Eight months of integrated yoga, hydrotherapy and acupuncture on serum IgE levels and symptoms severity of a patient with chronic allergic rhinosinusitis: A case report.

A 27-year-old man with Allergic rhino sinusitis presented to our hospital in July 2020 with complaints of continuous sneezing, coughing while rising from bed for half an hour, and the same complaints repeated in the afternoon for half an hour, as well as a continuous dry cough for half an hour in the evening. He also had complaints of itching and skin rashes, particularly in his limbs. He underwent yoga (45 minutes, 5-6 days a week) including Jalaneti (a yogic cleansing technique, i.e. nasal irrigation with warm salt water for twice a week), hydrotherapy (enema using neem leaves paste mixed with water and steam bath on first day, followed by facial steam on alternate days) and Acupuncture (one session a week) for 8 months. Results showed a reduction in immunoglobulin E (IgE) levels and symptom severity suggesting that integrated yoga, hydrotherapy, and acupuncture are effective in the management of chronic allergic rhinosinusitis. All treatments were well tolerated without adverse effects. Though the result is encouraging, further studies are required with a larger sample size.

Decoding the link associated with areca nut chewing and cardiovascular disease using hsCRP as a biomarker.

Background: Chewing of areca nut is associated with various oral and systemic ill effects. The deleterious oral effects of areca nut have been widely documented to range from reactive lesions, periodontal health compromise to oral pre-cancer and cancerous states and have been described widely in the literature. The reported systemic effects of areca nut chewing are relatively less documented but reported in literature. Areca nut chewing may predispose to cardiovascular disease due to a systemic inflammatory response from the elevated levels of circulating inflammatory mediators. High-sensitivity C-reactive protein (hsCRP) is a systemic inflammatory biomarker to assess the risk of cardiovascular disease. Materials and Methods: This cross-sectional, observational study was conducted among areca nut chewers (n = 50) and non-chewers (n = 50). Areca nut chewers were considered as chewers/cases. Blood samples were collected from the participants and hsCRP levels were studied. The data were analysed using SPSS software, version 21 for statistical significance. Chi-square test was used to compare categorical variables. Mann-Whitney U test was done to analyse continuous variables. The level of statistical significance was set at P value < 0.05. Results: hsCRP mean was higher among the chewers (2.3 ± 3.7) compared to non-chewers (0.9 ± 1.3). The difference in hsCRP levels between the study group was statistically significant (P = 0.002). Conclusion: This study demonstrates the link between areca nut and cardiovascular disease using hsCRP as biomarker.

Evaluation of stress among dental undergraduates and postgraduates using salivary cortisol as a biomarker.

Background: Stress is a non-specific response of the body to any demand. Professional education has a certain level of stress inherent in it. Dental students have been reported in the literature to experience more stress than medical students. Objective: To evaluate the stress levels of dental students: first-year undergraduates, house surgeons, and final-year postgraduates, using salivary cortisol as a stress biomarker. Materials and Methods: Dental students above 18 years of age and without any systemic illness were included in the study. Those students with a drug history of corticosteroids, anti-depressants, and oral contraceptives were excluded from the study. Female participants experiencing pre-menstrual symptoms, pregnancy, and familial stressor issues were excluded from the study. First-year undergraduates, house surgeons, and final-year postgraduates were enrolled in the study. Unstimulated whole saliva was collected in the morning and evening between 9:00 and 10:00 am and between 3:00 and 4:00 pm. Salivary cortisol levels were assessed by chemiluminescence immuno-assay (CLIA). Results: Paired sample t-test was used to compare the diurnal variation among morning and afternoon samples within the groups. The salivary cortisol levels were found to be significant within the groups. One-way ANOVA was used to compare the salivary cortisol levels between the groups. The salivary cortisol levels within the groups were not statistically significant. Conclusion: Salivary cortisol is a non-invasive biomarker of stress. Postgraduates had higher salivary cortisol levels than other study groups.

Performance of radio-iodine discharge control methods of nuclear reprocessing plants.

