Clinicopathological Profile and Survival Outcomes in Patients with Localised Extremity Synovial Sarcomas

AIMS

Synovial sarcoma is a rare but aggressive variant of soft-tissue sarcoma. Literature is sparse and reported mostly from the West. We analysed the clinical profiles and prognostic factors of extremity synovial sarcoma patients in order to study their clinical journey.

MATERIALS AND METHODS

This was a retrospective analysis. All patients with extremity synovial sarcoma treated between 1992 and 2020 were included. Patients with metastases at presentation were excluded. A descriptive analysis of demographic and clinicopathological features of patients undergoing limb salvage surgery (LSS) or amputation was carried out. Overall survival and disease-free survival were calculated for the entire cohort as well as for the LSS and amputation groups. Factors prognostic for survival were identified.

RESULTS

In total, 157 patients had localised extremity synovial sarcoma. Predominantly, young adults (median 31 years) and males (61%) were affected. Over 70% of patients presented after recurrence or unplanned surgeries. Sixty-seven per cent of tumours were >5 cm, 69% were deep and 23% involved bone. The limb salvage rate was 64%. In the LSS group, adjuvant radiotherapy and chemotherapy were given to 72% and 68% of patients, respectively. In the amputation group, 72% of patients received adjuvant chemotherapy. In a median follow-up of 59 months, 39.4% of patients had recurrences, the majority (61.2%) were systemic. Five-year overall survival and disease-free survival were 53.4% and 49.8%, respectively. Overall survival was 63.9% and 29.7% in the LSS and amputation groups, respectively. On multivariate analysis, tumour size, depth, omission of radiotherapy and bone invasion were found to be the adverse prognostic factors.

CONCLUSION

This is one of the largest studies on extremity synovial sarcoma. Mostly males and young adults were affected. The limb salvage rate was 64%, despite most being referred after unplanned surgery. Almost 70% of patients received radiotherapy and chemotherapy. Overall survival was inferior in the amputation group. Tumour size >5 cm, depth and bone invasion were negative, whereas adjuvant radiotherapy was a positive prognostic factor for survival. Chemotherapy had no impact on survival.

The uncommon preoperative diagnosis of a De Garengeot hernia and its more novel laparoscopic treatment

This case report involves an elderly woman who presented with a 3-day history of a tender groin swelling on her right side. Her admission bloods were fairly unremarkable, but a preoperative ultrasound impressively confirmed a femoral hernia containing the appendix (De Garengeot hernia) and she underwent emergency laparoscopic hernioplasty with a prosthetic mesh and appendicectomy. The procedure found an incarcerated hernia with a strangulated tip of the appendix that unexpectedly separated upon gentle manipulation and histopathology revealed appendiceal inflammation. There were no complications with the patient's recovery and she was discharged 2 days after surgery.

Evaluation of Stain Removal Efficacy and Color Stability of Three Different Dentifrices on Artificially Stained Enamel Surface-An In Vitro Study

AIM

The aim of the present study was to assess the stain removal ability and color stability of three distinct dentifrices on artificially stained enamel surface.

MATERIALS AND METHODS

This study included 75 intact, healthy premolars free of dental caries that were extracted during orthodontic therapy. The samples were allowed to dry for 6 hours after being submerged in the prepared tea solution for roughly 18 hours every day. Then this procedure was repeated for seven successive days. All samples were randomly divided into three experimental groups with 25 samples in each group. Group I: control dentifrice, group II: dentifrice containing hydrogen peroxide, group III: dentifrice containing papain and bromelain. A specially designed toothbrushing simulator was used to brush every sample in the relevant group. Using a spectrophotometer and a measurement program, color measurement was evaluated after staining process after 4 weeks and 8 weeks of teeth cleaning. Using a profilometer, the surface roughness values (Ra) were assessed.

RESULTS

After 8 weeks of brushing of stained samples, the color stability was better in dentifrice containing hydrogen peroxide (1.14 ± 0.11) followed by dentifrice containing papain and bromelain (1.22 ± 0.08) and control group (1.30 ± 0.09). And after 8 weeks of brushing of stained samples, the surface roughness was more in dentifrice containing hydrogen peroxide (0.237 ± 0.02) followed by dentifrice containing papain and bromelain (0.229 ± 0.13) and control group (0.207 ± 0.05).

CONCLUSION

The present study concluded that the dentifrice containing hydrogen peroxide showed a superior whitening effect on the stained enamel surface than dentifrice containing papain and bromelain and control dentifrice.

CLINICAL SIGNIFICANCE

The development of various dentifrice products has been greatly aided by the increased demand for an improved esthetic appearance. Teeth's natural color and any external stains that could accumulate on the tooth surface combine to determine a tooth's color. Additionally, the use of whitening dental pastes to remove external stains has grown in favor. With the development of these whitening toothpastes, dentifrices' ability to lessen or eliminate extrinsic dental stains has increased. How to cite this article: Mishra D, Kamath DG, Alagla M, et al. Evaluation of Stain Removal Efficacy and Color Stability of Three Different Dentifrices on Artificially Stained Enamel Surface-An In Vitro Study. J Contemp Dent Pract 2024;25(1):68-71.

CT coronary angiography as an alternative imaging method to ascertain cardiac output and its correlation with echocardiography

AIM

To assess the feasibility and accuracy of cardiac output (CO) obtained using a test bolus in patients scanned with single-source prospective-gated cardiac computed tomography (CT), and comparing it with CO obtained from unenhanced two-dimensional (2D) echocardiography using biplane Simpson's method.

MATERIALS AND METHODS

In the present study, 100 patients with a mean age of 55 ± 12 years who underwent coronary CT angiography with prospective electrocardiogram (ECG)-gated CT in which the scan delay was evaluated using a test bolus. The time-attenuation curves obtained from the test bolus were used to calculate the CO of the patients. The CO obtained was then compared with that obtained after follow-up 2D echocardiography using biplane modified Simpson method.

RESULTS

Linear regression was calculated between the CO and contrast enhancement: CO = -0.16(HUmax) + 7.65. The study showed good correlation between the two methods with r=0.77, p<0.001. On Bland-Altman analysis, no significant difference was noted between the two methods.

