Fish-tail Plasty: A Secure Technique to Enhance Cosmesis at the Lateral End of Mastectomy Scar and Prevent Dog Ear

Mastectomy is very common surgical procedure for breast cancer. The closure of transverse elliptical mastectomy incisions has been represented with numerous modifications since 1915. The technical challenge is to avoid a fold of skin dogging laterally ("dog-ear"). This might lead to off future discomfort and poor cosmetic result. However, various surgical techniques are reported to tackle this lateral dog ear, there is no standardized technique. We therefore conduct a systematic review of the surgical techniques with the aim of comparing the merits and limitations of every technique. The comparative study among 72 patients was performed in Bangabandhu Sheikh Mujib Medical University, Anower Khan Modern Medical College & Hospital and Care Medical College & Hospital, Bangladesh from July 2017 to January 2020. Patients were divided randomly into two groups: Group I underwent fishtail technique group (36 patients), Group II underwent modified suturing technique group (36 patients). The follow up periods were 1 month and 3 months post-operatively for determination of the presence of dog ear and patient's satisfaction regarding cosmetic outcome and comfortability. Incidence of dog ear in fish-tail plasty group patients was less than that for Group II yet the difference is not significant less (p value 0.001). In consideration of patient satisfaction, doctor satisfaction and patient comfortability were significantly higher in Group I than Group II (p value 0.476 and 0.001 respectively). Fish-tail plasty was significantly better in patient satisfaction, comfortability and doctor satisfaction than modified suturing techniques and it might be recommended following mastectomy in obese patients for improving cosmesis and avoiding discomfort due to redundant skin.

Layered Sheath-Assisted Dissection and Retrieval of Stuck Port Catheters: A Single-Center Experience

Chemoports are often required for oncological patients requiring repeated blood draws and long-term drug therapy. However, complications such as dislodgement, fracture, thrombosis, and venous occlusion may occur if the ports remain unremoved when not in use. Nonetheless, existing techniques require multiple accesses or release of the stuck catheter tip to retrieve the catheter, making the procedure inconvenient. We present our experience with a technique using the Bard Denali inferior vena cava filter retrieval kit to remove a stuck or fractured chemoport catheter through a single vascular access. The technique was performed in two female patients with satisfactory results (complete retrieval of broken chemoports) and an event-free follow-up period. The entire procedure was completed within 15-30 minutes with fluoroscopic time under two minutes. The technique allows for better case management by simplifying the procedure, reducing radiation, and improving workflow efficiency in the operating room.

A Rare Case of Cystic Artery Pseudoaneurysm because of Cholecystitis Managed with Non-invasive Technique

Cystic artery pseudoaneurysm due to acute on chronic cholecystitis is very rare in spite of the high incidence of cholecystitis, and very few cases have been reported in the literature. Most of the pseudoaneurysms are symptomatic at the time of diagnosis due to rupture. Very few cases of unruptured cystic artery pseudoaneurysm caused by cholecystitis have been reported in the literature. We present a case of a 41-year-old man who presented in the Intervention Radiology Department with the diagnosis of cholecystitis and cystic artery pseudoaneurysm. Three treatment options are available for such cases. The first approach is surgical clipping of the pseudoaneurysm and cholecystectomy. The second approach is endovascular management of pseudoaneurysm and cholecystectomy. We chose the third approach, endovascular management of the pseudoaneurysm, percutaneous cholecystostomy, and elective laparoscopic cholecystectomy.

Thrombosis with Thrombocytopenia Syndrome (TTS) After ChAdOx1 nCoV-19 Immunization: An Investigative Case Report

