Endoscopic full-thickness plication along with argon plasma coagulation for treatment of proton pump inhibitor dependent gastroesophageal reflux disease.

BACKGROUND: Most endoscopic anti-reflux interventions for gastroesophageal reflux disease (GERD) management are technically challenging to practice with inadequate data to support it utility. Therefore, this study was carried to evaluate the effectiveness and safety newer endoscopic full-thickness fundoplication (EFTP) device along with Argon Plasma Coagulation to treat individuals with GERD. AIM: To evaluate the effectiveness and safety newer EFTP device along with Argon Plasma Coagulation to treat individuals with GERD. METHODS: This study was a single-center comparative analysis conducted on patients treated at a Noble Institute of Gastroenterology, Ahmedabad, hospital between 2020 and 2022. The research aimed to retrospectively analyze patient data on GERD symptoms and proton pump inhibitor (PPI) dependence who underwent EFTP using the GERD-X system along with argon plasma coagulation (APC). The primary endpoint was the mean change in the total gastroesophageal reflux disease health-related quality of life (GERD-HRQL) score compared to the baseline measurement at the 3-month follow-up. Secondary endpoints encompassed enhancements in the overall GERD-HRQL score, improvements in GERD symptom scores at the 3 and changes in PPI usage at the 3 and 12-month time points. RESULTS: In this study, patients most were in Hill Class II, and over half had ineffective esophageal motility. Following the EFTP procedure, there were significant improvements in heartburn and regurgitation scores, as well as GERD-HRQL scores (P < 0.001). PPI use significantly decreased, with 82.6% not needing PPIs or prokinetics at end of 1 year. No significant adverse events related to the procedures were observed in either group. CONCLUSION: The EFTP along with APC procedure shows promise in addressing GERD symptoms and improving patients' quality of life, particularly for suitable candidates. Moreover, the application of a lone clip with APC yielded superior outcomes and exhibited greater cost-effectiveness.

Can 18F FDG PET/CT metabolic parameters be used to noninvasively differentiate between different histopathological subtypes and Fuhrman grades of renal cell cancer?

AIM: To evaluate relationship between metabolic PET metabolic parameters and size of the primary tumor, various histopathological subtypes of renal cell carcinoma (RCC) and Fuhrman grade of the tumors. MATERIAL AND METHODS: Retrospective analysis of 93 biopsy-proven RCC patients who underwent pretreatment flourine 18 flourodeoxyglucose PET/computed tomography (18F FDG PET/CT) was performed. Quantitative PET parameters, size of the primary tumor, histopathological subtypes and Fuhrman grades of the tumor were extracted. We tried to assess if there was any significant difference in the metabolic patterns of various histopathological subtypes of RCCs, Fuhrman grade of the tumors and size of the primary tumor. RESULTS: A significant correlation was noted between the size of primary tumor and maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) (P < 0.01, P < 0.001 and P < 0.001, respectively). SUVmax values correlated significantly with the histopathological subtype (P < 0.001). Further sub-analyses was also done by segregating the patients into Low grade (Fuhrman grade 1 and 2) vs. High grade (Fuhrman grade 3 and 4). SUVmax, MTV and TLG were significantly different between high grade vs. low grade tumors. ROC analysis yielded cut off values for SUVmax, MTV and TLG to differentiate between high grade from low grade tumors. CONCLUSION: FDG PET/CT with the use of metabolic PET parameters can differentiate between different histopathological subtypes of RCC. Incorporation of metabolic parameters into clinical practice can potentially noninvasively identify patients with low-grade vs. high-grade RCC.

Is FAST FORWARD the Way Forward in Radiotherapy for Locally Advanced Breast Cancer - Learnings From the COVID Pandemic.

