Discrepancies in Gleason score between needle core biopsy and radical prostatectomy specimens with correlation between clinical and pathological staging.

BACKGROUND: The studies have shown that GS given after assessment of the entire prostate gland on the radical prostatectomy specimen may differ from GS given after examination of a small sample from needle core biopsy. We conducted this study to assess discrepancies in the Gleason score between NCB and RP specimens and to find out the correlation between the clinical stage and pathological stage. METHODS: The study included 174 patients with carcinoma prostate which underwent robotic-assisted radical prostatectomy (RARP). Pre-operative Gleason score was determined on 12-core biopsy samples under trans-rectal ultrasound (TRUS) guidance. The Gleason score obtained from the radical prostatectomy specimen was compared with that of the NCB Gleason score to find out differences. RESULTS: The preoperative Gleason score (GS) ranges from 6 to 9 with a mean GS of 6.97 ± 1.02. The post-operative GS ranges between 6 and 10 with mean and GS of 7.5 ± 1.10. On the pre-operative assessment of biopsy specimens, 70 (43.2%) patients had a GS of 6, while 44 patients had a GS of 7 (27.1%) and 48 (29.8%) patients had a GS of more than 7. On the postoperative assessment of specimens, 31 (19.1%) patients had post-operative GS of 6, while 66 (41%) patients had GS of 7 and 74 (41.1%) patients had GS of more than 7. When pre-operative GS and post-operative GS were compared, no changes were observed in the GS of 79 patients, whereas 83 patients showed the difference in GS, with 75 patients showing up-gradation and eight patients marked as down-graded. CONCLUSION: concordance between biopsy and the pathology results directly affects the prognosis of the patient. The results of our study demonstrated the rate of discordance between Gleason scores obtained from transrectal prostate biopsy and RP surgical specimens. This rate brings into question the accuracy of the chosen treatment.

An audit of patient radiation doses during interventional cardiology procedures in Uttarakhand, India, and establishment of local diagnostic reference levels.

The objective of this study was to investigate patient radiation doses by a dose audit of three common interventional cardiology (IC) procedures: coronary angiography (CA), percutaneous transluminal coronary angioplasty (PTCA) and CA-PTCA procedures performed in IC centres in the Uttarakhand state of India, for the establishment of local diagnostic reference levels (DRLs) and the estimation of average effective dose (Eav) for these procedures. For each procedure, the values of kerma-area product (PKA), reference air kerma (Ka,r), fluoroscopy time (FT) and the number of cine images were recorded from 1233 CA, 458 PTCA and 736 CA-PTCA procedures performed over a 12-month period at 13 IC centres of the state. From the recorded dose data, 0.6%, 1.53% and 7.9% patients were identified to have exceeded the PKA trigger level of 500 Gy cm2 for possible skin injury for CA, PTCA and CA-PTCA procedures, respectively. The 3rd quartile of the distribution of the recorded PKA values for each type of procedure was calculated to estimate local DRL values. The estimated values of DRLs and Eav were 37, 153 and 224 Gy cm2, and 6.72, 23.97 and 34.79 mSv for CA, PTCA and CA-PTCA procedures, respectively. For about 77% of the surveyed centres, the recorded patient doses were in agreement with the international standards. The local DRLs proposed in this study may be used to achieve patient dose optimization during IC procedures and the obtained patient dose data may also be archived into national dose database for the establishment of national DRLs.

Trends in comorbid chronic kidney disease and atrial fibrillation-related cardiovascular mortality in the United States.

Background: The impact of chronic kidney disease (CKD) on atrial fibrillation outcomes (AF) is not well understood. Methods: We conducted analyses of comorbid AF and CKD related death in the United States from 1999 to 2020 using descriptive epidemiology. Results: Age-adjusted mortality rates (AAMR) per 100,000 increased from 0.39 in 1999 to 1.65 in 2020. Non-Hispanic populations (1.01) and nonmetropolitan areas (1.08) had higher AAMRs compared to Hispanic (0.62) and metropolitan (0.97) areas. Midwestern (1.11) and Western (1.13) US regions recorded the highest AAMRs. Conclusions: These findings highlight the need for interventions to address AF death disparities in patients with CKD.

