Prospective Evaluation of Locoregional Control in Oral Cavity Squamous Cell Carcinoma with Infratemporal Fossa Involvement Treated with Surgery and Adjuvant Concurrent Chemoradiotherapy

PURPOSE/OBJECTIVE(S)

Oral cavity squamous cell carcinoma (OCSCC) is the most common head and neck cancer in India. Definitive surgery with or without post-op radiotherapy (PORT) with or without chemotherapy (CT) provides better outcomes in locally advanced OCSCC as compared to definitive chemoradiotherapy. T4b OCSCC with infra temporal fossa (ITF) involvement has varied outcome depending on the extent of ITF involvement, with low and mid ITF having relatively favorable prognosis. We aimed to prospectively evaluate outcomes in patients of OCSCC with low or mid ITF involvement treated with curative surgery followed by adjuvant concurrent chemoradiotherapy (CCRT).

MATERIALS/METHODS

A total of 20 patients of T4b OCSCC (as per AJCC 8th edition) with low or mid ITF involvement were included in this single arm prospective interventional study from January 2021 to October 2022. Patients with involvement of skull base, carotid artery, prevertebral fascia and/or pterygomaxillary fissure were excluded. All patients were treated with definitive surgery with ITF clearance followed by adjuvant CCRT as indicated. Loco-regional control (LRC), Disease free survival (DFS), Overall survival (OS) were assessed using Kaplan-Meier survival analysis. Acute toxicities were assessed according to the CTCAE v5.0.

RESULTS

Patient characteristics are summarized in table 1. Median follow-up was 11.5 months (4-21months). All patients received adjuvant CCRT with weekly cisplatin 40mg/m2 to a median number of 6 cycles (5-7 cycles). Median RT dose was 64Gy (60-64Gy). All patients tolerated treatment well. Grade 3 oral mucositis, odynophagia were seen in 8 (40%) patients each and skin toxicity, oral pain in 6 (30%) and 5 (25%) patients respectively. No grade 4 toxicities were observed LRC at three month was 73.68% with 4 local and 1 locoregional failure only. LRC at one year was 36.8% with 8 local, 1 locoregional, 2 locodistant and 1 distant failure only. Median DFS was 10.4 months. Median OS was not reached; four patients died. LRC at three months was better for patients with low ITF disease as compared to mid ITF disease (85.7% vs. 40% (p = 0.04) and at one year was 42.8% vs. 40% (p = 0.50).

CONCLUSION

Selected patient of locally advanced OCSCC with low ITF involvement may benefit from trimodality therapy of surgery with ITF clearance followed by adjuvant CCRT. Acute toxicity profile was acceptable in our study.

A65 VISCERAL FAT INDICES: DO THEY HELP DIFFERENTIATE CROHN’S DISEASE AND INTESTINAL TUBERCULOSIS IN CHILDREN?

Background

Crohn’s disease (CD) and Intestinal tuberculosis (ITB) mimic each other and are often difficult to differentiate. A correct and prompt diagnosis is essential for a good outcome. Mesenteric fat hypertrophy is a feature of CD and studies in adults have shown higher visceral fat in CD than ITB. There is no published data in children.

Purpose

This study evaluated the utility of visceral fat indices in differentiating CD and ITB in children.

Method

Symptomatic children diagnosed to have CD or ITB based on standard recommended criteria were enrolled. The clinical and laboratory details were noted. Abdominal fat was measured on Computed Tomography in supine position at the level of L4 vertebrae. Visceral fat (VF) and subcutaneous fat (SF) area was measured separately by an experienced radiologist, blinded to the diagnosis. Sum of VF and SF was taken as total fat (TF). VF/SF and VF/TF ratio was calculated.

Result(s)

34 children [14 boys, median age 14.0 (inter quartile range 10.8-17.0)] years were recruited, of which 12 (29%) had CD [7 boys, age 13.0 (IQR 9.25-16.5) years] and 22 (71%) had ITB [7 boys, age-14.5 (IQR 11-17) years]. Visceral fat area (VF) was significantly higher in CD compared to ITB (table 1). However, there was no significant difference in the SF (2199.5 (1537.6-3881.6) vs 2176.5 (671.0-6651.5) mm²; p=0.958) and TF (3096.1 (2108.2-5373.5) vs 4518.2 (2677.6-8456.3) mm²; p=0.245) in ITB and CD respectively. The ratio of VF/SF and VF/TF was significantly higher in CD as compared to ITB for all cases (table1). When comparing CD and ITB in boys and girls separately the same trend was observed but the difference was statistically significant only for boys. On ROC analysis, VF:SF ratio of 0.609 predicted CD with the sensitivity of 75% and specificity of 86.4% (area under curve [AUC]-0.795, 95% CI 0.636-0.955; p=0.005). VF:TF ratio of 0.379 had similar sensitivity of 75% and specificity of 86.4% (AUC-0.795, 95% CI 0.636-0.955; p=0.005). The VF area of 1485.26 mm² had a sensitivity of 83.3% and specificity of 72.7% for CD (AUC-0.758, 95% CI 0.590-0.925; p=0.01).

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Conclusion(s)

The VF/SF ratio is a simple, non-invasive, objective parameter to differentiate CD and ITB in children with a good sensitivity and specificity.

