Concurrent chemoradiation with low-dose and long-duration weekly infusion of gemcitabine in unresectable squamous cell carcinoma of head and neck (SCCHN).

BACKGROUND: Concurrent chemoradiotherapy now represents the standard of care in locally advanced unresectable squamous cell carcinoma of the head and neck, and the administration of cisplatin in triweekly or weekly schedules is the most commonly used chemotherapeutic agent. However, the chemotherapeutic agent and its scheduling with radiation is still an area of investigation with safer toxicity profile and better response rates. Gemcitabine is a potent radiosensitizer, and non-cytotoxic concentration results in decreased systemic toxicity while maintaining radiosensitization properties. Furthermore, data are emerging for low-dose and long-duration infusion where this strategy is found to be effective and a safe alternative to standard brief infusion. Based on these two strategies, that is, non-cytotoxic concentration with long duration, we have explored the unique possibility of further lowering the toxicity profile without compromising the efficacy. METHOD: Eligible patients of locally advanced unresectable squamous cell carcinoma of the head and neck underwent radiation treatment with concurrent gemcitabine. A total dose of 70 Gy in 35 fractions over a period of seven weeks with conventional fractionation schedule was delivered with cord off after 44 Gy. Concurrent gemcitabine was administered intravenously for over two hours once a week, 1-2 h before radiation and for seven consecutive weeks at 50 mg/m2. RESULT: Fifty-two patients was enrolled in this study, out of which 41 completed the treatment. Fifty-nine percent completed treatment within seven weeks. Sixty-four percent were found to have received more than five cycles. Mean follow-up of patients was found to be 4.9 months. Sixty-eight percent had complete response. Stage III patients achieved more complete response compared to stage IV. There was no site-wise difference in achieving complete response. Patients who have received less than five chemo cycles or completed the treatment in more than seven weeks had less complete response. Sixty-one percent had severe mucositis while 39% developed mild/moderate mucositis. Considering skin toxicity, 80% were found to have mild/moderate skin toxicity, while only 20% suffered from severe grades of skin toxicity. CONCLUSION: Gemcitabine in low-dose and long-duration infusion is a potent radiosensitizer with safer hematological toxicity and manageable local toxicities.

The Effect of Mechanical Alteration on Repair Bond Strength of S-PRG-Filler-Based Resin Composite Materials.

This study investigates the impact of mechanical alteration on resin composite surfaces and its subsequent effect on repair bond strength. A total of 100 resin composite disks were prepared and were allocated for 24 h or 1 year of artificial aging. Specimens were embedded in epoxy resin, and the composite surfaces were mechanically altered using either diamond burs or air abrasion with aluminum oxide or glass beads. A universal bonding material was applied and a 2 mm circular and 3 mm high repair composite cylinder were prepared using a Teflon mold. Then, the specimens were tested for their shear bond strength, and the de-bonded specimens were observed under a scanning electron microscope to determine the failure pattern. SPSS 26.0 statistical software was used to analyze the data. Two-way ANOVA showed a statistically significant effect of mechanical alteration and aging on the shear bond strength of S-PRG-filler-based resin composite (p < 0.05). Surface modification with a fine diamond bur showed a significantly higher bond strength in both 24-h- and 1-year-aged specimens. Surface modification with alumina significantly increased the bond strength of 1-year-aged specimens; however, it was statistically insignificant for 24 h-aged specimens. Mechanical alteration with a fine diamond bur and 50-micron alumina can improve the repair bond strength of the composite.

A fully-flexible and thermally adjustable implantable neural probe with a U-turn polyester microchannel.

This work presents a fully flexible implantable neural probe fabricated with Polydimethylsiloxane (PDMS) and including a thermally-tunable stiffness microchannel filled with Polyester. The probe includes an optimized microfluidics mixer for drug delivery. Polyester, which is solid at room temperature and has a low melting point close to body temperature, is used to decrease the stiffness of the probe after insertion, after getting in contact with tissues. We designed a U-turn microchannel inside the PDMS neural probe and filled it up with melted polyester. The microchannel has a cross-section of 30 µm × 5 µm and a length of 14.7 mm. The following probe dimensions were chosen after extensive simulation: thickness = 20 µm, width = 300 µm, and length = 7 mm. These values yield a buckling force above 1 mN, which is sufficient for proper insertion into the brain tissues. Simulation results show that the microfluidics mixer with a cross-section of 90 µm × 5 µm and a length of 7 mm has optimum performance for the desired flow rate and quantity of drug to deliver. The pressure drop inside the microfluidic channel is less than 0.43 kPa, which is appropriate for PDMS-PDMS bonding, whereas the Reynolds number is near 1.91k in the laminar regime. No leakage or bubble occurred during the experimental validation, which suggests an appropriate pressure and a laminar flow in the channel.