CONCLUSION

This less researched method for CO estimation appears feasible; however, the clinical usefulness of this parameter is uncertain in absence of further clinical and reference standard validation.

Bacterial production of recombinant contraceptive vaccine antigen from CatSper displayed on a human papilloma virus-like particle

CatSper is a voltage dependent calcium ion channel present in the principal piece of sperm tail. It plays a crucial role in sperm hyperactivated motility and so in fertilization. Extracellular loops of mouse sperm CatSper were used to develop a vaccine to achieve protection from pregnancy. These loops were inserted at one of the three hypervariable regions of Human Papilloma Virus (HPV) capsid protein (L1). Recombinant vaccines were expressed in E.coli as inclusion body (IB), purified, refolded and assembled into virus-like particles (VLP) in vitro, and adsorbed on alum. Four vaccine candidates were tested in Balb/C mice. All the constructs proved immunogenic, one showed contraceptive efficacy. This recombinant contraceptive vaccine is a non-hormonal intervention and is expected to give long-acting protection from undesired pregnancies.

Effect of Preoperative Volume Overload on Left Ventricular Function Recovery After Ventricular Septal Defect Repair

Significant left-to-right shunt across a ventricular septal defect (VSD) may lead to left ventricle (LV) volume overload and dilation. The acute loss of LV preload after repair of VSD may contribute to postoperative LV systolic dysfunction. The primary aim of the study is to assess the effect of presence of preoperative LV dilation on LV systolic function recovery after VSD repair. We evaluated the LV systolic function by measuring LV longitudinal strain and ejection fraction (EF) before surgery (time point 1) and at 5 time points after VSD repair (time point 2: 0 to 2 weeks, time point 3: 2 to 6 weeks, time point 4: 6 weeks to 4 months, time point 5: 4 to 12 months, and time point 6: >12 months). A total of 120 patients were included in the study cohort. A total of 84 patients (70%) had LV dilation (group 1) and 36 patients (30%) had normal LV size on preoperative echocardiogram (group 2). Median age (interquartile range 25% to 75%) at surgery was 5.5 months (4 to 10) and 7 months (5 to 44.5) in groups 1 and 2 respectively (p = 0.03). Mean LV EF and strain were not significantly different among the 2 groups at time point 1. At time point 2, both mean EF and strain were significantly lower in group 1 compared with group 2 (p <0.05). At time point 3, mean EF was not significantly different among the two groups, while mean LV strain was significantly lower in group 1 (p = 0.044). At time points 4, 5 and 6, mean EF and strain were not significantly different between the two groups. In conclusion, presence of preoperative LV dilation is associated with a more pronounced LV systolic dysfunction in the early postoperative period only. The LV systolic function recovers back to the baseline after the first year following the repair. These are very reassuring prognostic findings.

UNVEILING THE COMPLEX ROLE OF NF-ΚB IN ALZHEIMER'S DISEASE: INSIGHTS INTO BRAIN INFLAMMATION AND POTENTIAL THERAPEUTIC TARGETS

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline and dementia. One of the major pathologies underlying AD is chronic neuroinflammation mediated by microglia and astrocytes in the brain. The nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signalling pathway is a key regulator of inflammation and has been implicated in the neuroinflammatory processes associated with AD. This review comprehensively summarizes current findings on the complex role of NF-κB signalling in AD pathogenesis. The canonical and non-canonical NF-κB activation pathways are described, along with evidence from human studies and animal models demonstrating increased NF-κB activity in AD brains. The deleterious effects of NF-κB-mediated neuroinflammation are discussed, including the upregulation of inflammatory cytokines, chemokines, and enzymes that exacerbate neuronal damage over time. Targeting the NF-κB pathway is proposed as a promising therapeutic approach to dampen neuroinflammation in AD. Preclinical studies utilizing genetic or pharmacological inhibition of NF-κB are reviewed, and key challenges in translating these findings to clinical applications are analyzed. Overall, this review unveils the multifaceted contributions of NF-κB signalling to AD neuropathology and highlights anti-neuroinflammatory NF-κB modulation as a potential avenue for future AD treatments. Further research is warranted to fully elucidate the complex interactions between NF-κB and AD pathogenesis.

Post-COVID-19 vaccine uveitis: A case series

OBJECTIVE

With the recent emergence and worldwide distribution of COVID-19 vaccines, many side effects may be underreported and possibly unknown. Cases of vaccine-associated uveitis have been linked to almost all vaccines administered in the past; however, there is scarcity of literature providing insight into post-COVID-19 vaccine-associated uveitis. This case series documents patients presenting with uveitis after administration of the Pfizer and Moderna mRNA vaccines, in hope of advancing our current understanding of potential ocular complications of COVID-19 vaccines.

METHODS

Patients with ocular symptoms consistent with uveitis within 14 days after administration of the Pfizer or Moderna COVID-19 vaccines were included in this case series.

RESULTS

Eight patients with a mean age of 44.4 years (range, 19-83) were included. Six patients received a Pfizer, and 2 received a Moderna vaccine. Four patients presented after their first dose, 3 after their second dose, and 1 after both doses. The mean onset of ocular symptoms after the vaccine was 5.19 days (range, 1-14), and the mean BCVA was 0.678. Patients were diagnosed with bilateral anterior granulomatous uveitis (case 1), unilateral non-granulomatous anterior uveitis (case 2, 5-8), and bilateral non-granulomatous anterior uveitis (case 3-4).

CONCLUSIONS

The pathogenesis of vaccine-induced uveitis is not properly understood; however, the outcomes of this case series will aid in establishing a temporal association between the Pfizer and Moderna COVID-19 vaccines and the onset of uveitis. As the rate of COVID-19 vaccinations increases globally, it is imperative for physicians to be aware of the possible association and presentation of these ocular findings and diagnoses in order to treat patients effectively.

