Internet addiction among MBBS students at a New Delhi medical college: Prevalence and determinants of a silent pandemic

Background and Objective

The 21st century has witnessed a surge in global internet usage, particularly in developing nations like India. Internet addiction, also known as pathological internet use (PIU) or internet addiction (IA), has emerged as a mental health concern, especially among university students. This study aimed to investigate the prevalence of IA among MBBS students in a medical college in Delhi, India, and explore the association of IA with sociodemographic and internet usage patterns.

Materials and Methods

A cross-sectional observational study was conducted among 300 undergraduate medical students. Data was collected using a self-administered questionnaire, which included the Internet Addiction Test (IAT) developed by Dr. Kimberley Young. The IAT measures various aspects of internet use, and scores are categorized as normal user, mild addiction, moderate addiction, and severe addiction. Descriptive statistics and chi-square tests were used for data analysis.

Results

The mean age of onset of internet use was 14.4 ± 1.6 years. Smartphones were the most common devices used for internet access (96.3%), and the mean daily internet usage was 2.9 h ± 0.9 (standard deviation [SD]). The study found that 70.7% of students maintained a permanent login status. The majority of subjects used the Internet for coursework (89.7%) and information searches (88.7%). The prevalence of IA was significant, with 90% of participants being addicted to varying degrees. The grading of IA revealed 10% with no addiction, 54.6% with mild addiction, 32% with moderate addiction, and 3.3% with severe addiction.

Conclusion

IA is a prevalent public health concern among medical students in Delhi, with a majority of participants being addicted to some extent. Females showed a higher proportion of addiction compared to males. Certain internet activities, such as social networking and watching online videos, were significantly associated with IA. The study highlights the need for recognizing IA as a public health concern and further research to understand its impact on the youth. Longitudinal studies are recommended to observe the development and progression of IA over time.

In vitro and in vivo anthelmintic response of the seeds of Amomum subulatum roxb and Vitex negundo

Abstract The current study was designed to check the anthelmintic activities of some local plants. Seeds of Amomum (A.) subulatum and Vitex (V.) negundo in different solvents were subjected to in vitro (adult motility assay; AMA and egg hatch assay; EHA) and in vivo (faecal egg count reduction test; FECRT) anthelmintic activity testing protocols using Haemonchus (H.) contortus as an experimental model. The results of AMA, EHA, and FECRT were statistically analysed through linear regression and Duncan multiple range test. In AMA test, at 50 mg mL-1 concentration, the percent mortality of H. contortus was higher in A. subulatum than V. negundo, whereas, in EHA test, A. subulatum was proven better ovicidal (LC50=14.2 µg mL-1) than V. negundo (LC50= 65.7405 µg mL-1). The FECRT also indicated the better efficacy of A. subulatum than V. negundo against natural infection of gastrointestinal (GI) parasites. The crude powder of plants used in this study showed 29.6% to 57.7% anthelmintic. The reduction rate was found higher for A. subulatum (3 g kg-1) as compared to V. negundo (7 g kg-1). Reagrding efficacy analysis of solvents used for plants extract, ethyl acetate and chloroform were found better in increasing ovicidal activity in adult worms (in vitro testing), whereas, the crude aqueous methanol was found better than the crude powders in in vivo testing. It will be beneficial to document the indigenous knowledge to standard scientific procedures for their validation. This study will help to motivate the farmers to make a better choice of cultivation of the indigenous plants because of their varying efficacies as an alternative preventive approach against the GI parasitic infections.

Evaluating the secondary bioactive metabolites in Geodia corticostylifera

Abstract Ophiactis savignyi could be discovered all over the world in tropical marine environments. People could have aided in the spread of O. savignyi, particularly in the western and eastern populations of Panama's Isthmus. The brittle star Ophiactis savignyi, often known as savigny's brittle star, coexists alongside the sponge Geodia corticostylifera. The focus of this research has been to assess the functional relevance of G. corticostylifera secondary metabolites as antifoulant against mussels, protection against generalist fish, and chemical cues to affiliated brittle stars. Both in flow-through and static seawater laboratory studies, O. savignyi which has previously been connected with sponges, was given both treated and control mimics at the same time. The sponge extract was also tested for its ability to protect fish against predators and fouling. Deterrence test using chemicals indicated that the normal level of the sponge extract may also suppress generalist fish predation in the field as well as the mussel Perna perna’s normal attachment in clinical contexts. According to the findings, G. corticostylifera crude extract has many roles in the aquatic environments, apparently being accountable for this sponge's tighter relationship with O. savignyi, which protects the ophiuroid and inhibits epibionts on itself.

A Rare Presentation of Undifferentiated Pleomorphic Sarcoma in the Subpectoral Space

Soft tissue sarcomas (STS) are often described as asymptomatic, rapidly expanding masses, particularly in the extremities or trunk. Undifferentiated pleomorphic sarcoma (UPS), a high-grade variant of STS, ranks as the second most prevalent subtype in the United States. It predominantly affects males between their fifth and seventh decades. Its often benign symptomatology, however, can lead to initial misdiagnosis and subsequent mismanagement. We present the case of a 57-year-old Caucasian male, previously in good health, who experienced a recurring subpectoral lesion causing discomfort and mass-related effects. Initial management included incision and drainage, which provided temporary relief. The biopsy revealed a diagnosis of grade 3 UPS. The lesion's recurrence two months later was accompanied by local invasion into adjacent skin and musculature as well as metastasis to the right hemiliver. A comprehensive understanding of UPS among medical professionals is vital for accurate diagnosis and facilitating prompt intervention to prevent avoidable complications and optimize patient outcomes.