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Disclosure of Interest

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Hydrogen sulphide infiltration downregulates oxidative metabolism and extends postharvest life of banana

Hydrogen sulphide (H₂ S) has emerged as a potential regulator of plant defence against different abiotic stresses. As a climacteric fruit, banana undergoes oxidative stresses shortly after harvest, resulting in faster ripening and senescence. This work examines the effects of vacuum infiltrated H₂ S on ripening inhibition of banana. Banana fruits were vacuum infiltrated with 1 mm H₂ S. Effects on oxidative stress markers, physiological changes, bioactive compounds and antioxidant potentials were examined during storage at 25 °C and 75-80% RH. Results indicate that treated fruits were less affected by oxidative stress, as evident by lower accumulation of ROS (superoxide and peroxide ions), elevated phenols content and antioxidant capacity. The ripening inhibitory effects of H₂ S delayed chlorophyll loss and reduced ethylene and CO₂ production. H₂ S infiltration also reduced MDA accumulation and electrolytic leakage, resulting in longer shelf life. Vacuum infiltration with H₂ S had a protective effect on postharvest banana through overcoming the deleterious effect of ROS and strengthening antioxidant potential. Thus, this method could be promising for enhanced preservation of banana during storage.

Bronco T (Shirisadi kasaya), a polyherbal formulation prevents LPS induced septicemia in rats

OBJECTIVE

Here, Bronco T (BT), a polyherbal formulation developed in 1984 for treating asthma, has been repurposed against septicemia-induced ALI.

MATERIALS AND METHODS

Lipopolysaccharides (3 mg/kg BW) were injected intraperitoneally before 24 hours of surgery to assess the cardiorespiratory parameters, blood PaO2/FiO2 and MPO, pulmonary water content and histological changes in the lungs. The pentoxifylline (PTX) (25 mg/kg BW) was used as the positive control and given one hour before LPS. BT was given 3 hours (orally at different doses of 3, 1.5 and 0.75 g/kg BW) before LPS.

RESULTS

The LPS treated group showed significant bradypnea, hypotension and bradycardia, through elongated peaks (RR) and (MAP) respectively and finally death after 95 minutes of LPS injection. The PTX and BT (3 g/kg BW) pretreatment significantly prevented these changes (dose-dependent in the BT group). The survival in these groups was maintained up to 190 min after LPS. The Pentoxifylline showed a better response (75%) than Bronco T (72%). In both the treatments, a significant decrease in pulmonary water content and minimal neutrophil infiltration and intact alveoli-capillary membrane was seen in the transverse section (T.S) of the lungs.

CONCLUSIONS

Significant improvement was noted in survival time with lesser tissue damage and improved pulmonary function was observed by pre-treating with Bronco T in LPS induced septicemia.

Molecular detection of Salmonella isolated from commercial chicken

BACKGROUND

Salmonella in chicken, specially, the motile salmonellae, causes the food chain unsafe from farm to table and is considered a significant global threat to public health.

AIMS

The present study was carried out for molecular detection of Salmonellae in commercial poultry using PCR.

METHODS

The study was conducted for eight months, from July 2019 to February 2020, and a total of 26 poultry farms, including 15 broiler and 11-layer farms, were visited individually. Pooled faecal samples were obtained from the sheds. A total of 189 necropsy cases were examined for gastrointestinal lesions. Isolation and identification of the organism were done using microbe culture method, and the molecular characterization was performed via PCR targeting invA and ent genes.

RESULTS

The prevalence of salmonellosis in the broiler and layer farms was recorded at 20.0% and 45.4%, respectively, through the traditional gold standard culture method. From 189 necropsy birds, salmonellosis was recorded at 1.58% dead cases. Molecular detection of Salmonella isolates by PCR targeting invA gene was confirmed in 13.33% of the broiler farms and 36.3% of the layer farms. Further detection of Salmonella enteritidis was performed by PCR targeting ent gene by which 11.11% positivity was determined.

CONCLUSION

This study, focused on the Salmonella prevalence, highlighted the zoonotic importance of the bacterium in the commercial poultry farms, which can subsequently be dispersed into the human food chain causing harmful health effects.

Effect of a dietary supplement on the reduction of lymphedema-progression in mouse tail-cut model

OBJECTIVE

The aim of our study was to evaluate in vivo, in a mouse tail model of lymphedema, the effects of a dietary supplement, Garlive®, based on hydroxytyrosol from olive leaves, spermidine from rice seeds, hesperidin from citrus fruits and vitamin A. Hydroxytyrosol has anti-inflammatory, antioxidant and antimicrobial activities and inhibits leukotriene B4 generation; spermidine is able to inhibit the production of pro-inflammatory cytokines and mediators; hesperidin inhibits the secretion of pro-inflammatory cytokines: IFN-γ, IL-2, IL-4, IL-10; vitamin A deficiency was shown to induce inflammation and aggravate existing inflammatory states, whereas supplementation with vitamin A could ameliorate inflammation.

MATERIALS AND METHODS

The active compounds were included in tablets: 250 mg of olive leaf extract titrated in 10% hydroxytyrosol, 200 mg of citrus fruits extract titrated in 60% hesperidin, 10 mg of rice (Oryza sativa) seeds extract titrated in 1% spermidine and 0.8 mg of vitamin A. Mice of an inbred group were randomly selected and divided in the control group and drug-treated group. The wound necessary for lymphedema generation was made on the tail of each mice 1 cm below the base of the trunk.