BACKGROUND Thrombosis with thrombocytopenia syndrome (TTS), including vaccine-induced immune thrombotic thrombocytopenia (VITT), is an extremely rare adverse effect, mostly seen after initial vaccination with the viral vector-based AstraZeneca-Oxford COVID-19 vaccine. It is characterized by mild to severe thrombocytopenia and venous or arterial thrombosis. CASE REPORT Herein, we present a case of an 18-year-old male patient who developed Level 1 TTS (probable VITT) eight days after immunization with the ChADOx1 nCOV-19 vaccine (Covishield; AZ-Oxford). Initial investigations revealed severe thrombocytopenia, hemiparesis, and intracranial hemorrhage, after which the patient was treated conservatively. However, a decompressive craniotomy was performed later due to patient deterioration. One week after surgery, the patient developed bilious vomiting, lower-gastrointestinal bleeding, and abdominal distension. An abdominal CT scan was performed that showed thrombosis of the portal vein with occlusion of the left iliac vein. The patient underwent an exploratory laparotomy followed by resection and anastomosis of the small bowel due to massive gut gangrene. Due to persistent thrombocytopenia after surgery, intravenous immune globulin (IVIG) was administered. The platelet count increased thereafter, and the patient stabilized. He was discharged on the 33rd day after admission and was followed up for a year. No post-hospitalization complications were observed in the follow-up period. CONCLUSIONS Although vaccines have been proven to be highly safe and effective to end the Coronavirus Disease 2019 (COVID-19) caused pandemic, there is still a small risk of developing rare complications, including TTS and VITT. Early diagnosis and prompt intervention are key for patient management.

Role of MRI and FIGO Staging in Evaluation of Fibroids - A Pictorial Review

Uterine fibroids are the most common gynaecologic malignancy, but only 20% of women need treatment to relieve their symptoms. The management of fibroids has changed from open to laparoscopic hysterectomy, myomectomy and minimal invasive techniques such as uterine artery embolization and ablation. Magnetic resonance imaging (MRI) is considered the best modality in the diagnosis, characterization and number of fibroids as well as for accessing extrauterine relationships, associated diseases; it also helps in planning, choosing and prognosis of treatment options. Traditionally, uterine fibroids were classified according to their location as submucosal, intramural or subserosal. However, for minimally invasive techniques, the relation of the fibroid with the endometrium, the degree of fibroid extension in the myometrium and the pedunculated nature of the fibroid are required before the procedure. The FIGO classification system was created to describe and classify fibroid locations in a systematic and consistent manner with suitable communication to the referring doctor. We are providing an array of clinical symptoms, MRI images, and surgical approaches on the basis of FIGO classification and associated important points to diagnosis and clinical implications.

Imaging findings in invasive rhino-orbito-cerebral mucormycosis in post-COVID-19 patients

Rhino-orbito-cerebral mucormycosis (ROCM) is a life-threatening addition to the COVID-19 disease spectrum and is caused by an angioinvasive saprophytic opportunistic fungus. Early diagnosis is important to avoid disease spread and mortality. Contrast-enhanced magnetic resonance imaging plays a major role in detection of intraorbital and intracranial extension. We present imaging findings of 15 patients with post-COVID-19 rhino-orbito-cerebral mucormycosis who were diagnosed with invasive sinus mucormycosis at our institution and are currently undergoing treatment. All patients were diabetics, and 80% had a history of steroid intake during the course of COVID-19 treatment. There was a male preponderance (73.3%). The maxillary sinus was most commonly involved (86.7%). Orbital and intracranial invasion was seen in 73.3% and 60% of patients, respectively. The presence of retroantral, facial, infratemporal, and orbital fat stranding was an early sign of extrasinus spread. Other common sites of extrasinus involvement were the orbit and face, followed by the orbital apex, masticator space, pterygopalatine fossa, bone, skull base, cavernous sinus, brain, and internal carotid artery. In conclusion, early detection of extrasinus spread of mucormycosis by imaging is important so that aggressive treatment can be given and mortality can be reduced.

Prevalence of elevated blood lead levels and risk factors among children living in Patna, Bihar, India 2020