Hybrid Steel/NSM/GFRP System versus GFRP Wrapping for Upgrading RC Wall-like Columns

Reinforced concrete (RC) wall-like columns are commonly employed in structures in Saudi Arabia. These columns are preferred by architects owing to their minimum projection in the usable space. However, they often need strengthening due to several reasons, such as the addition of more stories and increasing the live load as a result of changing the usage of the building. This research aimed to obtain the best scheme for the axial strengthening of RC wall-like columns. The challenge in this research is to develop strengthening schemes for RC wall-like columns, which are favored by architects. Accordingly, these schemes were designed so that the dimensions of the column cross-section are not increased. In this regard, six wall-like columns were experimentally examined in the event of axial compression with zero eccentricity. Two specimens were not retrofitted to be used as control columns, whereas four specimens were retrofitted with four schemes. The first scheme incorporated traditional glass fiber-reinforced polymer (GFRP) wrapping, while the second one utilized GFRP wrapping combined with steel plates. The last two schemes involved the addition of near-surface mounted (NSM) steel bars combined with GFRP wrapping and steel plates. The strengthened specimens were compared with regard to axial stiffness, maximum load, and dissipated energy. Besides column testing, two analytical approaches were suggested for computing the axial capacity of tested columns. Moreover, finite element (FE) analysis was performed for evaluating the axial load versus displacement response of tested columns. As an outcome of the study, the best strengthening scheme was proposed to be used by practicing engineers for axial upgrading of wall-like columns.

Performance of Concentrically Loaded RC Wall-like Columns Upgraded with Innovative Hybrid NSM/CFRP System

In RC (reinforced concrete) frame structures, wall-like columns are laid within the space occupied by masonry walls to maximize usable space and thus minimize the column projections into the usable area. These columns often require strengthening owing to various reasons, including increasing the number of stories, changes in building usage, and others. The use of a hybrid system comprising NSM (near-surface mounted) steel rebars combined with CFRP (carbon-fiber reinforced polymer) laminates may be considered a sound technique for strengthening such wall-like building columns. The prime aim of this study is to devise an efficient scheme using a hybrid NSM/CFRP system to strengthen existing RC wall-like columns. Six half-scale RC wall-like columns were prepared and tested under monotonic concentric axial compression. Two columns were unstrengthened to serve as control specimens (CW1 and CW2), and four specimens were strengthened using four different schemes (SW1, SW2, SW3, and SW4). As favored by architects, all strengthening schemes were designed so that the dimensions of the column cross-section were not increased. The effects of strengthening schemes on the enhancement of axial capacity, energy dissipated, and stiffness were evaluated to find the most efficient scheme. Among the four studied schemes, using vertical continuous NSM rebars in combination with the wrapping of the three CFRP layers onto the exterior column surface (in specimen SW2) was the most efficient as it enhanced the ultimate load capacity by 80%. Three-dimensional FE (finite element) analysis was also conducted to predict the response of test specimens. The test results matched well with the FE outputs, which justified the accuracy of the used constitutive models for concrete, steel rebars, and CFRP sheets.

Concrete Performance Produced Using Recycled Construction and By-Product Industrial Waste Coarse Aggregates

Concrete is classified as a multi-composite material comprising three phases: coarse aggregate, mortar, and interfacial transition zone (ITZ). Fine and coarse aggregates occupy approximately 70-85% by volume, of which coarse aggregate typically constitutes more than two-thirds of the total quantity of aggregate by volume. The current study investigates the concrete performance produced using various recycled construction and by-product industrial waste coarse aggregates. Six types of coarse aggregates: manufactured limestone, quartzite, natural scoria, by-product industrial waste aggregate, and two sources of recycled concrete aggregates with densities ranging from 860 to 2300 kg/m³ and with different strength properties were studied. To determine the coarse aggregate contribution to the overall concrete performance, lean and rich concrete mixtures (Mix 1 and Mix 2) were used. Mix 1 (lean mixture) consisted of a ratio of water to cement (w/c) of 0.5 and cement content of 300 kg/m³, whereas a higher quantity of cement of 500 kg/m³ and a lower w/c ratio of 0.3 were used for Mix 2 (rich mixture). The results showed that while the compressive strength for different aggregate types in Mix 1 was comparable, the contribution of aggregate to concrete performance was very significant for Mix 2. Heavyweight aggregate produced the highest strength, while the lightweight and recycled aggregates resulted in lower mechanical properties compared to normal weight aggregates. The modulus of elasticity was also substantially affected by the coarse aggregate characteristics and even for Mix 1. The ACI 363R-92 and CSA A23.3-04 appeared to have the best model for predicting the modulus of elasticity, followed by the ACI-318-19 (density-based formula) and AS-3600-09. The density of coarse aggregate, and hence concrete, greatly influenced the mechanical properties of concrete. The water absorption percentage for the concrete produced from various types of aggregates was found to be higher for the aggregates of higher absorption capacity.

Prevalence of Ruminant Paramphistomosis and Comparative Histopathology of the Infected Rumens in Narowal District, Punjab, Pakistan

The present study reports the prevalence of Paramphistomum spp. in small and large ruminants and their association with the histopathology of the infected rumens. A total of 384 animals were screened for Paramphistomum spp. The animals found positive for Paramphistomum spp. were divided into three groups according to the worm load/5 cm2 (G1: 10 - 20 worms/5 cm2 = Low, G2: 20 - 40 worms/5 cm2 = Medium, and G3: >41 worms/5 cm2 = High). Tissue slides were prepared from samples of the rumen (1 cm2) taken from animals positive for ruminal fluke to determine the histological parameters, including epithelial length or thickness, length and width of the ruminal papilla, and thickness of tunica submucosa and mucularis externae. The overall prevalence of Paramphistomum spp. in the ruminant population of district Narowal was 56.25 % with a significant (P < 0.05) variation among different species of ruminants. The highest prevalence was in cattle, followed in order by buffalo, goat, and sheep. Epithelium thickness was significantly correlated with parasite load in large ruminants and the most significant (P < 0.05) decrease in epithelium thickness was in Group B (31.12 ± 1.82 μm) and Group C (31.07 ± 1.68 μm) and a same trend was recorded in small ruminants. Histopathological changes due to Paramphistomum spp. are reported for the first time, which explained the histomorphological and physiological changes in Paramphistomum-infected rumens which might be associated with lowered feed efficiency and productivity in ruminants.