It is imperative to control radio-iodine discharges to atmosphere from nuclear reprocessing plants. Inhalation and ingestion of radio-iodine cause its concentration in the thyroid gland leading to risk of thyroid cancer in humans. Two isotopes of iodine viz. iodine-131 (131I) and iodine-129 (129I) are generated in considerable quantities in the nuclear fuel as fission products in the nuclear reactors. From nuclear reactors, no iodine is released to the atmosphere during normal operations, whereas from spent fuel reprocessing plants, during normal operation, iodine is discharged to the atmosphere, mainly through gaseous discharges. Shortly after the initial periods of reprocessing in 1944, iodine emission control methods were incorporated in the design of reprocessing plants. At the time of spent fuel discharge from reactor, quantity of 131I is high and can contribute radiation dose to humans during reprocessing operations. A delay or cooling period of spent fuel, before reprocessing for a definite number of days can reduce the quantities to below the permissible limits of discharge due to its short half-life of 8 days. 129I has a very long half-life, and is only significant for reprocessing plants of large throughput and high fuel burn-ups. Minimum required de-contamination factor (DF) for iodine for a reprocessing plant can be estimated from the limits of discharge of iodine stipulated by regulatory authority of each country. Though many processes were developed and demonstrated extensively in lab and pilot scale, only a few of these processes were found to be suitable for commercial deployment. This paper reviews systematically the operation experiences and performance characteristics of iodine control methods implemented so far. The review also focus on the effect of integrating various iodine control methods on the main reprocessing operations and thereby facilitate selection of the optimum iodine control method.

Upfront Xpert MTB/RIF for diagnosis of pediatric TB-Does it work? Experience from India.

BACKGROUND: Diagnosis of TB in pediatric population poses several challenges. A novel initiative was implemented in several major cities of India aimed at providing upfront access to free-of-cost Xpert MTB/RIF to presumptive pediatric TB cases. This paper aims to describe the experience of implementing this large initiative and assess feasibility of the intervention in high TB burden settings. METHODS: Data were drawn from the pediatric TB project implemented in 10 major cities of India between April 2014 and March 2018. In each city, providers, both public and private, were engaged and linked with a high throughput Xpert MTB/RIF lab (established in that city) through rapid specimen transportation and electronic reporting system. Rates and proportions were estimated to describe the characteristics of this cohort. RESULTS: Of the total 94,415 presumptive pediatric TB cases tested in the project, 6,270 were diagnosed positive for MTB (6.6%) on Xpert MTB/RIF (vs 2% on smear microscopy). Among MTB positives, 545 cases were rifampicin resistant (8.7%). The median duration between collection of specimens and reporting of results was 0 days (same day) and >89% cases were initiated on treatment. Approximately 50% of the specimens tested were non-sputum. The number of providers/facilities engaged under the project increased >10-fold (from 124 in Q2'14 to 1416 in Q1'18). CONCLUSION: This project, which was one of the largest initiatives globally among pediatric population, demonstrated the feasibility of sustaining rapid and upfront access to free-of-cost Xpert MTB/RIF testing. The project underscores the efficiency of this rapid diagnostic assay in tackling several challenges in pediatric TB diagnosis, identifies opportunities for further interventions as well as brings to light scope for effective engagement with healthcare providers. The findings have facilitated a policy decision by National TB Programme mandating the use of Xpert MTB/RIF as a primary diagnostic tool for TB diagnosis in children, which is being scaled-up.

Study of Hypoxia-inducible factor-2α expression in the malignant transformation of Oral submucous fibrosis.