RESULTS

After surgical intervention, there was a gradual increase in the circumference of both ends of the wound. The control group showed higher increase of tail volume than the drug-treated group. The differences in tail swelling between the control group and the drug-treated group were significantly different. The peak of swelling was anticipated to the 6th day in the drug-treated group, whereas in the control group the peak was reached later on.

CONCLUSIONS

The tested drug prevented the induction of swelling from day 5th of wound creation and decreased the duration of swelling, favoring the wound healing.

1444 Is FBC Being Investigated Within 32 Hours of Surgery in Neck of Femur Fractures?

Introduction

The UK treats approximately 76,000 neck of femur (NOF) fractures annually (NHFD 2018). These patients are known to be frail and dehydrated upon arrival to the emergency department. Surgery can expose patients to substantial blood loss both preoperatively and postoperatively (Foss et al). Furthermore, studies have shown that postoperative anaemia is detrimental in patients who have had hip surgery (Marval et al 2014). Thus, it is imperative to monitor patients’ haemoglobin (Hb) levels immediately after the operation so that optimum treatment can be assured. The current audit standard in our local trust states that all patients must have their full blood count (FBC) within 32 hours post-surgery. As Covid-19 has brought disruption to the NHS, It is important for us to highlight any issues that arise in the monitoring of Hb in the post-operative phase of these NOF patients.

Method

Using retrospective analysis, this study analysed the number of patients having the FBC within 32 hours post-surgery during the pandemic (n = 60) and was compared to a similar cohort pre-pandemic (n = 139).

Results

91% of patients overall had their Hb checked within 32 hours. 92% in the pre-covid group had a Hb check within time compared to 81% in the covid group. The risk ratio calculated was 1.5.

Conclusions

Conclusively, patients in the covid group were 1.5 times more likely to have their FBC checked past 32 hours post-surgery. However, this finding was not significant. Overall, the audit standard was not met.

Role of postoperative intact serum PTH as an early predictor of severe post-thyroidectomy hypocalcemia: a prospective study

BACKGROUND

Post thyroidectomy hypocalcemia is a major sequel of thyroidectomy and continues to trouble the endocrinologists and the endocrine surgeons as there is no ideal predictive marker of hypocalcemia which has the potential to develop into a life-threatening complication. The role of early serum intact parathormone (iPTH) to predict post thyroidectomy hypocalcemia is becoming useful but the literature is still unclear regarding the optimal time of testing and the optimal cut-off value of serum iPTH.

PATIENTS AND METHODS

This is a prospective cohort study of 111 patients who underwent total thyroidectomy in a tertiary care endocrine surgery referral unit. Serum iPTH was measured after 20 min and 4 h of surgery. Receiver-Operator characteristic Curve (ROC) was used to find out of the best cut-off value of S. iPTH 20 min and 4 h after surgery in predicting hypocalcemia.

RESULTS

Hypocalcemia was noted in 60 (54%) out of 111 subjects who underwent total thyroidectomy. The best cut-off values of Serum iPTH to predict hypocalcemia was found to be 4.28 pmol/l at 20 min post total thyroidectomy with a sensitivity and specificity of 81.7% and 51%, respectively. In addition, patients with malignancy or central lymph nodal dissection were significantly over-represented in the hypocalcemia group with serum iPTH above the threshold level of 4.28 pmol/l. Below the cut off level, parenteral calcium supplementation was required in 23% (17/74) subjects while the rate was only 5.4% (2/37) patients when serum iPTH was above the cut-off level.

CONCLUSIONS

The decline of serum iPTH below a specific level after surgery has predictive value together with other factors strictly related to patient, the thyroid disease itself and surgery. The risk of development of hypocalcemia and consequent need for calcium supplementation should be evaluated by clinical assessment along with serum PTH measurement.

Characterization of plastic debris from surface waters of the eastern Arabian Sea-Indian Ocean

The quantity of floating plastic debris (FPD) is continuously being increased in the oceans. To assess their size, structure, and composition along the eastern Arabian Sea (EAS), FPD samples were collected by using a surface plankton net. The microplastic size fraction (0.5-5 mm) was the most prevalent accounting for >50% of the total, followed by mesoplastics (5-25 mm; ~40%) and macroplastics (>25 mm; ~10%). The collected FPDs were categorized into five different types and eight colours. Attenuated Total Reflectance-Fourier Transform Infrared Spectrometry (ATR-FTIR) analysis of the plastics revealed that polypropylene, polyethylene, and nylon were the most dominant polymers, and these comprised mostly of fibre/fishing line. The abundance of FPD in the EAS (0.013 ± 0.012 no.s/m³) was found to be very low compared to elsewhere. The prevalent microplastics presence in the oceans might have occurred mainly by the degradation of larger items. It increases bioavailability, and hence, is a risk to marine ecosystems.