Acute Leukaemias in Bauchi State, Northeastern Nigeria: Pattern of Presentations and Clinical Entities

BACKGROUND

Acute leukaemias are very aggressive diseases that run a rapidly fatal course if not promptly diagnosed and appropriately treated. The clinical presentations range from bone marrow failure such as anaemia, neutropenia or thrombocytopenia to features of organ infiltrations such as lymphadenopathy, splenomegaly, etc, but presentations may be non-specific. Misdiagnosis is very common with delay in diagnosis and prompt treatment being the causes of high morbidity and mortality in acute leukaemias. This study aims to determine the pattern of presentation and various clinical entities of acute leukaemias in Bauchi State, North-Eastern Nigeria.

SUBJECTS, MATERIALS AND METHODS

This was a three year retrospective study in which records of cases of acute leukaemias diagnosed in the Haematology Department of Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH) Bauchi from the bone marrow aspiration cytology register from 1st January, 2018 to 31st December, 2020 were collected. Data on socio-demographic characteristics of the patients that include age, gender, diagnosis as well as subtypes of some of the malignancies diagnosed were also collated. The collated data were analyzed using SPSS Version 20.0. A p-value of < 0.05 was considered significant.

RESULTS

Twenty-nine cases of acute leukaemias were diagnosed during the period under review. Majority of cases had acute lymphoblastic leukaemia (ALL) 19/29 (65.5%) while acute myeloid leukaemia (AML) was seen in 10/29 (34.5%). The mean ± SD age of the patients was 22.2±9.2 years with a range 6 months to 60 years. Males constituted 75.9% (22/29) of the cases of acute leukaemias diagnosed. The male to female ratios for AML and ALL were 2:1 and 2.6:1 respectively. The mean±SD ages for AML and ALL were 27±9.2years and 17.3±11.3 years respectively. The most common form of presentation of acute leukaemia in this study is recurrent anaemia necessitating blood transfusion while proptosis and epistaxis were the least forms of presentation.

CONCLUSION

Acute lymphoblastic leukaemia is the commonest form of acute leukaemias while recurrent anaemia is the commonest form of clinical presentations in our setting. Early referral of patients with clinical features suggestive of acute leukaemias is recommended.

Oral Status and Dementia Onset: Mediation of Nutritional and Social Factors

Some modifiable risk factors for dementia are closely related to oral health. Although eating and speaking abilities are fundamental oral functions, limited studies have focused on the effect of malnutrition and lack of social interaction between oral health and dementia. We investigated the mediating effects of nutritional and social factors on the association between the number of teeth and the incidence of dementia. This 6-y cohort study used data from the Japan Gerontological Evaluation Study targeting older adults aged 65 y and above. The number of teeth (exposure) and covariates in 2010 (baseline survey), mediators (weight loss, vegetable and fruit intake, homeboundness, social network) in 2013, and the onset of dementia (outcome) between 2013 and 2016 were obtained. The Karlson-Holm-Breen mediation method was applied. A total of 35,744 participants were included (54.0% women). The mean age at baseline was 73.1 ± 5.5 y for men and 73.2 ± 5.5 y for women. A total of 1,776 participants (5.0%) had dementia during the follow-up period. There was a significant total effect of the number of teeth on the onset of dementia (hazard ratio, 1.14; 95% CI, 1.01-1.28). Controlling for nutritional and social mediators, the effect of the number of teeth was reduced to 1.10 (95% CI, 0.98-1.25), leaving an indirect effect of 1.03 (95% CI, 1.02-1.04). In the sex-stratified analysis, the proportion mediated by weight loss was 6.35% for men and 4.07% for women. The proportions mediated by vegetable and fruit intake and homeboundness were 4.44% and 4.83% for men and 8.45% and 0.93% for women, respectively. Furthermore, the proportion mediated by social networks was 13.79% for men and 4.00% for women. Tooth loss was associated with the onset of dementia. Nutritional and social factors partially mediated this association.

Can quantitative 18F-FDG PET/CT and serum cytokine analysis differentiate ARVC from cardiac sarcoidosis?

Background

Arrhythmogenic right ventricular cardiomyopathy (ARVC) and Cardiac Sarcoidosis (CS) may both cause malignant arrhythmia and sudden death, but differentiating the two can be difficult.

Purpose

To investigate the role of quantitative FDG PET/CT at distinguishing ARVC from CS, and explore whether addition of an inflammatory panel correlates with PET uptake, aiding diagnosis.

Methods

10 patients with CS, 10 with ARVC were enrolled. Participants were prospectively studied with PET/CT. LV uptake was quantified using software and a 17-segment model, measuring maximum standardised uptake (SUVmax) and mean myocardial uptake, comparing these to a local normal reference range (21 volunteers) using a z-score. Blood levels of IL-1b, IL-6, IL-8, IL10, IL-12p40, MCP-1, TGFb, GRO, TNFa, IFNy, FGF2, PDGF were measured using ELISA, compared with 10 healthy controls.