Investigation of a two-dimensional photovoltaic thermal system using hybrid nanofluids and a rotating cylinder.

This article focuses on a numerical investigation aimed at enhancing the electrical performance of a two-dimensional photovoltaic thermal system (PV/T) through the application of cooling using hybrid nanofluids. The hybrid nanofluids consist of titanium oxide and silver nanoparticles suspended in water, while the PV/T system is based on polycrystalline silicon, copper, and a flow channel with a rotating cylinder. PV/T devices generate electricity from sunlight, but their performance degrades over time due to the heat generated by solar radiation. Therefore, nanofluids can be circulated through the bottom flow channel to cool the device. This study utilizes 2D incompressible Navier-Stokes equations to control fluid flow and energy equations to manage energy distribution. The COMSOL 6.0 finite element software is employed for comprehensive modeling and simulation. To enhance the performance of the PV/T system, a parametric study is conducted by varying the Reynolds number (ranging from 100 to 1000), cylinder rotational speed (varying from 0.01 to 0.2 m s-1), and silver volume fraction (ranging from 0.01 to 0.2). The results show that increasing the Reynolds number and the volume fraction of silver leads to a reduction in the maximum temperature of the cell. The maximum temperature of the cell also decreases with the rotational speed of the cylinder but only for high Reynolds numbers. By applying the present model, the cell's efficiency is improved by 5.93%.

Urdbean Leaf Crinkle Virus: A Mystery Waiting to Be Solved.

Urdbean leaf crinkle disease (ULCD) affects mainly the urdbean or blackgram (Vigna mungo (L.) Hepper) causing distinct symptoms that often result in serious yield losses. It has been known to occur for more than five decades and is considered to be of viral etiology. The identity of the causal agent, often referred to as the urdbean leaf crinkle virus, is not unequivocally proved. There are few attempts to characterize the causal agent of ULCD; however, there is no unanimity in the results. Recent attempts to characterize the causal agent of ULCD using next-generation sequencing of the virome of ULCD-affected urdbean plants indicated the involvement of cowpea mild mottle virus; however, without conforming through Koch's postulates, the etiology of ULCD remains inconclusive. Claims of different insect vectors involved in the transmission of ULCD make this disease even more mysterious. The information available so far indicates that either two different viruses are causing ULCD or a mixture of viruses is involved. The identity of the virus/es causing ULCD still remains to be unambiguously ascertained. In this review, we attempt to analyze information on the various aspects of ULCD.

Needlescopic Primary Paediatric Inguinal Hernia Repair By Hernia Sac Disconnection And Peritoneal Closure.

Objectives: To evaluate the short-term outcome of the needlescopic hernia sac disconnection and peritoneal closure in the treatment of primary paediatric inguinal hernia. Method: The prospective study was conducted from April 2019 to April 2021 at the Paediatric Surgery Unit of the General Surgery Department at Kafrelsheikh University Hospital, Egypt, and comprised patients aged 6-144 months having uncomplicated paediatric inguinal hernia. The patients were subjected to needlescopic hernia sac disconnection and peritoneal closure. The follow-up protocol included outpatient visits at 1 week and at 1, 3 and 6 months postoperatively to check for recurrence and other complications. Data was analysed using SPSS 24. RESULTS: Of the 50 patients with 65 hernias, 37(74%) were males and 13(26%) were females. The overall mean age was 50.78± 31.74 months (range: 9-120 months) and mean internal ring diameter was 11.90±3.518mm (range: 8-20mm). The mean operative time was 20.66±2.94 minutesfor unilateral cases and 30.60±5.15 minutesfor bilateral cases. There was no conversion to conventional laparoscopy or to open herniotomy. All cases were followed up for a mean of 11.56± 3.99 months. No recurrence was encountered in any case and the scars were invisible in 40(80%) cases 6 months postoperatively. CONCLUSIONS: Needlescopic hernia sac disconnection and peritoneal closure wasfound to be feasible,safe and effective in the treatment of primary paediatric inguinal hernia.