CONTEXT: Hypoxia-inducible factor (HIF)-2α is overexpressed in primary and metastatic human cancers, whose expression is correlated with tumor angiogenesis and patient mortality. HIF plays a role in the progression of fibrosis in oral submucous fibrosis (OSF). AIM AND OBJECTIVE: The aim is to study and compare the expression of HIF-2α in OSF (a), oral squamous cell carcinoma (OSCC) with areca nut usage (b), OSCC without areca nut usage (c) and normal mucosa (d) by immunohistochemistry. SUBJECTS AND METHODS: Immunohistochemical detection of HIF-2α was done on 51 samples, which included 11 cases (a), 15 cases (b), 15 cases (c) and the expression was compared with that of (d). STATISTICAL ANALYSIS: Data were analyzed using the SPSS™ software (ver. 21.0). Chi-square test and kappa analysis were performed to compare the intensity of staining between the groups and for inter-observer agreement, respectively. Value of P ≤ 0.05 was considered statistically significant. The mean labeling index between the groups was studied by the Kruskal-Wallis test. RESULTS: All the cases of (d), (a), (b) and (c) showed HIF-2α expression (P = 0.329). About 13% cases of (c) showed intense expression (P = 0.406) and 27% of (a) cases showed expression only in the connective tissue (P = 0.023). The number of positively stained nuclei in both (b and c) cases reduced as the tumor progression was from well to poorly differentiated. CONCLUSION: Areca nut initiates fibrosis and subsequent hypoxia in OSF which triggers HIF-2α expression in the epithelium. HIF-2α could be a surrogate marker for cancer initiation and progression.

Loricrin expression and its implication in oral submucous fibrosis, hyperkeratosis and normal mucosa with association to habits - An immunohistochemical study.

OBJECTIVE: The coarse fibres of areca nut and the continuous friction from occluding teeth are major causes of mechanical stress to the oral mucosa in conditions like oral submucous fibrosis and frictional keratosis. The continuous micro trauma provided in areca nut chewers, creates an environment where the keratinocytes exhibit alteration. Loricrin, is expressed abundantly in keratinizing epithelium in response to mechanical stress. Their expression or absence could play a role in malignant transformation. This study attempts to assess the potential of Loricrin as an early diagnostic marker in patients with chewing habit. METHODS: 73 archival samples of formalin fixed, paraffin embedded tissue specimens histopathologically confirmed, were segregated as normal mucosa 11, hyperkeratotic 32 and oral submucous fibrosis 30 and stained with antibodies to Loricrin and graded as negative, mild, moderate and intense based on the staining intensity. Pearson's chi square test was done for statistical analysis. RESULTS: Loricrin expression was observed in all groups with staining in the stratum granulosum showing a significant association to habits (P = 0.000). CONCLUSION: This prominent staining indicates a compensatory cytoskeletal rearrangement of surface epithelium during cell division in early oral submucous fibrosis showing potential as an early marker of the condition.

Identification of Helicobacter pylori in Saliva of Patients with and without Gastritis by Polymerase Chain Reaction.

AIMS AND OBJECTIVE: The aim of this study was to identify the presence of Helicobacter pylori in saliva of patients with and without gastritis by polymerase chain reaction (PCR) method. MATERIALS AND METHODS: The study comprised 20 patients in Group I presenting with various symptoms of gastritis and 10 asymptomatic subjects in Group II. The intestinal endoscopy antral biopsies were collected from 20 symptomatic patients with gastroduodenal disorders. The saliva specimens were taken from all patients before endoscopy. PCR was performed using genomic DNA, isolated from the saliva and the biopsies of the patients as the template to detect the presence of the 16S ribosomal RNA gene in H. pylori. RESULTS: In Group I, 10 (50%) cases of clinical gastritis were positive for H. pylori by endoscopy biopsy and 10 (50%) were negative. Of the 10 endoscopy biopsy positive cases for H. pylori, eight were PCR positive in saliva and two were negative. Of the 10 endoscopy biopsy negative cases, three were PCR positive for H. pylori in saliva and seven were negative. In Groups II, four were symptomatic for gastritis and six were negative. Of the six gastritis negative cases, three were PCR positive, four were gastritis positive, and three were PCR positive. Sensitivity and specificity of PCR were found to be 80% and 70%, respectively. The positive predictive and negative predictive values of PCR in saliva were 72.7% and 77.7%, respectively. CONCLUSION: PCR analysis of saliva may be handy in identification of H. pylori and serves as a noninvasive technique to diagnose and monitor the prognosis.

Upfront Xpert MTB/RIF testing on various specimen types for presumptive infant TB cases for early and appropriate treatment initiation.