Results

There were no significant differences in cytokine levels between CS and ARVC; most cytokine levels were higher in CS, except IL-6, IL-8 and MCP-1 in ARVC (Table 1). Increased PET uptake was noted in 1 segment of 1 ARVC patient, and in 1–2 segments of 5 CS patients (z-scores 2.25 SD; 2.15–2.38 SD). No pattern of uptake distinguished ARVC from CS, qualitatively assessing LV polar maps (Figure 1A, B). SUVmax and mean uptake were higher in CS vs. ARVC (p&lt;0.05; p=0.13). No significant correlation between cytokine levels and PET uptake was detected (Figure 1C, D).

Conclusion

Quantitative PET/CT uptake and a blood inflammatory panel did not have utility in differentiating the two conditions in our population. There was generally more PET and serum inflammatory activity in CS.

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): NHS Endowments

Initial experience with the convergent procedure for longstanding persistent atrial fibrillation: A 5 year dataset

In patients with longstanding persistent atrial fibrillation (AF), outcomes from catheter ablation remain suboptimal. The convergent procedure combines minimally invasive surgical ablation with subsequent catheter ablation, and may contribute towards maintenance of sinus rhythm in this patient group. We performed the convergent procedure on 43 patients with longstanding persistent AF from 2013–2018. Patients underwent clinical review at 3, 6, and 12 months and thereafter as necessitated by their symptoms. Our dataset describes patients’ baseline characteristics and rhythm control protocols, as well as outcomes including arrhythmia recurrence, the need for antiarrhythmic drugs, requirement for repeat rhythm control procedures, and complications. These data provide a real world insight into the risks and benefits of the convergent procedure in patients with longstanding persistent AF.

4324Fast-field cycling magnetic resonance detection of intracellular iron in the nanomolar range - A pre-requisite for in-vivo study of inflammation

Background

Ultra-small superparamagnetic iron oxide (USPIO) nanoparticles are phagocytosed by macrophages and when subjected to magnetic resonance imaging (MRI) detect inflammation. We describe a novel MR technique where the magnetic field is rapidly cycled (Fast field-cycling MR, FFC-MR), assessing T1 dispersion over a range of low (100μT-0.2T) fields and offering superior T1-based iron quantification.

AIM

To quantify iron using the FFC-MR R1 (1/T1) dispersion profile and flow cytometry features of USPIO-laden cells, in comparison to colorimetric assays.

Methods

Murine J774 macrophage-like cells were incubated with 0–200μg/ml Fe as USPIO (ferumoxytol) for 16 hours, washed and suspended in 500μl PBS/2mM EDTA. Prussian blue staining confirmed USPIO phagocytosis. Relaxation was measured using a clinical, in-house built prototype 0.2T FFC-MR system with a custom test tube coil. R1 dispersion was derived from a saturation recovery sequence (Fig. 1A). R1 (s–1) values were calculated with a monoexponential curve fitting algorithm, R2 of fits were ≥0.999. R1 dispersion profiles were generated plotting R1 against the magnetic field (T). Quantification of side scatter (SCC) intensity and the USPIO-occupied fraction of total cell area was performed with imaging flow cytometry. A colorimetric assay provided validation of cell iron content. All data are mean±SEM, analysed with t-tests, Pearson correlation and linear regression; statistical significance set at p<0.05.

Results

Table 1 shows quantitative data derived by all 3 modalities with increasing USPIO exposure. FFC-MR detection of intracellular iron was excellent (p≤0.001 vs. control for all), with separation of average R1 dispersion profiles (Fig. 1B), strong correlation with colorimetry (r=0.993 p<0.001) and good fit on linear regression model (R2=0.9222, Fig 1C). Flow cytometry quantification of SCC was comparable (p≤0.001 for all), whereas USPIO-occupied area was only sensitive at exposures ≥10μg/ml USPIO (r=0.967 p<0.001 & r=0.983 p<0.001 vs. colorimetric respectively). FFC-MR detected iron at ≥1.12ng/μg protein.

USPIO exposure (μg/ml medium) 0 5 10 40 80 100 200 FFC-MR Mean R1 1x106 cell suspension (s–1) 0.308±0.014 0.356±0.013** 0.432±0.016** 0.706±0.021** 1.174±0.031** 1.239±0.033** 1.599±0.041** Flow cytometry USPIO area/cell area 0.034±0.001 0.036±0.001 0.037±0.001* 0.069±0.001** 0.085±0.001** 0.090±0.001** 0.097±0.001** Flow cytometry SSC intensity 26860 32815** 39573** 69285** 80967** 82693** 86373** Colorimetric assay Iron concentration 1x106 cells (ng/μg protein) 0.115±0.118 1.121±0.045** 2.074±0.084** 5.496±0.134** 8.421±0.269** 9.771±0.100** 12.398±0.233** SSC = side-scattered light; *p<0.05 vs. control; **p<0.001 vs. control.

Conclusion

Field-cycling MR is capable of highly accurate intracellular USPIO quantification, which has potential to non-invasively detect clinically relevant amounts of iron in inflammatory cardiovascular diseases.

Acknowledgement/Funding

NHS Grampian Endowment Fund

Small Bowel Intussusception Caused by Metastatic Melanoma: A Case Report

Intussusception, as a rare cause of small bowel obstruction, can be secondary to benign or malignant pathology. Malignant lesions causing intussusception can be primary or metastatic lesions. Metastasis can occur many years later. We present a case of metastatic melanoma in a 69-year-old man as the underlying etiology of his intussusception. The patient had laparoscopic Roux-en-Y gastric bypass four years prior to his presentation and did recall excision of a skin melanoma at age 64. Laparoscopic or open surgical resection is the best therapeutic option in cases such as this.