Childhood lead exposure remains a key health concern for officials worldwide, contributing some 600,000 new cases of intellectually disabled children annually. Most children affected by high exposure to lead live in low- and middle-income countries. The leaded gasoline phase out in India was completed in 2000. Yet, in 2020, an estimated 275 million children aged 0 to 9 years had blood lead levels (BLLs) ≥ 5 μg/dL known to adversely affect intelligence and behavior. Lead sources reported in India include spices, cookware, paint, traditional medicines and cosmetics, and lead-acid battery recycling and repair. However, their relative contribution has not been characterized. More than 200 lead pollution sites related to battery recycling and repair activities were identified in Bihar and Jharkhand, India. Ninety percent of the recycling sites had soil lead concentrations exceeding the US Environmental Protection Agency's standards. We compared blood and environmental lead levels in two groups of children in Patna, Bihar. Households in proximity to battery recycling operations (Proximal n = 67) versus households distal to these operations (Distal n = 68). The average age of children was 40 months; 46% were female. Overall, the geometric mean (GM) BLL was 11.6 μg/dL. GM BLLs of children in Proximal and Distal households were not significantly different (10.2 μg/dL vs. 13.1 μg/dL respectively; p≤0.07). About 87% children, 56 Proximal and 62 Distal had BLLs ≥5 μg/dl. Lead concentrations in environmental samples were significantly higher in Proximal households (soil mean 9.8 vs. 1.6 μg/ft2; dust mean 52.9 vs. 29.9 μg/ft2 p<0.001; Proximal vs. Distal respectively) whereas concentrations in all spices were higher in Distal households (mean 46.8 vs 134.5 ppm p<0.001; Proximal vs. Distal respectively), and turmeric (mean 59.4 vs. 216.9 ppm Proximal vs. Distal respectively). In multivariate analyses for all children lead in spices and turmeric and number of rooms in the house were significant while for the Proximal group only lead in spices remained in the model. The predictive value of these models was poor. For the Distal group, a model with lead concentration in spices, turmeric and soil and number of rooms in the house was a much better fit. Of the 34 water samples collected, 7 were above the Indian standard of 10 ppb for lead in drinking water (2 in the Proximal area, 5 in the Distal area). Children in Patna, Bihar, India are exposed to multiple sources of lead, with lead levels in house dust and loose, locally sourced spices the most likely to increase blood lead levels. A holistic approach to blood lead testing and source identification and remediation are necessary to prevent lead exposure.

Experiences and perceptions from non-internal medicine clinicians deployed to COVID-19 units

Introduction

When New York City became an epicenter of the COVID-19 pandemic, healthcare workers from an array of specialties were deployed to work on general medicine units with limited time for clinical retraining.

Objectives

This study assesses the subjective experience and perceived preparedness of a cohort of non-internal medicine clinicians who were deployed to assist with inpatient management of patients with COVID-19 in the Spring of 2020.

Methods

An online survey was distributed to clinicians (residents, fellows, attendings, nurse practitioners, and physician assistants) who cared for patients in roles outside their usual specialties during the pandemic at the Montefiore Health System in the Bronx, NY.

Results

85/169 (50.3%) clinicians responded. 16.5% reported strong feelings of preparedness prior to deployment (≥7/10 Likert scale). ‘Access to appropriate and efficient review materials prior to deployment’ was ranked as 6/10, overall level of stress as 8/10 and concern for contracting COVID-19 while deployed as 8/10. Responses regarding ‘general feelings of preparedness’ had a weak negative association with ‘feelings of frustration about one’s circumstance’ (r= -0.39, p<0.001). Weak negative associations were found between feelings of ‘access to adequate review materials’ and ‘overall stress levels’ (r= -0.31, p<0.001). A moderate positive association was found between ‘feelings of access to adequate review materials’ and ‘feeling on top of one’s work responsibilities’ (r= 0.40, p< 0.001).

Conclusions

The majority of respondents did not feel adequately prepared to care for patients with COVID-19 prior to deployment and had both high stress levels and fear of contracting COVID-19 in the first wave of the pandemic.

Disclosure

No significant relationships.

Economic and environmental impact analyses of hybrid generation system in respect to Rajasthan

This paper intends to show the aspects of an environment-friendly hybrid energy system (HES) for reducing the electrical power problems in remote areas and providing pollution-free energy. It draws attention towards renewable HES to attain a consistent and independent system. Optimization of the apparatus extent, step-up asset price, and effects on environment is also taken care of. The HES is capable of supply green electricity to population living in remote areas, where supply from grid is a major hurdle. In the proposed HES, the main proportion of power has been generated from the solar panels and wind turbines, while the batteries act as backup power source. The optimization of designed system has been done using the HOMER software. The design and application of the proposed method is a novel solution for the selected location. The results obtained from simulation justify that the proposed HES acts as viable solution for electrification of remote areas which are not connected from the grid.