BACKGROUND: Diagnosis of tuberculosis (TB) in infants is challenging due to non-specific clinical presentations of the disease in this age-group and low sensitivity of widely available TB diagnostic tools, which in turn delays prompt access to TB treatment. Upfront access to Xpert/MTB RIF (Xpert) testing, a highly sensitive and specific rapid diagnostic tool, could potentially address some of these challenges. Under the current project, we assessed the utility and feasibility of applying upfront Xpert for diagnosis of tuberculosis in infants, including for testing of non-sputum specimens. METHODS: A high throughput lab was established in each of the four project cities, and linked to various health care providers across the city, through rapid specimen transportation and electronic reporting linkages. Free Xpert testing was offered to all infant (<2 years of age) presumptive TB cases (both pulmonary and extra-pulmonary) seeking care at public and private health facilities. RESULTS: A total of 7,994 presumptive infant TB cases were enrolled in the project from April 2014 to October 2016, detecting 465 (5.8%, CI: 5.3-6.4) TB cases. The majority (93.9%; CI: 93.4-94.4) of patient specimens were non-sputum and TB positivity was higher amongst non-sputum specimens. Further, a high proportion (5.6% CI 3.8-8.1) of infant TB cases were found to be rifampicin resistant. Covering large cities with a single lab per city over more than two years, the project demonstrated the feasibility of same-day diagnosis with upfront Xpert testing. This in turn led to prompt treatment initiation, with a two-day median turnaround time to treatment initiation. Case mortality observed in the project cohort of diagnosed TB cases was 11.0% (CI 8.4-14.1), the majority of which was pre- or early treatment mortality, in spite of prompt access to treatment for most diagnosed cases. CONCLUSION: The current project demonstrated the feasibility of applying rapid and upfront Xpert testing for presumptive infant TB cases. Rapid TB diagnosis in turn facilitates prompt and appropriate treatment initiation. Further, levels of rifampicin resistance observed in infants TB cases highlight the additional benefit of upfront resistance testing. However, high rates of early case mortality, in spite of prompt diagnosis and treatment initiation, highlight the need for further research in infant patient pathways for overall improvement in TB care for infant populations.

Accelerating access to quality TB care for pediatric TB cases through better diagnostic strategy in four major cities of India.

BACKGROUND: Diagnosis of TB in children is challenging, and is largely based on positive history of contact with a TB case, clinical and radiological findings, often without microbiological confirmation. Diagnostic efforts are also undermined by challenges in specimen collection and the limited availability of high sensitivity, rapid diagnostic tests that can be applied with a quick turnaround time. The current project was undertaken in four major cities of India to address TB diagnostic challenges in pediatric population, by offering free of cost Xpert testing to pediatric presumptive TB cases, thereby paving the way for better TB care. METHODS: A high throughput lab was established in each of the four project cities, and linked to various health care providers across the city through rapid specimen transportation and electronic reporting linkages. Free Xpert testing was offered to all pediatric (0-14 years) presumptive TB cases (both pulmonary and extra-pulmonary) seeking care at public and private health facilities. RESULTS: The current project enrolled 42,238 pediatric presumptive TB cases from April, 2014 to June, 2016. A total of 3,340 (7.91%, CI 7.65-8.17) bacteriologically confirmed TB cases were detected, of which 295 (8.83%, CI 7.9-9.86) were rifampicin-resistant. The level of rifampicin resistance in the project cohort was high. Overall Xpert yielded a high proportion of valid results and TB detection rates were more than three-fold higher than smear microscopy. The project provided same-day testing and early availability of results led to rapid treatment initiation and success rates and very low rates of treatment failure and loss to follow-up. CONCLUSION: The current project demonstrated the feasibility of rolling out rapid and upfront Xpert testing for pediatric presumptive TB cases through a single Xpert lab per city in an efficient manner. Rapid turnaround testing time facilitated prompt and appropriate treatment initiation. These results suggest that the upfront Xpert assay is a promising solution to address TB diagnosis in children. The high levels of rifampicin resistance detected in presumptive pediatric TB patients tested under the project are a major cause of concern from a public health perspective which underscores the need to further prioritize upfront Xpert access to this vulnerable population.

Catalysing progressive uptake of newer diagnostics by health care providers through outreach and education in four major cities of India.

