constituents that influenced the monsoonal rainwater chemistry over Brahmaputra Valley.

Particulate matter exposure in biomass-burning homes of different communities of Brahmaputra Valley.

Biomass burning for cooking prevalent in the developing countries is an issue which has been a concern for the past several decades for the noxious emissions and subsequent effects on the health of women and children due to the exposure of particulate matter (PM) and other gases. In this study, PM (PM1, PM2.5, and PM10) were measured in biomass-burning households for different communities of Brahmaputra Valley region northeast India by a 31-channel aerosol spectrometer. The levels of emission of PM in the case of different community households were found to be significantly different. Also, the emission characteristics of different cooking time of the day were found to be different across communities. The emission levels in the biomass-burning households were compared with emission in household using "clean" LPG fuel, and it was found that the biomass fuels emitted 10-12 times more PM2.5 and 6-7 times more PM10. The number densities of the emission were found to be more with smaller sizes of particulates which could explain why such biomass-burning emissions can pose with greater health risks. The exposure doses were calculated and were found to be about three times higher in biomass-burning houses than "clean" LPG fuel. It is important to note that the exposure from biomass burning while cooking has a gender perspective. The woman of the house generally takes care of the activities in the kitchen and get exposed to the noxious PM and the gases. Children often accompany their mothers and face the same fate.

Ambient ozone over mid-Brahmaputra Valley, India: effects of local emissions and atmospheric transport on the photostationary state.

This study presents the characteristics of ground level atmospheric ozone (O3) over the rural mid-Brahmaputra Valley region of the northeastern India. Ozone and oxides of nitrogen (NOx = NO + NO2) concentration data were obtained from continuous measurement of O3 and NOx housed at the MAPAN-AQM station at Tezpur University. The meteorological parameters were obtained from the same station. The diel, monthly, and seasonal variations of O3 were studied. The O3-NOx photostationary state (PS) was carefully examined and it was found that the net O3 concertation deviated substantially from the PS during the winter season. The deviation could be attributed to local biomass burning, biogenic VOC emission from forest and agriculture, and long-range transport of peroxyacyl nitrate (PAN). The long-range transport has been ascertained by examining the ventilation coefficients (VC), which correlated with the steep growth of net O3 concentrations in the morning hours. The HYSPLIT air mass back trajectories were used in concentration-weighted trajectory (CWT) analyses of O3 to assess the long-range regional transport of O3 precursors, which positively influenced local O3 concentrations.

Anatomical, physiological, and chemical alterations in lichen (Parmotrema tinctorum (Nyl.) Hale) transplants due to air pollution in two cities of Brahmaputra Valley, India.

The lichen species Parmotrema tinctorum (Nyl.) Hale was transplanted in two cities-Tezpur (small) and Guwahati (large)-of the Brahmaputra Valley to assess the impact of air pollution on the anatomy and physiology, and accumulation of pollutants. Significant damage to the anatomy was observed in samples, and the degree of damage was found to be higher in the transplants of the larger city. In the lichen transplants from locations having high traffic density, the total chlorophyll content was found to fall; on the contrary, electrical conductivity was found to be higher. The exposed-to-control ratio showed severe accumulation of Cd in all the transplants. Elements such as Cd, Pb, and Zn were found to be enriched in all the lichen samples from both Guwahati as well as Tezpur city. Besides, Cr, Cu, K, and Ni were also realized to be enhanced to a moderate extent. The correlations of indicator metal species pairs showed that anthropogenic influence was quite clear.

Soil PAHs against varied land use of a small city (Tezpur) of middle Brahmaputra Valley: seasonality, sources, and long-range transport.

This study reports soil PAHs from a small city (Tezpur) of the mid-Brahmaputra Valley. The soil PAHs has been assessed from representative land use using detailed protocol of extracting, cleaning, and quantitative analysis by HPLC technique. The concentrations of PAHs showed minimum spatial variability and yet showed strong seasonal variability, which could be typical of small cities having weak local source strengths. On examining the air mass reaching the region, it appeared that there has been explicit effect of long-range transport. The HYSPLIT back trajectories reaching the study area during different seasons showed variations in terms of their origins and transport pathways. This might have led to differential long-range transport of PAHs, which is reflected in the seasonal variabilities of the concentrations of PAHs. The seasonal variations were much profound with the highest ΣPAHs concentration during post-monsoon (7961 ng g-1) followed by pre-monsoon (2414 ng g-1) and monsoon (773 ng g-1) season. The toxicity of the PAHs was examined as BaP equivalent (BaPeq) concentrations, which were found to be on the lower side as compared to the studies conducted elsewhere. The percentage contribution of 3- and 4-ring compounds was found to be greater. An attempt also was made to apportion the sources of the PAHs by application of diagnostic ratios, principal component analysis-multiple linear regression (PCA-MLR) and hierarchal cluster analysis (HCA), which revealed that coal and biomass burning and vehicular emissions are the major contributors to the PAHs load in Tezpur city.