Outcome of early detection approach in control of breast, cervical, and oral cancer: Experience from a rural cancer center in India.

In low- and middle-income countries most of the cancer patients attend the hospital at a late stage and treatment completion of these cases is challenging. The early detection program (EDP), in rural areas of Punjab state, India was initiated to identify breast, cervical, and oral cancer at an early stage by raising awareness and providing easy access to diagnosis and treatment. A total of 361 health education programs and 99 early detection clinics were organized. The symptomatic and self-interested (non-symptomatic individuals who opted for screening) cases visited the detection clinic. They were screened for breast, cervical, and/or oral cancer. Further diagnosis and treatment of screen-positive cases were carried out at Homi Bhabha Cancer Hospital (HBCH), Sangrur. Community leaders and healthcare workers were involved in all the activities. The EDP, Sangrur removed barriers between cancer diagnosis and treatment with the help of project staff. From 2019 to 2023, a total of 221,317 populations were covered. Symptomatic and self-interested individuals attended the breast (1627), cervical (1601), and oral (1111) examinations. 46 breast (in situ-4.3%; localized-52.2%), 9 cervical (localized-77.8%), and 12 oral (localized-66.7%) cancer cases were detected, and treatment completion was 82.6%, 77.8%, and 50.0%, respectively. We compared cancer staging and treatment completion of cases detected through EDP with the cases attended HBCH from Sangrur district in 2018; the difference between two groups is statistically significant. Due to the early detection approach, there is disease down-staging and improvement in treatment completion. This approach is feasible and can be implemented to control these cancers in low- and middle-income countries.

Pharmacoeconomics of medicines used for geriatric individuals in a tertiary care hospital in Delhi.

BACKGROUND OBJECTIVES: Expenditure on healthcare is a major concern in the geriatric age group. The current study was carried out to assess the expenditure patterns on medicines utilized in geriatric inpatients. METHODS: An observational study was conducted on 1000 geriatric inpatients, aged ≥60 yr, admitted to the medicine unit. Data were collected regarding demographic characteristics, prescribed medicines, expenditure incurred on medicines, appropriateness of medicines prescribed and adverse drug reactions (ADRs). Appropriateness of the prescribed medicines was determined using the American Geriatrics Society 2015 Updated Beers Criteria. RESULTS: Geriatric inpatients comprised 41.3 per cent of the total individuals admitted in the ward during the study period. A total of 8366 medicines were prescribed in 127 formulations. The total expenditure on prescribed medicines was INR 1,087,175 with a per capita expenditure of INR 1087.17. Parenteral medicines accounted for 91 per cent of the expenditure on medicines. Maximum expenditure (70%) was incurred on 11.9 per cent of the medicines prescribed. The per capita expenditure was significantly higher in individuals with comorbidities (P=0.03) and those who had a longer duration of hospital stay (P<0.0001). About 28.1 per cent prescriptions were inappropriate. ADRs (140) were observed in 139 (13.9%) inpatients. Individuals with inappropriate medicines prescriptions and ADRs had a longer duration of hospital stay and more number of medicines prescribed. INTERPRETATION CONCLUSIONS: Comorbidities, prolonged hospitalization, polypharmacy, inappropriate medicines and parenteral medicines being prescribed contribute to increased expenditure on medicines in geriatric inpatients. In view of the rising number of geriatric inpatients, there is a need to frame a drug policy for them along with surveillance of expenditure on prescribed medicines. This needs to be treated as a priority.

Interesting case of regional left ventricular hypertrophy.

