Fungicide Sensitivity of Sclerotinia sclerotiorum from U.S. Soybean and Dry Bean, Compared to Different Regions and Climates.

Fungicide use is integral to reduce yield loss from Sclerotinia sclerotiorum on dry bean and soybean. Increasing fungicide use against this fungus may lead to resistance to the most common fungicides. Resistance has been reported in Brazil (Glycine max) and China (Brassica napus subsp. napus), however, few studies have investigated fungicide sensitivity of S. sclerotiorum in the United States. This work was conducted to determine if there was a difference in fungicide sensitivity of S. sclerotiorum isolates in the United States from: (i) dry bean versus soybean and (ii) fields with different frequencies of fungicide application. We further hypothesized that isolates with fungicide applications of a single active ingredient from tropical Brazil and subtropical Mexico were less sensitive than temperate U.S. isolates due to different management practices and climates. The EC50(D) fungicide sensitivity of 512 S. sclerotiorum isolates from the United States (443), Brazil (36), and Mexico (33) was determined using a discriminatory concentration (DC) previously identified for tetraconazole (2.0 ppm; EC50(D) range of 0.197 to 2.27 ppm), boscalid (0.2; 0.042 to 0.222), picoxystrobin (0.01; 0.006 to 0.027), and thiophanate-methyl, which had a qualitative DC of 10 ppm. Among the 10 least sensitive isolates to boscalid and picoxystrobin, 2 presented mutations known to confer resistance in the SdhB (qualitative) and SdhC (quantitative) genes; however, no strong resistance was found. This study established novel DCs that can be used for further resistance monitoring and baseline sensitivity of S. sclerotiorum to tetraconazole worldwide plus baseline sensitivity to boscalid in the United States.

Structural and optical properties of a new Milarite type Na3 Mg4 LiSi12 O30 :Eu3+ phosphor.

A new red-emitting Eu3+ (1-17 mol%)-doped Na3 Mg4 LiSi12 O30 (NMLS) phosphor was prepared using a conventional solid-state reaction method at low temperature. The prepared samples belong to a hexagonal structure with a good match to JCPDS card no. 73-0934. The photoluminescence (PL) emission spectrum showed an intense peak at 612 nm when excited at 393 nm. The variation of electric dipole transition (5 D0 -7 F2 ) emission intensity with increasing Eu3+ ion concentration was investigated. The concentration quenching at 11 mol% is due to the dipole-dipole interaction mechanism in the NMLS host. The optimized NMLS:Eu3+ phosphor shows 2.18 times higher luminescence intensity than the (Y,Gd)BO3 (YGB) commercial phosphor. The NMLS:Eu3+ showed an intense red emission, having Commission Internationale de l'éclairage (CIE) coordinates (0.6280, 0.3691) and colour purity of 99.2%. The resulting phosphor exhibits good thermal stability of 80% at 423 K. The magnified images of fingerprint showed various minute features such as bridges, sweat pores, ridge end, bifurcation, island and core with better visualization under 393 nm excitation. Furthermore, the optimized NMLS:Eu3+ was used for pc-LED, latent fingerprints, and anticounterfeit applications as a promising red phosphor.

Immunotherapy With Bacillus Calmette-Guerin (BCG) in a 16-Year-Old With Urothelial Bladder Carcinoma.

Urothelial bladder cancer (UBC) is an exceptionally rare condition in adolescents between 15 and 19 years of age. Typically, adolescents and pediatric patients with UBC are more likely to have a favorable histological report. The aim of the paper is to report our experience in the management of a 16-year-old patient with UBC with no risk factors that came to the office because of a history of painless gross hematuria.

Autoimmune Haemolytic Anaemia following ChAd Ox 1 nCoV-19 in Haemodialysis.

Autoimmune haemolytic anaemia (AIHA) is caused by autoantibodies that react with self-red blood cells (RBCs) and cause them to be destroyed with or without complement mediated mechanism. Its clinical presentation is heterogeneous, ranging from asymptomatic to severe forms with fatal outcomes, also it can be either idiopathic or secondary to a coexisting disorder. We report an elderly gentleman on haemodialysis, who presented with severe haemolytic anaemia after one month of first dose of ChAd Ox 1 nCoV-19 vaccine (viral vector vaccine) for SARS- CoV - 2, who also had asymptomatic COVID 19 infection around 6 months prior to vaccination. This is the first reported case of AIHA following COVISHIELD vaccine and till now there are no other reported cases from India.

