Exploring optical, electrochemical, thermal, and theoretical aspects of simple carbazole-derived organic dyes

This study highlights the recent advancements in organic electronic materials and their potential for cost-effective optoelectronic devices. The investigation focuses on the molecular design, synthesis, and comprehensive analysis of two organic dyes, aiming to explore their suitability for optoelectronic applications. The dyes are strategically constructed with carbazole as the foundational structure, connecting two electron-withdrawing groups: barbituric acid (Cz-BA) and thiobarbituric acid (Cz-TBA). These dyes, featuring carbazole as the core and electron-withdrawing groups, demonstrate promising spectral, optical, electrochemical, thermal, and theoretical properties. They show strong potential for diverse optoelectronic applications, promising efficient light absorption and robust stability. The results endorse their suitability for practical optoelectronic systems.

Correction: In situ laser irradiation: the kinetics of the changes in the nonlinear/linear optical parameters of As50Se40Sb10 thin films for photonic applications

[This corrects the article DOI: 10.1039/D1RA02368C.].

Correction: Influence of time dependent laser-irradiation for tuning the linear-nonlinear optical response of quaternary Ag10In15S15Se60 films for optoelectronic applications

[This corrects the article DOI: 10.1039/D2RA07981J.].

Annealing-induced phase transformation in In10Se70Te20 thin films and its structural, optical and morphological changes for optoelectronic applications

In2Se3 and In2Te3 have great importance in various device fabrications. The present report is based on the annealing-induced phase formation of both In2Se3 and In2Te3 from In10Se70Te20 thin films at different annealing temperatures as found from the XRD analysis and well supported by the Raman study. The average crystallite size increased with a decrease in the dislocation density. The surface morphology changed with annealing and increased in particle size as noticed from the FESEM images. The uniform distribution and presence of constituent elements in the film were verified using EDX data. The increase in transmittance is accompanied by a decrease in extinction coefficient, optical density and increase in skin depth with annealing. The increase in optical bandgap from 0.418 eV to 0.645 eV upon annealing at 250 °C is associated with a decrease in disorder. The steepness parameter increased and the Se-p value decreased with annealing. The refractive index decreased with an increase in oscillator energy and decrease in dispersion energy. The quality factor, dielectric loss, optical conductivity and electrical susceptibility decreased. The optical electronegativity and plasma frequency increased with annealing. There is a significant change in the non-linear susceptibility and non-linear refractive index with annealing. The observed changes in the film structure and optical behaviour are due to the annealing-induced phase formation from the In10Se70Te20 host matrix upon annealing. Such materials are suitable for optoelectronic and phase change devices.

Influence of time dependent laser-irradiation for tuning the linear-nonlinear optical response of quaternary Ag10In15S15Se60 films for optoelectronic applications

The impact of laser irradiation on thin films results in multiple beneficial modifications of their structural, morphological, nonlinear-linear properties for optoelectronics applications. This work deals with the thermally evaporated Ag10In15S15Se60 films and post-laser irradiation to study the variations in structural and optical properties. The current investigation was carried out for different laser irradiation time durations such as 0, 10, 20, 30, and 60 minutes by 532 nm laser (2.34 eV). According to the X-ray diffraction analysis, all thin films have polycrystalline character. The change in the surface morphology after being exposed to the laser has been checked by FESEM, whereas the presence of constitutional elements has been verified by the EDX study. The related changes with laser irradiation in the optical properties, including both linear and nonlinear, were studied using UV-Vis spectroscopy data. The irradiation caused an enhancement in the transmission, and the absorption edge moved towards a lower wavelength, increasing the bandgap energy from 1.71 eV to 1.88 eV. The refractive index reduced as a result of the film's altered structure. The behaviour of the refractive index satisfies Moss's rule (E g n 4 = const). The nonlinear refractive index, first-order and 3rd order nonlinear susceptibility, is found to be decreased with laser irradiation. The dielectric parameters are also observed to be decreased with irradiation. Considering all the alterations in its properties caused by irradiation, the Ag10In15S15Se60 sample could be a favourable material for various photonic devices.