Appearance of Temporal and Spatial Chaos in an Ecological System: A Mathematical Modeling Study

The ecological theory of species interactions rests largely on the competition, interference, and predator-prey models. In this paper, we propose and investigate a three-species predator-prey model to inspect the mutual interference between predators. We analyze boundedness and Kolmogorov conditions for the non-spatial model. The dynamical behavior of the system is analyzed by stability and Hopf bifurcation analysis. The Turing instability criteria for the Spatio-temporal system is estimated. In the numerical simulation, phase portrait with time evolution diagrams shows periodic and chaotic oscillations. Bifurcation diagrams show the very rich and complex dynamical behavior of the non-spatial model. We calculate the Lyapunov exponent to justify the dynamics of the non-spatial model. A variety of patterns like interference, spot, and stripe are observed with special emphasis on Beddington-DeAngelis function response. These complex patterns explore the beauty of the spatio-temporal model and it can be easily related to real-world biological systems.

Complications of tuberculous meningitis and their effect on outcome in a tertiary care cohort

BACKGROUND: To report the frequency and severity of complications, and their effect on the outcome of tuberculous meningitis (TBM).METHODS: In this retrospective cohort study, the following TBM complications were observed: status epilepticus (SE), hydrocephalus, paradoxical clinical worsening (PCW), hyponatremia, drug-induced hepatitis (DIH), infarction and mechanical ventilation (MV). These were recorded and correlated with stage of meningitis and outcome.RESULTS: A total of 144 patients with TBM (median age 26 years, range 12-75) were included. There were 76 (52.8%) females. The patients were in Stage I (n = 33), Stage II (n = 82) and Stage III (n = 29); 58 had definite TBM. Complications occurred in 128 (88.9%); complications included hydrocephalus (n = 58, 40.3%), hyponatremia (n = 70, 48.6%), infarction (n = 48, 33.3%), DIH (n = 42, 29.2%), SE (n = 16, 18.0%), MV (n = 43, 29.9%) and PCW (n = 24, 16.7%), with variable overlap. By 6 months, 33 patients had died. Death was related to PCW (P = 0.016), hyponatremia (P = 0.03), MV (P = 0.02), infarction (P = 0.03) and the number of complications. Except PCW, most complications occurred during the first month.CONCLUSIONS: In TBM, complications occurred in 128 (88.9%) patients, mainly in the early stages, with variable overlap. Infarction, PCW, hyponatremia and MV were predictive of poor outcome.

Evaluation of Changes in Microbiology and Periodontal Parameters During and After Fixed Orthodontic Appliances

The objective of the study was to evaluate the changes in microbiology through quantitative analysis of aerobic and anaerobic colonies and periodontal measurements during and after 1 month of removal of fixed orthodontic appliances. This prospective study comprised 30 patients, aged 12-30 years seeking orthodontic treatment in the department of Orthodontics and Dentofacial Orthopaedics of People's College of Dental Sciences and Research Centre, Bhopal from May 2016 to November 2017. Microbiological samples (supra- and subgingival plaque) and periodontal measurements like bleeding on probing (BOP), periodontal pocket depth (PPD) with oral hygiene assessment indices {plaque index (PI), gingival index (GI)} were used at 2 time interval: when patient undergoing orthodontic treatment >12 month (baseline, T₁) and 1 month after the removal of appliance (T₂). Bacterial culture method used to detect aerobic and anaerobic colony forming units (CFU) and their ratio (aerobic/anaerobic). Data analyzed using paired t-test and chi-square test. There was a significant decrease in an aerobic and anaerobic CFU (both supra- and subgingivally) and increase in CFU ratio (relatively less anaerobes) (p≤0.05) at T₂. Supragingival plaque sampling showed greater diminution in the CFU count as compared to the subgingival CFU, as these sites are more accessible for maintaining hygiene. Also, periodontal measurements showed significant decrement (PI, GI, PPD and BOP) at T₂ (p≤0.05). Fixed orthodontic treatment has transient effect on periodontium as supra- and subgingival CFU count decreases and periodontal health was ameliorated after removal of appliances which was accompanied with periodontopathic bacteria and clinical periodontal signs of inflammation during treatment.

Drying of citrus grandis (pomelo) fruit juice using block freeze concentration and spray drying

Pomelo fruit juice is concentrated using two different techniques, i.e. block freeze concentration (BFC) and thermal concentration (TC), and both concentrates were spray dried separately to observe the effects of two different concentration techniques on the physicochemical properties of the spray dried powder. BFC juice had comparatively better values of retention of acidity, colour, vitamin C, DPPH● scavenging activity, total phenolic content (TPC), and total sugar content than TC juice. The powder obtained from the combination of BFC and spray drying had better retention of vitamin C (121.17 mg/100 g), colour, and exhibited higher DPPH● scavenging activity than TC spray dried powder. The physical parameters including solubility index, bulk density, and hygroscopicity were significantly higher in BFC spray dried powder. BFC was observed as an efficient concentration technique in comparison to TC as a pretreatment to produce spray dried powder with a better retention of bioactive components and powder flow properties.

A Comparison of the Reliability of the Patellar Tendon-Trochlear Groove (PTTG) Distance and the Tibial Tuberosity-Trochlear Groove (TTTG) Distance Measured on MRI

Introduction:

An increased tibial tuberosity-trochlear groove (TTTG) distance is used for deciding a treatment plan in patello-femoral instability (PFI). The centre of the patellar tendon and the chondral trochlear groove can be directly visualised on MRI, and measured, giving the patellar tendon-trochlear groove (PTTG) distance. A study was designed to compare the inter-rater and the test-retest reliabilities of PTTG and TTTG measurements in MRI of patients without PFI and in a group with PFI.