INTRODUCTION: Low middle-income countries (LMICs), including India, have paucity of external beam radiotherapy (RT) machines leading to prolonged wait times for RT. Delay in delivery of RT has been shown to adversely affect outcomes in locally advanced breast cancer (LABC). With the availability of results of multiple randomized controlled trials, hypofractionated RT delivered over 3 to 4 weeks became the standard of care in breast cancer RT. METHODS: We conducted a retrospective audit of 172 LABC patients treated with ultrahypofractionated adjuvant RT (radiotherapy completed in 1 week) during the COVID pandemic. Log rank and Cox-regression model used for univariate and multi-variate analyses. RESULTS: No patient developed grade 3 esophagitis. Grade 2 esophagitis requiring short term narcotic analgesics was seen in 12 (6.9%) patients. Grade 2 or higher toxicity peaked between 2 and 3 weeks after RT. The estimated 2 and 3- year recurrence free survival (RFS) for the cohort is 87.1 % and 81.4 %, respectively. The estimated 2 and 3-year overall survival for the cohort is 95% and 91.3%. On multivariate analysis, presence of extra-nodal extension was found to be an independent factor associated with worse RFS (P = .028). CONCLUSIONS: FAST FORWARD protocol RT in LABC appears well tolerated.

Incidental FAPI Localization in Benign Bone Lesions in a Case of Carcinoma Stomach.

ABSTRACT: Recently developed radiolabeled FAPI (fibroblast-activation protein inhibitors) have attracted researcher's attention in diagnosing various tumors because of its high specificity and better tumor-to-background ratio. Increasing use of 68 Ga-FAPI PET/CT has resulted in reporting of incidental benign findings as well. We hereby present a case of suspected carcinoma stomach showing increased uptake in primary tumor in stomach as well as incidental uptake in benign subchondral cysts in bilateral shoulder joints and right hip joint on 68 Ga-FAPI PET CT scan.

On utilizing modified TOPSIS with R-norm q-rung picture fuzzy information measure green supplier selection.

The present communication introduces a new discriminant measure coined as R-norm q-rung picture fuzzy discriminant information measure which is more generalized in nature and has the capability to handle more flexibility inherited in the inexact information. The notion of q-rung picture fuzzy set (q-RPFS) has an integrated advantage of picture fuzzy set and q-rung orthopair fuzzy set with flexibility of qth level relations. The proposed parametric measure is then applied in the conventional "technique for order preference by similarity to the ideal solution (TOPSIS) method" for solving a green supplier selection problem. The numerical illustration to exhibit the proposed methodology for the green supplier selection problem has been presented in an empirical form to establish the consistency of the model. Also, the advantageous features of the proposed scheme in the setup of impreciseness have been discussed.

Unmasking the uncommon: post COVID-19's sinister encore. A clinical report of acute invasive fungal rhinosinusitis in a non-diabetic, non-steroid therapy patient / Descubriendo lo inusual: el siniestro epílogo post-COVID-19. Informe clínico de una rinosinusitis fúngica invasiva aguda en un paciente no diabético, sin terapia de esteroides

COVID-19, caused by SARS-CoV-2, has been linked to various bacterial and fungal infections. The incidence of mucormycosis has notably increased in individuals with COVID-19, with many cases reported globally, especially in India. The risk factors for developing mucormycosis include uncontrolled diabetes and use of immunosuppressants such as corticosteroids. We report a case of acute invasive fungal rhino-sinusitis (mucormycosis) in a 42 year old patient with no history of diabetes or steroid therapy but recently diagnosed with COVID-19. The patient presented with facial swelling, loose teeth, and imaging findings consistent with mucormycosis. The history, examination, and laboratory investigations were sufficient to exclude other causes of immunocompromised status in the patient. The diagnosis was confirmed through KOH staining of excised tissue, which tested positive for mucor. The patient underwent systemic antifungal therapy and Functional Endoscopic Sinus surgery (FESS) associated with a bilateral maxillectomy to remove the affected tissue. These interventions were successful, and the patient experienced a positive clinical response. This case report details an uncommon presentation of post COVID-19 acute invasive fungal rhino-sinusitis in a patient without typical risk factors for the infection. Therefore, clinicians should have a high index of suspicion for mucormycosis in patients with a recent history of COVID-19 infection, especially those with symptoms such as facial swelling or tooth loss. Prompt detection and management of mucormycosis are critical for improving patient outcomes. However, delays in diagnosis and treatment can lead to significant morbidity and mortality. (AU)