The impact of fluence dependent proton ion irradiation on the structural and optical properties of Bi5In30Se65 thin films for nonlinear optical devices

The influence of 30 keV proton ion irradiation on the surface morphology, surface topography and optical properties of Bi5In30Se65 thin films.

A supramolecular thermosensitive gel of ketoconazole for ocular applications: In silico, in vitro, and ex vivo studies

The incidence of corneal fungal infections continues to be a growing concern worldwide. Ocular delivery of anti-fungal drugs is challenging due to the anatomical and physiological barriers of the eye. The ocular bioavailability of ketoconazole (KTZ), a widely prescribed antifungal agent, is hampered by its limited aqueous solubility and permeation. In the study, the physicochemical properties of KTZ were improved by complexation with sulfobutylether-β-cyclodextrin (SBE-β-CD).KTZ-SBE-β-CD complex was studied in silico with docking and dynamics simulations, followed by wet-lab experiments.The optimized KTZ-SBE-β-CD complex was loaded into a thermosensitivein situ gel to increase corneal bioavailability. The supramolecular complex increased the solubility of KTZ by 5-folds and exhibited a 10-fold increment in drug release compared to the pure KTZ. Owing to the diffusion, thein situ gel exhibited a more sustained drug release profile. Theex vivocorneal permeation studies showed higher permeation from KTZ-SBE-β-CD in situ gel (flux of ∼19.11 µg/cm²/h) than KTZin situ gel (flux of ∼1.17 µg/cm²/h). The cytotoxicity assays and the hen's egg chorioallantoic membrane assay (HET-CAM) confirmed the formulations' safety and non-irritancy. In silico guided design of KTZ-SBE-β-CD inclusion complexes successfully modified the physicochemical properties of KTZ. In addition, the loading of the KTZ-SBE-β-CD complex into an in situ gel significantly increased the precorneal retention and permeation of KTZ, indicating that the developed formulation is a viable modality to treat fungal keratitis.

The impact of fluence dependent 120 MeV Ag swift heavy ion irradiation on the changes in structural, electronic, and optical properties of AgInSe2 nano-crystalline thin films for optoelectronic applications

Swift heavy ion (SHI) irradiation in thin films significantly modifies the structure and related properties in a controlled manner. In the present study, the 120 MeV Ag ion irradiation on AgInSe₂ nanoparticle thin films prepared by the thermal evaporation method and the induced modifications in the structure and other properties are being discussed. The ion irradiation led to the suppression of GIXRD and Raman peaks with increasing ion fluence, which indicated amorphization of the AgInSe₂ structure along the path of 120 MeV Ag ions. The Poisson's fitting of the ion fluence dependence of the normalized area under the GIXRD peak of AgInSe₂ gave the radius of the ion track as 5.8 nm. Microstructural analysis using FESEM revealed a broad bi-modal distribution of particles with mean particle sizes of 67.5 nm and 159 nm in the pristine film. The ion irradiation led to the development of uniform particles on the film surface with a mean size of 36 nm at high ion fluences. The composition of the film was checked by the energy dispersive X-ray fluorescence (EDXRF) spectrometer. The UV-visible spectroscopy revealed the increase of the electronic bandgap of AgInSe₂ films with an increase in ion fluence due to quantum confinement. The Hall measurement and EDXRF studies showed that the unirradiated and irradiated AgInSe₂ films have n-type conductivity and vary with the ion fluence. The changes in the films were tuned with different ion fluence and are favorable for both optical and electronic applications.

Swift heavy ion (SHI) irradiation in thin films significantly modifies the structure and related properties in a controlled manner.

Burden of arrhythmia in hospitalized patients with cannabis use related disorders: analysis of 2016-2018 national inpatient sample

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cannabis is being more widely use as a recreational substance worldwide. There have been case reports and systematic review describing the association of cannabis use and cardiac arrhythmia (1).

Purpose

We sought out to measure the prevalence of different types of cardiac arrhythmia in hospitalizations associated with cannabis use disorder.