Impact of smallholder cattle farms on the environment: a study

With increasing evidence of global warming, the pressure is building to limit greenhouse gas emission from many human activities including dairy production systems. In this context, the present study was conducted to estimate the carbon footprint (CF) of cattle milk produced in the Hisar district of Haryana, India. The data about feeding practices, crops grown, manure management systems, etc. was collected through personal interviews with cattle-rearing rural male farmers chosen through multistep random sampling. The life cycle assessment (LCA) methodology was adopted to estimate carbon footprint, with the system boundary being "Cradle to farm gate." The latest methodologies prescribed by the IPCC were used to estimate GHG emissions using the tier-2 approach. The current study has presented a detailed and recent GHG inventory from smallholder cattle farms at the village level. On the basis of the inventory analysis, a simplified life cycle-based analysis is used in order to quantify the carbon footprint of fat- and protein-corrected milk (FPCM). The carbon footprint of cattle milk was estimated at 2.13 kg CO₂-eq/kilogram FPCM. Enteric fermentation was the most potent contributor to GHG, contributing around 35.5% of the total emissions, followed by manure management (13.8%) and soil management (8.2%). Further studies to accurately estimate carbon footprint are advocated besides suggesting ways to reduce GHG emissions and using efficient production technologies.

Evolution of neural network to deep learning in prediction of air, water pollution and its Indian context

The scenario of developed and developing countries nowadays is disturbed due to modern living style which affects environment, wildlife and natural habitat. Environmental quality has become or is a subject of major concern as it is responsible for health hazard of mankind and animals. Measurements and prediction of hazardous parameters in different fields of environment is a recent research topic for safety and betterment of people as well as nature. Pollution in nature is an after-effect of civilization. To combat the damage already happened, some processes should be evolved for measurement and prediction of pollution in various fields. Researchers of all over the world are active to find out ways of predicting such hazard. In this paper, application of neural network and deep learning algorithms is chosen for air pollution and water pollution cases. The purpose of this review is to reveal how family of neural network algorithms has applied on these two pollution parameters. In this paper, importance is given on algorithm, and datasets used for air and water pollution as well as the predicted parameters have also been noted for ease of future development. One major concern of this paper is Indian context of air and water pollution research, and the research potential presents in this area using Indian dataset. Another aspect for including both air and water pollutions in one review paper is to generate an idea of artificial neural network and deep learning techniques which can be cross applicable for future purpose.

Perception of dental students regarding possible career challenges and associated factors towards working in rural areas: A questionnaire based survey

OBJECTIVE

The shortage of health care professionals in rural areas contributes toward discriminatory health care delivery. The present study was planned with a similar intent and aimed to evaluate the perception of dental students regarding their future in rural areas.

MATERIALS AND METHODS

The present study was designed as a cross-sectional study comprising of a 30-item questionnaire survey instrument distributed among a total of 550 dental students while the results obtained were subjected to statistical analysis. Statistical analysis was done using SPSS version 12.0 (SPSS Inc., Chicago, IL, USA). Independent student's t-test and one-way analysis of variance (ANOVA) were used for comparison among the variables while the Chi-square test was used to determine the association between the variables. P < 0.05 was considered statistically significant.

RESULTS

No significant difference was observed in the attitude based on gender (P = 0.43), although, a statistically significant difference was observed in the attitude of students based on the year of their education with a positive attitude toward rural dental practice generally noted in the first year Bachelor of Dental Surgery (BDS) students which significantly declined with the increasing level of education (P = 0.01).

CONCLUSIONS

Dental students were more influenced by the negative aspects of rural dental practice though they had, in their mind, a positive approach for the same at the beginning of their education, but this significantly declined with the increasing level of their education.

Development of a Quartz-Based Photo-Mobile Polymer Film for Controlled Motion Triggered by Light or Heat

We have developed a photo-mobile polymer film, that combines organic and inorganic materials, to allow for controlled motion that can be triggered by light or heat. Our film is made using recycled quartz and consists of two layers: a multi-acrylate polymer layer and a layer containing oxidized 4-amino-phenol and N-Vinyl-1-Pyrrolidinone. The use of quartz in our film also gives it a high temperature resistance of at least 350 °C. When exposed to heat, the film moves in a direction that is independent of the heat source, due to its asymmetrical design. Once the heat source is removed, the film returns to its original position. ATR-FTIR measurements confirm this asymmetrical configuration. This technology may have potential applications in energy harvesting, due to the piezoelectric properties of quartz.

Prevalence and Predictors of Depression, Anxiety and Stress among Elderly during COVID-19: A Cross-sectional Study from Central India

During the COVID-19 pandemic, elderly people have been more prone to depression, anxiety and stress. During these trying times, they require more attention and support for their mental health. This cross-sectional study was performed with the duration of 06 months from March 2021 to August 2021 in AIIMS, Bhopal in the state of Madhya Pradesh, in central India. And the participants recruited by systematic random sampling from a population aged more than 60 years, those who were able to read and write Hindi or English and having at least one family member; who reported to AIIMS, Bhopal during the second wave of COVID-19 in India. Those who were confirmed COVID-19 cases and undergoing treatment for the same, with diagnosed mental health disorders and who didn't give consent were excluded. A Google form based online semi-structured questionnaire along with DASS-21 scale was completed by participants. Elderly (>=60 years) will be selected. Of the 690 participants 7.25% reported mild to moderate depression, whereas 0.58 percent had severe or extremely severe depression. Mild to moderate anxiety were found in 9.56% of people, while 2.46% had severe or extremely severe anxiety. Mildly or moderately were stressed 4.78%, while 0.42% was severely or extremely anxious. Alcoholism and depression were found to have a statistically significant relationship (p=0.028). During the COVID-19 pandemic, elderly subjects who napped during the day were substantially less depressed (p=0.033). The older the respondents were, the more nervous they were during the pandemic (p=0.042). There is a link between alcohol consumption and stress (p=0.043) and it was seen that females were more stressed as compared to males (p=0.045). There was a strong correlation between participants' alcohol addiction and depressive symptoms. Psychological therapies for the elderly are thought to be necessary to enhance their psychological resilience and mental health. We need to tackle the stigma related to the COVID-19 and mental health issues.