Participatory Workshop-Based Intervention for Better Preparedness and Awareness About Disaster Management Among Accredited Social Health Activists in India: A Brief Report.

OBJECTIVES: The aim of this study was to evaluate the effectiveness of training programs in improving the knowledge about disaster management among Accredited Social Health Activists (ASHAs) in Mysuru, India. METHODS: A quasi-experimental study was conducted among 40 ASHAs of 3 Primary Health Centers in Mysuru district. A 3-h disaster management training and workshop followed by a mock-drill was organized in each center. Knowledge about disaster preparedness and management was assessed before and 1 mo after the intervention using a questionnaire by interview method. The data obtained were entered into an MS Excel spreadsheet and analyzed using licensed SPSS 22 software. RESULTS: The mean score obtained by the ASHAs in pretraining assessment was 37.2 ± 10.4. Improvement was evident in the knowledge and preparedness of ASHAs 1 mo after the training, which showed a mean score of 90.14 ± 5.05. This change in score was statistically significant with a P-value < 0.001 on performing a paired t-test. CONCLUSION: Training programs with mock drills and hands-on activities are effective in improving the knowledge of frontline health workers about disaster management. We recommend such training to be organized in all public health facilities.

An android smartphone-based randomized intervention improves the quality of life in patients with type 2 diabetes in Mysore, Karnataka, India.

BACKGROUND AND AIMS: Associated with severe complications and morbidity, Diabetes Mellitus is a significant public health burden. The need for regular monitoring and adherence to treatment and lifestyle changes have a high impact on the quality of life of the patients. This study attempts to assess the effect of smartphone-based lifestyle modification intervention in the quality of life of patients with type 2 Diabetes through a randomized filed trial. METHODS: A randomized field trial was performed among the patients attending the outpatient department of a tertiary care hospital in Mysuru city. A mobile application named DIAGURU, mainly focusing on the lifestyle modification and medication management was used for a period of 6 months from April 2019 to September 2019 by 150 patients in the intervention group while another 150 participants served as controls. The quality of life was assessed using the WHO QOL BREF questionnaire at the beginning of the study and after six months. RESULTS: The change in the quality of life in a positive direction was significantly higher in the intervention group compared to the non-intervention group after six months. The differences in the change in scores of quality of life of participants recruited in intervention and non-intervention groups were statistically significant in all the four domains after the intervention with a p value < 0.001. CONCLUSION: The evidence generated in this study suggest that such technological approaches can be used as a public health measure to improve the quality of life of patients with type 2 Diabetes Mellitus.

Coagulopathy in the nephrotic syndrome.

Coagulopathy in the nephrotic syndrome (NS) is very rare. Simultaneous prolongation of both prothrombin time and activated partial thromboplastin time suggests common coagulation pathway abnormality such as liver dysfunction, Vitamin K deficiency, disseminated intravascular coagulation, or primary fibrinolysis. This results in difficulty in proceeding with renal biopsy and tissue diagnosis. We report one such case of NS with coagulopathy and refractoriness to correction with blood products, which led us to make a diagnosis of AL amyloidosis, which was confirmed with abdominal fat pad biopsy and other work-up.

The impact of preradiosurgery embolization on intracranial arteriovenous malformations: a matched cohort analysis based on de novo lesion volume.

OBJECTIVE: The benefits and risks of pre-stereotactic radiosurgery (SRS) embolization have been reported in different studies. The goal of this study was to compare the long-term outcome of arteriovenous malformations (AVMs) treated with and without pre-SRS embolization. METHODS: A database including 1159 patients with AVMs who underwent SRS was reviewed. The embolized group was selected by including AVMs with pre-SRS embolization, maximal diameter > 30 mm, and estimated volume > 8 ml. The nonembolized group was defined as AVMs treated by SRS alone with matched de novo nidus volume. Outcomes including incidences of favorable clinical outcome (obliteration without hemorrhage, cyst formation, worsening, or new seizures), obliteration, adverse effects, and angioarchitectural complexity were evaluated. RESULTS: The study cohort comprised 17 patients in the embolized group (median AVM volume 17.0 ml) and 35 patients in the nonembolized group (median AVM volume 13.1 ml). The rates of obliteration (embolized cohort: 33%, 44%, and 56%; nonembolized cohort: 32%, 47%, and 47% at 4, 6, and 10 years, respectively) and favorable outcome were comparable between the 2 groups. However, the embolized group had a significantly higher incidence of repeat SRS (41% vs 23%, p = 0.012) and total procedures (median number of procedures 4 vs 1, p < 0.001), even with a significantly higher margin dose delivered at the first SRS (23 Gy vs 17 Gy, p < 0.001). The median angioarchitectural complexity score was reduced from 7 to 5 after embolization. Collateral flow and neovascularization were more frequently observed in the embolized nonobliterated AVMs. CONCLUSIONS: Both embolization plus SRS and SRS alone were effective therapies for moderately large (8-39 ml) AVMs. Even with a significantly higher prescription dose at the time of initial SRS, the embolized group still required more procedures to reach final obliteration. The presence of collateral flow and neovascularization could be risk factors for a failure to obliterate following treatment.