Irreversibility analysis of hydromagnetic nanofluid flow past a horizontal surface via Koo-Kleinstreuer-Li (KKL) model.

The goal of this research is to investigate the effects of Ohmic heating, heat generation, and viscous dissipative flow on magneto (MHD) boundary-layer heat transmission flowing of Jeffrey nanofluid across a stretchable surface using the Koo-Kleinstreuer-Li (KKL) model. Engine oil serves as the primary fluid and is suspended with copper oxide nanomolecules. The governing equations that regulate the flowing and heat transmission fields are partial-differential equations (PDEs) that are then converted to a model of non-linear ordinary differential equations (ODEs) via similarity transformation. The resultant ODEs are numerically resolved using a Keller box technique via MATLAB software that is suggested. Diagrams and tables are used to express the effects of various normal liquids, nanomolecule sizes, magneto parameters, Prandtl, Deborah, and Eckert numbers on the velocity field and temperature field. The outcomes display that the copper oxide-engine oil nanofluid has a lower velocity, drag force, and Nusselt number than the plain liquid, although the introduction of nanoparticles raises the heat. The heat transference rate is reduced by Eckert number, size of nanomolecules, and magneto parameter rising. Whilst, Deborah number is shown to enhance both the drag-force factor and the heat transfer rate. Furthermore, the discoveries reported are advantageous to upgrading incandescent lighting bulbs, heating, and cooling equipment, filament-generating light, energy generation, multiple heating devices, and other similar devices.

Age-wise cancer incidence in western Uttar Pradesh in India: An observational study.

CONTEXT: According to the World Health Organization report of 2011, the main cause of death was cancer rather than heart diseases. 14.1 million new cases and about 8.2 million deaths occur due to cancer according to the report given by GLOBOCAN 2012. AIMS: This study was conducted to highlight the age-wise cancer incidence in western Uttar Pradesh. MATERIALS AND METHODS: This was a cross-sectional study conducted in the department of radiotherapy from 2018-2020. Data were collected from the hospital records of histopathologically confirmed cases of malignancies from 2018 to 2020. Details regarding age, sex and site of the tumor were collected from the clinical records. STATISTICAL ANALYSIS USED: Descriptive statistics were used for data calculation as well as summarization, Mean ± SD, percentage, and proportions were calculated. RESULTS: Age-wise cancer incidence in the head and neck region among both the genders shows that the highest percentage of mouth cancer of 23.19% (409) was found among males above 40 years of age as compared to females with 4.76% (84), the prevalence of breast cancer was increasing with increasing age reaching 42.79% (603) prevalence above the age of 40 years. The highest percentage of lung cancer was found above the age of 40 years 32.57% (459) in the case of males. Gallbladder carcinoma in females was 37.882% (161) and liver malignancies in males were found at 9.41% (40). In the case of the female reproductive system, highest percentage of cervical malignancies having 56.85% (485) next to the cervix it was the ovarian malignancy with a significant percentage of 19.22% (164).

[Delirium after electroconvulsive therapy] / Delirium etter elektrokonvulsiv behandling.

BACKGROUND: Transient, acute delirium after electroconvulsive therapy (ECT) occurs in approximately one in eight patients. This case report describes a man with no known risk factors who developed a rare form of delirium, which is of longer duration and occurs longer after electroconvulsive therapy. CASE PRESENTATION: A man in his forties with major depression with psychosis was admitted to the acute psychiatric ward after his sixth ECT treatment. He was disoriented, walked around restlessly, and seemed suspicious. He could not understand instructions and he ate his meals while wandering around. He constantly asked where he was. INTERPRETATION: Despite having no risk factors (advanced age, cardiovascular disease, dementia, Parkinson's disease, unilateral stimulation) for developing post-ECT delirium, our patient developed this after his sixth treatment. Post-ECT delirium should be known by anyone working with patients receiving ECT and good routines should be in place for monitoring cognitive side effects during an ECT series.

Fluorescent spectroscopic assessment before and after radiation treatment in oral cavity cancer and its clinical correlation.