Light-Controlled Rotational Speed of an Acoustically Levitating Photomobile Polymer Film

In this work, we study the light-induced changes of the rotational speed of a thin photomobile film using a single-axis acoustic levitator operating at 40 kHz. In our experiments, a 50 μm thick photomobile polymer film (PMP) is placed in one of the nodes of a stationary acoustic field. Under the action of the field, the film remains suspended in air. By externally perturbing this stable equilibrium condition, the film begins to rotate with its natural frequency. The rotations are detected in real time by monitoring the light of a low power He-Ne laser impinging on and reflected by the film itself. During the rotational motion, an external laser source is used to illuminate the PMP film; as a consequence, the film bends and the rotational speed changes by about 20 Hz. This kind of contactless long-distance interaction is an ideal platform for the development and study of many electro-optics devices in microgravity and low-friction conditions. In particular, we believe that this technology could find applications in research fields such as 3D dynamic displays and aerospace applications.

Effect of endogenous hormones, antisperm antibody and oxidative stress on semen quality of crossbred bulls

The present study was designed to evaluate the effect of factors like hormones, antisperm antibody (ASA), and oxidative stress and its relation with semen quality in crossbred bulls. Ejaculates from two bulls were categorized into good (n = 12) and poor (n = 12) based on initial progressive motility, that is, ≥70% and ≤50%, respectively. The level of hormones like Testosterone (p < 0.05) and PGE₂ (p < 0.01) was significantly higher in good-quality ejaculates compared to poor-quality ejaculates; however, estradiol (p < 0.05), progesterone, oxidative stress, and ASAs were significantly higher (p < 0.01) in poor-quality ejaculates compared to good-quality ejaculates. Therefore, it could be concluded that oxidative stress and hormonal imbalance might have resulted in high number of dead and defective spermatozoa which was ultimately responsible for poor quality semen ejaculates.

An audit to review high risk asthma patients with over-use of short-acting beta-agonist inhalers

Introduction

The UK National Review of Asthma deaths (NRAD)1 has shown that the over-prescribing of Short Acting Beta Agonist’s (SABA) inhalers is a risk factor for exacerbation and death in asthmatic patients. A quality improvement audit was identified as a priority to review practice performance in line with national guidelines.2,3

Aim

The aim was to identify patients on the asthma register who were prescribed 12 or more SABA inhalers within the preceding 12 months and investigate any reasons for overuse. Additionally, patients were highlighted for review to optimise management in line with national recommendations2,3.

Methods

A search run in a GP practice highlighted high-risk patients on the asthma register prescribed 12 or more SABAs in the preceding 12 months. Audit criteria were defined to assess if 100% of patients had a completed annual asthma review. Patients who were not asthmatics or undergoing investigations for a potential diagnosis of chronic obstructive pulmonary disease (COPD) were excluded. Phase 1 of the audit was notes-based data-collection on recent asthma reviews and reasons for potential overuse. In Phase 2, patients were contacted prioritising those overdue a review. During contact, the Asthma Control Test, checking inhaler technique, discussing any reasons for SABA over-use and patient education on their inhalers were all discussed. Patients requiring treatment optimisation or a follow-up review were highlighted for referral to various members of the multidisciplinary team. This audit did not require ethical approval.

Results

42 out of 988 patients with asthma were identified as being issued more than 12 SABA’s in the preceding 12 months. 1 patient was excluded due to having a diagnosis of COPD. Out of the remaining 41 patients, 16 patients had already had an up to date annual asthma review prior to the search. 13 patients were contacted and referred to the pharmacist or asthma nurse for a review. As a result of the audit, a total of 29 patients had an asthma review conducted. 12 patients were unable to be contacted and follow-up remains outstanding. A number of themes were highlighted during the audit such as patients using the incorrect dose or inhaler, lack of understanding on how the inhaler worked, requests for spare inhalers, absence/lack of using an inhaled corticosteroid (ICS) and worsening asthma.

Discussion/Conclusion

The audit successfully identified reasons for SABA overuse and using the multidisciplinary team to educate patients and optimise medication where needed. Following this audit, the practice has reviewed cohorts of patients that are at high risk of exacerbations and implemented quarterly safety searches to highlight these for review on a regular basis. Two further audits were also identified to improve practice in line with updated national guidance; patients prescribed a SABA alone without an ICS and patients prescribed a Long-acting beta-agonist (LABA) alone without an ICS.

References

1. Royal College of Physicians. Why asthma still kills: the National Review of Asthma Deaths (NRAD) Confidential Enquiry report.2014. [cited 2022 Jul 15] Available from: http://www.rcplondon.ac.uk/sites/default/files/why-asthma-still-kills-full-report.pdf .

2. National Institute for Health and Care Excellence. Asthma: diagnosis, monitoring and chronic asthma management [internet]. [London] NICE; 2017 [updated 2021 Nov; cited 2022 Jul 15]. NICE Guideline 80 [NG80] Available from: https://www.nice.org.uk/guidance/ng80/chapter/Recommendations-for-research

3. British Thoracic Society, Scottish Intercollegiate Guideline Network. SIGN 158 - The British Guideline on the Management of Asthma. 2019. [Internet]. [London] [cited 2022 July 15]. Available from: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/asthma.

Development of bamboo- (Bambusa bambos) based bio-fence to protect field crops: Insights from a study in India's Bundelkhand region

Stray/wild animals can cause serious damages to crops, leading to accusations and counter accusations among villagers. In the Bundelkhand region of India, this problem is more severe due to “Anna Pratha,” that is, letting loose animals to open graze. Protective measures employed by farmers (barbed wire fencing, conventional fencing, etc.) are not fully effective and also require periodical maintenance, which involves additional costs and manpower. This necessitates the evolution of a cost-effective and long-term solution to minimize the problem. The current study seeks to evaluate the potential of thorny bamboo (Bambusa bambos) as a bio-fence creating deterrence to stray/wild animals at the ICAR—IISWC RC, the research farm of Datia, Madhya Pradesh, India. After 21 months of planting, bamboo plants attained the maximum plant height up to 4.47 m with the highest clump spread diameter of 30.50 cm. However, the growth of the bamboo bio-fence to be effective depends on the edaphic and management conditions. The findings revealed that planting bamboo at a distance of 80.00 cm in the continuous trench can be an effective bio-fence to avoid man–animal conflict. Huge crop losses were reported before the establishment of a bio-fence. In 2021–2022 (when bamboo plants turned into a closely spaced thicket, making a bio-fence), only two incidents of the invasion of animals were reported with no crop damage. The initial cost to develop a bamboo bio-fence was estimated at INR 5,796 for a length of 100 m. Therefore, the present study suggests that bamboo bio-fencing is an economical and effective crop protection measure against damage by wild/stray animals.