Adjunctive simvastatin for treatment-resistant depression: study protocol of a 12-week randomised controlled trial.

BACKGROUND: A third of patients diagnosed with major depressive disorder (MDD) experience treatment-resistant depression (TRD). Relatively few pharmacological agents have established efficacy for TRD. Therefore, the evaluation of novel treatments for TRD is a pressing priority. Statins are pleiotropic agents and preclinical studies as well as preliminary clinical trials have suggested that these drugs may have antidepressant properties.AimsTo report on a protocol for a 12-week, randomised, double-blind, placebo-controlled trial of add-on treatment with simvastatin for patients meeting DSM-5 criteria for MDD who have failed to respond to at least two adequate trials with approved antidepressants. The trial has been registered with Clinicaltrials.gov in (ClinicalTrials.gov identifier: NCT03435744). METHOD: After screening and randomisation to the two parallel arms of the trial, 75 patients will receive simvastatin and 75 patients will receive placebo as adjuncts to treatment as usual. The primary outcome is change in Montgomery-Åsberg Depression Rating Scale scores from baseline to week 12 and secondary outcomes include changes in scores on the 24-item Hamilton Rating Scale for Depression, the Clinical Global Impression scale, the 7-item Generalized Anxiety Disorder scale and change in body mass index from baseline to week 12. Assessments will take place at screening, baseline, and weeks 2, 4, 8 and 12. Checklists for adverse effects will be undertaken at each visit. Simvastatin (20 mg) will be given once daily. Other secondary outcomes include C-reactive protein and plasma lipids measured at baseline and week 12. RESULTS: This trial will assess simvastatin's efficacy and tolerability as an add-on treatment option for patients with TRD and provide insights into its putative mechanisms of action. CONCLUSIONS: As the first trial investigating the use of simvastatin as an augmentation strategy in patients with TRD, if the results indicate that adjuvant simvastatin is efficacious in reducing depressive symptoms, it will deliver immediate clinical benefit.Declaration of interestI.B.C. and N.H. have given lectures and advice to Eli Lilly, Bristol Myers Squibb, Lundbeck, Astra Zeneca and Janssen pharmaceuticals for which they or their employing institution have been reimbursed. R.R. and M.M.H. have received educational grants and support for academic meetings from Pfizer, Roche, Novartis and Nabiqasim. A.H.Y. has been commissioned to provide lectures and advice to all major pharmaceutical companies with drugs used in affective and related disorders. A.H.Y. has undertaken investigator-initiated studies from Astra Zeneca, Eli Lilly, Lundbeck and Wyeth. None of the companies have a financial interest in this research.

Microzonation, ecological risk and attributes of metals in highway road dust traversing through the Kaziranga National Park, Northeast India: implication for confining metal pollution in the national forest.

Despite the abundant literature on metal contamination through road dust (RD) in urban/suburban and residential/highway regions, the RD of highways traversing through the Kaziranga National Park, NE India, has not been studied and lacks baseline data. The objective of the present study was to ascertain the possibility of highway microzonation based on temporal and spatial variability of metal pollution level and ecological risk. It was found that the RD contains an average content of (1.7-33.5 mg/kg) for Cd, Co, Cu and Pb and (121-574 mg/kg) for Ni, Zn, Cr and Mn across the highway passing through the national forest attributed by various sources. The study revealed three possible microzones present in the studied highway NH-37 based on spatial trend of metal as well as human interference. An attempt was made to understand the possible source of metals by principal component analysis, and four sources were identified: Three were of vehicular origin, and another was related to road surface and subsurface condition. The use of noise barrier walls as an effective measure to control the translocation of RD from one place to other was recommended to reduce the hostile effects of metal accumulation in the sensitive ecosystem. Thus, the study suggested and necessitated micronizing the system based on human interference level, ecological risk factors, spatial variability of pollutants and traffic pattern for their efficient management and conservation.