This is an account of an interesting case with an unusual cardiac presentation. He is a man in his 60s who presented with chest tightness to the accident and emergency unit. The initial thoughts were of acute coronary syndrome or acute aortic syndrome. The initial set of investigations was non-conclusive. His echocardiogram which was done during hospital admission showed asymmetric hypertrophy of the heart muscle. It was prudent to assess that new finding with an MRI scan. The patient presented to the hospital twice during the investigation and was treated for a lower respiratory tract infection. The MRI report showed an interventricular mass lesion extending to the right ventricular free wall with angiosarcoma being high up in the differential diagnosis. Going through the heart team discussion, the decision was to go for a transcatheter biopsy. The biopsy showed B-cell lymphoma. The treatment started and interestingly with satisfactory results.

Pharmacokinetics, Fecal Output, and Grimace Scores in Rabbits Given Long-acting Buprenorphine or Fentanyl for Postsurgical Analgesia.

The New Zealand white rabbit (Oryctolagus cuniculus) is a frequently used surgical model. Pain management after surgery is a critical aspect of animal welfare. Recently, a long-acting buprenorphine formulation (Ethiqa XR; EXR) was approved for use in rats and mice but has not yet been investigated in rabbits. The current study aimed to determine whether a single subcutaneous dose of 0.15 mg/kg of EXR could achieve and maintain therapeutic buprenorphine plasma concentrations (0.1 ng/mL) for 72 h in male and female rabbits. We also evaluated the safety profiles of EXR and the fentanyl patch (FP) by assessing fecal output after surgery, because opioids are known to decrease intestinal motility. Behavior and pain scores were compared for rabbits that received either EXR or the FP after undergoing an annulus puncture procedure to induce osteoarthritis. EXR at 0.15 mg/kg SC provided a shorter time to onset and sustained analgesia for 72 h in male and female rabbits, whereas the FP provided suboptimal analgesia after 48 h. Both EXR and FP reduced fecal output after surgery. Output returned to baseline levels within 72 h for the EXR group and remained slightly below baseline at 96 h after surgery for the fentanyl group. Grimace pain scores revealed no significant difference between treatment groups. These results suggest that EXR is a safe and effective option for postoperative pain management in rabbits.

The Society of Thoracic Surgeons Adult Cardiac Surgery Database: Intraoperative Echocardiography Reporting.

OBJECTIVES: To identify trends in the reporting of intraoperative transesophageal echocardiographic (TEE) data in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) and the Adult Cardiac Anesthesiology (ACA) module by period, practice type, and geographic distribution, and to elucidate ongoing areas for practice improvement. DESIGN: A retrospective study. SETTING: STS ACSD. PARTICIPANTS: Procedures reported in the STS ACSD between July 2017 and December 2021 in participating programs in the United States. INTERVENTIONS: None MEASUREMENTS AND MAIN RESULTS: Intraoperative TEE is reported for 73% of all procedures in ACSD. Although the intraoperative TEE data reporting rate increased from 2017 to 2021 for isolated coronary artery bypass graft surgery, it remained low at 62.2%. The reporting of relevant echocardiographic variables across a wide range of procedures has steadily increased over the study period but also remained low. The reporting in the ACA module is high for most variables and across all anesthesia care models; however, the overall contribution of the ACA module to the ACSD remains low. CONCLUSIONS: This progress report suggests a continued need to raise awareness regarding current practices of reporting intraoperative TEE in the ACSD and the ACA, and highlights opportunities for improving reporting and data abstraction.

Oral Plasmablastic Lymphoma: A Rare Manifestation of HIV-Related Neoplasm-A Brief Clinical Study.

Plasmablastic lymphoma (PBL) is an uncommon and aggressive large B-cell lymphoma commonly diagnosed in human immunodeficiency virus-positive patients. Though the oral cavity is a common site for PBL, this condition is not commonly reported in the literature as an oral manifestation. Most oral PBLs presented as an asymptomatic swelling, frequently associated with ulcerations and bleeding. No standard treatment is yet advocated for oral PBL. Five-year survival rate was recorded not more than 33.5%. This presentation emphasizes on oral manifestation of plasmablastic lymphoma (PBL) as a rare entity, which was provisionally diagnosed for carcinoma (CA) oral cavity. A simple presentation of ulcerated growth in the upper jaw was excised for histopathologic evaluation. Subsequently, it turned out to be a rare oral manifestation of HIV-related lymphoma. It is imperative to understand simple oral presentation as a manifestation of an underlying systemic condition. With this interest, this case presentation is published with a literature review.