Materials and Methods:

This cross-sectional reliability study was done on archival MRI films of 50 patients without patellar instability and 20 patients with patellar instability. TTTG and PTTG distances were independently measured by two orthopaedic surgeons and two radiologists. A hybrid PTTG measurement with bony landmarks on the femoral side and the patellar tendon landmark on the tibial side, was used to estimate the influence of the differences in the femoral and tibial landmarks on the difference in reliabilities. The intra-class correlation coefficient (ICC) was calculated for all four raters, as well as separately for each rater.

Results:

The PTTG distance had a higher inter-rater reliability (ICC=0.86, 95% CI=0.79-0.92) compared to the TTTG distance (ICC=0.70, 95% CI=0.59-0.80) in patients without PFI. Similar trends were seen in patients with PFI (0.83 vs 0.66). The inter-rater reliability for the hybrid PTTG distance was found to lie in between the TTTG and PTTG.

Conclusions:

The MRI-based PTTG distance had better inter-rater reliability compared with the MRI-based TTTG distance.

SERS Platform for Dengue Diagnosis from Clinical Samples Employing a Hand Held Raman Spectrometer

Dengue is a serious global health concern especially in tropical and subtropical countries. About 2.5 billion of the world's population is at risk for dengue infection. Early diagnosis is the key to prevent the deterioration of health of the patient to severe illness. Laboratory diagnosis of dengue is essential for providing appropriate supportive treatment to dengue patients with febrile illness, which is difficult to diagnose clinically. Here, we demonstrate surface enhanced Raman scattering (SERS) based diagnosis of dengue virus in clinical blood samples collected from total of 102 subjects. All of the samples were well characterized by conventional NS1 antigen and IgM antibody ELISA kits. The silver nanorods array fabricated by glancing angle deposition technique were employed as SERS substrates. A small amount of patient blood serum (5 μL) was taken for analysis and the report was prepared within a minute. SERS spectra of pure NS1 protein as well as spiked in serum was also recorded separately. Principal component analysis (PCA) was employed as the statistical tool to differentiate dengue positive, dengue negative, and healthy subjects on the basis of their respective SERS spectra. This method provides a sensitive, rapid, and field deployable diagnosis of dengue at the early stage (within 5 days of the onset of symptoms).

Prompt diagnosis of Scedosporium apiospermum soft tissue infection: Life-saving in a renal transplant recipient

Scedosporium apiospermum, an ubiquitous filamentous fungus, a known cause of mycetoma, is emerging as an opportunistic pathogen in immunocompromised individuals. We report a case of painful foot abscess in a renal allograft recipient on immunosuppressive therapy, which was clinically diagnosed as a suppurative bacterial abscess. Pus was aspirated, which showed septate, branching hyphal elements and culture on Sabouraud's dextrose agar yielded S. apiospermum, which was identified based on its macroscopic and microscopic features. There are very few reports of scedosporiasis from India. High index of suspicion for unusual fungal infection helps in prompt etiological diagnosis in a transplant recipient and rapid management prevents further dissemination.

Prevalence and predictors of delayed clinical diagnosis of Type 2 diabetes: a longitudinal cohort study

AIMS

To examine the prevalence and person-level predictors of undiagnosed Type 2 diabetes among adults with elevated HbA_1c values.

METHODS

We identified adults without diabetes who had a first elevated HbA_1c (index HbA_1c ≥ 48 mmol/mol; ≥ 6.5%) between January 2014 and December 2015, and classified them by Type 2 diabetes diagnosis status at 1 year following this result. Multilevel modelling techniques were used to examine the association of individual demographic, clinical, and utilization characteristics with remaining undiagnosed. We quantified differences in early Type 2 diabetes care between diagnosed and undiagnosed individuals.

RESULTS

Of the 18 356 adults with a first elevated index HbA_1c , 30.2% remained undiagnosed with Type 2 diabetes 1 year later. Individuals with lower index HbA_1c values [adjusted odds ratio (aOR) 5.95, 95% confidence interval (CI) 5.21-6.78 for 48 to <53 mmol/mol (6.5% to 7.0%); referent 53 to <64 mmol/mol (7.0% to <8.0%)], who were ≥ 70 years old (aOR 1.40, 95% CI 1.24-1.59; referent 50-59 years), and who had a prior prediabetes diagnosis (aOR 1.35, 95% CI 1.24-1.47; referent no prediabetes) had increased odds of remaining undiagnosed. After adjusting for age, race, and index HbA_1c , remaining undiagnosed was associated with lower odds of initiating metformin (aOR 0.06, 95% CI 0.05-0.07).

CONCLUSIONS

Almost one-third of adults with an elevated HbA_1c value were not diagnosed with Type 2 diabetes within 1 year. Undiagnosed Type 2 diabetes, in turn, was associated with differences in early care. Strategies that leverage the electronic health record to facilitate earlier diagnosis may help reduce delays and allow for early intervention towards the goal of improved outcomes.

Vulnerabilities and risks of HIV infection among migrants in the Thane district, India

OBJECTIVES

To explore the vulnerabilities and risks of HIV infection among female migrants compared with male migrants in the Thane district of Maharashtra, India.

STUDY DESIGN

This is a cross-sectional epidemiological study.