Methods

We queried January 2016 to December 2018 National Inpatient Sample (NIS) databases to identify adult (≥18 yrs) hospitalizations in the US with a diagnosis of cannabis use related disorders. Patients with an associated diagnosis of arrhythmias were also identified based on appropriate ICD-10 CM codes. We used the Chi-square test to evaluate the differences between binary or categorical variables, and Student’s t-test for continuous variables. Multivariate logistic regression was used in outcomes analysis to adjust for potential hospital and patient-level confounders (age, sex, race, diabetes, heart failure, chronic kidney disease, anemia, obesity, elixhauser co-morbidity index, hospital location, teaching status, bed size, income status and others). The discharge weights provided in the databases were used to calculate the national estimates. STATA 16.1 software was used to perform all statistical analysis.

Results

We identified 2,457,544 hospitalizations associated with cannabis use related disorders across three years. Of which, 187,825 (7.6%) were associated with any arrhythmia. We found that atrial fibrillation was the most associated arrhythmia. The complete list of types of arrhythmia and their prevalence are described in Figure-1. Patients with arrhythmia group were older (mean age 50.5 vs 38.3 yrs; P < 0.01) and had higher co-morbidity (% of >3 Elixhauser comorbidity score 94.1% vs 60.6%; P < 0.01). After adjusting for patient and hospital-level confounders, we observed arrhythmia group was associated with higher odds of in-hospital mortality compared to the group without arrhythmia [Odds Ratio (OR): 4.5 (4.09 – 5.00); P < 0.01]. We also observed statistically significant increase in hospitalization length of stay due to the status of any arrhythmia [5.7 vs 5.1 days; P < 0.01].

Conclusion

The prevalence of Afib is high in hospitalizations associated with cannabis use. Hospitalizations associated with cannabis use disorder and any arrhythmia are associated with higher in-hospital mortality and LOS. Therefore, all electrocardiograms should be scrutinized in hospitalized cannabis users. However, further prospective studies are necessary to endorse our study results. Abstract Figure.

Obesity paradox in HFrEF hospitalizations: analysis of national inpatient sample 2016-2018

Funding Acknowledgements

Type of funding sources: None.

Introduction

Obesity is a common and known risk factor for many cardiovascular diseases. Prior studies on chronic systolic heart failure have demonstrated that obesity is inversely associated with mortality, the so-called obesity paradox.

Purpose

 To study the phenomenon of obesity paradox in HFrEF hospitalizations

Methods

We queried January 2016 to December 2018 National Inpatient Sample (NIS) to identify adult (≥18 yrs) hospitalizations with a primary diagnosis of HFrEF. Patients with an associated diagnosis of obesity and higher BMI were also identified based on appropriate ICD-10 CM codes. We used the Chi-square test to evaluate the differences between binary or categorical variables, and Student’s t-test for continuous variables. Multivariate logistic regression was used in outcomes analysis to adjust for potential hospital and patient-level confounders.

Results

 We identified 639,944 weighted HFrEF hospitalizations across three years. Of which, 130,949 (20.4%) of them were associated with obesity. HFrEF with obesity hospitalizations were associated with younger age (mean age 62.0 vs 70.7 yrs; P < 0.01), lesser CAD (55% vs 61%; P < 0.01), higher rate of comorbidity (% of >3 Elixhauser comorbidity score 99.2% vs 94.1%; P < 0.01) and higher Medicaid primary payer (18.2% vs 12.7%, P < 0.01). After adjusting for patient and hospital-level characteristics, we observe statistically significant difference in odds of in-hospital mortality when HFrEF with obesity hospitalizations was compared to HFrEF without obesity [Odds Ratio (OR): 1.1 (0.8 – 1.5); P = 0.52]. We observed statistically significant association with increased LOS [6.0 vs 5.3 days; P < 0.01], increased total hospitalization charges [US$ 61524 vs 55677; P < 0.01] and decreased coronary catheterizations [OR: 0.7 (0.5 – 0.9); P = 0.01] in HFrEF with obesity group compared to HFrEF without obesity.