Minocycline as an adjunct for treatment-resistant depressive symptoms: A pilot randomised placebo-controlled trial.

BACKGROUND: Evidence suggests that anti-inflammatory medication may be effective in the treatment of depressive symptoms. In this study, we aimed to investigate whether minocycline added to treatment as usual (TAU) for 3 months in patients with treatment-resistant depression will lead to an improvement in depressive symptoms. METHODS: Multi-site, 12-week, double-blind, placebo-controlled, pilot trial of minocycline added to TAU for patients suffering from DSM-5 major depressive disorder, whose current episode has failed to respond to at least two antidepressants. The primary outcome measure was mean change in Hamilton Depression Rating Scale (HAMD-17) scores from baseline to week 12. Secondary measures were the Clinical Global Impression scale (CGI), Patient Health Questionnaire-9 (PHQ-9), the Generalised Anxiety Disorder scale (GAD-7) and EuroQoL (EQ-5D) quality-of-life questionnaire. Side-effect checklists were also used. Minocycline was started at 100 mg once daily (OD) and increased to 200 mg after 2 weeks. RESULTS: A total of 41 participants were randomised, with 21 in the minocycline group and 20 in the placebo group. A large decrease in HAMD scores was observed in the minocycline group compared to the placebo group (standardised effect size (ES) -1.21, p < 0.001). CGI scores in the minocycline group also showed a large improvement compared with placebo (odds ratio (OR): 17.6, p < 0.001). PHQ-9, GAD-7 and EQ-5D total showed more moderate improvements (ES ~ 0.4-0.5). CONCLUSION: The findings indicate that adjunctive minocycline leads to improvement in symptoms of treatment-resistant depression. However, our findings require replication in a larger sample. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02263872, registered October 2014.

Pilot study of a culturally adapted psychoeducation (CaPE) intervention for bipolar disorder in Pakistan.

BACKGROUND: Despite the use of maintenance medication, recurrence rates in bipolar affective disorder (BPAD) are high. To date, there are no clinical trials that have investigated the use of psychological interventions in bipolar disorder in Pakistan. AIM: The purpose of the study was to assess the feasibility and acceptability of a culturally adapted bipolar psychoeducation programme (CaPE) in Pakistan. METHODS: Thirty-four euthymic bipolar I and II outpatients were randomized to either 12 weekly sessions of individual psychoeducation plus Treatment As Usual (Intervention) or Treatment As Usual (TAU) (Control). Outcomes were assessed using the Young Mania Rating Scale (YMRS), Beck Depression Inventory (BDI), EuroQoL (EQ-5D), Bipolar Knowledge and Attitudes and Questionnaire (BKAQ), and a self-reported measure of medication adherence (Morisky Medication Adherence Scale-4 items, MMAS-4). Effect sizes were derived from baseline adjusted standardized regression coefficients. RESULTS: Retention in the study was good, 80% of patients in the TAU follow-up assessment and 100% of patients in the CaPE group attended all 12 sessions. Patient satisfaction was higher in the CaPE group relative to control (ES = 1.41). Further, there were large effect sizes shown for CaPE versus TAU for medication adherence (MMAS-4: ES = 0.81), knowledge and attitudes towards bipolar (BKAQ: ES = 0.68), mania (YMRS: ES = 1.18), depression (BDI: ES = 1.17) and quality of life measures (EQ-5D: ES ⇒ 0.88). CONCLUSIONS: Culturally adapted psychoeducation intervention is acceptable and feasible, and can be effective in improving mood symptoms and knowledge and attitudes to BPAD when compared with TAU. Larger scale studies are needed to confirm our findings. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT02210390.

Minocycline as an adjunct for treatment-resistant depressive symptoms: study protocol for a pilot randomised controlled trial.