METHODS

Data from 35,841 migrants (men 96.2% and women 3.8%) were collected using the web-based 'Migrant Service Delivery System.' The data were then analysed in SPSS, version 23.0. Statistical analysis, including Chi-squared test and multivariate logistic regression, was used to identify factors influencing HIV infection for both male and female migrants.

RESULTS

It was observed that 2.96% of female migrants had HIV infection compared with 0.77% of male migrants. We found that 12.1% of women consumed alcohol compared with 41.9% of men, and access to bars was 1.5% among women and 3.5% in men. We observed an even larger difference between men and women in their previous history of using brothels for sex; only 5.9% of female migrants reported previously having used brothels for sex, compared with 62.9% of male migrants. Approximately 12.3% of married women and 93.6% of married men had sex with someone other than their spouse. We found that 67.0% of married women and 73.9% of married men reported using a condom during their last sexual act compared with 60.9% of unmarried women and 68.1% of unmarried men.

CONCLUSIONS

In Thane, female migrants faced higher vulnerabilities and risks of HIV infection than male migrants. Consequently, innovative strategies are required to address these particular needs of female migrants.

A Randomized Controlled Trial to Compare the Efficacy of Intravenous Dexmedetomidine and Clonidine as Adjuvants to Low Dose Opioid in Attenuation of Hemodynamic Response to Laryngoscopy and Tracheal Intubation

Increase in sympathetic activity as a result of cardiovascular stress response to laryngoscopy can be detrimental to the patient. The primary objective is to compare intravenous dexmedetomidine and clonidine as adjuvants to low dose opioid (fentanyl) for attenuation of hemodynamic response to laryngoscopy and tracheal intubation. The secondary objectives are to compare the perioperative dose requirement of fentanyl and thiopentone, to compare the duration of postoperative analgesia, and to look for side effects in all three groups. This randomized controlled trial was performed in a tertiary care hospital in North India from November 2012 to April 2014. One hundred twenty (120) patients (ASA I or II) posted for elective surgery under general anesthesia. Group D received intravenous dexmedetomidine (1μg/kg) with intravenous fentanyl (1μg/kg), Group C received intravenous clonidine (1μg/kg) with intravenous fentanyl (1μg/kg) and Group F received intravenous fentanyl (2μg/kg). Heart rate and mean arterial pressure were recorded at baseline, after study drug at 5, 10 & 15 minutes, after induction, intubation (0 min) and 1, 3, 5, 10, 15 minutes after intubation. The required perioperative doses of thiopentone and fentanyl, and time to first rescue analgesia given in postoperative period were also noted. One way ANOVA and Repeated Measures ANOVA followed by multiple comparisons (if applicable) were used for data analysis. P value <0.05 was considered statistically significant. The rise in HR and MAP at laryngoscopy and intubation was found to be less in clonidine group as compared to fentanyl group and dexmedetomidine was able to abolish this rise completely. The requirement of thiopentone and fentanyl were significantly least in dexmedetomidine group and the duration of time to first rescue analgesia was significantly prolonged in clonidine group. Intravenous fentanyl (2μg/kg) failed, addition of clonidine to fentanyl was able to partially blunt it, but the addition of dexmedetomidine to fentanyl completely abolished the hemodynamic response to laryngoscopy and intubation.

Health care resource use, health care expenditures and absenteeism costs associated with osteoarthritis in US healthcare system

OBJECTIVES

We determined incremental health care resource utilization, incremental health care expenditures, incremental absenteeism, and incremental absenteeism costs associated with osteoarthritis.

DESIGN

Medical Expenditure Panel Survey (MEPS) for 2011 was used as data source. Individuals 18 years or older and employed during 2011 were eligible for inclusion in the sample for analyses. Individuals with osteoarthritis were identified based on ICD-9-CM codes. Incremental health care resource utilization included annual hospitalization, hospital days, emergency room visits and outpatient visits. Incremental health expenditures included annual inpatient, outpatient, emergency room, medications, miscellaneous and annual total expenditures.

RESULTS

Of the total sample, 1354 were diagnosed with osteoarthritis, and compared to non osteoarthritis individuals. Incremental resource utilization, expenditures, absenteeism and absenteeism costs were estimated using regression models, adjusting for age, gender, sex, region, marital status, insurance coverage, comorbidities, anxiety, asthma, hypertension and hyperlipidemia. Regression models revealed incremental mean annual resource use associated with osteoarthritis of 0.07 hospitalizations, equal to 70 additional hospitalizations per 100 osteoarthritic patients annually, and 3.63 outpatient visits, equal to 363 additional visits per 100 osteoarthritic patients annually. Mean annual incremental total expenditures associated with osteoarthritis were $2046. Annually, mean incremental expenditures were largest for inpatient expenditures at $826, followed by mean incremental outpatient expenditures of $659, and mean incremental medication expenditures of $325. Mean annual incremental absenteeism was 2.2 days and mean annual incremental absenteeism costs were $715.74. Total direct expenditures were estimated at $41.7 billion.

CONCLUSION

Osteoarthritis was associated with significant incremental health care resource utilization, expenditures, absenteeism and absenteeism costs.

Spectrum of hemostatic disorders in Indian females presenting with bleeding manifestations

INTRODUCTION

Hemostatic disorders are often missed in women with bleeding particularly menorrhagia. Preexisting hemostatic disorders are now known as common risk factor for postpartum hemorrhage and prolonged bleeding in puerperium. Females with bleeding complaints constitute an important population referred to hematology clinic. Hence, we aim to evaluate the type and frequency of hemostatic disorders among females presenting with bleeding in a tertiary care hospital and a basic hemostatic laboratory.