Comparison of 36 Gy, 20 Gy, or No Radiation Therapy After 6 Cycles of EBVP Chemotherapy and Complete Remission in Early-Stage Hodgkin Lymphoma Without Risk Factors: Results of the EORT-GELA H9-F Intergroup Randomized Trial.

PURPOSE: While patients with early-stage Hodgkin lymphoma (HL) have an excellent outcome with combined treatment, the radiation therapy (RT) dose and treatment with chemotherapy alone remain questionable. This noninferiority trial evaluates the feasibility of reducing the dose or omitting RT after chemotherapy. METHODS AND MATERIALS: Patients with untreated supradiaphragmatic HL without risk factors (age ≥ 50 years, 4 to 5 nodal areas involved, mediastinum-thoracic ratio ≥ 0.35, and erythrocyte sedimentation rate ≥ 50 mm in first hour without B symptoms or erythrocyte sedimentation rate ≥ 30 mm in first hour with B symptoms) were eligible for the trial. Patients in complete remission after chemotherapy were randomized to no RT, low-dose RT (20 Gy in 10 fractions), or standard-dose involved-field RT (36 Gy in 18 fractions). The limit of noninferiority was 10% for the difference between 5-year relapse-free survival (RFS) estimates. From September 1998 to May 2004, 783 patients received 6 cycles of epirubicin, bleomycin, vinblastine, and prednisone; 592 achieved complete remission or unconfirmed complete remission, of whom 578 were randomized to receive 36 Gy (n=239), 20 Gy of involved-field RT (n=209), or no RT (n=130). RESULTS: Randomization to the no-RT arm was prematurely stopped (≥20% rate of inacceptable events: toxicity, treatment modification, early relapse, or death). Results in the 20-Gy arm (5-year RFS, 84.2%) were not inferior to those in the 36-Gy arm (5-year RFS, 88.6%) (difference, 4.4%; 90% confidence interval [CI] -1.2% to 9.9%). A difference of 16.5% (90% CI 8.0%-25.0%) in 5-year RFS estimates was observed between the no-RT arm (69.8%) and the 36-Gy arm (86.3%); the hazard ratio was 2.55 (95% CI 1.44-4.53; P<.001). The 5-year overall survival estimates ranged from 97% to 99%. CONCLUSIONS: In adult patients with early-stage HL without risk factors in complete remission after epirubicin, bleomycin, vinblastine, and prednisone chemotherapy, the RT dose may be limited to 20 Gy without compromising disease control. Omitting RT in these patients may jeopardize the treatment outcome.

Enhancement of multiple cranial and spinal nerves in vanishing white matter: expanding the differential diagnosis.

Abnormal cranial or spinal nerve contrast enhancement on MRI in cases of suspected pediatric leukodystrophy is recognized as an important clue to the diagnosis of either metachromatic leukodystrophy or globoid cell leukodystrophy (Krabbe disease). We report a case of genetically confirmed childhood vanishing white matter with enhancement of multiple cranial and spinal nerves in addition to the more typical intracranial findings. This case expands the limited differential diagnosis of cranial nerve or spinal nerve enhancement in cases of suspected leukodystrophy and may aid in more efficient work-up and earlier diagnosis of vanishing white matter.

Inhalation Dose and Source Term Studies in a Tribal Area of Wayanad, Kerala, India.