BACKGROUND: Biochemical changes in irradiated malignant tissue lead to altered autofluorophores status which should be different for cancerous tissue (residual/recurrence) and irradiated normal tissue. If this irradiated tissue is examined through fluorescent spectroscopy, we can find the spectroscopic changes occurring after the completion of treatment which can be helpful in evaluating treatment response. METHODS: Punch biopsy sample was examined through fluorescent spectroscopy in oral cavity cancer patients before and after definitive radiation treatment. The change in spectroscopic pattern before and after radiation treatment was recorded and assessed. RESULTS: Final analysis was done in 36 samples. In irradiated tissue, it has been observed that there was increase in the intensity of collagen fluorescence. It was found that the Half width half maximum (HWHM) is more in case of preirradiated sample. The decrease in the HWHM in case of irradiated sample shows the decrease in the number of cells (cell density as compared to that in preirradiated sample). These spectral findings are well-explained pathophysiologically and clinically as amount of collagen are increased in irradiated tissues due to loss of cancerous cells and regeneration of collagen cross-links (fibrosis) and reproduction of normal tissue as a response to radiation treatment. CONCLUSION: After thorough study in a large number of samples, we may be able in the future to grade the alteration in fluorescence of collagen obtained after radiation treatment in terms of complete, partial, or no response.

Analysis of prophylactic antibiotic use and risk factor of postoperative infection in urological surgery patients.

OBJECTIVES: The widespread use of inappropriate prophylactic antibiotics in urological surgery patients can increase the risk of resistance and development of postoperative infection. This study was aimed to analyze the quality of prophylactic antibiotics use and identify the risk factor of postoperative nosocomial infection in urological surgery patients. METHODS: Observational prospective data were obtained from patients' medical records. Data were the pattern of prophylactic antibiotic use in surgical patients' urology in Dr. H. Slamet Martodirdjo Hospital, Pamekasan, for the period of April-June 2020. Inclusion criteria included patients hospitalized with urological surgery and received prophylactic antibiotics before surgery. Exclusion criteria consisted of medical records that were incomplete, and the patient disagreed to participate in the research. Analysis qualitative antibiotic prophylactic used the Gyssens method and risk factor used Chi square. RESULTS: Seventeen patients were not administered for antibiotic prophylactic and nine patients with skin incision were observed to determine the incidence of surgical site infection (SSI) and 55 patients with urethral incision were observed to determine the incidence of urinary tract infection (UTI) postoperative. There was no incidence of SSI and there were three incidences of UTI. The qualitative analysis of the Gyssens method showed that category-0 was of 51 (79.7%) and category-I was of 13 (20.31%). CONCLUSIONS: The quality of the use of prophylactic antibiotics with the Gyssens method shows that there is an appropriate category (category-0) and a few are in category-I (inappropriate administration time) and no incidence of surgical wound infection.

Analysis of the use of antibiotics profile and factors of surgical site infections study on digestive and oncology surgeries.

OBJECTIVES: The incision method operation with a high risk of infection in a clean and clean-contaminated operation requires the use of prophylactic antibiotics to minimize the risk of infection. This study was designed to analyze the effectiveness of prophylactic antibiotics in patients with digestive and oncology surgeries. METHODS: The statistical method used was chi-square to determine the risk factors for infection at surgical site infections (SSI) in patients with digestive and oncology surgeries. This study had received ethical approval from the Ethics Committee of Dr. H. Slamet Martodirdjo Hospital, Pamekasan. RESULTS: There were 67 patients consisted of 48 digestive surgeries (71.6%) and 19 oncology surgeries (28.4%). The criteria of observation on day 30 showed that as 1 (1.5%) SSI patient experienced purulence, inflammation, and erythema around the surgical wound so an analysis of p>0.05 was carried out so that there was no association with the incidence of SSI during hospitalization, but other factors originating from the patient, such as a lack of personal hygiene at home and lack of nutritious food intake was measured in temperature, pulse, respiration, and white blood cells examination before surgery and 24 h after surgery, all within normal ranges. The qualitative analysis of prophylactic antibiotics using the Gyssen method showed that 31 (46.3%) rationales needed an improvement process. CONCLUSIONS: The widely used prophylactic antibiotics, namely cefazolin and cefuroxime are recommended antibiotics used in incision surgery and rationale used.