METHODS

Three-year data were retrospectively analyzed for 200 females with various bleeding complaints. Due to resource constraints, a hemostatic workup was done with prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen assay, clot solubility test, mixing studies, specific factor assays, platelet function test, and von Willebrand factor antigen level.

RESULTS

A total of 200 females were investigated to identify the cause of their bleeding. Thirty-five of 200 (17.5%) females were found with an underlying bleeding disorder. Of these 35 females, 65.7% presented with bleeding from more than 1 site. Most common bleeding manifestation was spontaneous bruising in 18 of 35 (51.4%) patients followed by petechiae (48.6%). Inherited bleeding disorders were noted in majority. The most common inherited bleeding disorder identified was von Willebrand disease (VWD) in 34.3% females. Second most common disorder was Glanzmann's thrombasthenia accounting for 22.8%. Rare coagulation factor deficiency, such as factors VII, X, and XIII deficiencies, was noted. Three cases revealed acquired causes of coagulation defects.

CONCLUSION

Underlying hemostatic defects should be searched for in women with unexplained bleeding complaints. This will not only help in diagnosis but also in proper management for future hemostatic challenges.

Optimization of treatment modality in elderly end-stage renal disease population: Peritoneal dialysis versus transplant

Despite kidney transplantation (KT) being considered as the best treatment modality for end-stage renal disease (ESRD), patient and graft survival in the elderly population is poorer than younger individuals. Many authors argue that prolonged life expectancy outweighs the risk of remaining on dialysis, but few studies had compared the treatment modalities, especially with peritoneal dialysis (PD). A retrospective study was conducted at a tertiary care institute to compare outcome of elderly ESRD patients, who received KT with those continued on PD; and to evaluate the predictors of patient survival. Patient survival at 1 year was (76.2% vs. 91.1%); 5 years (53.7% vs. 21.8%); and 10 years (35.6% vs. 0.00%) among KT and PD population, respectively. Infection was the most common cause of death among KT group (35 [41.2%] vs. 34 [28.2%]) while cardiovascular mortality in PD group (55 [46.2%] vs. 7 [8.2%]). Technique survival at 1, 5, and 10 years in PD group was 92.8%, 58.5%, and 0%, respectively. Similarly, graft survival at 1, 5, and 10 years in KT group was 98.7%, 90.2%, and 90.2%, respectively. Multivariate analysis showed body mass index (BMI) (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.82–0.93, p < 0.001), and albumin (HR 0.55, 95% CI 0.37–0.80, p = 0.002) were significant predictors of survival. In the 1^st year, patient survival was better in PD than KT, but after adjustment for BMI and albumin, both short-term and long-term survival in elderly KT group was better than that of PD. Hence, elderly ESRD patients should not be barred from KT just because of age.

Neutrophil Gelatinase-associated Lipocalin: As a Predictor of Early Diabetic Nephropathy in Type 2 Diabetes Mellitus

This study was carried out to look for diagnostic and prognostic role of neutrophil gelatinase-associated lipocalin (NGAL) in early diabetic nephropathy (DN) in type 2 diabetes individuals. NGAL was measured in both urinary and serum sample of 144 type 2 diabetes individuals stratified into three categories based on urinary albumin-creatinine ratio and 54 control populations with estimated glomerular filtration rate >60 mL/min/1.73 m² and serum creatinine <1.2 mg/dl. The serum NGAL (sNGAL), urine NGAL (uNGAL), and uNGAL/urine creatinine were significantly higher in diabetic individuals than in the control populations with significant difference in between the groups (P < 0.05). Difference of above values between control value and normoalbuminuria was also statistically significant (P < 0.05). Again, sNGAL and uNGAL correlate positively with albuminuria (P < 0.05). Tubular injury may precede glomerular injury in diabetic individuals, and NGAL can be used as a biomarker to diagnose DN even earlier to incipient nephropathy. Both sNGAL and uNGAL can predict albuminuria and be used as a noninvasive tool for diagnosis, staging, and progression of DN.

Hydronephrotic kidney with multiple extra-renal calyces

Extra-renal calyces are a rare anomaly of the renal collecting system, characterised by the presence of calyces and pelvis outside the renal parenchyma. It may also be associated with other anomalies, such as renal ectopia, fusion and malrotation. We describe an unusual case of extra-renal calyces with six long calyces arising from a suspected multicystic dysplastic kidney that was successfully managed laparoscopically.

Stability of nano-sized permethrin in its colloidal state and its effect on the physiological and biochemical profile of Culex tritaeniorhynchus larvae

The occurrence of pesticidal pollution in the environment and the resistance in the mosquito species makes an urge for the safer and an effective pesticide. Permethrin, a poorly water-soluble pyrethroid pesticide, was formulated into a hydrodispersible nanopowder through rapid solvent evaporation of pesticide-loaded oil in water microemulsion. Stability studies confirmed that the nanopermethrin dispersion was stable in paddy field water for 5 days with the mean particle sizes of 175.3 ± 0.75 nm and zeta potential of -30.6 ± 0.62 mV. The instability rate of the nanopermethrin particles was greater in alkaline (pH 10) medium when compared with the neutral (pH 7) and acidic (pH 4) dispersion medium. The colloidal dispersion at 45°C was found to be less stable compared with the dispersions at 25 and 5°C. The 12- and 24-h lethal indices (LC50) for nanopermethrin were found to be 0.057 and 0.014 mg l-1, respectively. These results were corroborative with the severity of damages observed in the mosquito larvae manifested in epithelial cells and the evacuation of the midgut contents. Further, the results were substantiated by the decrease in cellular biomolecules and biomarker enzyme activity in nanopermethrin treated larvae when compared to bulk and control treatment.