La COVID-19, causada por el virus SARS-CoV-2, se ha relacionado con varias infecciones bacterianas y fúngicas. La incidencia de mucormicosis ha aumentado notablemente en individuos con COVID-19, habiéndose reportado muchos casos a nivel mundial, especialmente en la India. Los factores de riesgo para desarrollar mucormicosis incluyen diabetes descontrolada y el uso de inmunosupresores como los corticosteroides. Presentamos un caso de rinosinusitis fúngica invasiva aguda (mucormicosis) en un paciente de 42 años sin antecedentes de diabetes ni terapia con esteroides, pero recientemente diagnosticado con COVID-19. El paciente presentaba hinchazón facial, movilidad dental y hallazgos de imágenes consistentes con mucormicosis. La historia clínica, el examen físico y las investigaciones de laboratorio fueron suficientes para descartar otras causas de inmunocompromiso en el paciente. El diagnóstico se confirmó mediante tinción con KOH del tejido extirpado, que resultó positiva para mucor. El paciente recibió terapia antifúngica sistémica y se sometió a una cirugía endoscópica funcional de senos paranasales (FESS) junto con una maxilectomía bilateral para extirpar el tejido afectado. Estas intervenciones fueron exitosas y el paciente experimentó una respuesta clínica positiva.Este informe de caso detalla una presentación poco común de rinosinusitis fúngica invasiva aguda post-COVID-19 en un paciente sin factores de riesgo típicos para la infección. Por lo tanto, los médicos deben tener un alto índice de sospecha de mucormicosis en pacientes con antecedentes recientes de infección por COVID-19, especialmente aquellos con síntomas como hinchazón facial o pérdida de dientes. La detección y el manejo oportunos de la mucormicosis son fundamentales para mejorar los resultados del paciente. Sin embargo, los retrasos en el diagnóstico y el tratamiento pueden provocar una morbilidad y mortalidad significativas. (AU)

Orthomorphic surgery for correction of mandibular dysmorphology post TMJ ankylosis. A report of 4 cases and review of literature / Cirugía ortomórfica para la corrección de la dismorfología mandibular posterior a la anquilosis de la ATM. Un informe de 4 casos y revisión de la literatura

La dismorfología mandibular es predominantemente el resultado de una deficiencia o exceso de crecimiento no coordinado. La anquilosis unilateral de la articulación temporomandibular durante la fase de crecimiento activo, si no se opera, produce cambios en el tamaño y la forma de la mandíbula y las estructuras circundantes. El uso de la cirugía ortognática para corregir las deformidades faciales que surgen de las discrepancias en las relaciones espaciales, aunque bien aceptado, no puede corregir las anomalías que surgen de una morfología alterada. La corrección quirúrgica utilizando principios ortomórficos restaura la morfología sin cambiar el estado oclusal, lo que demuestra ser una adición invaluable al repertorio de un cirujano maxilofacial.Cuatro pacientes previamente operados por anquilosis unilateral de la articulación temporomandibular que presentaban asimetría mandibular fueron tratados mediante corrección ortomórfica. El factor etiológico en todos los pacientes reclutados fue un traumatismo en la articulación temporomandibular durante la infancia. Los pacientes fueron evaluados para cambios neurosensoriales, evaluación de la apertura bucal antes y después de la cirugía, evaluación postoperatoria de la simetría mandibular y complicaciones postoperatorias al 3.er día, 3 semanas y 3 meses después de la cirugía. Se observó una buena a moderada corrección de la asimetría en todos los casos. Se observó parestesia del nervio mentoniano en un paciente. No se observaron complicaciones postoperatorias.La técnica descrita se puede utilizar como complemento de la cirugía ortognática convencional o como una alternativa de tratamiento de una sola etapa confiable para entidades dismórficas complejas. (AU)