Conclusion

In this retrospective cohort of hospitalized patients with HFrEF, higher BMI and obesity was not associated with in-hospital mortality. However, it was associated with longer LOS and higher total hospitalization charges. HFrEF with obesity hospitalizations are associated with lesser left coronary catheterizations. This may be explained by lesser burden of CAD in this patient population.

In situ laser irradiation: the kinetics of the changes in the nonlinear/linear optical parameters of As50Se40Sb10 thin films for photonic applications

The photosensitivity of amorphous chalcogenide thin films brings out light-induced changes in the nonlinear and linear optical parameters upon sub-bandgap and bandgap laser irradiation. The present work reports the in situ laser irradiated changes in the optical properties of As50Se40Sb10 thin films. The thermally evaporated film showed an exponential decrease in optical bandgap and increase in Urbach energy. The decay rate of the bandgap was 6.24 min and growth rate of Urbach energy was 6.67 min respectively. The dynamics of photo-induced changes were observed from the changes in linear refractive index and its dependent parameters such as 3rd order nonlinear susceptibility, nonlinear refractive index, dispersion and dielectric parameters. The conversion of heteropolar to homopolar bonds induced the photodarkening mechanism that changed the dispersion parameters. The decrease in E d and E o reduced the oscillator strength along with the zero-frequency dielectric constant. The optical and electrical conductivity changed significantly with time. The changes were saturated with time which brings stability in the film properties that is useful for various optical applications. However, no structural and compositional changes upon laser irradiation were noticed from the X-ray diffraction and EDX studies respectively. The surface homogeneity was checked from the FESEM picture.

Calvarial involvement in disseminated rhinosporidiosis - A case report and literature review

Rhinosporidiosis is a chronic granulomatous infection caused by Rhinosporidium seeberi and mainly involves nasal and ocular mucosa. Bony involvement in rhinosporidiosis is very rare. A young male, previously operated for nasal rhinosporidiosis, presented with two bony swellings on the forehead and multiple subcutaneous lesions on the right lower limb. The diagnosis of disseminated cutaneous rhinosporidiosis with frontal bone involvement was made with the help of fine needle aspiration cytology (FNAC), histopathology, and computed tomography (CT) scan head. Wide excision of the bony lesion was performed. To the best of our knowledge, this is the first radiologically proven case of frontal bone involvement in disseminated rhinosporidiosis. Early diagnosis can be established with a good clinicopathological and radiological correlation. It also emphasizes the importance of CT scan for the evaluation of any subcutaneous skull lesion.

Role of annealing temperature on optimizing the linear and nonlinear optical properties of As40Se50Ge10 films

The present work shows the effect of annealing conditions on the linear and nonlinear optical properties of two-year-old thermally evaporated 800 nm As₄₀Se₅₀Ge₁₀ thin films. The aging effect in this film is clearly noticeable as compared with the old observation. The two-year-old films were annealed at different temperatures like 373, 413, 453 and 493 K for 1 h. The optical parameters were calculated from the optical transmittance and reflectance spectra measured at normal incidence of light by spectrometer in the 500-1000 nm range. The linear refractive index (n) and extinction coefficient (k) were decreased with annealing temperature. The observation reveals the increase in optical band gap with increase in annealing temperature while the width of the tail in the gap has an opposite behaviour. The oscillator energy, dispersion energy, dielectric constant, the loss factor, and optical conductivity were discussed in detail. The nonlinear refractive index and optical susceptibility were calculated by using Miller's formula which decreased with annealing temperature. The changes in both linear and nonlinear optical parameters with annealing temperature showed that annealing temperature can be considered as a useful factor for controlling the optical properties of As₄₀Se₅₀Ge₁₀ chalcogenide films which could be the candidate for numerous photonic applications. The structural study was done by X-ray diffraction and Raman spectroscopy.

International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher.

CONCLUSIONS

Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.