Molecular Response to Imatinib and Its Correlation with mRNA Expression Levels of Imatinib Influx Transporter (OCT1) in Indian Chronic Myeloid Leukemia Patients

Background and objectives:

Imatinib mesylate is approved for the treatment of Chronic Myeloid Leukemia (CML). About 20% of patients with CML do not respond to treatment with Imatinib either initially or because of acquired resistance. In addition to mutated BCR-ABL1 kinase, the organic cation transporter1 (OCT1, encoded by SLC22A1) has been considered to contribute to Imatinib resistance in patients with chronic myeloid leukemia (CML). OCT1 has been reported to be the main influx transporter involved in Imatinib uptake into CML cells. To date, only a few studies have been reported on involvement of influx transporters in development of Imatinib resistance. Therefore this study was aimed to determine the expression level of Imatinib uptake transporter (OCT1) in CML patients and to correlate this level with molecular response.

Methods:

One hundred fifty eight patients on Imatinib were considered for gene expression analysis study for OCT1 gene. Total RNA was extracted from peripheral blood mononuclear cells. Complementary DNAs (cDNAs) were synthesized and Real Time Polymerase Chain Reaction (RQ-PCR) was performed.

Results:

High OCT1 expression was present in 81 (51.8%) patients and low OCT1 expression was in 77 (48.7%) patients. Low Sokal risk score group have a significantly high OCT1 expression (p=0.048). The rate of molecular response was higher in those with high OCT1 expression than in those with low OCT1 expression (p=0.05). Both event-free survival and median overall survival were significantly shorter in patients with low OCT1 expressions when compared to the patients with high OCT1 expression (p=0.03 and p=0.05).

Conclusions:

Our findings demonstrated that the mRNA expression level of OCT1 was significantly correlated with molecular response in CML patients. Based on these findings, present study believes that the pre-therapeutic higher expression of OCT1 may help to predict response to imatinib therapy in CML patients.

Band Structure of Topological Insulator BiSbTe1.25Se1.75

We present our angle resolved photoelectron spectroscopy (ARPES) and density functional theory results on quaternary topological insulator (TI) BiSbTe_1.25Se_1.75 (BSTS) confirming the non-trivial topology of the surface state bands (SSBs) in this compound. We find that the SSBs, which are are sensitive to the atomic composition of the terminating surface have a partial 3D character. Our detailed study of the band bending (BB) effects shows that in BSTS the Dirac point (DP) shifts by more than two times compared to that in Bi₂Se₃ to reach the saturation. The stronger BB in BSTS could be due to the difference in screening of the surface charges. From momentum density curves (MDCs) of the ARPES data we obtained an energy dispersion relation showing the warping strength of the Fermi surface in BSTS to be intermediate between those found in Bi₂Se₃ and Bi₂Te₃ and also to be tunable by controlling the ratio of chalcogen/pnictogen atoms. Our experiments also reveal that the nature of the BB effects are highly sensitive to the exposure of the fresh surface to various gas species. These findings have important implications in the tuning of DP in TIs for technological applications.

Spectrum average cross section measurement of 183W (n, p)183Ta and 184W (n, p)184Ta reaction cross section in 252Cf(sf) neutron field

Neutron induced nuclear reactions are of prime importance for both fusion and fission nuclear reactor technology. Present work describes the first time measurement of spectrum average cross section of nuclear reactions ¹⁸³W(n,p)¹⁸³Ta and ¹⁸⁴W(n,p)¹⁸⁴Ta using ²⁵²Cf spontaneous fission neutron source. Standard neutron activation analysis (NAA) technique was used. The neutron spectra were calculated using Monte Carlo N Particle Code (MCNP). The effects of self-shielding and back scattering were taken into account by optimizing the detector modeling. These effects along with efficiency of detector were corrected for volume sample in the actual source-detector geometry. The measured data were compared with the previously measured data available in Exchange Format (EXFOR) data base and evaluated data using EMPIRE - 3.2.2.

Utilizing PBPK Modeling to Evaluate the Potential of a Significant Drug-Drug Interaction Between Clopidogrel and Dasabuvir: A Scientific Perspective

Dasabuvir, a component of VIEKIRA PAK, is a substrate of CYP2C8 enzymes. Prescribing information for VIEKIRA PAK contraindicates gemfibrozil, a strong CYP2C8 inhibitor, because coadministration significantly increases dasabuvir exposures, which may increase the risk of QT prolongation. Clopidogrel may increase dasabuvir exposures primarily due to CYP2C8 inhibition by clopidogrel-acyl-β-D-glucuronide. This commentary outlines the US Food and Drug Administration (FDA) interdisciplinary review team's scientific perspective to address the potential for a significant drug-drug interaction (DDI) between clopidogrel and VIEKIRA PAK.