An insight into the ecobiology, vector significance and control of Hyalomma ticks (Acari: Ixodidae): A review

Ticks (Acari:Ixodoidea) are important ectoparasites infesting livestock and human populations around the globe. Ticks can cause damage directly by affecting the site of infestation, or indirectly as vectors of a wide range of protozoa, bacteria and viruses which ultimately lead to lowered productivity of livestock populations. Hyalomma is a genus of hard ticks, having more than 30 species well-adapted to hot, humid and cold climates. Habitat diversity, vector ability, and emerging problem of acaricidal resistance in enzootic regions typify this genus in various countries around the world. This paper reviews the epidemiology, associated risk factors (temperature, climate, age, sex, breed etc.), vector role, vector-pathogen association, and reported control strategies of genus Hyalomma. The various proteins in saliva of Hyalomma secreted into the blood stream of host and the prolonged attachment are responsible for the successful engorgement of female ticks in spite of host immune defense system. The various immunological approaches that have been tried by researchers in order to cause tick rejection are also discussed. In addition, the novel biological control approaches involving the use of entomo-pathogenic nematodes and Bacillus thuringiensis (B. thuringiensis) serovar thuringiensis H14; an endotoxin, for their acaricidal effect on different species and life cycle stages of Hyalomma are also presented.

Abstract P4-06-04: Germline alterations in African-American versus Caucasian patients with triple-negative breast cancer in the era of multi-gene panel testing

Background. Triple negative breast cancer (TNBC) has been associated with a relatively high rate of germline BRCA1/2 deleterious mutations (11-20%). With use of panel testing, additional predisposition genes are being identified. Among Caucasian (CC) patients (pts), pathogenic germline variants in BRCA1/2 are mainly associated with TNBC. However, these may not fully explain the higher incidence of TNBC among African Americans (AA). Additionally, partly due to under-testing among AA, the distribution of predisposition genes for AA TNBC pts is unknown, and a greater proportion of germline alterations may be classified as a variant of uncertain significance (VUS). We hypothesized that additional clinically significant germline mutations in genes, other than in BRCA1/2, may explain the increased incidence of TNBC among AA, which may be better elucidated by panel testing.

Methods. A retrospective chart review was completed of all self-identified CC and AA TNBC pts who presented to two institutions from 10/2013 to 12/2016. A total of 596 pts were analyzed. 434 (73%) were CC and 162 (27%) were AA. Clinicopathologic features including histologic subtype, age, gender, bilateral disease and stage were examined. Patients were assessed for meeting the National Comprehensive Cancer Network (NCCN) criteria for genetic testing in TNBC, type of testing performed, and the results. The distribution of mutations in higher penetrance genes (BRCA1, BRCA2, and PALB2), pathogenic variants in other genes, and VUS in AA vs. CC were analyzed. Significance was determined using a two-tailed Fisher exact test with significance of p&lt;0.05.

Results. 306/434 (71%) CC and 98/162 (60%) AA TNBC pts met criteria for genetic testing (p=0.023). For those who met NCCN criteria for testing, 216/306 (71%) CC and 66/98 (67%) AA TNBC pts underwent testing (p=0.61). For all pts, the average age of first diagnosis was 59.5 (SD 14) for CC vs. 62.4 (SD 12.9) for AA pts. For pts who underwent testing, regardless of meeting NCCN criteria, 18% (40/221) of CC vs.12% (8/68) of AA patients had a mutation in a higher penetrance gene (p=0.27), 1% (3/221) of CC vs. 3% (2/68) of AA had a mutation in other genes (BRIP1, Lynch genes; p=0.34), and 16% (36/221) of CC vs. 18% (12/68) of AA had a VUS (p=0.982). Of VUS, 42% (5/12) in AA vs. 19% (7/36) in CC were in higher penetrance breast cancer genes (p=0.14).

Conclusion. More CC than AA TNBC pts met criteria for genetic testing. This difference may in part be explained by the later age at diagnosis for AA given that age is a major factor in determining genetic testing. Broadening eligibility for testing in AA may help to identify more patients with an underlying genetic predisposition to TNBC. No difference was seen in the frequency of higher penetrance genes, other genes, and VUS between AA and CC pts. However, important non-BRCA genes were identified with panel testing in both AA and CC pts. In addition to broadening testing criteria for existing multi-gene panels, further genetic analysis may be necessary to explain the predisposition to TNBC in AA pts. To our knowledge, this is the first report of evaluation of predisposition genes among AA TNBC pts using germline panel testing.

Citation Format: Nizialek EA, Gopalakrishnan D, Yanda C, Abbas H, Kline M, Stephens M, Grobmyer SR, Eng C, Mitchell A, Pederson H, Vinayak S. Germline alterations in African-American versus Caucasian patients with triple-negative breast cancer in the era of multi-gene panel testing [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-06-04.

Abstract P4-10-13: Analyses of racial disparities in genetic testing and surgical management of patients with triple-negative breast cancer in the era of multigene panel testing

Background

Under-utilization of genetic counseling and testing among African-American (AA) women with breast cancer (BC) has been reported in previous studies, and there are concerns that disparities may widen with further genomic advances. Our objective was to compare AA and Caucasian (CC) patients with triple-negative breast cancer (TNBC) with regards to referral for genetic counseling, patterns of genetic testing, and patient-compliance with genetic counseling recommendations. We chose TNBC since a majority of these patients would qualify for genetic counseling ± testing. We also analyzed for differences between the two races in prevalence of deleterious BC-associated mutations, stage of BC on presentation, and surgical choices.

Methods

In this retrospective medical records-based observational study, we included all patients in our tumor registry with TNBC diagnosed between 09/01/2013 and 02/28/2017. Race, clinical characteristics and details pertaining to genetic counseling and testing were recorded. X2 test was used to compare categorical variables. A p-value &lt; 0.05 was considered significant.