BACKGROUND: Depression is one of the leading causes of disability worldwide. A high proportion of patients do not respond to standard drug treatments. Recent evidence has suggested that anti-inflammatory treatment may have beneficial effects in major depression. Minocycline is a tetracycline antibiotic with good CNS penetration that exerts effects on multiple interacting symptoms implicated in the pathophysiology of mood disorders. Open-label studies have suggested that minocycline is effective as an adjunct drug in improving depressive symptoms. METHODS/DESIGN: This is a multi-centre, 3-month, double-blind, placebo-controlled, pilot trial of minocycline added to treatment as usual for patients suffering from DSM-IV major depressive disorder. This will be a double-blind, randomised, controlled, two parallel-arm study with 20 participants in each arm, giving a total of 40 participants. There will be a screening visit, a randomization visit and four follow-up visits. Clinical assessments using the Hamilton Depression Rating Scale (HAM-D), Clinical Global Impression scale (CGI), Patient Health Questionnaire-9 (PHQ -9) and the Generalised Anxiety Disorder scale (GAD-7) will be carried out at every visit. Side effects checklists will also be undertaken at each visit. Biomarkers (inflammatory cytokines and CRP) will be measured at baseline and at the end of the treatment phase. Minocycline will be started at 100 mg once daily (OD) and will be increased to 200 mg at two weeks. DISCUSSION: Anti-inflammatory treatments have been shown to have some beneficial effects in the treatment of major depressive disorder. The aim of this pilot randomised controlled trial is to establish the degree of improvement in depressive symptoms with the addition of minocycline to treatment as usual. TRIAL REGISTRATION: ClinicalTrials.gov NCT02263872 registered 10 October 2014.

Identification of mongoose (genus: Herpestes) species from hair through band pattern studies using discriminate functional analysis (DFA) and microscopic examination.

India is home to seven species of mongoose (Herpestes sp). Mongooses are being poached primarily for their hair, which is used in the production of painting and shaving brushes. Prior to September 2002, mongooses were listed under Schedule-IV of the Wildlife (Protection) Act 1972 (India). Indiscriminate poaching of the mongoose created an immediate threat to their survival and hence mongooses have now been placed under Schedule-II of the Wildlife (Protection) Act-1972 (India). In order to convict a person under this legislation, species identification of case related samples is necessary. Four species of mongoose i.e. H. edwardsii, H. smithii, H. palustris and H. urva were characterised by performing discriminate functional analysis (DFA) on measurements of their dorsal guard hair banding pattern and by microscopic hair characteristics (Cuticular, medullar and cross section). It was possible to distinguish between the four species studied, based on both these methods.

Differential anti-inflammatory effects of immunosuppressive drugs: cyclosporin, rapamycin and FK-506 on inducible nitric oxide synthase, nitric oxide, cyclooxygenase-2 and PGE2 production.

OBJECTIVE AND DESIGN: Cyclosporin, FK-506 and rapamycin have similar but distinct modes of interaction with cyclophilins, calcineurins and transcription factors. These immunosuppressive drugs have also been shown to inhibit cytotoxic and inflammatory responses in macrophage. Therefore, we evaluated the mechanism of action of these drugs on iNOS and COX-2 expression by macrophages, the products of which (NO and PGE2) have cytotoxic and proinflammatory activities. MATERIALS AND METHODS: The murine macrophage cell line RAW 264.7 was grown as monolayer cultures. The effects of pharmacologically relevant concentrations of cyclosporin, rapamycin and FK-506 were evaluated in the presence and absence of lipopolysaccharide (LPS) which is a known inducer of iNOS and COX-2. Subsequently the expression of iNOS and COX-2 were analyzed by Western and Northern analysis. The production of NO and PGE2 were assayed by Greiss and RIA respectively. RESULTS: Cyclosporin (1-5 microg/ml) and rapamycin (1.0-10 nM) but not FK-506 (5-10 nM) inhibited both iNOS and COX-2 expression at mRNA level which led to significant inhibition of NO and PGE2 production. CONCLUSION: These studies characterize differential mechanistic capacity of the immunophilin-binding immunosuppressive drugs (comparable to hydrocortisone) to inhibit both iNOS and COX-2 expression. Inhibition of iNOS and COX-2 mRNA accumulation by cyclosporin and rapamycin seem to be distinct. These studies also highlight potential anti-inflammatory properties of these drugs in addition to their known immunosuppressive activity.

The safety and efficacy of clarithromycin in patients with Legionella pneumonia.