BACKGROUND: Unlike in adults, diagnosis of TB can be challenging in children, as signs and symptoms of paediatric TB can be very non-specific and similar to other common childhood chest infections, which may lead to under or delayed diagnosis of TB disease. In spite of the increasing availability of rapid high-sensitivity diagnostics in public and private sectors, majority of paediatric TB cases are empirically diagnosed, without laboratory confirmation. To address these diagnostic challenges, World Health Organization (WHO) has recommended upfront Xpert MTB/RIF (Xpert) testing for the diagnosis of TB in paediatric presumptive pulmonary and extra-pulmonary TB (EPTB) cases. However, in spite of the increasing availability of rapid high-sensitivity diagnostics, a significant gap exists in its application with Xpert being rarely used as an upfront diagnostic among patients presumed to have TB. Under an ongoing paediatric project since April 2014, which provided free-of-cost upfront Xpert testing, several low-cost outreach and education interventions were undertaken to increase the diagnostic uptake by different providers catering to the paediatric population, thereby increasing adherence to global guidance. METHODS: Providers catering to paediatric population in the project cities were systematically mapped and contacted using different outreach strategies. The focus of outreach efforts was to increase provider literacy and increase their awareness of the availability of free rapid diagnostic services with the goal of changing their diagnostic approaches. RESULTS: From April 2014 to June 2016, more than 5,700 providers/facilities were mapped and 3,670 of them were approached. The number of providers/facilities engaged under the project increased more than 10-fold (43 in April, 2014 to 466 in June, 2016), with significant increase in project uptake, both from public and private sector. Overall 42,238 paediatric presumptive TB cases were enrolled in the project, across the four cities. Over the project period, quarterly diagnostic uptake and paediatric TB cases detection rates increased more than two-fold. TB detection rates were similar in patients from public and private sectors. CONCLUSIONS: Ongoing efforts in scaling up new rapid diagnostics involves significant investments. These efforts need to be complemented with proactive provider engagement to ensure provider-literacy and awareness, for maximizing impact of this scale-up. The current project demonstrated the usefulness of outreach and education interventions for the effective uptake of newer diagnostics.

PknB remains an essential and a conserved target for drug development in susceptible and MDR strains of M. Tuberculosis.

BACKGROUND: The Mycobacterium tuberculosis (M.tb) protein kinase B (PknB) which is now proved to be essential for the growth and survival of M.tb, is a transmembrane protein with a potential to be a good drug target. However it is not known if this target remains conserved in otherwise resistant isolates from clinical origin. The present study describes the conservation analysis of sequences covering the inhibitor binding domain of PknB to assess if it remains conserved in susceptible and resistant clinical strains of mycobacteria picked from three different geographical areas of India. METHODS: A total of 116 isolates from North, South and West India were used in the study with a variable profile of their susceptibilities towards streptomycin, isoniazid, rifampicin, ethambutol and ofloxacin. Isolates were also spoligotyped in order to find if the conservation pattern of pknB gene remain consistent or differ with different spoligotypes. The impact of variation as found in the study was analyzed using Molecular dynamics simulations. RESULTS: The sequencing results with 115/116 isolates revealed the conserved nature of pknB sequences irrespective of their susceptibility status and spoligotypes. The only variation found was in one strains wherein pnkB sequence had G to A mutation at 664 position translating into a change of amino acid, Valine to Isoleucine. After analyzing the impact of this sequence variation using Molecular dynamics simulations, it was observed that the variation is causing no significant change in protein structure or the inhibitor binding. CONCLUSIONS: Hence, the study endorses that PknB is an ideal target for drug development and there is no pre-existing or induced resistance with respect to the sequences involved in inhibitor binding. Also if the mutation that we are reporting for the first time is found again in subsequent work, it should be checked with phenotypic profile before drawing the conclusion that it would affect the activity in any way. Bioinformatics analysis in our study says that it has no significant effect on the binding and hence the activity of the protein.

Biomass production of multipopulation microalgae in open air pond for biofuel potential.

