Sugammadex use in pediatric patients with stage IV-V chronic kidney disease in a quaternary referral hospital: a case series.

BACKGROUND: Sugammadex is a pharmacologic agent that provides rapid reversal of neuromuscular blockade via encapsulation of the neuromuscular blocking agent (NMBA). The sugammadex-NMBA complex is primarily cleared through glomerular filtration from the kidney, raising the possibility that alterations in renal function could affect its elimination. In pediatric patients, the benefits of sugammadex have led to widespread utilization; however, there is limited information on its application in pediatric renal impairment. This study examined sugammadex use and postoperative outcomes in pediatric patients with severe chronic renal impairment at our quaternary pediatric referral hospital. METHODS: After IRB approval, we performed a retrospective analysis in pediatric patients with stage IV and V chronic kidney disease who received sugammadex from January 2017 to March 2022. Postoperative outcomes studied included new or increased respiratory requirement, unplanned intensive care unit (ICU) admission, postoperative pneumonia, anaphylaxis, and death within 48 h postoperatively, unplanned deferral of intraoperative extubation, and repeat administrations of NMBA reversal after leaving the operating room. RESULTS: The final cohort included 17 patients ranging from 8 months to 16 years old. One patient required new postoperative noninvasive ventilation on postoperative day 2, which was credited to hypervolemia. Another patient had bronchospasm intraoperatively resolving with medication, which could not definitively be associated sugammadex administration. There were no instances of deferred extubation, unplanned ICU or need for supplemental oxygen after tracheal extubation identified. CONCLUSION: No adverse effects directly attributable to sugammadex in pediatric patients with severe renal impairment were detected. There may be a role for utilization of sugammadex for neuromuscular reversal in this population.

Angiosarcoma of the head and neck: A clinicopathologic study with special emphasis on diagnostic pitfalls.

BACKGROUND AND AIMS: Angiosarcoma (AS) is a rare malignant vascular tumor that phenotypically and functionally recapitulate normal endothelium. They constitute approximately 2-4% of soft tissue sarcomas. We present 36 cases of head and neck AS diagnosed for 11 years at a tertiary care hospital in South India to analyze the clinical, pathological, and immunophenotypic profiles with special emphasis on their differential diagnoses and diagnostic pitfalls. MATERIALS AND METHODS: Head and neck AS diagnosed from January 2006 to December 2017 were included. Clinical characteristics, treatment received, and follow-up data were obtained from electronic medical records. Hematoxylin and eosin (H&E)-stained slides and immunohistochemistry (IHC) slides were reviewed, and the histomorphological features, immunohistochemical staining, and their utility in resolving differential diagnosis were assessed. RESULTS: Twenty-two females and 14 males were diagnosed with head and neck AS in the study period. Histomorphological patterns observed were mixed vasoformative and solid ( n = 22), pure vasoformative ( n = 13), and pure solid ( n = 1). Neoplastic cells showed epithelioid, spindly, signet cell-like, clear cell, and rhabdoid morphology. CD31 was positive in 100% of cases, and CD34 was positive in 40% of cases. Differential diagnoses included melanoma, rhabdomyosarcoma, and large-cell lymphoma. Surgery, radiotherapy, and chemotherapy were the treatment modalities used. Twelve patients developed local recurrence, and 12 patients developed metastasis on follow-up. Twenty-five patients died of disease, on an average of 24 months after diagnosis. CONCLUSION: Head and neck AS pose a significant diagnostic challenge due to their broad morphologic spectrum. Proper clinicopathologic correlation is necessary to avoid misdiagnosis.

Cohort profile: maternal antecedents of adiposity and studying the transgenerational role of hyperglycaemia and insulin (MAASTHI).