Clarithromycin, a new macrolide antibiotic, is at least four times more active in vitro than erythromycin against Legionella pneumophila. In this study the safety and efficacy of orally administered clarithromycin (500 to 1,000 mg bid) in the treatment of Legionella pneumonia were evaluated. Forty-six patients were enrolled in the study, 15 of whom had not responded to previous routine anti-Legionella therapy (erythromycin, ofloxacin, rifampin [rifampicin], or tetracycline). Twelve patients prematurely discontinued the study (nine by the patient's request while feeling well; one because of cancer diagnosis; and two because of adverse events). The response rates after treatment were as follows: clinical cure rate, 98 percent (43/44); clinical success (cure or improved), 100 percent (44/44); radiographic success (cure and improved), 93 percent (28/30); direct antigen fluorescence resolution, 100 percent (40/40); and bacteriologic cure, 100 percent (13/13). Ten patients reported 13 adverse events (seven mild, four moderate, and two severe). Clarithromycin is a safe effective treatment for patients with severe chest infections due to Legionella pneumophila.

Can health education increase uptake of cervical smear testing among Asian women?

OBJECTIVES: To determine the effects of three different methods of providing health education on the uptake of cervical smear testing among Asian women, and to evaluate the acceptability of different health education materials. DESIGN: Prospective cohort study over one year of effects of written materials by post, personal visit to give written materials, and personal visit to show a video on the uptake of smear testing. Techniques included a personally administered questionnaire. SETTING: Leicester, a city with a large Asian population. SUBJECTS: 737 randomly selected Asian women aged 18 to 52 who were not recorded on the central cytology laboratory's computer as ever having had a cervical smear test. 159 declined to participate or were not contactable. INTERVENTIONS: Women were randomised into four groups: visited and shown a video (263), visited and shown a leaflet and fact sheet (219), posted a leaflet and fact sheet (131), not contacted at all (124). MAIN OUTCOME MEASURES: Cervical smear test recorded on computer within four months after intervention. RESULTS: 57 (37%, 26% of group) of the women visited and given leaflets and 80 (47%, 30% of group) shown the video attended for cervical smears. Only six (5%) of those who were not contacted and 14 (11%) of those sent leaflets had a smear test during the study. CONCLUSION: Health education interventions increased the uptake of cervical cytology among Asian women in Leicester who had never been tested. Personal visits were most effective irrespective of the health education materials used, but there was some evidence that home viewed videos may be particularly effective in one of the most hard to reach groups: Urdu speaking, Pakistani Moslems. Written translated materials sent by post were ineffective.

Laboratory diagnosis of iron deficiency in a developing country, Pakistan.

In developing countries, such as Pakistan, laboratories do not routinely screen for iron deficiency unless the patient presents with symptoms of anaemia. Efforts to prevent the often serious consequences of iron depletion are hampered in developing countries by the expense and impracticality of routinely screening patients using bone marrow examination. Assays for serum iron concentrations, total iron-binding capacity or haemoglobin and examinations of blood films, although more practical, cannot detect the earliest stages of iron deficiency. Serum ferritin appears to be a sensitive, early indicator of iron deficiency and can be easily and relatively inexpensively determined using an immunoassay kit. In the present study, serum ferritin levels were determined using immunoassay and compared to blood films, serum iron levels and total iron-binding capacity values in 300 apparently healthy Pakistanis. In the early stages of iron deficiency, serum ferritin appeared to be a sensitive measure of iron depletion.

Respiratory symptoms due to Branhamella catarrhalis and other Neisseria species infections--response to erythromycin therapy.

Neisseria microorganisms (Neisseria lactamica, Neisseria sicca, and Neisseria mucosa) are regarded as normal respiratory commensals. Branhamella catarrhalis (formerly Neisseria catarrhalis) has also been regarded as a normal respiratory commensal, but reports indicate that it can be pathogenic. The role of Neisseria spp was studied in 160 patients with chest infections and symptoms and signs of obstructive respiratory disease. Group I patients (n = 140) had a history of asthma, bronchitis, and emphysema. Group II patients (n = 20) had an initially responsive pulmonary tuberculosis but presented with fever and obstructive airway disease. Group I patients had disease that was difficult to control despite increased bronchodilator therapy, but they responded dramatically after two to three days of appropriate antibiotic therapy. Patients in group II showed a similar response to erythromycin. Neisseria infection was responsible for precipitating or exacerbating respiratory distress in both groups. Accordingly, it is concluded that Neisseria can be pathogenic and that patients with fever and obstructive respiratory symptoms require treatment.