Results

477 patients -358 CC and 96 AA- with TNBC were included. Mean age was 60.3 years. 331 patients met National Comprehensive Cancer Network (NCCN) criteria for genetic counseling - of these, 85.5% had genetic consult order placed, 72.8% attended counseling, and 71.9% underwent genetic testing (multigene panel testing 55.0%, BRCA 1/2 testing 39.9%, single-site testing 2.5%, and multisite-3 testing 2.5%). Between CC and AA, no significant differences were found in the proportion of qualifying patients who had referral for genetic counseling (84.7 vs 87.7%, p=0.562), attended counseling (72.2% vs 73.7%, p=0.816), or underwent genetic testing (72.1% vs 70.1%, p=0.764). The choices of type of genetic tests were also not significantly different between the two groups (p=0.349). Though the prevalence of highly penetrant mutations in breast cancer-associated genes trended to be higher among CC than AA (14.1% vs 9.5%), this difference did not reach statistical significance (p=0.429). In our population, stage of TNBC at presentation was comparable between the two races – 80.4% of CC presented with stage I or II disease compared to 80.2% of AA (p=0.931). The two groups were also comparable with regards to the choices of breast surgery and reconstruction, as shown in the table.

  CaucasiansAfrican-Americansp-valueSurgery TypePartial Mastectomy154(47.4%)38(44.7%)0.317 Unilateral Mastectomy101(31.1%)35(41.2%) Bilateral Mastectomy70(21.5%)12(14.1%)ReconstructionYes96(56.1%)24(51.1%)0.535 No75(43.9%)23(48.9%)Reconstruction TypeImplant87(90.6%)19(79.2%)0.118 Tissue Flap9(9.4%)5(20.8%)

Conclusions

Contrary to previous reports, in this cohort of TNBC patients, we did not identify significant disparities between AA and CC in patterns of referral for genetic counseling, in patient compliance with testing or in type of testing performed. Also, no significant differences were found between the two races in choices of breast surgery or reconstruction. As a caveat, with an overall insured rate of ˜97% across our network, the uninsured population may have been under-represented by our cohort.

Citation Format: Gopalakrishnan D, Yanda C, Abbas H, Kline M, Stephens M, Grobmyer SR, Pederson HJ. Analyses of racial disparities in genetic testing and surgical management of patients with triple-negative breast cancer in the era of multigene panel testing [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-13.

Outcome of a screening programme for the prevention of neonatal invasive early-onset group B Streptococcus infection in a UK maternity unit: an observational study

BACKGROUND

Against a background of failure to prevent neonatal invasive early-onset group B Streptococcus infections (GBS) in our maternity unit using risk-based approach for intrapartum antibiotic prophylaxis, we introduced an antenatal GBS carriage screening programme to identify additional women to target for prophylaxis.

OBJECTIVES

To describe the implementation and outcome of an antepartum screening programme for prevention of invasive early-onset GBS infection in a UK maternity unit.

DESIGN

Observational study of outcome of screening programme (intervention) with comparison to historical controls (preintervention).

SETTING

Hospital and community-based maternity services provided by Northwick Park and Central Middlesex Hospitals in North West London.

PARTICIPANTS

Women who gave birth between March 2014 and December 2015 at Northwick Park Hospital.

METHODS

Women were screened for GBS at 35-37 weeks and carriers offered intrapartum antibiotic prophylaxis. Screening programme was first introduced in hospital (March 2014) and then in community (August 2014). Compliance was audited by review of randomly selected case records. Invasive early-onset GBS infections were defined through GBS being cultured from neonatal blood, cerebrospinal fluid or sterile fluids within 0-6 days of birth.

MAIN OUTCOME

Incidence of early-onset GBS infections.

RESULTS

6309 (69%) of the 9098 eligible women were tested. Screening rate improved progressively from 42% in 2014 to 75% in 2015. Audit showed that 98% of women accepted the offer of screening. Recto-vaginal GBS carriage rate was 29.4% (1822/6193). All strains were susceptible to penicillin but 11.3% (206/1822) were resistant to clindamycin. Early onset GBS rate fell from 0.99/1000 live births (25/25276) in the prescreening period to 0.33/1000 in the screening period (Rate Ratio=0.33; p=0.08). In the subset of mothers actually screened, the rate was 0.16/1000 live births (1/6309), (Rate Ratio=0.16; p<0.05).

CONCLUSIONS

Our findings confirm that an antenatal screening programme for prevention of early-onset GBS infection can be implemented in a UK maternity setting and is associated with a fall in infection rates.

Effect of some biotic factors on microbially-induced calcite precipitation in cement mortar

Sporosarcina pasteurii, a common soil bacterium has been tested for microbial treatment of cement mortar. The present study also seeks to investigate the effects of growth medium, bacterial concentration and different buffers concerning the preparation of bacterial suspensions on the compressive strength of cement mortar. Two growth media, six different suspensions and two bacterial concentrations were used in the study. The influence of growth medium on calcification efficiency of S. pasteurii was insignificant. Significant improvement in the compressive as well as the tensile strength of cement mortar was observed. Microbial mineral precipitation visualized by Scanning Electron Microscopy (SEM) shows fibrous material that increased the strength of cement mortar. Formation of thin strands of fillers observed through SEM micrographs improves the pore structure, impermeability and thus the compressive as well as the tensile strengths of the cement mortar. The type of substrate and its molarity have a significant influence on the strength of cement mortar.

Robotic esophagectomy: new era of surgery

Esophagectomy is a surgical operation which requires technical expertise to decrease the morbidity and mortality frequently associated with this advance procedure. Various minimally invasive esophagectomy techniques have been developed to decrease the negative impact of esophageal resection. Recently, robotic assisted esophagectomies have been described with a wide variety in technique and outcome disparity. This article is a summation review of the current literature regarding the various techniques and surgical outcomes of robotic assisted esophagectomies.