Biodiesel gains attention as it is made from renewable resources and has considerable environmental benefits. The present investigation has focused on large scale cultivation of multipopulation microalgae in open air pond using natural sea water without any additional nutritive supplements for low cost biomass production as a possible source of biofuel in large scale. Open air algal pond attained average chlorophyll concentration of 11.01 µg/L with the maximum of 43.65 µg/L as well as a higher lipid concentration of 18% (w/w) with lipid content 9.3 mg/L on the 10th day of the culture; and maximum biomass of 0.36 g/L on the 7th day of the culture. Composition analysis of fatty acid methyl ester (FAME) was performed by gas chromatography and mass spectrometry (GCMS). Multipopulation of algal biomass had 18% of total lipid content with 55% of total saturated fatty acids (SFA), 35.3% of monounsaturated fatty acids (MUFA) and 9.7% of polyunsaturated fatty acids (PUFA), revealing a potential source of biofuel production at low cost.

Expression of VEGF-A in Epithelial Ovarian Cancer: Correlation with Morphologic Types, Grade and Clinical Stage.

AIM: The objective of this study was to evaluate the expression pattern of vascular endothelial growth factor A (VEGF A) in epithelial ovarian cancers (EOC) and to correlate the intensity of expression with morphologic types, histologic grade and clinical stage of the disease. METHODS: Tissue microarrays were constructed from paraffin blocks of 78 cases of EOC in duplicate. Immunohistochemical staining for VEGF A was carried out with mouse monoclonal antibody and the intensity was scored independently by two pathologists (CSP and MA). RESULTS: Twenty six of 78 (33.3%) cases of primary malignant epithelial ovarian neoplasm showed high VEGF A expression. Among high expressors, 23 were seen in serous carcinomas, two in undifferentiated carcinomas and one in mixed carcinoma. High expression was not seen in other types like, endometrioid, mucinous and clear cell carcinomas. High VEGF-A expression was also associated high grade and advanced stage of the disease. CONCLUSION: High VEGF-A expression in epithelial ovarian cancer was found to be associated with serous morphology, high grade and advanced stage of the disease. Though some degree of VEGF A expression was seen in most ovarian carcinomas, high expression was seen in only one third of cases and this may help in selecting the patients for targeted therapy with antiangiogenic agents.

Synthesis, in vitro antimycobacterial evaluation and docking studies of some new 5,6,7,8-tetrahydropyrido[4',3':4,5]thieno[2,3-d]pyrimidin-4(3H)-one schiff bases.

Development of multidrug resistant (MDR) and extensively drug resistant (XDR) tuberculosis (TB) has been considered as major health burden, globally. In order to develop novel, potential molecules against drug resistant TB, twenty two (22) new 3-substituted-7-benzyl-5,6,7,8-tetrahydropyrido[4',3':4,5]thieno[2,3-d]pyrimidin-4(3H)-one (6a-k) and 3-substituted-7-benzyl-2-methyl-5,6,7,8-tetrahydropyrido[4',3':4,5]thieno[2,3-d]pyrimidin-4(3H)-one (7a-k) derivatives were designed and synthesized by using appropriate synthetic protocols. Pantothenate synthetase (PS) was considered as the target for the molecular docking studies and evaluated the binding pattern at active site, as PS plays a significant role in the biosynthesis of pantothenate in Mycobacterium tuberculosis (MTB). The preliminary in vitro antibacterial screening of test compounds was carried out against two strains of Gram-positive (Bacillus subtilis and Staphylococcus aureus) and Gram-negative (Escherichia coli and Klebsiella pneumoniae) bacteria. The antimycobacterial screening was performed against MTB H37Rv and an isoniazid-resistant clinical isolate of MTB. The compounds 6b, 6c, 6d, 6k, 7b, 7c, 7d and 7k exhibited promising antibacterial activity MIC in the range of 15-73 µM against all bacterial strains used and compounds 6d and 7b showed antimycobacterial activity (IC50 <340 µM in LRP assay) and (MIC <9 µM in broth microdilution method).

Piloting Upfront Xpert MTB/RIF Testing on Various Specimens under Programmatic Conditions for Diagnosis of TB & DR-TB in Paediatric Population.