Mandibular dysmorphology is predominantly a result of uncoordinated growth deficiency or surfeit. Unilateral temporomandibular joint ankylosis during the active growth phase, if left unoperated, brings about changes in the size and shape of the mandible and the surrounding structures. The use of orthognathic surgery in correcting the facial deformities arising from discrepancies in spatial relationships although well accepted is unable to correct anomalies arising from an altered morphology. The surgical correction using orthomorphic principles restore the morphology without changing the occlusal status, thus proving to be an invaluable addition to a maxillofacial surgeon’s repertoire.Four patients previously operated on for unilateral temporomandibular ankylosis having mandibular asymmetry were managed by orthomorphic correction. The etiological factor in all the recruited patients was trauma to the temporomandibular joint during childhood. The patients were evaluated for neurosensory changes, assessment of mouth opening before and after surgery, postoperative assessment of mandibular symmetry, and postoperative complications on 3rd day, 3 weeks, and 3 months postoperatively. Good to moderate asymmetry correction was seen in all the cases. Mental nerve paraesthesia was noted in one patient. No postoperative complications were noted.The described technique can be used as a complement to conventional orthognathic surgery or as a reliable single-stage treatment alternative for complex dysmorphic entities. (AU)

Magnetically engineered sulfurized peat-based activated carbon for remediation of emerging pharmaceutical contaminants.

Activated carbon derived from peat-based biomass was sulfurized and magnetized forming magnetically-engineered sulfurized peat-based activated carbon (MEPBAC) and used for adsorption of caffeine (CFN) and sulfamethoxazole (SMX) from aqueous media. Modification increased the surface area (724 m2/g) and introduced sulphur-groups and Fe-based nano-structures in MEPBAC. Sulphur-groups enhanced adsorption efficiency, whereas Fe-based nano-structures facilitated easy magnetic separation of MEPBAC after intended use leading to high reusability with consistent removal efficiency (∼95 %). Response surface methodology was employed for design of experiments and process optimization. The results revealed that the maximum removal (SMX 94 %; CFN 97 %) could be achieved at an adsorbent dose of 1.4 and 1.6 g/L, respectively (pH 11, 311 K). Adsorption kinetics was best explained by a pseudo-second-order kinetic model. Adsorption data of SMX was fitted better to Langmuir (linear) and Freundlich (non-linear) isotherms, whereas that of CFN was fitted well with Freundlich (linear) and Langmuir (non-linear) isotherms (R2 ≥ 0.99).

Is Chitosan Dental Dressing Better Than Cotton Gauze in Achieving Hemostasis in Patients on Antithrombotics?

PURPOSE: Tooth extraction leads to bleeding which may be longer in patients on antithrombotics. This study was aimed to evaluate the hemostatic and wound healing efficacy of chitosan-based dressing in comparison to the cotton pressure pack after tooth extraction in patients receiving single or dual antithrombotics. MATERIALS AND METHODS: This is a prospective, randomized split mouth study. Patients undergoing tooth extractions taking either single or dual antithrombotics, with an international normalized ratio (INR) value ≤ 3 were enrolled at JSS Dental College & Hospital, Mysuru, India during February 2020 to January 2022. The study compared the efficiency of chitosan dressing in achieving quicker hemostasis in comparison to cotton pressure pack. The primary outcome was time to achieve hemostasis and the secondary outcomes were alveolar clinical healing index and alveolar osteitis. The covariates were gender, age, reason for extraction, INR, type of antithrombotic therapy, and the disease condition. RESULTS: Of the 54 enrolled subjects, 39 were males and 15 were females, aged between 33 and 86 years. Thirty six patients were on single antithrombotics, whereas 18 patients were on dual antithrombotics. The reason for extraction was periodontitis in 37 patients and dental caries in 17 patients. The time to achieve hemostasis was lesser with chitosan dental dressing when compared to cotton pressure packs (96 ± 4 and 797 ± 23 seconds; P < .001). In the chitosan group, the time to hemostasis was similar irrespective of single or dual antithrombotic therapy (90 ± 6 and 109 ± 8 seconds, respectively). On the contrary, in the cotton pressure pack group, patients on dual antithrombotics had longer time to achieve hemostasis compared to those on single antithrombotics (940 ± 20 and 726 ± 26 seconds; P < .001). The time to achieve hemostasis was dependent on INR only in cotton pressure pack group (r2 = 0.7756). The alveolar clinical healing index was better in 88.9% with chitosan and only 3.7% with cotton pressure packs. None of the patients treated with chitosan presented with alveolar osteitis, as opposed to 3.7% of patients with cotton pressure packs. CONCLUSION: When compared to cotton pressure packs, chitosan-based dressing was more effective in controlling postoperative bleeding in patients treated with single and dual antithrombotic therapy.