Minimally invasive esophagectomy is safe in patients with previous gastric bypass

BACKGROUND

The prevalence of morbid obesity in the United States has been steadily increasing, and there is an established relationship between obesity and the risk of developing certain cancers. Patients who have undergone prior gastric bypass (GB) and present with newly diagnosed esophageal cancer represent a new and challenging cohort for surgical resection of their disease. We present our case series of consecutive patients with previous GB who underwent minimally invasive esophagectomy (MIE).

METHODS

Retrospective review of consecutive patients with a history of GB who underwent a MIE for esophageal cancer between July 2010 and August 2012.

RESULTS

Five patients were identified with a mean age of 57 years. Mean follow-up was 9.1 months. Four patients had undergone laparoscopic GB, and 1 patient had an open GB. Two patients received neoadjuvant chemoradiation therapy for locally advanced disease. Minimally invasive procedures were thoracoscopic/laparoscopic esophagectomy with cervical anastomosis in 4 patients and colonic interposition in 1 patient. Mean operative time was 6 hours and 52 minutes. Median length of stay was 7 days. There was no mortality. Postoperative complications occurred in 3 patients and included pneumonia/respiratory failure, recurrent laryngeal nerve injury, and pyloric stenosis. All patients are alive and disease free at last follow-up.

CONCLUSIONS

Minimally invasive esophagectomy after prior GB is well tolerated, is technically feasible, and has acceptable oncologic and perioperative outcomes. We conclude that precise endoscopic evaluation before bariatric surgery in patients with gastroesophageal reflux disease is essential, as is the necessity for continuing postsurgical surveillance in patients with known Barrett's esophagitis and for early evaluation in patients who develop new symptoms of gastroesophageal reflux disease after bariatric surgery.

No evidence for relevant QT interval prolongation in mitotane-treated patients with adrenocortical carcinoma

OBJECTIVE

We designed a single-center retrospective study to assess the QT interval duration and to describe cardio vascular events among patients treated with mitotane for a adrenocortical carcinoma (ACC).

DESIGN

We selected 14 patients (6 males and 8 females) that met the following criteria: ACC treated with mitotane, for whom an electrocardiogram (ECG) at baseline (before mitotane initiation) was available and for whom at least one ECG was available during the course of mitotane therapy together with a concomitant mitotane plasma level determination.

RESULTS

Mean mitotane plasma level at baseline and after treatment showed a significant increase (mean level increased from 0 to 14.9±2 mg/l). At baseline and before mitotane was initiated all QTc intervals were <450 msec for men and <460 msec for women. During the treatment phase with mitotane, no QTc>470 msec was found in any patients respectively for men and women. In addition, no patient showed any significant QTc prolongation (>5% or >10 msec) at any time during mitotane treatment. During a mean follow-up of 15.9±3.5 months (range 2-45 months). No cardiovascular deaths or hospitalization for cardiovascular events was documented. No torsades de pointes were documented on ECG. No syncope, dizziness, heart failure were observed during follow up. Six out of 14 patients died during the follow-up, in five cases due to the progression of the disease, one patient died suddenly at home during followup.

CONCLUSION

This short and retrospective series shows no evidence that mitotane induce any QT prolongation, even when plasma levels are well above the therapeutic window.

Response to antenatal HIV testing and prevention of parent to child transmission: an experience in a tertiary hospital in Chitwan, Nepal

The antenatal screening of HIV in all women is becoming an integral part of routine antenatal checkup in Nepal, by prevention of parent to child transmission (PPTCT) program. The aim was to analyze the response to implementation of PPTCT program in a peripheral hospital and to study the involvement of husbands for counseling and testing. Data of 3360 women attending the antenatal clinic from January 2010 to December 2010. Data of husband counseling and testing was also analyzed. Acceptability of the test after pretest counseling is 99 %. Women attended post test counseling and collected reports in 58.6%. Sero prevalence of HIV was 0.73% of which 62.5% came for post test counseling. Only 10 % of husbands of total antenatal cases came for counseling of which 6.6% got tested. The acceptability of the test after pretest counseling is satisfactory but the follow up for the post test counseling is to be improved. There is need to enhance male involvement to make husband friendly antenatal clinic.DOI: http://dx.doi.org/10.3126/jcmsn.v7i3.6707 Journal of College of Medical Sciences-Nepal, 2011, Vol-7, No-3, 36-38

Electrochemical Lithium Insertion/Extraction in Partially Reduced α-MoO3

This work concerns with synthesis, structural, thermal and electrochemical characterization of molybdenum oxides (stoichiometric MoO3, sub-stoichiometric oxide MoO3− x (where x is a small fraction) with layered type structure. XRD investigations of the samples proved that the crystal structure of the layered α-MoO3) has been maintained after the reduction process.

The reduced samples exhibited a drastically improved charge/discharge cycling stability and capacity retention on cycling in 1 M LiClO4/propylene carbonate. At higher cycle numbers (approx. cycle 50) the discharge capacity of the reduced molybdenum oxides stabilizes at a level of approx. 50 mAh g−1, whereas the non-reduced MoO3 has retained only about 45 mAh g−1 after 20 cycles. This significant improvement of the rechargeability may be related to improvement in the electronic conductivity after reduction process.