The impact of chronic obstructive pulmonary disease on right ventricular dysfunction and remodeling after aortic valve replacement

Background

Chronic obstructive pulmonary disease (COPD) is one of the most common comorbidities in patients with aortic stenosis (AS) and has been associated with a poor prognosis after both transcatheter and surgical aortic valve replacement (AVR). Since COPD is associated with an increase in right ventricular (RV) afterload, some studies already suggested that COPD causes RV dysfunction (RVD) and dilatation. On the other hand, RVD and remodeling can also occur due to chronic pressure overload secondary to the AS itself. However, there is no data that studied RVD and remodeling in AVR recipients in terms of COPD severity.

Purpose

We aimed to evaluate the impact of COPD on RVD and remodeling in patients with severe AS undergoing AVR before AVR and at 1-year follow-up, as well as the association between COPD severity and all-cause mortality.

Methods

Patients with severe AS who received either transcatheter or surgical AVR were included. Patients' demographic data, medical history and documented spirometry data were carefully collected, while two-dimensional and speckle tracking echocardiography measurements were performed according to recommended guidelines to evaluate RV systolic function and RV size. RVD was defined as tricuspid annular plane systolic excursion (TAPSE) ≤17mm. RV dilatation was defined by RV mid cavity &gt;35 mm, RV basal diameter &gt;42mm, and RV longitudinal diameter &gt;83mm. RV wall thickness above 5mm was considered as RV hypertrophy. Diagnosis of COPD was determined by the Society of Thoracic Surgeons' definition based on forced expiratory volume in first second (FEV 1&lt;75%, cut-off for COPD). The primary outcome was all-cause death at 1-year.

Results

A total of 293 patients (78.0 years, 58.4% male) were included. RVD was detected in 54 (18.4%) patients, while 55 (18.8%) patients had mild COPD and 43 (14.7%) patients had moderate or severe COPD. At 1-year follow-up, the prevalence of RVD significantly increased (18.4% versus 23.6%, p=0.004). Compared to baseline, RV free wall strain of lateral basal segment (p=0.046), TAPSE (p&lt;0.0001) and tricuspid regurgitation gradient (p=0.018) impaired whereas RV wall thickness (p=0.014), RV diameter index of lateral basal segment (p&lt;0.0001), and RV diameter index of lateral mid segment (p&lt;0.0001) increased, respectively. At 1-year follow-up, 33 patients died (Figure 1). On multivariate cox regression analysis, RVD (hazard ratio (HR) 2.781, 95% confidence interval (CI) 1.172–6.598; p=0.020) as well as mild (HR 4.695, 95% CI 1.787–12.336; p=0.002) and moderate-severe COPD (HR 4.725, 95% CI 1.717–13.006; p=0.003) were significantly associated with the endpoint (Table 1).

Conclusions

The prevalence of RVD significantly increased and it deteriorated at 1-year after AVR. RV remodeling observed more at lateral basal and mid segments of RV as well as wall thickness. RV dysfunction and COPD were the strongest predictors of mortality in this population.

Funding Acknowledgement

Type of funding sources: None.

Association between chronic obstructive pulmonary disease and all-cause mortality after aortic valve replacement for aortic stenosis

Introduction

Chronic obstructive pulmonary disease (COPD) and aortic stenosis (AS) are the most common diseases in aging population that their prevalence and percental change in mortality increase over the years. In severe AS, aortic valve replacement (AVR) is the only treatment that has demonstrated to improve survival, however the presence of comorbidities increases the operative risk and influences negatively on the outcomes after AVR. Therefore, the definition of COPD varies across the studies and is not always based on the use of pulmonary functional tests. Accordingly, the aim of the present study is to evaluate the association between pulmonary functional parameters and all-cause mortality after AVR in a large cohort of patients with severe AS.

Methods

Total of 400 patients (78.0 year-old, 56.7% men) with severe AS and documented preoperative pulmonary functional test (PFT) were retrospectively analyzed. Demographic and clinical characteristics were collected from electronic medical records while echocardiography was performed and measured according to the recommendations. PFTs were performed prior to AVR and categories defined in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database: normal pulmonary function was defined by an FEV1 &gt;75% of predicted; mild COPD if FEV1 was 60–75% of predicted; moderate COPD if FEV1 was 50–59% of predicted and severe COPD when FEV1 &lt;50% of predicted.

Results

Mild, moderate and severe COPD were documented in 75 (19%), 31 (8%) and 22 (5%) while the remaining 68% had normal PFTs. Patients with moderate and severe COPD had significantly larger LV mass and LV end-systolic volume whereas LV ejection fraction was significantly lower. The FVC, FEV1, Tiffeneau index, VC, PEF, and IC were the worst among patients with moderate and severe COPD (per definition) (p&lt;0.0001). Over a median follow-up of 32 months, 92 (23%) patients died. The survival rates were significantly lower in patients with moderate and severe COPD (Log rank p=0.003, Figure 1). In multivariable Cox regression analysis, some clinical factors and COPD were independently associated with all-cause mortality (table 1). Remarkably, any grade of COPD was associated with 2-fold increased risk of all cause-mortality (HR 1.933; 95% CI 1.166–3.204; p=0.011 for mild COPD and HR 2.028; 95% CI 1.154–3.564; p=0.014 for moderate/ severe COPD, separately).

Conclusion

Patients with moderate and severe COPD had higher LV hypertrophy and reduced LV ejection fraction while PFT parameters were the worst among these patients. The survival rates were significantly lower in patients with moderate and severe COPD compared with patients without COPD. In addition to other clinical factors, any grade of COPD was associated with 2-fold increased risk of all cause-mortality.

Funding Acknowledgement

Type of funding sources: None.