PURPOSE: The Maternal Antecedents of Adiposity and Studying the transgenerational role of Hyperglycaemia and Insulin cohort in Bengaluru, South India, aims to understand the transgenerational role of increased circulating glucose levels or hyperglycaemia and other nutrients and psychosocial environment, on the risk of childhood obesity, as an early marker of chronic diseases. PARTICIPANTS: Through this paper, we describe the baseline characteristics of the cohort participants and their children, along with plans and challenges. A total of 5694 pregnant women were screened, with 4862 (85.4%) eligible pregnant women recruited at baseline. We assessed anthropometry, Haemoglobin status, Oral Glucose Tolerance Test (OGTT), dietary practices, depressive symptoms using the Edinburgh Postnatal Depression Scale and social support in all women. Follow-up visits involved assessing anthropometry and the health profile of mothers and children. FINDINGS TO DATE: Among 4862 eligible participants recruited, 3260 (67%) underwent OGTT, while 2962 participants completed OGTT (90.9%). During the pregnancy, 9.7% of women were obese (>90th percentile of skinfold thickness), and 14.3% had gestational diabetesmellitus. Moreover, 6.2% and 16.8% of women had symptoms suggestive of depression during pregnancy and the immediate postnatal period, respectively. We found that 3.3% of children were small for gestational age, 10.8% were large for gestational age and 9.7% of children were obese at birth. FUTURE PLANS: We have completed recruitment and baseline data collection in 2019, and are conducting annual follow-ups until age 4 of the participant's children. For delineating causal pathways of childhood obesity, blood aliquots are stored in the biorepository. The study will inform policy formulation and community awareness in the prevention and control of non-communicable diseases and health promotion.

Validation of Malayalam Version of National Comprehensive Cancer Network Distress Thermometer and its Feasibility in Oncology Patients.

CONTEXT: This study was designed to translate and validate the National Comprehensive Cancer Network (NCCN) distress thermometer (DT) in regional language " Malayalam" and to see the feasibility of using it in our patients. AIMS: (1) To translate and validate the NCCN DT. (2) To study the feasibility of using validated Malayalam translated DT in Malabar Cancer center. SETTINGS AND DESIGN: This is a single-arm prospective observational study. The study was conducted at author's institution between December 8, 2015, and January 20, 2016 in the Department of Cancer Palliative Medicine. MATERIALS AND METHODS: This was a prospective observational study carried out in two phases. In Phase 1, the linguistic validation of the NCCN DT was done. In Phase 2, the feasibility, face validity, and utility of the translated of NCCN DT in accordance with QQ-10 too was done. STATISTICAL ANALYSIS USED: SPSS version 16 (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc.) was used for analysis. RESULTS: Ten patients were enrolled in Phase 2. The median age was 51.5 years and 40% of patients were male. All patients had completed at least basic education up to the primary level. The primary site of cancer was heterogeneous. The NCCN DT completion rate was 100%. The face validity, utility, reliability, and feasibility were 100%, 100%, 100%, and 90%, respectively. CONCLUSION: It can be concluded that the Malayalam validated DT has high face validity, utility, and it is feasible for its use.

Concurrent infection of Bluetongue and Peste-des-petits-ruminants virus in small ruminants in Haryana State of India.

Bluetongue (BT) and peste-des-petits-ruminants (PPR) are major transboundary diseases of small ruminant, which are endemic in India. Testing of bluetongue virus (BTV) and peste-des-petits-ruminants virus (PPRV) from recent outbreaks (2015-2016) in different regions of Haryana State of India revealed that 27.5% of the samples showed the presence of dual infection of BTV and PPRV. Analysis of Seg-2 of BTV (the serotype-determining protein) showed the presence of BTV-12w in several isolates. However, analysis of N gene fragment amplicons showed that viruses belong to lineage IV were most closely related to a pathogenic strain of PPRV from Delhi. This is the first report of co-circulation of PPRV lineage IV and bluetongue virus serotype 12 in the state.

Assessment of alternative disposal methods to reduce greenhouse gas emissions from municipal solid waste in India.

Open dumping, the most commonly practiced method of solid waste disposal in Indian cities, creates serious environment and economic challenges, and also contributes significantly to greenhouse gas emissions. The present article attempts to analyse and identify economically effective ways to reduce greenhouse gas emissions from municipal solid waste. The article looks at the selection of appropriate methods for the control of methane emissions. Multivariate functional models are presented, based on theoretical considerations as well as the field measurements to forecast the greenhouse gas mitigation potential for all the methodologies under consideration. Economic feasibility is tested by calculating the unit cost of waste disposal for the respective disposal process. The purpose-built landfill system proposed by Yedla and Parikh has shown promise in controlling greenhouse gas and saving land. However, these studies show that aerobic composting offers the optimal method, both in terms of controlling greenhouse gas emissions and reducing costs, mainly by requiring less land than other methods.

Platelet-derived CXCL12 regulates monocyte function, survival, differentiation into macrophages and foam cells through differential involvement of CXCR4-CXCR7.