Modelling the colonisation of maize by toxigenic and non-toxigenic Aspergillus flavus strains: implications for biological control

To successfully exploit biological control it is desirable to understand how the introduced agent colonises the host and interferes with establishment of the pest. This study assessed field colonisation of maize by Aspergillus flavus strains as biological control agents to reduce aflatoxin contamination. Maize (corn, Zea mays L.) ears were inoculated with A. flavus using a pin-bar technique in 2004 and 2005. Non-aflatoxigenic strains K49 (NRRL 30797) & CT3 (NRRL 30798) and toxigenic F3W4 (NRRL 30798) were compared against a carrier control (0.2% aqueous Tween 20). Ten ears were sampled over 12 to 20 days, visually assessed, and curves fit to a three compartment Gompertz equation or other best appropriate regressions. Aflatoxin was determined by HPLC and cyclopiazonic acid (CPA) by LC/MS. The Gompertz model describes growth parameters, e.g. growth constant, lag phase and maximum colonisation characterised patterns of maize colonisation for most inoculated treatments. Aflatoxin accumulation in maize inoculated with F3W4 was about 35,000 ng/g in 2004 and 2005, with kinetics of aflatoxin accumulation in 2005 well described by the Gompertz equation. Less than 200 ng/g was observed in maize inoculated with strains CT3 & K49 and accumulation was described by a linear or logistic model. Maize inoculated with strains CT3 and F3W4 accumulated a maximum of 220 and 169 µg/kg CPA, respectively, compared to 22 and 0.2 µg/kg in the control and K49 inoculated, respectively. This technique can be used to elucidate colonisation potential of non-toxigenic A. flavus in maize in relation to biological control of aflatoxin. The greatest reduction of aflatoxin and CPA in maize inoculated with strain K49 and Gompertz parameters on colonisation indicates its superiority to CT3 as a biological control agent. The dynamics of maize colonisation by A. flavus strains and subsequent mycotoxin accumulation generated by using the pin-bar technique has implications for characterising the competence of biocontrol strains for reducing aflatoxin contamination.

Ocimum sanctumLinn. (Holy Basil) Ethanolic Leaf Extract Protects Against 7,12-Dimethylbenz[a]Anthracene-Induced Genotoxicity, Oxidative Stress, and Imbalance in Xenobiotic-Metabolizing Enzymes

The present study was designed to evaluate the protective effects of ethanolic Ocimum sanctum leaf extract against 7,12-dimethylbenz[a]anthracene (DMBA)-induced genotoxicity, oxidative stress, and imbalance in xenobiotic-metabolizing enzymes. Four different concentrations of ethanolic O. sanctum leaf extract (100, 200, 300, and 400 mg/kg of body weight) were administered to Wistar rats by intragastric intubation for five consecutive days followed by intraperitoneal injection of DMBA (35 mg/kg of body weight) 90 minutes after the final dose of the extract. Administration of DMBA increased bone marrow micronuclei, phase I enzymes, lipid peroxidation, and protein carbonyl formation. This was accompanied by a significant decrease in the activities of phase II detoxification enzymes and antioxidants in the liver, erythrocytes, and bone marrow. Pretreatment with ethanolic O. sanctum leaf extract at a concentration of 300 mg/kg of body weight significantly reduced micronuclei formation and phase I enzymes as well as lipid and protein oxidation with enhanced antioxidant and phase II enzyme activities. The results of the present study suggest that ethanolic O. sanctum leaf extract inhibits DMBA-induced genotoxicity and oxidative stress by modulating xenobiotic-metabolizing enzymes, reducing the extent of lipid and protein oxidation and up-regulating antioxidant defenses.

Treatment of prosthetic valve infective endocarditis due to multi-resistant Gram-positive bacteria with linezolid

OBJECTIVES

Clinical experience with linezolid in the treatment of infective endocarditis either alone or in combination with other agents is limited. We describe our experience in the treatment of two patients with IE due to multi-resistant Gram-positive bacteria.

METHODS

One patient with MRSE and one with VRE endocarditis were treated with regimens containing linezolid. The killing kinetics of linezolid in combination with gentamicin or vancomycin against isolates of Staphylococcus epidermidis and Enterococcus faecalis were analysed in vitro.

RESULTS

Clinical response and eradication of bacteraemia was achieved with linezolid therapy in both patients. Time-kill curve studies showed that linezolid was bacteriostatic against the MRSE and VRE isolates used. Combination with gentamicin or vancomycin did not produce synergy or antagonism but at best only marginal additive effect.

CONCLUSIONS

Although bacteriostatic, linezolid provides an important therapeutic option in IE due to multi-resistant Gram-positive pathogens. It challenges the conventional wisdom that bactericidal synergy is required for the effective treatment of most cases of IE due to Gram-positive organisms.

Electrophysiological and molecular identification of hepatocellular volume-activated K+ channels

Although K+ channels are essential for hepatocellular function, it is not known which channels are involved in the regulatory volume decrease (RVD) in these cells. We have used a combination of electrophysiological and molecular approaches to describe the potential candidates for these channels. The dialysis of short-term cultured rat hepatocytes with a hypotonic solution containing high K+ and low Cl- concentration caused the slow activation of an outward, time-independent current under whole-cell configuration of the patch electrode voltage clamp. The reversal potential of this current suggested that K+ was the primary charge carrier. The swelling-induced K+ current (IKvol) occurred in the absence of Ca2+ and was inhibited with 1 microM Ca2+ in the pipette solution. The activation of IKvol required both Mg2+ and ATP and an increasing concentration of Mg-ATP from 0.25 through 0.5 to 0.9 mM activated IKvol increasingly faster and to a larger extent. The KCNQ1 inhibitor chromanol 293B reversibly depressed IKvol with an IC50 of 26 microM. RT-PCR detected the expression of members of the KCNQ family from KCNQ1 to KCNQ5 and of the accessory proteins KCNE1 to KCNE3 in the rat hepatocytes, but not KCNQ2 and KCNE2 in human liver. Western blotting showed KCNE3 expression in a plasma membrane-enriched fraction from rat hepatocytes. The results suggest that KCNQ1, probably with KCNE2 or KCNE3 as its accessory unit, provides a significant fraction of IKvol in rat hepatocytes.