BACKGROUND: India accounts for one-fifth of the global TB incidence. While the exact burden of childhood TB is not known, TB remains one of the leading causes of childhood mortality in India. Bacteriological confirmation of TB in children is challenging due to difficulty in obtaining quality specimens, in the absence of which diagnosis is largely based on clinical judgement. While testing multiple specimens can potentially contribute to higher proportion of laboratory confirmed paediatric TB cases, lack of high sensitivity tests adds to the diagnostic challenge. We describe here our experiences in piloting upfront Xpert MTB/RIF testing, for diagnosis of TB in paediatric population in respiratory and extra pulmonary specimens, as recently recommended by WHO. METHOD: Xpert MTB/RIF testing was offered to all paediatric (0-14 years) presumptive TB cases (both pulmonary and extra-pulmonary) seeking care at public and private health facilities in the project areas covering 4 cities of India. RESULTS: Under this pilot project, 8,370 paediatric presumptive TB & presumptive DR-TB cases were tested between April and-November 2014. Overall, 9,149 specimens were tested, of which 4,445 (48.6%) were non-sputum specimens. Xpert MTB/RIF gave 9,083 (99.2%, CI 99.0-99.4) valid results. Of the 8,143 presumptive TB cases enrolled, 517 (6.3%, CI 5.8-6.9) were bacteriologically confirmed. TB detection rates were two fold higher with Xpert MTB/RIF as compared to smear microscopy. Further, a total of 60 rifampicin resistant TB cases were detected, of which 38 were detected among 512 presumptive TB cases while 22 were detected amongst 227 presumptive DR-TB cases tested under the project. CONCLUSION: Xpert MTB/RIF with advantages of quick turnaround testing-time, high proportion of interpretable results and feasibility of rapid rollout, substantially improved the diagnosis of bacteriologically confirmed TB in children, while simultaneously detecting rifampicin resistance.

Immature teratoma of ovary--outcome following primary and secondary surgery: study of a single institution cohort.

OBJECTIVE: To analyse the clinical presentation, treatment - primary and secondary debulking and outcomes with focus on recurrences in ovarian immature teratoma. STUDY DESIGN: This is a single institution, retrospective analysis of 24 women who presented to a gynecologic oncology unit from 1999 to 2011 with ovarian immature teratoma. Patient's clinical presentation, operative and chemotherapy details were included in a database. Follow up details regarding recurrence and management and future outcomes were also noted. Overall survival was calculated from the date of registration to last follow up or date of death. Survival curve was constructed by Kaplan-Meier method. RESULTS: Immature teratoma accounted for 11% of 218 malignant germ cell tumors. Of the 24 patients, pain was the predominant symptom and abdominal mass was the commonest clinical presentation. Sixteen out of 24 patients presented in Stage I and grade 3 tumors were found in 43% of patients. Six patients had only unilateral salpingo oophorectomy and no staging procedure. Twelve patients underwent staging, with omentectomy being the commonest procedure. All but one, had cisplatin based combination chemotherapy. Six patients underwent secondary debulking of recurrence. Most recurrences were recorded in Stage III, higher grade tumors. With secondary cytoreduction and platinum based chemotherapy, it was possible to salvage most recurrences as well. Overall survival after a mean follow-up of 39 months was 91.6%. CONCLUSION: Majority of the patients did well with conservative surgery in terms of survival, menstrual and reproductive function. Platinum based chemotherapy was indicated in higher grade and higher stage tumors as recurrences commonly occurred in this subgroup of patients. Recurrences could be salvaged with selected secondary cytoreduction and platinum based chemotherapy.

Awareness of Forensic Odontology among Legal Professionals, Chennai, India.

BACKGROUND: The forensic discipline of law is a multidisciplinary team comprising of specialists in forensic medicine, forensic odontology, security and law. AIM: The study was to find the awareness level of scope and utility of forensic odontology among lawyers in Chennai, South India. MATERIALS AND METHODS: A cross-sectional study using a self administered structured questionnaire was conducted in 200 lawyers between August and September of 2013. The data was analyzed depending on age, gender, type and years of practice. RESULTS: Lawyers above 40 years of experience were more aware of palatal rugae analysis (P = 0.02), and those with more than 20 years were aware of lip print (P = 0.001) and bite mark analysis (P = 0.001). Males were more aware of forensic odontology with respect to criminal identification (P = 0.001). The knowledge of bite mark analysis was higher among male lawyers (P = 0.001), civil and criminal practicing lawyers (P = 0.004). All participants were aware that loss or fracture of tooth constitutes a grievous injury under Indian Penal Code (IPC) 320 clause 7(5). CONCLUSION: This study highlighted the knowledge of forensic odontology among legal professionals and also identified the areas in which they need further appraisal.