Among radiation exposure pathways to human beings, inhalation dose is the most prominent one. Radon, thoron, and their progeny contribute more than 50 per cent to the annual effective dose due to natural radioactivity. South west coast of India is classified as a High Natural Background Radioactivity Area and large scale data on natural radioactivity and dosimetry are available from these coastal regions including the Neendakara-Chavara belt in the south of Kerala. However, similar studies and reports from the northern part of Kerala are scarce. The present study involves the data collection and analysis of radon, thoron, and progeny concentration in the Wayanad district of Kerala. The radon concentration was found to be within a range of 12-378 Bq/m3. The thoron concentration varied from 15 to 621 Bq/m3. Progeny concentration of radon and thoron and the diurnal variation of radon were also studied. In order to assess source term, wall and floor exhalation studies have been done for the houses showing elevated concentration of radon and thoron. The average values of radon, thoron, and their progeny are found to be above the Indian average as well as the average values reported from the High Natural Background Radioactivity Areas of Kerala. Exhalation studies of the soil samples collected from the vicinity of the houses show that radon mass exhalation rate varied from below detectable limit (BDL) to a maximum of 80 mBq/kg/h. The thoron surface exhalation rate ranged from BDL to 17470 Bq/m2/h.

ABVD or BEACOPPbaseline along with involved-field radiotherapy in early-stage Hodgkin Lymphoma with risk factors: Results of the European Organisation for Research and Treatment of Cancer (EORTC)-Groupe d'Étude des Lymphomes de l'Adulte (GELA) H9-U intergroup randomised trial.

PURPOSE: For early-stage Hodgkin lymphoma (HL), optimal chemotherapy regimen and the number of cycles to be delivered remain to settle down. The H9-U trial compared three modalities of chemotherapy followed by involved-field radiotherapy (IFRT) in patients with stage I-II HL and risk factors (NCT00005584). PATIENTS AND METHODS: Patients aged 15-70 years with untreated supradiaphragmatic HL with at least one risk factor (age ≥ 50, involvement of 4-5 nodal areas, mediastinum/thoracic ratio ≥ 0.35, erythrocyte sedimentation rate (ESR) ≥ 50 without B-symptoms or ESR ≥ 30 and B-symptoms) were eligible for the randomised, open label, multicentre, non-inferiority H9-U trial. The limit of non-inferiority was set at 10% for the difference between 5-year event-free survival (EFS) estimates. From October 1998 to September 2002, 808 patients were randomised to receive either the control arm 6-ABVD-IFRT (n = 276), or one of the two experimental arms: 4-ABVD-IFRT (n = 277) or 4-BEACOPPbaseline-IFRT (n = 255). RESULTS: Results in the 4-ABVD-IFRT (5-year EFS, 85.9%) and the 4-BEACOPPbaseline-IFRT (5-year EFS, 88.8%) were not inferior to 6-ABVD-IFRT (5-year EFS, 89.9%): difference of 4.0% (90%CI, -0.7%-8.8%) and of 1.1% (90%CI,-3.5%-5.6%) respectively. The 5-year overall survival estimates were 94%, 93%, and 93%, respectively. Patients treated with combined modality treatment chemotherapeutic regimen comprising doxorubicin (Adriamycin), bleomycin, vincristine (Oncovin), cyclophosphamide, procarbazine, etoposide and prednisone (BEACOPP)baseline more often developed serious adverse events requiring supportive measures and hospitalisation compared with patients receiving the chemotherapeutic regimen comprising doxorubicin (Adriamycin), bleomycin, vinblastine and dacarbazine (ABVD). CONCLUSIONS: The trial demonstrates that 4-ABVD followed by IFRT yields high disease control in patients with early-stage HL and risk factors responding to chemotherapy. Although non-inferior in terms of efficacy, four cycles of BEACOPPbaseline were more toxic than four or six cycles of ABVD.

Primary osteogenic osteosarcoma of the ethmoid sinus in an adolescent: case report.

Osteosarcomas of the craniofacial bones account for fewer than 10% of all osteosarcomas. Primary osteosarcomas of the nasal cavity and paranasal sinus are rare (0.5-8.1% of the osteosarcomas occur in this location). Because of the rarity of this presentation, we report a case of osteogenic osteosarcoma arising de novo from the ethmoid bone in a 13 year old male who presented with discharge from the right eye and headaches. We describe the imaging features of this rare tumor and provide a brief review of the literature.

Sialadenitis following low dose I-131 diagnostic thyroid scan with Thyrogen® (recombinant human thyroid stimulating hormone--thyrotropin alfa).