Study of secondary organic aerosol formation and aging using ambient air in an oxidation flow reactor during high pollution events over Delhi.

Secondary aerosols constitute a significant fraction of atmospheric aerosols, yet our understanding of their formation mechanism and fate is very limited. In this work, the secondary organic aerosol (SOA) formation and aging of ambient air of Delhi are studied using a potential aerosol mass (PAM) reactor, an oxidation flow reactor (OFR), coupled with aerosol chemical speciation monitor (ACSM), proton transfer reaction time of flight mass spectrometer (PTR-ToF-MS), and scanning mobility particle sizer with counter (SMPS + C). The setup mimics atmospheric aging of up to several days with the generation of OH radicals. Variations in primary volatile organic compounds (VOCs) and oxygenated volatile organic compounds (OVOCs) as a function of photochemical age were investigated. Primary VOCs such as benzene, toluene, xylene, trimethyl benzene, etc. decrease and OVOCs like formic acid, formaldehyde, acetone, ethanol, etc. increase substantially upon oxidation in OFR. The highest organic aerosol (OA) enhancement was observed for the 4.2 equivalent photochemical days of aging i.e., 1.84 times the ambient concentration, and net OA loss was observed at very high OH exposure, typically after 8.4 days of photochemical aging due to heterogeneous oxidation followed by fragmentation/evaporation. In ambient air, OA enhancement is highest during nighttime due to the high concentrations of precursor VOCs in the atmosphere. SMPS + C results demonstrated substantial new particle formation upon aging and decrement in preexisting aerosol mass. This is the first experimental study conducting an in-situ evaluation of potential SOA mass generated from the ambient aerosols in India.

Development of amine-functionalized fluorescent silica nanoparticles from coal fly ash as a sustainable source for nanofertilizer.

Scaling up the synthesis of fluorescent silica nanoparticles to meet the current demand in diverse applications involves technological limitations. The present study relates to the hydrothermal synthesis of water-soluble, crystalline, blue-emitting amine-functionalized silica nanoparticles from coal fly ash sustainably and economically. This study used tertiary amine (trimethylamine) to prepare amine-functionalized fluorescent silica nanoparticles, enhancing fluorescence quantum yield and nitrogen content for nanofertilizer application. The TEM and FESEM studies show that the silica nanoparticles have a spherical morphology with an average diameter of 4.0 nm. The x-ray photoelectron and Fourier transform infrared spectroscopy studies reveal the presence of the amine group at the surface of silica nanoparticles. The silica nanoparticles exhibit blue fluorescence with an emission maximum of 454 nm at 370 nm excitation and show excitation-dependent emission properties in the aqueous medium. With the perfect spectral overlap between silica nanoparticle emission (donor) and chlorophyll absorption (acceptor), fluorescent silica nanoparticles enhance plant photosynthesis rate by resonance energy transfer. This process accelerates the photosynthesis rate to improve the individual plant's quality and growth. These findings suggested that the fly ash-derived functionalized silica nanoparticles could be employed as nanofertilizers and novel delivery agents.

Stabilization of Naphthalene Diimide Anions by Ion Pair Formation in Nonaqueous Organic Redox Flow Batteries.

In redox flow batteries, a compelling strategy for enhancing the charge capacity of redox-active organic molecules involves storing multiple electrons within a single molecule. However, this approach poses unique challenges such as chemical instability by forming radicals, elevated energy requirements, and unsustainable charge concentration. Ion pairing is a possible solution to achieve charge neutrality and engineer redox potential shifts but has received limited attention. In this study, we demonstrate that Li+ can stabilize naphthalene diimide (NDI) anions dissolved in acetonitrile and significantly shift the second cathodic potential close to the first. Our findings, supported by density functional theory calculations and Fourier transform infrared spectroscopy, indicate that dimeric NDI species form stable ion pairs with Li+. Conversely, K+ ions exhibit weak interactions, and cyclic voltammograms confirm significant potential shifts when stronger Lewis acids and solvents with lower donor numbers are employed. Galvanostatic examinations reveal a single voltage plateau with Li+, which indicates a rapid redox process involving doubly charged NDI2- with Li+. These aggregated ion pairs offer the additional benefits of hindering crossover events, contributing to excellent cyclability, and suppressing undesirable side reactions even after 1000 redox cycles.