Light-Controlled Direction of Distributed Feedback Laser Emission by Photo-Mobile Polymer Films

We report on the realization of Distributed Feedback (DFB) lasing by a high-resolution reflection grating integrated in a Photomobile Polymer (PMP) film. The grating is recorded in a recently developed holographic mixture basically containing halolakanes/acrylates and a fluorescent dye molecule (Rhodamine 6G). The PMP-mixture is placed around the grating spot and a subsequent curing/photo-polymerization process is promoted by UV-irradiation. Such a process brings to the simultaneous formation of the PMP-film and the covalent link of the PMP-film to the DFB-grating area (PMP-DFB system). The PMP-DFB allows lasing action when optically pumped with a nano-pulsed green laser source. Moreover, under a low-power light-irradiation the PMP-DFB bends inducing a spatial readdressing of the DFB-laser emission. This device is the first example of a light-controlled direction of a DFB laser emission. It could represent a novel disruptive optical technology in many fields of Science, making feasible the approach to free standing and light-controllable lasers.

TH7.5 De Garengeot hernia: a combination of niche presentation, diagnostic, and anatomical factors

Background

De Garengeot hernias occur in almost 1% of femoral hernias and are diagnosed when the appendix is also present within. They are more commonly observed in post-menopausal women, but their pathogenesis remains controversial. Theories involve abnormalities in bowel rotation during embryological growth, caecum mobility or size, and increased abdominal pressure. Most are diagnosed intra-operatively and are otherwise incidentally discovered on imaging. An advised surgical technique has not been determined due to its rarity; however, most literature suggests laparoscopic hernioplasty and appendicectomy in absence of infection.

Case report

A 77-year-old female presented with a three-day history of a painless, right groin mass. Blood results were within normal range, and sonography identified a De Garengeot hernia suggesting appendiceal inflammation. She underwent emergency laparoscopic surgery that discovered a strangulated appendiceal tip within an incarcerated femoral hernia, which then unexpectedly divided during manipulation. Additional findings included a broad mesoappendix and lack of appendicitis. The team proceeded with a hernioplasty and appendicectomy, and the patient was discharged two days later without complications.

Conclusion

This case report highlights a few niche aspects of De Garengeot hernias. Firstly, it is unusual our patient's diagnosis occurred preoperatively via ultrasound; secondly, the ischaemic tip of the appendix unexpectedly self-detached upon mobilisation; and thirdly, the widened mesoappendix likely contributed towards her predisposition to De Garengeot hernias. Overall, our case represents laparoscopic surgery being optimal in treating De Garengeot hernias that are diagnosed preoperatively, and that they should remain a differential diagnosis for non-specific groin lumps, regardless of pain.

TH2.7 Pancreatitis and Cancer. An evaluation of clinical practice with focus on links to the development of pancreatic cancer

Aim

Pancreatitis is a common surgical pathology that burdens all healthcare systems. Acute or chronic presentations require dedicated resources and evidence-based management. Literature suggests increased risk of cancer is two-fold with acute and up to 8-fold with chronic pancreatitis. Our study aims: 1. Assess current practice against NCEPOD 2016 guidelines, 2. Explore the incidence of cancer.

Method

Prospectively collected electronic records and clinical systems were interrogated from Jan 2015 to Feb 2018. Data was collected on patient demographics, analytics, clinical outcomes and follow up. All patients and hospital episodes’ data were included.

Results

Over the 3 years, 337 patients presented with a male: female ratio of 1:1. Median age was 61.2 (IQR 51.3–74.4). Diagnosis was acute pancreatitis 82% and chronic 18%. Aetiology was biliary 63%, alcohol-related 20% and idiopathic 10%. Ca19–9 was performed in 10% overall; and IgG4 in 10% of unknown aetiology. Ultrasound scan within 24 hours performed in 62% (improved to 79% on re-audit after an educational campaign). Within the study period, 120 patients completed 5 years follow up. 4 patients developed cancer: 3 (1.1%) in acute group and 1 (1.6%) in chronic pancreatitis group. All had Ca19–9 levels done at initial presentation with values of 6310, 19, 14 and 239u/ml respectively.

Conclusions

Compliance with guidelines is improved through awareness and clinical focus, to the benefit of patients. Pancreatitis can be an early marker of cancer, and Ca 19–9 (best validated serum tumour marker) may help clinical suspicion. Larger multi-centred collaborations may further the knowledge base.

SARS-CoV-2 Seroprevalence in Delhi, India, During September-October 2021: A Population-Based Seroepidemiological Study

Background

A previous community-based severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serosurvey in Delhi in January 2021 reported a seroprevalence of 50.52%. We conducted a repeat serosurvey to obtain a recent estimate of the seroprevalence of IgG SARS-CoV-2 in the general population of Delhi, India.

Methods

This cross-sectional study was conducted from September 24 to October 14, 2021, in 274 wards of Delhi among 27,811 participants through a multistage sampling technique.

Results

The crude seroprevalence was 89.5% (95% CI 89.1, 89.8), weight for age and sex was 88% (95% CI 87.6, 88.4), and after adjustment for assay performance was estimated as 97.5% (95% CI 97.0, 98.0). On adjusted analysis, the odds of seroconversion in the participants vaccinated with at least one dose of either COVID-19 vaccine (Covishield/Covaxin) was more than four times compared to the unvaccinated ones (aOR 4.2 (3.8, 4.6)). 86.8% of the seropositive individuals had a SARS-CoV-2 signal/cut-off ≥4.0 although it was significantly lower in the pediatric age group. Post-second wave (August to October 2021), on average there were daily 39 new COVID-19 cases and 0.44 deaths which during Omicron driven the third wave in January to March 2022 increased to daily 4,267 cases and 11.6 deaths.

Conclusion

A high prevalence of IgG antibodies against SARS-CoV-2 with likely higher antibody titres in the vaccinated compared to the unvaccinated groups with evidence of hybrid immunity in a majority of the population was protective against severe disease during transmission of subsequent omicron variants.

COVID-19 Vaccine Acceptance and Its Determinants in the General Population of Delhi, India: A State Level Cross-Sectional Survey

Objective: To ascertain the COVID-19 vaccination acceptance and the factors contributing to vaccine hesitancy and vaccine confidence in the adult population, and the intention for vaccination of their children.