Fungal Planet description sheets: 868-950

Novel species of fungi described in this study include those from various countries as follows: Australia, Chaetomella pseudocircinoseta and Coniella pseudodiospyri on Eucalyptus microcorys leaves, Cladophialophora eucalypti, Teratosphaeria dunnii and Vermiculariopsiella dunnii on Eucalyptus dunnii leaves, Cylindrium grande and Hypsotheca eucalyptorum on Eucalyptus grandis leaves, Elsinoe salignae on Eucalyptus saligna leaves, Marasmius lebeliae on litter of regenerating subtropical rainforest, Phialoseptomonium eucalypti (incl. Phialoseptomonium gen. nov.) on Eucalyptus grandis × camaldulensis leaves, Phlogicylindrium pawpawense on Eucalyptus tereticornis leaves, Phyllosticta longicauda as an endophyte from healthy Eustrephus latifolius leaves, Pseudosydowia eucalyptorum on Eucalyptus sp. leaves, Saitozyma wallum on Banksia aemula leaves, Teratosphaeria henryi on Corymbia henryi leaves. Brazil, Aspergillus bezerrae, Backusella azygospora, Mariannaea terricola and Talaromyces pernambucoensis from soil, Calonectria matogrossensis on Eucalyptus urophylla leaves, Calvatia brasiliensis on soil, Carcinomyces nordestinensis on Bromelia antiacantha leaves, Dendryphiella stromaticola on small branches of an unidentified plant, Nigrospora brasiliensis on Nopalea cochenillifera leaves, Penicillium alagoense as a leaf endophyte on a Miconia sp., Podosordaria nigrobrunnea on dung, Spegazzinia bromeliacearum as a leaf endophyte on Tilandsia catimbauensis, Xylobolus brasiliensis on decaying wood. Bulgaria, Kazachstania molopis from the gut of the beetle Molops piceus. Croatia, Mollisia endocrystallina from a fallen decorticated Picea abies tree trunk. Ecuador, Hygrocybe rodomaculata on soil. Hungary, Alfoldia vorosii (incl. Alfoldia gen. nov.) from Juniperus communis roots, Kiskunsagia ubrizsyi (incl. Kiskunsagia gen. nov.) from Fumana procumbens roots. India, Aureobasidium tremulum as laboratory contaminant, Leucosporidium himalayensis and Naganishia indica from windblown dust on glaciers. Italy, Neodevriesia cycadicola on Cycas sp. leaves, Pseudocercospora pseudomyrticola on Myrtus communis leaves, Ramularia pistaciae on Pistacia lentiscus leaves, Neognomoniopsis quercina (incl. Neognomoniopsis gen. nov.) on Quercus ilex leaves. Japan, Diaporthe fructicola on Passiflora edulis × P. edulis f. flavicarpa fruit, Entoloma nipponicum on leaf litter in a mixed Cryptomeria japonica and Acer spp. forest. Macedonia, Astraeus macedonicus on soil. Malaysia, Fusicladium eucalyptigenum on Eucalyptus sp. twigs, Neoacrodontiella eucalypti (incl. Neoacrodontiella gen. nov.) on Eucalyptus urophylla leaves. Mozambique, Meliola gorongosensis on dead Philenoptera violacea leaflets. Nepal, Coniochaeta dendrobiicola from Dendriobium lognicornu roots. New Zealand, Neodevriesia sexualis and Thozetella neonivea on Archontophoenix cunninghamiana leaves. Norway, Calophoma sandfjordenica from a piece of board on a rocky shoreline, Clavaria parvispora on soil, Didymella finnmarkica from a piece of Pinus sylvestris driftwood. Poland, Sugiyamaella trypani from soil. Portugal, Colletotrichum feijoicola from Acca sellowiana. Russia, Crepidotus tobolensis on Populus tremula debris, Entoloma ekaterinae, Entoloma erhardii and Suillus gastroflavus on soil, Nakazawaea ambrosiae from the galleries of Ips typographus under the bark of Picea abies. Slovenia, Pluteus ludwigii on twigs of broadleaved trees. South Africa, Anungitiomyces stellenboschiensis (incl. Anungitiomyces gen. nov.) and Niesslia stellenboschiana on Eucalyptus sp. leaves, Beltraniella pseudoportoricensis on Podocarpus falcatus leaf litter, Corynespora encephalarti on Encephalartos sp. leaves, Cytospora pavettae on Pavetta revoluta leaves, Helminthosporium erythrinicola on Erythrina humeana leaves, Helminthosporium syzygii on a Syzygium sp. bark canker, Libertasomyces aloeticus on Aloe sp. leaves, Penicillium lunae from Musa sp. fruit, Phyllosticta lauridiae on Lauridia tetragona leaves, Pseudotruncatella bolusanthi (incl. Pseudotruncatellaceae fam. nov.) and Dactylella bolusanthi on Bolusanthus speciosus leaves. Spain, Apenidiella foetida on submerged plant debris, Inocybe grammatoides on Quercus ilex subsp. ilex forest humus, Ossicaulis salomii on soil, Phialemonium guarroi from soil. Thailand, Pantospora chromolaenae on Chromolaena odorata leaves. Ukraine, Cadophora helianthi from Helianthus annuus stems. USA, Boletus pseudopinophilus on soil under slash pine, Botryotrichum foricae, Penicillium americanum and Penicillium minnesotense from air. Vietnam, Lycoperdon vietnamense on soil. Morphological and culture characteristics are supported by DNA barcodes.