Salivary dysfunction and sialadenitis are well known complications of radioiodine treatment for thyroid cancer. The parotid gland is more frequently affected and the salivary gland injury is dose related. The symptoms may develop shortly after therapeutic Iodine 131(I-131) administration or months later and progress with time. The development of unilateral parotiditis following a low dose, diagnostic I-131 scan performed following Thyrogen stimulation in a patient without prior history of sialadenitis is rare in our experience, and has not been reported in the medical literature.

Isolated contralateral sudden sensorineural hearing loss: an unusual manifestation of pontine infarct.

Unilateral, acute onset sensorineural hearing loss ("sudden sensorineural hearing loss" [SSNHL]) as an isolated event without other associated neurological deficits usually results from a lesion of the cochlea. Lesions in the ascending central auditory pathways cranial to the cochlear nucleus seldom result in unilateral hearing loss due to decussation of the central auditory pathways at multiple levels. We describe a patient with a tiny acute infarct in the right pons resulting in isolated acute onset left-sided SSHNL, without any other associated acute neurological deficits.

Spontaneous regression and recurrence of a tumefactive perivascular space.

Perivascular spaces can occasionally appear mass-like (tumefactive or giant perivascular space), and can be associated with clinical symptoms. Spontaneous regression of a tumefactive perivascular space is a very rare phenomenon with only two reported cases in the English medical literature. Spontaneous regression of a tumefactive perivascular space along with resolution of clinical symptoms, followed by spontaneous recurrence associated with symptom recurrence is an extremely rare occurrence, which to the best of our knowledge, has not been reported in the medical literature. We describe a case of spontaneous regression of a tumefactive perivascular space, three years after its initial detection, followed by spontaneous recurrence after two years.

Nitrofurantoin related pulmonary disease: a clinical reminder.

A 57-year-old woman presented to the admissions unit with a 2-month history of malaise, chest tightness and non-productive cough. An outpatient chest radiograph arranged by her general practitioner was reported as showing 'changes in keeping with a severe chest infection' and she had been started on oral antibiotics but her clinical condition subsequently deteriorated. On admission she was febrile (39.2°C) and her oxygen saturation was 99% on 60% oxygen via facemask (rapidly desaturating when supplementary oxygen was removed). Auscultation revealed fine mid-late inspiratory crackles over both lung bases. It transpired that 4 months prior to the onset of symptoms she had been started on nitrofurantoin for prophylaxis against urinary tract infections. The nitrofurantoin was stopped and she was started on prednisolone. Her fever and oxygen saturation gradually improved and she was discharged home after 11 days in the hospital. Her improvement was sustained on outpatient review 8 months later.

Parenthood in survivors of Hodgkin lymphoma: an EORTC-GELA general population case-control study.

PURPOSE: We investigated the impact of Hodgkin lymphoma (HL) on parenthood, including factors influencing parenthood probability, by comparing long-term HL survivors with matched general population controls. PATIENTS AND METHODS: A Life Situation Questionnaire was sent to 3,604 survivors treated from 1964 to 2004 in successive clinical trials. Responders were matched with controls (1:3 or 4) for sex, country, education, and year of birth (10-year groups). Controls were given an artificial date of start of treatment equal to that of their matched case. The main end point was presence of biologic children after treatment, which was evaluated by using conditional logistic regression analysis. Logistic regression analysis was used to analyze factors influencing spontaneous post-treatment parenthood. RESULTS: In all, 1,654 French and Dutch survivors were matched with 6,414 controls. Median follow-up was 14 years (range, 5 to 44 years). After treatment, the odds ratio (OR) for having children was 0.77 (95% CI, 0.68 to 0.87; P < .001) for survivors compared with controls. Of 898 survivors who were childless before treatment, 46.7% achieved post-treatment parenthood compared with 49.3% of 3,196 childless controls (OR, 0.87; P = .08). Among 756 survivors with children before treatment, 12.4% became parents after HL treatment compared with 22.2% of 3,218 controls with children before treatment (OR, 0.49; P < .001). Treatment with alkylating agents, second-line therapy, and age older than 35 years at treatment appeared to reduce the chances of spontaneous post-treatment parenthood. CONCLUSION: Survivors of HL had slightly but significantly fewer children after treatment than matched general population controls. The difference concerned only survivors who had children before treatment and appears to have more personal than biologic reasons. The chance of successful post-treatment parenthood was 76%.