Methods: This cross-sectional analysis reports the ancillary results of a population-based SARS-CoV-2 serosurvey conducted in Delhi, India, from September 24 to October 14, 2021. Data were collected from 20312 adult participants through a multistage sampling method from all the 274 wards in the 11 districts of the national capital territory region.

Results: We enrolled 12093 (59.3%) females and 8219 (40.5%) male participants with mean (SD) age of 40.3 (14.6) years. The vaccine acceptance rate in the participants was 67.7% (95% CI 67.1, 68.4), with 6031 (43.8%) having received one dose and 7727 (56.2%) having received two vaccine doses. On adjusted analysis, lack of vaccine acceptance was independently associated with female gender aOR 1.15 (95% CI 1.1, 1.23), younger age-group (18-49 years) aOR 1.85 (95% CI 1.71, 2.0), low educational status aOR 1.88 (95% CI 1.77, 2.0), in those with no history of COVID-19 aOR 1.81 (95% CI 1.69, 1.95), non-healthcare workers aOR 2.1 (95% CI 1.7, 2.53), and in the absence of hypertension comorbidity aOR 1.22 (1.1, 1.38). Lack of awareness of COVID-19 vaccines, including doubts on vaccine efficacy and long-term safety, were primary drivers of vaccine hesitancy in the unvaccinated subgroup. Only 35.6% participants reported a positive intention to vaccinate their children.

Conclusions: One in three adults lacked vaccine acceptance. High prevalence of delay in second dose vaccination was also observed.

POS1166 GOUT AND SERIOUS KIDNEY DISEASE IN THE US: A NATIONAL PERSPECTIVE

Background

There is a strong association between gout and kidney disease due to the kidney’s key role in uric acid excretion.1-4 Several studies have also demonstrated that serum uric acid is an independent risk factor for decline in renal function1,2. There are little national data available regarding the clinical burden of kidney disease in gout patients in the US.

Objectives

To estimate the percentage of US hospitalizations with a concomitant diagnosis of gout and either acute or chronic kidney disease compared with percentage of hospitalizations with kidney disease in the general population.

Methods

The Nationwide Inpatient Sample (NIS) is a stratified random sample of all US community hospitals. It is the only US national hospital database with information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. Detailed information including clinical and nonclinical data elements on each hospital stay including International Classification of Diseases (ICD) 10 diagnosis, age, gender, length of stay, payer, charges, and comorbidities etc. is available.

We examined all hospitalizations with acute renal failure (ICD10 codes N170-179), chronic kidney disease stages 3-5 (ICD10 codes N183-185), N19 (unspecified kidney failure), and end-stage renal disease (ICD10 code N186) in persons with gout (ICD 10 codes M10.* and M1A.*) and compared these with hospitalizations with kidney disease in the general US population.

Results

In 2019, there were 35.4 million all-cause hospitalizations in the US. Of these, 7.9 million had a diagnosis of serious kidney disease (22.3%). There were 915,070 hospitalizations with primary or secondary diagnosis of gout in the US (mean age 70.8 years, 68.4% men and 31.6% women). Of these 533,365 hospitalizations (mean age 72.6 years, 65.9% men) also had a concomitant diagnosis of serious kidney disease (58.3%, p<0.0001 compared to general population).

Concomitant diagnosis of serious kidney disease increased with age, reaching 38.3% of all hospitalizations in 65 years and older in the general population compared to 62.5% in persons with gout (p<0.001).

Table 1.

Kidney disease-related hospitalization in the US general and gout populations.

GENERAL US HOSPITALIZATIONSUS HOSPITALIZATIONS WITH COMORBID GOUTPatient AgeOverall HospitalizationsNHospitalizations with Serious Kidney Diseasen (%)Overall HospitalizationsNHospitalizations with Serious Kidney Disease n (%)18-44 years8,356,284622,170 (7.4%)32,44513,480 (41.5%)45-64 years8,440,8312,160,220 (25.6%)232,695116,490 (50.1%)≥65 years13,421,1545,257,220 (39.2%)649,865414,620 (83.8%)Total in 201935,419,0237,907,730 (22.3%)915,070533,365 (58.3%)

Note: Total numbers include patients 0-17 years old.

Conclusion

Acute and chronic kidney disease are highly prevalent comorbid conditions in overall US hospitalizations. Among patients admitted with a diagnosis of gout, the proportion of kidney dysfunction is significantly higher affecting 58% of these hospitalizations. The high prevalence of kidney dysfunction in hospitalized gout patients in the US may represent an impactful component to the duration, complexity, and costs of hospital care.

References

[1]Jung SW, et al. Am J Physiol Renal Physiol 2020;318:F1327-40.

[2]Obermayr RP, et al. J Am Soc Nephrol 2008;19:2407-13.

[3]Roughley MJ, et al. Arthritis Res Ther 2015;17:90.

[4]Juraschek SP, et al. Semin Arthritis Rheum 2013;42:551-61.

Disclosure of Interests

Gurkirpal Singh Grant/research support from: Horizon Therapeutics (unrestricted research grant), Maanek Sehgal: None declared, Brad Marder Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Brian LaMoreaux Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Alka Mithal: None declared

Study of factors leading to poor sleep among management students

Sleep is the most important but often neglected element of an individual’s overall health and well-being. Lack of sleep or poor sleep can adversely affect health in an individual and lead to various diseases. At the same time, sleep problems are not uncommon among students. The factors leading to poor sleep among management students who have a comparatively tight schedule are still unclear. The paper aims to understand the factors leading to poor sleep among management students. The study has been focused on the management students (MBA’s) studying in the different management colleges of the state of Maharashtra. A total of 297 management students were surveyed. Apart from factor analysis, the Kessler distress scale was used for Measuring Psychological distress.52% of the respondents fell in the category of likely to have a mental disorder. Managements can draw inference from this and implement strategies to make sure this number reduces.