Weight loss in achalasia is determined by its phenotype

Patients with achalasia present with dysphagia, regurgitation, and varying degrees of weight loss. However, despite it being a disorder of the lower esophageal sphincter with functional obstruction in all patients, it is unclear why certain patients lose significantly more weight compared to others. The aims of this study are to assess demographic, clinical, and manometric characteristics of a large cohort of patients with achalasia to determine potential correlates of weight loss in this population. Patients with diagnosis of achalasia referred to our center between 2009 and 2016 were evaluated. Demographic and physiologic tests between those with and without weight loss were compared. The cohort of patients with initial self-reported weight loss were studied to determine change in weight after intervention (pneumatic dilation or myotomy). The Kruskal-Wallis test was used for comparison of continuous variables between groups and Pearson's χ2 test was used for comparison of categorical variables between groups. 138 patients with achalasia were evaluated. 35 patients were excluded due to lack of manometric data and 3 from lack of documented weight resulting in the study population of 100 patients with achalasia [51% male, median age: 56 years]. Weight loss was reported in 51/100 (51%) patients. BMI was lower in patients who reported weight loss (25 vs. 31, P < 0.001) with a median weight loss of 28 lbs (14-40 lbs). There were no significant differences in age at diagnosis, gender, or symptom presentation (dysphagia, regurgitation, or chest pain) between the groups. However, more patients with type II achalasia (63%) reported weight loss as compared to other sub-types (P = 0.013). 73% of type III achalasia denied having weight loss. Patients who denied weight loss had symptoms for longer duration (24 vs. 12 months, P < 0.001) and had lower mean residual LES pressure (20 vs. 30 mmHg, P = 0.006). Postintervention 42% of patients reported no weight regain despite appropriate therapy for achalasia with median follow-up of 22 months (range: 6-90 months). Type II achalasia patients are most likely and type III achalasia are least likely to have weight loss compared to type I achalasia. Given that no other demographic/physiologic parameters predicted weight loss, the role of underlying inflammatory cascade in achalasia phenotypes deserves special attention.

Collaborations in gynecologic oncology education and research in low- and middle- income countries: Current status, barriers and opportunities

Eighty-five percent of the incidents and deaths from cervical cancer occur in low and middle income countries. In many of these countries, this is the most common cancer in women. The survivals of the women with gynecologic cancers are hampered by the paucity of prevention, screening, treatment facilities and gynecologic oncology providers. Increasing efforts dedicated to improving education and research in these countries have been provided by international organizations. We describe here the existing educational and research programs that are offered by major international organizations, the barriers and opportunities provided by these collaborations and hope to improve the outcomes of cervical cancer through these efforts.