A digital solution to streamline access to smoking cessation interventions in England; findings from a primary care pilot (STOPNOW study).

Objectives: Despite the proven efficacy of several smoking cessation medications that have been shown to improve long-term abstinence rates, approximately two-thirds of smokers report not having used medication in their most recent quit attempt. A main barrier could be delayed access to pharmacological interventions. This study investigated the utility of a primary care linked online portal to streamline timely access to pharmacological support to patients who want to quit smoking by making an asynchronous request for treatment to their general practitioner. Study design: Prospective cohort study. Methods: An online portal with added functionality was developed, which allowed patients with a unique link to make an asynchronous request for treatment. Two GP practices identified a total of 4337 eligible patients who received an SMS or email invite to engage with an online portal including an electronic survey to capture information about smoking behaviours and to request treatment. Portal informatics and patient level data were analysed to measure the efficacy of the online system in reducing the time between making a formal request to treatment and access to pharmacological support. The primary outcome measure was the time between making a formal request for treatment and access to pharmacological support from a designated community pharmacy. Results: 323 patients (7.4%) initiated the survey, but only 56 patients completed the survey and made a formal request for treatment. 94% of participants did not return to use the portal to make a second or follow-up request for treatment. Only 3 participants completed the 12-week pathway. A total of 75 medication items were prescribed and collected by 56 patients. The time difference between the formal request to treatment and GP review ranged between 20 h and 1 week. The time difference between approval of prescription by the GP and access to medication was 5 days ± 2.1 days (range = 1.9-7.0 days). Conclusion: The widespread adoption and diffusion of an IT enabled and asynchronous primary care led remote consultation pathway can streamline timely access to smoking cessation support without the need for the patient to see a GP or an independent prescriber in the first instance.

Delirium Incidence and Risk Factors in Adult Critically Ill Patients in Saudi Arabia.

BACKGROUND: Delirium in intensive care units (ICUs) is associated with long ICU stay, long hospital stay and increased costs of treatment. Unfortunately, delirium in ICU is significantly underestimated and overlooked by healthcare providers. AIMS: The aim of this tudy is to determine the incidence and associated risk factors of delirium among critically ill patients in Saudi Arabia. METHODS: This is a prospective study. Patients were assessed for delirium using the confusion assessment method for the ICU. Delirium was the independent variable in this study. RESULTS: Fifty-nine patients (17.3%) showed positive delirium at least once compared to 283 patients (82.7%) who did not show positive delirium. Certain factors for delirium found to be significantly correlated with delirium (P < 0.005); including receiving sedation, mode of sedation, receiving mechanical ventilation, resistance to mechanical ventilator, and baseline Glasgow Coma Scale. CONCLUSION: Delirium occurred in >17% of our ICU patients. More efforts should be directed to consider ICU delirium and to minimize its triggering factors.

Interdigitated versus sequential high-dose-rate intracavitary brachytherapy with external beam radiotherapy in locally advanced carcinoma cervix.

AIMS: To decrease overall treatment time (OTT) and to compare the clinical outcome of interdigitated high-dose-rate intracavitary brachytherapy (HDRICBT) versus sequential HDRICBT with external beam radiotherapy (EBRT) in the treatment of locally advanced carcinoma cervix. METHODS: Eighty-two patients with histologically confirmed carcinoma of the cervix, untreated International Federation of Gynecology and Obstetrics Stage IIB-IIIB, were included and randomized into two groups. The study group received EBRT 50 Gy/25 fractions with interdigitated HDRICBT 8 Gy/fraction weekly a total of three fractions. Patients in the control group received EBRT 50 Gy/25 fractions with sequential HDRICBT 8 Gy/fraction weekly a total of three fractions. At the end of the study, results of both groups compared in terms of OTT, acute and late toxicities, and response to therapy clinically. RESULTS: A total of 82 patients were enrolled 41 in each arm. Seventy-two patients completed treatment and were analyzed. Mean OTT in study group and control group was 40 and 60 days, respectively. The median follow-up duration was 10 months (3-18). Most of the acute and late toxicities were of Grade 1 and 2 type and comparable in both study and control groups. Treatment interruption due to treatment-related toxicity was slightly higher in the study group than the control group, but it was statistically insignificant. Os negotiability was not found to be a limiting factor for interdigitated HDRICBT. CONCLUSION: Interdigitated HDRICBT has equivalent response and toxicities as sequential HDRICBT with the advantage of significant reduction in OTT.