Longitudinal Trends in Body Mass Index for Adults with Congenital Heart Disease

Obesity is a modifiable, independent risk factor for adverse long-term outcomes in children and adults. Our objective was to determine the prevalence of overweight and obese status in a cohort of adults with congenital heart disease (CHD) as well as to assess longitudinal trends over a 20-year period. The study group consisted of patients 18 years of age and older followed at our adult CHD clinic. Body mass index (BMI) data were collected from our index period, consisting of patient encounters from 2009 to 2012 (Period 2), as well as during 2000-2003 (Period 1) and 2017-2020 (Period 3) when available. The study cohort was subdivided into three groups per published guidelines: simple, moderate, and greater CHD complexity. The prevalence of obesity and overweight status was compared among the different groups as well as with published data (NHANES). Our cohort in Period 2 consisted of 261 subjects. The median age (25-75% interquartile range) for Period 2 was 27.6 (21.1-35.9) years and BMI was 25.2 (21.7-30.0) kg/m² with 8.0% underweight, 40.0% with normal weight, 27.0% overweight, and 25% obese. 95 patients had follow-up data from each time period, with 96% of patients having moderate or greater complexity of CHD. The combined percentage of overweight and obese patients for the moderate and greater complex CHD groups increased from 42 and 37% in period 1 to 60% and 65% in period 3, respectively. The percentage of obese patients with moderate and greater CHD complexity increased by 250% and 55%, respectively, from Period 1 to 3. Our study cohort had a high prevalence of overweight and obese weight status. Given adults with CHD have high baseline cardiovascular morbidity, the presence of obesity can increase their risk for poor outcomes, highlighting the need for prevention of this modifiable risk factor.

Light-Induced Dynamic Holography

Holographic photomobile polymers (H-PMP) are a novel class of photomobile materials in which holograms can be optically recorded. They can be used in a large variety of applications, including optical switches and color selectors. In this work, we show one of the most important properties of the photomobile film, which is the photophobicity of the unpolymerized parts of the photomobile mixture. In order to investigate this property, we recorded a transmission phase grating on an H-PMP film, and used a different experimental technique to measure the diffraction efficiency, surface tension, and mixture properties. The results allowed for a better understanding of the mechanism of the light-controlled bending observed in these compounds.

A highly virulent variant of HIV-1 circulating in the Netherlands

We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log₁₀ increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.

Interplay between inter- and intraparticle interactions in bi-magnetic core/shell nanoparticles

The synthesis strategy and magnetic characterisation of two systems consisting of nanoparticles with core/shell morphology are presented: an assembly of hard/soft nanoparticles with cores consisting of magnetically hard cobalt ferrite covered by a magnetically soft nickel ferrite shell, and the inverse system of almost the same size and shape. We have successfully designed these nanoparticle systems by gradually varying the magnetic anisotropy resulting in this way in the modulation of the magnetic dipolar interactions between particles. Both nanoparticle systems exhibit high saturation magnetisation and display superparamagnetic behaviour at room temperature. We have shown strong exchange coupling at the core/shell interface of these nanoparticles systems which was also confirmed by mesoscopic modelling. Our results demonstrate the possibility of modulating magnetic anisotropy not only by chemical composition but also by adopting the proper nano-architecture.

COVID-19-associated mucormycosis presenting to the Emergency Department-an observational study of 70 patients

BACKGROUND

Mucormycosis (MM) is a deadly opportunistic fungal infection and a large surge in COVID-19-associated mucormycosis (CAM) is occurring in India.

AIM

Our aim was to delineate the clinico-epidemiological profile and identify risk factors of CAM patients presenting to the Emergency Department (ED).

DESIGN

This was a retrospective, single-centre, observational study.

METHODS

We included patients who presented with clinical features or diagnosed MM and who were previously treated for COVID-19 in last 3 months of presentation (recent COVID-19) or currently being treated for COVID-19 (active COVID-19). Information regarding clinical features of CAM, possible risk factors, examination findings, diagnostic workup including imaging and treatment details were collected.

RESULTS

Seventy CAM patients (median age: 44.5 years, 60% males) with active (75.7%) or recent COVID-19 (24.3%) who presented to the ED in between 6 May 2021 and 1 June 2021, were included. A median duration of 20 days (interquartile range: 13.5-25) was present between the onset of COVID-19 symptoms and the onset of CAM symptoms. Ninety-three percent patients had at least one risk factor. Most common risk factors were diabetes mellitus (70%) and steroid use for COVID-19 disease (70%). After clinical, microbiological and radiological workup, final diagnosis of rhino-orbital CAM was made in most patients (68.6%). Systemic antifungals were started in the ED and urgent surgical debridement was planned.

CONCLUSION

COVID-19 infection along with its medical management have increased patient susceptibility to MM.

Postprandial endothelial dysfunction and CIMT after oral fat challenge in patients with type 2 diabetes mellitus with and without macrovascular disease - A preliminary study

BACKGROUND

Very few studies have reported on association of postprandial lipids and endothelial dysfunction among patients with diabetes. Whether endothelial dysfunction particularly postprandial FMD is worse in patients with T2DM with macrovascular disease compared to those without and whether this difference is related to postprandial hypertriglyceridemia (PPHTg) is unclear. Therefore, present study was aimed to assess the relationship between PPHTg and endothelial function in patients with T2DM with and without macrovascular disease.

METHOD

Endothelial dysfunction by FMD and CIMT were compared in patients with T2DM with and without macrovascular disease (n = 13 each group) and 13 age, sex and BMI matched healthy individuals after an oral fat challenge.

RESULTS

There was significant postprandial deterioration of FMD 4-hr after fat challenge in patients with diabetes (P < 0.001) as well as healthy individuals (P = 0.004). Patients with diabetes with macrovascular disease had significantly lower fasting (5.7 ± 6.1% vs. 22.7 ± 10.0% and vs. 24.7 ± 5.3%) as well as postprandial (4-hr) (3.1 ± 5.0% vs. 15.3 ± 8.1% and vs. 15.4 ± 5.7%) FMD compared to other two groups. Fasting, postprandial as well as change in FMD and CIMT in patients with diabetes correlated significantly with fasting as well as postprandial triglycerides with stronger correlation in those with macrovascular disease.

CONCLUSION

Study found significant endothelial dysfunction by FMD that shows substantial further deterioration postprandially following high fat meal in patients with diabetes with macrovascular disease compared to patients with diabetes without macrovascular disease and healthy individuals. Study also indicates that PPHTg is a contributor to endothelial dysfunction. However, more studies are required to corroborate these findings.