Over-expression of Caj1, a plasma membrane associated J-domain protein in Saccharomyces cerevisiae, stabilizes amino acid permeases

Hsp70: J-domain protein (JDP) machines, along with the cellular protein degradation systems play a central role in regulating cellular proteostasis. An equally robust surveillance system operates at the plasma membrane too that affects proper sorting, stability as well as the turnover of membrane proteins. Although plausible, a definitive role of the Hsp70: JDP machine in regulating the stability of plasma membrane proteins is not well understood in Saccharomyces cerevisiae. Here we show that a moderate over-expression of Caj1, one of the thirteen JDPs residing in the nucleo-cytosolic compartment of S. cerevisiae reduced the cold sensitivity of tryptophan auxotrophic yeast cells by stabilizing tryptophan permeases, Tat1 and Tat2 in a J-domain dependent manner. Concomitantly, higher Caj1 levels also caused slow growth and increased plasma membrane damage at elevated temperatures possibly due to the stabilization of thermolabile plasma membrane proteins. Finally, we show that although majorly cytosolic, Caj1 also co-localizes with the membrane dye FM4-64 at the cellular periphery suggesting that Caj1 might interact with the plasma membrane. Based on the results presented in this study, we implicate the Hsp70: Caj1 chaperone machine in regulating the stability or turnover of plasma membrane proteins in budding yeast.

The IMEx Coronavirus interactome: an evolving map of Coronaviridae-Host molecular interactions

The current Coronavirus Disease 2019 (COVID-19) pandemic, caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has spurred a wave of research of nearly unprecedented scale. Among the different strategies that are being used to understand the disease and develop effective treatments, the study of physical molecular interactions enables studying fine-grained resolution of the mechanisms behind the virus biology and the human organism response. Here we present a curated dataset of physical molecular interactions, manually extracted by IMEx Consortium curators focused on proteins from SARS-CoV-2, SARS-CoV-1 and other members of the Coronaviridae family. Currently, the dataset comprises over 2,200 binarized interactions extracted from 86 publications. The dataset can be accessed in the standard formats recommended by the Proteomics Standards Initiative (HUPO-PSI) at the IntAct database website ( www.ebi.ac.uk/intact ), and will be continuously updated as research on COVID-19 progresses.

Thermal neutron-induced γ-ray background in 124Sn

The thermal neutron-induced gamma-ray background in ¹²⁴Sn is investigated in connection with neutrinoless double beta decay (0νββ) studies in ¹²⁴Sn. For this purpose, a 99.26% enriched ¹²⁴Sn sample was irradiated with a thermal neutron fluence of 3×10¹⁵/cm² in the Dhruva reactor at the Bhabha Atomic Research Centre, Mumbai. The gamma ray spectra of the irradiated sample were measured in a low background counting setup to study both long-lived and short-lived activities. The present data give an independent measurement of the half-life of ¹²⁵Sn*(32⁺) and ¹²⁵Sn(112^-) as 10.01(8) min and 9.63(2) d, respectively. The impact of the observed high-energy gamma rays and the residual activity due to ¹²⁵Sb, on the background in the region of interest around the Q_ββ value of ¹²⁴Sn (~2.291 MeV) is discussed.

Association Between Serum Testosterone and Serum PSA Among Men With and Without Partial Androgen Deficiency

Serum prostatic specific antigen (PSA) and serum testosterone levels share an undefined relationship with each other, with many conflicting studies showing both positive and negative correlation between them. Our aim was to assess association between serum PSA and serum testosterone in healthy men with normal testosterone levels and men with partial androgen deficiency (PADAM). A cross sectional study was conducted at a teaching hospital setting where serum testosterone and aging male symptom scale (AMS) scores along with PSA were studied in 255 men (> 50 years) with and without PADAM. Mean total testosterone and serum PSA was 9.35 ± 1.33 nmol/L, 1.96 ± 0.76 ng/mL in males with PADAM and 15.30 ± 1.95 nmol/L, 1.85 ± 0.73 ng/mL respectively in males without PADAM. No significant relationship was observed between serum PSA and serum testosterone levels among healthy males irrespective of PADAM in the study population. We suggest, there is no need to adjust PSA values for biopsy decisions according to testosterone levels.