Solitary fibular metastasis from nonsmall cell lung carcinoma.

Solitary bone metastasis to fibula in patients of lung carcinoma is a rare entity, with only four cases reported in literature. We, hereby, present a case of a 50 year-old-male who was given three cycles of chemotherapy for lung carcinoma with no distant metastasis but presented 2 months later with a fusiform, painful swelling around the knee that was clinically suspected to be inflammatory in nature but proved to be fibular metastasis on cytology. There was no evidence of skeletal metastasis on initial bone scan. He was given palliative radiotherapy for this with symptomatic relief.

In vitro antimalarial and xanthine oxidase inhibition of 2-Aminoanthraquinone.

In the present research study 2-Aminoanthraquinone were scrutinized for their antimalarial and Xanthine oxidase inhibitor potential. It demonstrated marked concentration dependent antimalarial activity with maximum effect of 89.06% and with IC50 of 34.17 µM. Regarding Xanthine oxidase inhibitor activity, it evoked significant effect with 57.45% activity with IC50 value of 81.57.19 µM. In conclusion, 2-Aminoanthraquinone showed potent antimalarial and xanthine oxidase inhibitory activity.

PREVALENCE OF UNCORRECTED REFRACTIVE ERRORS IN ADULTS AGED 30 YEARS AND ABOVE IN A RURAL POPULATION IN PAKISTAN.

BACKGROUND: Uncorrected refractive errors are a leading cause of visual disability globally. This population-based study was done to estimate the prevalence of uncorrected refractive errors in adults aged 30 years and above of village Pawakah, Khyber Pakhtunkhwa (KPK), Pakistan. METHODS: It was a cross-sectional survey in which 1000 individuals were included randomly. All the individuals were screened for uncorrected refractive errors and those whose visual acuity (VA) was found to be less than 6/6 were refracted. In whom refraction was found to be unsatisfactory (i.e., a best corrected visual acuity of <6/6) further examination was done to establish the cause for the subnormal vision. RESULTS: A total of 917 subjects participated in the survey (response rate 92%). The prevalence of uncorrected refractive errors was found to be 23.97% among males and 20% among females. The prevalence of visually disabling refractive errors was 6.89% in males and 5.71% in females. The prevalence was seen to increase with age, with maximum prevalence in 51-60 years age group. Hypermetropia (10.14%) was found to be the commonest refractive error followed by Myopia (6.00%) and Astigmatism (5.6%). The prevalence of Presbyopia was 57.5% (60.45% in males and 55.23% in females). Poor affordability was the commonest barrier to the use of spectacles, followed by unawareness. Cataract was the commonest reason for impaired vision after refractive correction. The prevalence of blindness was 1.96% (1.53% in males and 2.28% in females) in this community with cataract as the commonest cause. CONCLUSIONS: Despite being the most easily avoidable cause of subnormal vision uncorrected refractive errors still account for a major proportion of the burden of decreased vision in this area. Effective measures for the screening and affordable correction of uncorrected refractive errors need to be incorpora'ted into the health care delivery system.

Papular skin lesions: Clue to a recurrence of breast cancer on fine needle non-aspiration cytology (FNNAC).

Cutaneous metastasis from underlying carcinoma is relatively uncommon in clinical practice. A high index of suspicion is required to diagnose these lesions, as these lesions can mimic benign skin lesions and clinical findings may be subtle. Fine needle aspiration cytology (FNAC) is commonly employed for diagnosing these skin lesions. However, it is often difficult to aspirate adequate material from small papular lesions. In these clinical situations, fine needle non-aspiration cytology (FNNAC) is proposed as an alternative procedure. FNNAC eliminates the negative suction pressure employed in FNAC and decreases the dilution of tumor cells by blood and hence yields adequate diagnostic material. We report here a case in which FNNAC was used in place of FNAC in diagnosing papular skin lesions. This procedure was carried out in a treated patient of carcinoma breast who was on regular follow-up and presented to us with a 20-day history of papular skin lesions over the chest and back. This article enlightens the clinicians about the utility of FNNAC, which is a relatively uncommon procedure.