Primary peritoneal carcinoma: regional cancer institute experience.

Primary peritoneal serous carcinoma (PPSC) is a rare malignancy that arises primarily from peritoneal surface epithelium. However there are limited studies on these tumors even in world literature. To study the clinical, pathologic profile, outcome and prognostic features of PPSC. A 5 year retrospective study of PPSC diagnosed and treated at our centre was conducted. The pathological specimen of PPSC diagnosed from January 2008 to December 2012 were reviewed by gynaeconcopathologists. The diagnosis was based on GOG criteria, complemented with IHC. Majority of the patients underwent upfront de-bulking surgery. Postoperatively, six cycles of combination chemotherapy with paclitaxel (175 mg/m(2)) and carboplatin (AUC 6) was administered every 3 weekly. These patients were analysed for progression free survival (PFS), this was correlated with stage and surgical adequacy. The median age of presentation was 56 years. The total number of ovarian cancers treated during study period was 374. The 30 cases were clinically suspected to have primary peritoneal carcinoma (PPC) on pre- and intra-operatve gross findings, but further evaluation with histopathological examination, IHC and GOG criteria revealed only 10 cases were genuine PPSC. The remaing 20 cases; 13 were found to poorly differentiated ovarian carcinomas, six were primary fallopian tube carcinoma and one was appendicular carcinoma. The 10 (2.7 %) cases of the 374 were eligible for the PPSC analysis. The two (20 %) of the 10 cases had family history of breast and ovarian cancers, two (20 %) cases were diagnosed as abdominal tuberculosis (TB) prior referral to our centre. Radiological presentation includes gross ascites, with omental caking and normal adenexa. The eight (80 %) of 10 cases presented with stage IIIC and other two cases (20 %) with stage IV disease. The eight (80 %) of 10 cases underwent upfront surgery; six (75 %) of these eight cases had optimal cytoreduction, i.e. residual disease (RD) <1 cm or no visible disease (R0) and other two (25 %) suboptimal cytoreduction. The two (20 %) of 10 cases with stage IV disease received neoadjuvant chemotherapy (NACT) followed by interval cytoreduction. After debulking surgery the most useful IHC marker include CK7+, CK20-, CA125+, WT-1+, and GCDFP- . At median follow up of 24 months (range 3-60 months), the median progression free survival (PFS) was 22 months, while the estimated 5 year PFS was 18 %. Stage IV disease and suboptimal surgery had poor outcome. The PPSC presents with advanced stage disease and are observed to be misdiagnosed abdominal TB in tropical countries. The GOG criteria and IHC complement the diagnosis. These have poor outcome despite optimal care, highlighting need for larger studies on this disease.

On factors influencing the absorption capacity of surgical sponges.

BACKGROUND: Cotton balls and surgical gauzes (CSG) have been routinely used for mopping fluids and blood in surgeries. Polyurethane sheets (PUS) are increasingly used instead of CSG. The factors influencing the absorption of fluids by CSG and PUS have not been studied in detail. There are a variety of factors that could be modified by the manufacturer while a limited number of them could be manipulated by the operator. MATERIALS AND METHODS: Mathematical models and equations have been employed in this study. The impact of absorbency was performed by modulating various factors. RESULTS AND DISCUSSION: A variety of factors such as thickness, density of the web, radius of fiber, temperature, surface tension and viscosity of fluid, all influenced the absorption rate and capacity to varying degrees. The optimal variation by which the PUS can be effectively used is discussed. The suggested mathematical model will help the operator to choose the appropriate type of PUS based on the individual's needs. CONCLUSION: In an area of rapidly developing technology and change in biomaterials, where the choice of such materials are overwhelming, hopefully this basic knowledge will help the clinician to make a more educated and rational decision.