The IMEx coronavirus interactome: an evolving map of Coronaviridae-host molecular interactions

The current coronavirus disease of 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus (SARS-CoV)-2, has spurred a wave of research of nearly unprecedented scale. Among the different strategies that are being used to understand the disease and develop effective treatments, the study of physical molecular interactions can provide fine-grained resolution of the mechanisms behind the virus biology and the human organism response. We present a curated dataset of physical molecular interactions focused on proteins from SARS-CoV-2, SARS-CoV-1 and other members of the Coronaviridae family that has been manually extracted by International Molecular Exchange (IMEx) Consortium curators. Currently, the dataset comprises over 4400 binarized interactions extracted from 151 publications. The dataset can be accessed in the standard formats recommended by the Proteomics Standards Initiative (HUPO-PSI) at the IntAct database website (https://www.ebi.ac.uk/intact) and will be continuously updated as research on COVID-19 progresses.

Comparison of two multifraction radiotherapy schedules in management of painful bone metastases: A single institution prospective study

Background

Metastatic disease of bone is a common complication of most of the advanced malignancies. The majority of patients with bone metastases (BM) experience pain during their disease course and pain control can significantly improve their quality of life. Radiotherapy (RT) is an important modality in the management of BM and different schedules are followed worldwide.

Aim

The aim of this study was to compare two multi-fractionated RT regimens (30Gy in 10 fractions and 20Gy in 5 fractions) with respect to the patient's performance, response and pain score in palliative management of painful BM.

Methods

This prospective observational study was undertaken between October 2015 and September 2017 at a government medical college in central India. Two fractionation regimens (30 Gy/10 fractions and 20 Gy/5 fractions) were used to treat 50 patients with painful BM (n = 25 in each arm). Patients were treated on telecobalt machine and response assessment done in terms of complete/partial/intermediate response and pain progression. Assessment was performed at one, two and three months post treatment. Statistical analysis was done using Fisher's exact test, student t-test and Chi-square test. A value of P < 0.05 was considered significant.

Results

There were 9 males (36%) and 16 females (64%) in arm A, and 15 males (60%) and 10 females (40%) in arm B. The median age was 47.50 years (range 28-81 years) in arm A and 54 years (range 34-85 years) in arm B. There was no statistically significant difference between the two groups in terms of pain palliation at a 1 month (p = 0.73), 2 month (p = 0.75) or 3 month (p = 0.71) follow up. In addition, the mean performance scores at the end of 3^rd month in the 2 arms did not show any statistically significant difference (p = 0.51).

Conclusion

A shorter treatment schedule (5 fractions) was equally efficacious as the standard schedule (10 fractions) in our setting. With the advantage of shorter overall treatment time and avoidance of re-irradiation, this schedule may be favourable for high volume centres.

Origin of Thyrolingual Trunk from the Common Carotid Artery

Common carotid artery (CCA) usually does not have any branches in the neck and divides into internal and external carotid artery. Superior thyroid and lingual artery (commonly called as thyro lingual trunk) are the branches of external carotid artery. We report a case of rare origin of thyrolingual trunk from the CCA in a case of ruptured intracranial aneurysm.

Retraction Note to: Environmental impact of plantations in and around the petroleum refinery: a case study

This article [1] has been retracted at the request of the Editor-in-Chief. Significant sections of the article show a similarity with the author's own article published previously [2]. All the authors agree with the retraction.

Encompassing new use cases - level 3.0 of the HUPO-PSI format for molecular interactions

BACKGROUND

Systems biologists study interaction data to understand the behaviour of whole cell systems, and their environment, at a molecular level. In order to effectively achieve this goal, it is critical that researchers have high quality interaction datasets available to them, in a standard data format, and also a suite of tools with which to analyse such data and form experimentally testable hypotheses from them. The PSI-MI XML standard interchange format was initially published in 2004, and expanded in 2007 to enable the download and interchange of molecular interaction data. PSI-XML2.5 was designed to describe experimental data and to date has fulfilled this basic requirement. However, new use cases have arisen that the format cannot properly accommodate. These include data abstracted from more than one publication such as allosteric/cooperative interactions and protein complexes, dynamic interactions and the need to link kinetic and affinity data to specific mutational changes.