Early port site and peritoneal metastasis following robot-assisted radical cystectomy: a rare case report.

Radical cystectomy with pelvic lymph node dissection is the recommended treatment for managing muscle-invasive carcinoma of the urinary bladder. Early recurrence is observed in only about 4.1% of cases. Port-site metastasis following robot-assisted radical cystectomy is extremely rare. We encountered a challenging and a rare case of bladder cancer that manifested with port-site and peritoneal metastasis within 6 weeks of surgery.

Atrial fibrillation mortality trends in individuals with heart failure.

Atrial fibrillation (AF) frequently occurs concurrently with heart failure (HF). The two conditions can exacerbate each other, resulting in higher morbidity and mortality. In our analysis, we evaluated mortality trends related to AF in individuals with underlying HF. Cross-sectional analyses were performed using publicly available data from the Center for Disease Control and Prevention database to compare AF-related age-adjusted mortality rates across age, gender, racial/ethnic, and geographic subgroups. Mortality trends were evaluated by fitting log-linear regression models followed by calculation of the average annual percentage change (AAPC) using the Monte Carlo permutation test. We identified a total of 55,917 deaths within the United States from AF with comorbid HF between 1999 and 2020. Males, older adults, White populations, and non-metropolitan regions had higher age-adjusted mortality compared to females, younger adults, Black populations, and metropolitan regions, respectively. The AAPC among younger adults was significantly higher compared to older adults. Our results demonstrate existing disparities among age, gender, racial, and geographic subgroups related to AF mortality among individuals with comorbid HF. Although decreased overall mortality was observed within younger populations compared to older populations, the prominent AAPC seen in younger populations warrants further investigation. Detection of AF among younger adults with comorbid HF should prompt the intensification of preventative and treatment measures.

Iodobenzene-Catalyzed Synthesis of Fully Functionalized NH-Pyrazoles and Isoxazoles from α,ß-Unsaturated Hydrazones and Oximes via 1,2-Aryl Shift.

An iodine(III)-catalyzed general method for the synthesis of fully functionalized NH-pyrazoles and isoxazoles from α,ß-unsaturated hydrazones and oximes, respectively, via cyclization/1,2-aryl shift/aromatization/detosylation, has been developed. The reaction progresses through an anti-Baldwin 5-endo-trig cyclization. It gives direct access to an advanced intermediate for the preparation of valdecoxib and parecoxib, drugs used for COX-inhibition. In addition, a method for N-alkynylation of pyrazoles has also been developed in the presence of TIPS-EBX.

Postradical cystectomy delayed urethral recurrence: a rare presentation posing diagnostic dilemma.

The incidence of urethral recurrence after radical cystectomy is 1% to 8%, with most cases occurring within the first 2 years of surgery. Prophylactic urethrectomy is rarely performed nowadays due to no known survival benefit and increased morbidity due to the procedure. However, we encountered a rare case of delayed urethral recurrence presenting as recurrent urethral collection 4 years after radical cystectomy with ileal conduit diversion, posing a diagnostic dilemma.

Phenotypic, Physiological and Biochemical Delineation of Wheat Genotypes Under Different Stress Conditions.