Platelets store and release CXCL12 (SDF-1), which governs differentiation of hematopoietic progenitors into either endothelial or macrophage-foam cells. CXCL12 ligates CXCR4 and CXCR7 and regulates monocyte/macrophage functions. This study deciphers the relative contribution of CXCR4-CXCR7 in mediating the effects of platelet-derived CXCL12 on monocyte function, survival, and differentiation. CXCL12 and macrophage migration inhibitory factor (MIF) that ligate CXCR4-CXCR7 induced a dynamic bidirectional trafficking of the receptors, causing CXCR4 internalization and CXCR7 externalization during chemotaxis, thereby influencing relative receptor availability, unlike MCP-1. In vivo we found enhanced accumulation of platelets and platelet-macrophage co-aggregates in peritoneal fluid following induction of peritonitis in mice. The relative surface expression of CXCL12, CXCR4, and CXCR7 among infiltrated monocytes was also enhanced as compared with peripheral blood. Platelet-derived CXCL12 from collagen-adherent platelets and recombinant CXCL12 induced monocyte chemotaxis specifically through CXCR4 engagement. Adhesion of monocytes to immobilized CXCL12 and CXCL12-enriched activated platelet surface under static and dynamic arterial flow conditions were mediated primarily through CXCR7 and were counter-regulated by neutralizing platelet-derived CXCL12. Monocytes and culture-derived-M1-M2 macrophages phagocytosed platelets, with the phagocytic potential of culture-derived-M1 macrophages higher than M2 involving CXCR4-CXCR7 participation. CXCR7 was the primary receptor in promoting monocyte survival as exerted by platelet-derived CXCL12 against BH3-mimetic induced apoptosis (phosphatidylserine exposure, caspase-3 activation, loss of mitochondrial transmembrane potential). In co-culture experiments with platelets, monocytes predominantly differentiated into CD163(+) macrophages, which was attenuated upon CXCL12 neutralization and CXCR4/CXCR7 blocking antibodies. Moreover, OxLDL uptake by platelets induced platelet apoptosis, like other platelet agonists TRAP and collagen-related peptide (CRP). CXCL12 facilitated phagocytosis of apoptotic platelets by monocytes and M1-M2 macrophages, also promoted their differentiation into foam cells via CXCR4 and CXCR7. Thus, platelet-derived CXCL12 could regulate monocyte-macrophage functions through differential engagement of CXCR4 and CXCR7, indicating an important role in inflammation at site of platelet accumulation.

Burden and outcomes of pressure ulcers in cancer patients receiving the kerala model of home based palliative care in India: results from a prospective observational study.

AIM: To report the prevalence and outcomes of pressure ulcers (PU) seen in a cohort of cancer patients requiring home-based palliative care. MATERIALS AND METHODS: All patients referred for home care were eligible for this prospective observational study, provided they were living within a distance of 35 km from the institute and gave informed consent. During each visit, caregivers were trained and educated for providing nursing care for the patient. Dressing material for PU care was provided to all patients free of cost and care methods were demonstrated. Factors influencing the occurrence and healing of PUs were analyzed using logistic regression. Duration for healing of PU was calculated using the Kaplan Meier method. P < 0.05 are taken as significant. RESULTS: Twenty-one of 108 (19.4%) enrolled patients had PU at the start of homecare services. None of the patients developed new PU during the course of home care. Complete healing of PU was seen in 9 (42.9%) patients. The median duration for healing of PU was found to be 56 days. Median expenditure incurred in patients with PU was Rs. 2323.40 with a median daily expenditure of Rs. 77.56. CONCLUSIONS: The present model of homecare service delivery was found to be effective in the prevention and management of PUs. The high prevalence of PU in this cohort indicates a need for greater awareness for this complication. CLINICAL TRIAL REGISTRY NUMBER: CTRI/2014/03/004477.

Infertility and pregnancy outcome in female genital tuberculosis.

OBJECTIVES: The aim of the study is to determine the prevalence rate, identify risk factors not conducive to pregnancy, and outcomes with regard to follow-up treatment. METHODS: This prospective study was carried out from 1988 to 2001, in the Department of Obstetrics and Gynecology in the S.C.B. Medical College, Cuttack, and in the private clinics of both the authors in Cuttack, India. The incidence of tuberculosis in infertility and tubal factor infertility cases were determined. The incidence of infertility in genital tuberculosis (GT) was examined and a total of 97 cases of infertility with genital tuberculosis were studied. The patients were given short course chemotherapy and prednisolone (wherever feasible). The risk factors not conducive to pregnancy were identified. RESULTS: The incidence of GT in infertility and tubal factor infertility were 3 and 41%, respectively. The incidence of infertility in GT was 58%. All patient were symptom free and no evidence of tuberculosis was detected after the end of the chemotherapy. The risk factors not conducive to pregnancy were secondary amenorrhea, no endometrium on curettage, and negative chromopertubation. The conception rate is low, i.e. 19.2%, the live birth rate being still low, i.e. 7.2%. CONCLUSION: The outcome of infertility in GT is not very optimistic. IVF and ET offers some hope to these unfortunate women.