RESULTS

The Molecular Interaction workgroup of the HUPO-PSI has extended the existing, well-used XML interchange format for molecular interaction data to meet new use cases and enable the capture of new data types, following extensive community consultation. PSI-MI XML3.0 expands the capabilities of the format beyond simple experimental data, with a concomitant update of the tool suite which serves this format. The format has been implemented by key data producers such as the International Molecular Exchange (IMEx) Consortium of protein interaction databases and the Complex Portal.

CONCLUSIONS

PSI-MI XML3.0 has been developed by the data producers, data users, tool developers and database providers who constitute the PSI-MI workgroup. This group now actively supports PSI-MI XML2.5 as the main interchange format for experimental data, PSI-MI XML3.0 which additionally handles more complex data types, and the simpler, tab-delimited MITAB2.5, 2.6 and 2.7 for rapid parsing and download.

JAMI: a Java library for molecular interactions and data interoperability

Background

A number of different molecular interactions data download formats now exist, designed to allow access to these valuable data by diverse user groups. These formats include the PSI-XML and MITAB standard interchange formats developed by Molecular Interaction workgroup of the HUPO-PSI in addition to other, use-specific downloads produced by other resources. The onus is currently on the user to ensure that a piece of software is capable of read/writing all necessary versions of each format. This problem may increase, as data providers strive to meet ever more sophisticated user demands and data types.

Results

A collaboration between EMBL-EBI and the University of Cambridge has produced JAMI, a single library to unify standard molecular interaction data formats such as PSI-MI XML and PSI-MITAB. The JAMI free, open-source library enables the development of molecular interaction computational tools and pipelines without the need to produce different versions of software to read different versions of the data formats.

Conclusion

Software and tools developed on top of the JAMI framework are able to integrate and support both PSI-MI XML and PSI-MITAB. The use of JAMI avoids the requirement to chain conversions between formats in order to reach a desired output format and prevents code and unit test duplication as the code becomes more modular. JAMI’s model interfaces are abstracted from the underlying format, hiding the complexity and requirements of each data format from developers using JAMI as a library.

Evaluation of Anxiety, Pain, and Hemodynamic Changes during Surgical Removal of Lower Third Molar under Local Anesthesia

Aim:

The aim of this study are to determine the hemodynamic changes in healthy patients during the surgical removal of lower third molar and to evaluate whether these variations are attributable to patient anxiety and pain experienced during surgical procedure.

Materials and Methods:

Sixty healthy patients were evaluated (i) to determine the hemodynamic changes (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], and oxygen saturation) at nine occasions: before starting the surgical procedure, 1 min and 4 min after local anesthetic injection, during the incision, at the time of ostectomy, at the completion of tooth removal, at the start and completion of suturing, and finally, after completion of surgery and (ii) to evaluate whether these variations are attributable to patient anxiety and pain experienced during the surgical procedure. Hemodynamic variables were compared between the gender and at different time points by performing two-way analysis of variance for repeated measures. Global mean values of hemodynamic variables were compared between male and female using unpaired t-test. Categorical variables were compared by Chi-square test. All the tests were two-sided. P < 0.05 was considered statistically significant.

Results:

SBP and DBP showed significant changes; the highest value was recorded at the time of ostectomy/tooth sectioning. Maximum HR was observed 4 min after local anesthetic injection and the lowest HR was recorded after completion of tooth extraction, i.e., during the suturing. In females, mean HR was significantly increased.

Conclusion:

The present study suggests that dental anxiety impacts the effect of delivery of local anesthesia on blood pressure and is significantly associated with increased HR.

Giant Intrahepatic Portal Vein Aneurysm: Leave it or Treat it?