Rare Case of Neuroendocrine Tumor of Common Bile Duct Identified With Somatostatin Receptor But Not With Glucose Transporter Imaging.

ABSTRACT: Neuroendocrine tumors (NETs) are heterogeneous group of tumors arising from enterochromaffin cells. Neuroendocrine tumors are most commonly found in bowel and pancreatic tissue. Because of paucity of enterochromaffin cells in biliary tract, NETs of bile duct are very rare. Most of the neoplasms in the extrahepatic bile duct are adenocarcinomas; only 0.2% to 0.3% of NETs arise from the bile duct. Cases reported in the literature of biliary carcinoid are diagnosed postoperatively on histopathologic evaluation. We hereby demonstrate a rare presentation of CBD NET identified preoperatively on somatostatin receptor but not on glucose transporter imaging, confirmed by histopathology and immunohistochemistry to be grade 2 NET (Ki-67, 20%).

Prevalence of extraintestinal manifestations in ulcerative colitis and associated risk factors.

BACKGROUND: The data on prevalence of extraintestinal manifestations (EIM) in ulcerative colitis (UC) are  scanty and highly variable. METHODS: Consecutive patients with UC were prospectively evaluated from November 2016 to August 2017. A detailed history was obtained and physical examination was done. Presence of EIM was confirmed by a consultant rheumatologist, ophthalmologist and dermatologist. Tests performed were hemogram, liver function test, abdominal ultrasound, slit lamp examination, X-ray and magnetic resonance imaging when deemed necessary. RESULTS: A total of 227 patients with UC were enrolled in this study. The prevalence of EIM was 7.92%. Mucocutaneous (4.84%) manifestations were the commonest, followed by musculoskeletal (1.32%) and ocular (0.88%). Hepatobiliary (0.44%) and vascular (0.44) manifestations were present in equal frequency. History of appendicectomy was associated with  EIM. CONCLUSION: The prevalence of EIM in UC was low in our study. History of appendicectomy was a risk factor for EIM.

Profiling of emerging contaminants and antibiotic resistance in sewage treatment plants: An Indian perspective.

In India, sewage (partially-treated/ untreated) is randomly used for irrigation because of easy availability and presence of residual organics and nutrients. However, data on the occurrence of contaminants of emerging concerns (CECs) such as pharmaceuticals and personal care products (PPCPs) and antibiotic resistant bacteria (ARB) and antibiotic resistant genes (ARGs) in sewage is scarce in Indian perspective. Herein, for the first time, we present a quantitative contamination profiling of selected PPCPs and antibiotic resistance in untreated and biologically-treated sewage from three different sewage treatment plants, located in northern and central part of India. Profiling of PPCPs were done using LC-ESI-MS/MS whereas antibiotic resistance was analyzed using gradient PCR and qPCR techniques. PPCPs were detected both in untreated and treated samples (0.4 - 1340 µg/L). A reduction in ARB and ARG load (2-3 log) and an increase in ARG copy number with respect to beta lactams and tetracycline were observed in treated sewage. Triclosan, estrone and 17α-ethynylestradiol, ubiquitous in all samples, could be used as markers for performance monitoring of sewage treatment facilities. The results obtained in this study help evaluate health and ecological risks associated with the presence of CECs in treated sewage used for irrigation and frame future policies.