Wheat is a vital crop, providing calories, nutrients and versatility in the food industry. However, the combination of heat and drought stress, exacerbated by climate change, poses a significant threat to wheat production, leading to potential yield losses. To ensure the sustainability of wheat production it is crucial to prioritize research on developing stress-tolerant wheat genotypes. The current study focused on identifying the traits that are important for developing stress-tolerant wheat varieties under timely sown irrigated, drought stress, heat stress, and combined stress conditions. It addresses the knowledge gap regarding the combined effects of heat and drought stress on wheat physiology and yield, aiming to shed light on the intricate interactions between these stresses. The experiment was conducted at CCS HAU, Hisar, during the Rabi seasons of 2019-2020 and 2020-2021. By evaluating variability parameters, conducting correlation analysis, and path coefficient analysis among 80 diverse wheat genotypes, this research identifies genetic factors contributing to stress tolerance and helps select plants with desirable characteristics. The results showed that traits i.e., malendialdehyde, wax covering on blade, wax covering on sheath and wax covering on spike had high potential for improvement through selection among genotypes for grain yield and its component traits. The study also highlighted the importance of selecting wheat varieties with early maturity to mitigate the risk of yield loss under combined stress conditions. Moreover, the interaction between drought and heat stress can increase oxidative stress, leading to elevated malondialdehyde levels. Selecting varieties with lower malondialdehyde and optimal canopy temperature is important. Understanding the complex response of wheat to heat, drought, and their combined stress is essential for improving crop quality and production potential. Overall, this research contributes to the field of plant breeding by facilitating the development of wheat varieties with high and stable yields in challenging environments.

Source apportionment, health risk assessment, and trajectory analysis of black carbon and light absorption properties of black and brown carbon in Delhi, India.

Black Carbon (BC) is an important atmospheric pollutant, well recognized for adverse health and climatic effects. The present work discusses the monthly and seasonal variations of BC sources, health risks, and light absorption properties. The measurement was done from January to December 2021 using a seven wavelength aethalometer. Annual average BC concentration during the study period was 12.2 ± 8.8 µg/m3 (ranged from 1.9 - 52.2 µg/m3). Results represent highest BC concentration during winter (W), followed by post-monsoon (P-M), summer (S), and monsoon (M) seasons where the fossil fuel (FF) combustion is the major source during W, S, and M seasons and biomass burning (BB) during the P-M season. The health risk assessment revealed that individuals in Delhi are exposed to BC levels equivalent to inhaling the smoke from 36 passively smoked cigarettes (PSC) everyday. The risk is highest during W reaching upto 71 PSC and minimum during M i.e., 9 PSC. The light absorption properties were calculated for BC (AbsBC) and Brown carbon (AbsBrC). AbsBC and varied from 229-89 Mm-1 between 370-950 nm and AbsBrC varied from 87-12 Mm-1 between 370-660 nm. AbsBC contributed substantially to total absorption at all wavelengths, while AbsBrC contribution is quite significant in the UV region only. Trajectory analysis confirmed significant influence of regional sources (e.g., biomass-burning aerosols from northwest and east direction) on air quality, health risks, and light absorption properties of BC over Delhi especially during the P-M season. The BB events of Punjab, Haryana, Uttar Pradesh, and eastern Pakistan seems to have significant influence on Delhi's air quality predominantly during P-M season.

Outcomes of Surgical Management for Parathyroid Adenomas.

Aim: Descriptive analysis of patients undergoing parathyroid adenoma surgery at a tertiary care hospital. Methodology: Patients with parathyroid adenoma operated from January 2016 to December 2020. Serum calcium and PTH were used to establish the diagnosis. Ultrasonography (USG) studies localized the adenoma. NIH criteria was used for decision regarding surgery. Patients were analyzed with regards to pre operative localization, biochemical monitoring and other outcomes. Results: Of the 15 eligible patients, all were symptomatic, with myalgia (34%) being the commonest symptom. Rome criteria confirmed the adequacy of the procedure by measuring intra operative drop in PTH. Average decrease in serum PTH level was 69.9% and serum calcium was 20.6% after excision of adenoma. The average size of excised adenoma was 2.5 cm. There were no post operative complications and all patients were normocalcemic on follow up. Conclusion: Parathyroidectomy is a simple, safe and effective solution that reduces the morbidity of symptomatic primary hyperparathyroidism patients. Pre operative localization studies affirm the diagnosis and intra operative biochemical confirmation clinches the adequacy of resection.