Portal vein aneurysm (PVA) is a rare vascular dilatation of the portal vein. It is a rare vascular anomaly representing less than 3% of all visceral aneurysms and is not well understood. Usually, PVA are incidental findings, are asymptomatic, and clinical symptoms are proportionally related to size. Patients present with nonspecific epigastric pain or gastrointestinal bleeding with underlying portal hypertension. PVA may be associated with various complications such as biliary tract compression, portal vein thrombosis/rupture, duodenal compression, gastrointestinal bleeding, and inferior vena cava obstruction. Differential diagnoses of portal vein aneurysms are solid, cystic, and hypervascular abdominal masses, and it is important that the radiologists be aware of their multi-modality appearance; hence, the aim of this article was to provide an overview of the available literature to better simplify various aspects of this rare entity and diagnostic appearance on different modality with available treatment options. In our case, a 55-year-old male patient came to the gastroenterology OPD for further management of pancreatitis with portal hypertension and biliary obstruction with plastic stents in CBD and PD for the same. In this article, we have reported a case of largest intrahepatic portal vein aneurysm and its management by endovascular technique. As per our knowledge, this is the largest intrahepatic portal vein aneurysm and first case where the endovascular technique was used for the treatment of the same.

CT Angiographic Evaluation of Pattern and Distribution of Stenosis and its Association with Risk Factors Among Indian Ischemic Stroke Patients

BACKGROUND

Stroke is the major cause of disability and third major cause of death. Ischemia causes about 80% of stroke cases; stenosis and occlusion are the predominant cause of stroke. Our purpose for this study was to evaluate the pattern and distribution of stenosis and its association with risk factors in Indian ischemic stroke patients and in other countries, for comparison.

MATERIAL/METHODS

We evaluated 60 patients after ischemic stroke with CT angiography. The degree of stenosis was measured by the North American Symptomatic Carotid Endarterectomy Trial (NASCET). The results were analyzed by descriptive statistics and chi-square test.

RESULTS

Out of 60 cases, 32 cases were positive for significant stenosis and a total number of stenotic segments was 45. Out of 45 stenotic segments, 29 were single stenotic segments (16 intracranial and 13 extracranial) and 16 were multiple stenotic segments (8 intracranial and 8 extracranial). In the total number of stenotic segments (single and multiple), there were 24 (53.33%) intracranial and 21 (46.67%) extracranial. The most commonly involved intracranial stenosis segment was MCA, present in 10 (41.6%) out of 24 intracranial segments. Most commonly involved extracranial stenosis segment was ICA, present in 14 (66.6%) out of 21 extracranial segments. Diabetes is found to be the most common risk factor of intracranial stenosis while hypertension and hypercholesterolemia are the major risk factors of extracranial stenosis.

CONCLUSIONS

In the Indian population, intracranial stenosis is more common than extracranial one, anterior circulation stenosis is more common than posterior circulation stenosis; single stenosis is more common than multiple stenosis.

Direct Needle Puncture and Embolization of Splenic Artery Pseudoaneurysm in Case of Chronic Atrophic Calcific Pancreatitis

Background

Gastro-Intestinal bleeding remains a frequent clinical dilemma and common cause of hospitalization, morbidity and mortality.

Case Report

We report a case of pseudo aneurysm of splenic artery developed after an episode of acute on chronic pancreatitis which was treated by direct percutaneous puncture of pseudoaneurysm and embolization by coils.

Conclusions

The aim was to preserve the main splenic artery and avoid the complications of splenic artery embolization like infarcts and abscess.

Study of atherogenic lipid profile, high sensitive C-reactive protein neurological deficit and short-term outcome in stroke subtypes

BACKGROUND

Stroke is one of the most frequent causes of death and disability worldwide and has significant clinical and socioeconomic impact. Hyperlipidemia and inflammation play major roles in atherothrombosis and in stroke. This study is conducted to compare the high sensitive C-reactive protein (hs-CRP) levels and the lipid profile parameters between stroke patients and control group and demonstrate correlation between markers, neurological deficit, and short-term outcome.

METHODS

We have studied a total 162 patients according to inclusion criteria. Serum level of hs-CRP and lipid profile estimated and correlated with neurological deficit and short-term outcome.