Cataract in enucleated goat eyes: training model for phacoemulsification.

We developed an inexpensive, reproducible technique of inducing cataract in enucleated animal eyes for phacoemulsification training. Injection of 0.3 to 0.5 mL of formalin 20% in the central and paracentral portion of the crystalline lens in a goat's eye induced cataract in about 5 to 10 minutes. Varying the interval would enable novice surgeons to practice different techniques of phacoemulsification based on cataract hardness.

Comparison of topical 0.3% ofloxacin to fortified tobramycin-cefazolin in the therapy of bacterial keratitis.

BACKGROUND: In this study we compared topical ofloxacin with a combination of fortified tobramycin sulphate and cefazolin sodium solutions in the treatment of culture-proved bacterial keratitis. METHODS: 30 eyes of culture-proved bacterial corneal ulcers of moderate severity were included in a prospective randomized, controlled, double-masked study for comparison. The cases were randomly allocated to treatment with 0.3% ofloxacin solution (Group I) and combination of fortified antibiotics (1.5% tobramycin and 5% cefazolin solutions--Group II as control) along with supportive cycloplegic, vitamins and antiglaucoma therapy. Time for healing of ulcer and subjective symptoms were main outcome measures. Student's t-test was used to compare the results. RESULTS: Staphylococcus aureus and coagulase-negative staphylococci were the two most common organisms isolated. Resolution of the ulcer was achieved in 93% and 87% in the treated and the control group, respectively. The mean duration of symptomatic relief was 7.8 +/- 1.54 days in the treated group and 8.33 +/- 1.44 days in the control group; for epithelial healing it was 15.0 +/- 3.86 days in the treated group and 15.46 +/- 3.86 days in the control group. Post resolution the best corrected visual acuity of 20/200 or better was achieved in all but one eye each in both groups. CONCLUSIONS: Both ofloxacin 0.3% and combined fortified tobramycin 1.5% and cefazolin 5% topical drops were comparable for treating cases of bacterial corneal ulcer of moderate severity. However, considering the easy availability and cost effectiveness of ofloxacin, a monotherapy with ofloxacin may be preferred over the combined, fortified tobramycin and cefazolin therapy.

Management of cataract--a revolutionary change that occurred during last two decades.

In the field of ophthalmology, perhaps no other surgery has undergone such rapid changes in the past few decades, as the surgery for cataract. Over these years there has been an emergence of small incision cataract surgery, especially by phaco-emulsification. It offers a number of attractive benefits to both the surgeon and the patient. Phaco has now captured the centre stage in the surgical management of cataract. With the advent of phaco it became imperative to design incision in a valvular manner to provide water tight anterior chamber, to design phacoprofile intra-ocular lenses specifically foldable intra-ocular lenses, instruments for precision and better control, better visco-elastic material and irrigating fluids. These advancements in this field have revolutionised the management of cataract surgery and have facilitated achieving new peaks in quality of surgery and recovery of visual acuity to precataract stage and correction of pre-existing astigmatism.

Postoperative intraocular pressure changes with use of different viscoelastics.

Sixty eyes with age-related cataract underwent extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PC-IOL) implantation under similar conditions using hydroxypropyl methylcellulose (HPMC) (Oculose) (n = 20), sodium hyaluronate (Healon) (n = 20), or hyaluronic acid (IAL) (n = 20) as the viscoelastic (VE). Postoperative evaluation was performed for intraocular pressure (IOP), corneal thickness, and anterior chamber reaction at 6, 24, 48, 72 hours, and 10 days. Statistically-significant rises in IOP with IAL and Healon were observed at 6 and 24 hours; no such rises were observed with Oculose (P < .05). Seven eyes in the IAL group and six in the Healon group had IOPs greater than 22 mm Hg at 6 hours (range: 22 to 38 mm Hg and 22 to 28 mm Hg, respectively). A significant increase in average corneal thickness was observed in all of the 60 patients at 6 hours (18.5%). The average thickness decreased to 6.8% by day 10, with no intergroup variations. There were significantly fewer anterior chamber cells at 6 hours in the Healon group. We conclude that all three viscoelastics are equally useful for routine ECCE with PC-IOL implantation. However, IAL and Healon do cause an early postoperative IOP increase, which, though transient, should be treated.