RESULTS

We found stroke patients had significantly higher levels of hs-CRP, total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), and low level of high-density lipoprotein (HDL) than control. When we compared ischemic and hemorrhagic stroke (HS), data show increased level of triglyceride, LDL and HDL, and decreased the level of hs-CRP in ischemic stroke group than HS group. However, the National Institutes of Health Stroke Scale (NIHSS) score significantly higher in HS as compared to ischemic stroke at the time of admission and on the 7(th) day.

CONCLUSION

Thus, continuous clinical observation is necessary for clear differentiation of those changes. Furthermore, the determination of some reliable soluble markers of neuronal damage in blood and cerebrospinal fluid in the early infarction period would be much easier and more useful for tracking the course and prognosis of the disease and for any appropriate therapeutic approach.

Association between osteoporosis and periodontal disease among postmenopausal Indian women

AIM

The aim of the present study was to determine the association between osteoporosis and periodontal disease among postmenopausal Indian women.

METHODS

A cross-sectional comparative study was conducted among postmenopausal women aged 45-65 years attending various hospitals in Bangalore, India. The examination was performed using the plaque index, gingival index, modified sulcus bleeding index, and community periodontal index. The women then underwent a bone mineral density (BMD) test using an ultrasonometer. Based on the BMD scores, participants were divided into osteoporotic and non-osteoporotic groups. For the statistical analysis, χ² -test, Student's t-test, and multiple regression analysis were applied.

RESULTS

The mean plaque, gingival, and bleeding scores were significantly higher among osteoporotic women (1.83 ± 0.47, 1.73 ± 0.49, 1.82 ± 0.52) compared to the non-osteoporotic women (1.31 ± 0.40, 1.09 ± 0.52, 1.25 ± 0.50). The mean number of sextants affected for codes 3 and 4 of the community periodontal index and codes 1, 2, and 3 of loss of attachment were significantly higher among osteoporotic group compared to the non-osteoporotic group. Multiple logistic regression tests confirmed the statistically-significant association between osteoporosis and menopause duration, loss of attachment, bleeding, and gingivitis scores.

CONCLUSIONS

Skeletal BMD is related to clinical attachment loss, bleeding, and gingivitis, which suggests that there is an association between osteoporosis and periodontal diseases.

Dextran Carrier Macromolecules for Colon-specific Delivery of 5-Aminosalicylic Acid

Present manuscript describes the sustained and targeted delivery of 5-aminosalicylic acid to the distal ileum and proximal colon, using dextran (40 kDa) as a carrier for targeting 5-aminosalicylic acid at the colonic site by attaching p-aminobenzoic acid and benzoic acid as linkers. Prepared conjugate were characterized by UV, HPLC, FT-IR, and ¹H NMR. The degree of substitution was estimated by complete hydrolysis of conjugates in borate buffer and in vitro hydrolysis study of conjugates was performed in different biological media. It was observed that 5-aminosalicylic acid alone have produced high incidence of gastric ulcer with high ulcer index whereas lower ulcer index was found for the dextran conjugates of 5-aminosalicylic acid. The release pattern of conjugates in 3% w/v rat caecal content was confirmed the colon specificity of 5-aminosalicylic acid conjugates.

Electromagnetic transition from the 4+ to 2+ resonance in 8Be measured via the radiative capture in 4He + 4He

An earlier measurement on the 4+ to 2+ radiative transition in 8Be provided the first electromagnetic signature of its dumbbell-like shape. However, the large uncertainty in the measured cross section does not allow a stringent test of nuclear structure models. This Letter reports a more elaborate and precise measurement for this transition, via the radiative capture in the 4He + 4He reaction, improving the accuracy by about a factor of 3. Ab initio calculations of the radiative transition strength with improved three-nucleon forces are also presented. The experimental results are compared with the predictions of the alpha cluster model and ab initio calculations.

Limited asymmetry dependence of correlations from single nucleon transfer

Single nucleon pickup reactions were performed with a 18.1 MeV/nucleon (14)O beam on a deuterium target. Within the coupled reaction channel framework, the measured cross sections were compared to theoretical predictions and analyzed using both phenomenological and microscopic overlap functions. The missing strength due to correlations does not show significant dependence on the nucleon separation energy asymmetry over a wide range of 37 MeV, in contrast with nucleon removal data analyzed within the sudden-eikonal formalism.