Recurrence of vulval intraepithelial neoplasia following treatment with cidofovir or imiquimod: results from a multicentre, randomised, phase II trial (RT3VIN)

OBJECTIVE

To compare the recurrence rates after complete response to topical treatment with either cidofovir or imiquimod for vulval intraepithelial neoplasia (VIN) 3.

DESIGN

A prospective, open, randomised multicentre trial.

SETTING

32 general hospitals located in Wales and England.

POPULATION OR SAMPLE

180 patients were randomised consecutively between 21 October 2009 and 11 January 2013, 89 to cidofoovir (of whom 41 completely responded to treatment) and 91 to imiquimod (of whom 42 completely responded to treatment).

METHODS

After 24 weeks of treatment, complete responders were followed up at 6-monthly intervals for 24 months. At each visit, the Common Terminology Criteria for Adverse Events (CTCAE) v3.0 was assessed and any new lesions were biopsied for histology.

MAIN OUTCOME MEASURES

Time to histologically confirmed disease recurrence (any grade of VIN).

RESULTS

The median length of follow up was 18.4 months. At 18 months, more participants were VIN-free in the cidofovir arm: 94% (95% CI 78.2-98.5) versus 71.6% (95% CI 52.0-84.3) [univariable hazard ratio (HR) 3.46, 95% CI 0.95-12.60, P = 0.059; multivariable HR 3.53, 95% CI 0.96-12.98, P = 0.057). The number of grade 2+ events was similar between treatment arms (imiquimod: 24/42 (57%) versus cidofovir: 27/41 (66%), χ2 = 0.665, P = 0.415), with no grade 4+.

CONCLUSIONS

Long-term data indicates a trend towards response being maintained for longer following treatment with cidofovir than with imiquimod, with similar low rates of adverse events for each drug. Adverse event rates indicated acceptable safety of both drugs TWEETABLE ABSTRACT: Long-term follow up in the RT3VIN trial suggests cidofovir may maintain response for longer than imiquimod.

Suicide and life insurance

In the study of suicide little attention has been paid to the role of life insurance. One might suppose that ‘deliberately accelerating the event insured against’ by homicide or suicide would void a policy. One might also predict that changes in attitude towards suicide, so that it is increasingly regarded as a medico-social problem rather than a criminal act, would be reflected in a softening of attitude among insurers. On the other hand, recent epidemiological changes, such as the increased suicide rate among young males, could make companies reluctant to relax their policy conditions.

Component analysis of enhanced recovery pathways for esophagectomy

The objective of this systematic review is to identify key components of enhanced recovery protocols (ERP) that lead to improved length of hospital stay (LOS) following esophagectomy. Relevant electronic databases were searched for studies comparing clinical outcome from esophagectomy followed by a conventional pathway versus ERP. Relevant outcome measures were compared and metaregression was performed to identify the key ERP components associated with reduced in LOS. Thirteen publications were included, ERP was associated with no changes in in-hospital mortality, total complications, anastomotic leak, or pulmonary complications compared with a conventional pathway, however LOS was reduced in the ERP group. Metaregression identified that immediate extubation was associated with reduced LOS (OR = -0.51, 95%CI -0.77 to -0.25; P < 0.01). Several postoperative factors were associated with a significant reduction in length of hospital stay, and in order of most important were (i) gastrograffin swallow ≤5 days (OR = -4.27, 95%CI -4.50 to -4.03); (ii) mobilization on postoperative day ≤1 (OR = -2.49, 95%CI -2.63 to -2.34); (iii) removal of urinary catheter ≤2 days (OR = -0.99, 95%CI -1.15 to -0.84); (iv) oral intake with at least sips of fluid ≤1 day (OR = -0.96, 95%CI -1.24 to -0.68); (v) enteral diet with feeding jejunostomy or gastrostomy ≤ 1 day (OR = -0.57, 95%CI -0.80 to -0.35) and (vi) epidural removal ≤ 4 days (OR = -0.17, 95%CI -0.27 to -0.07). Several core ERP components and principles appear to be associated with LOS reduction. These elements should form a part of the core ERP for the specialty, while surgical teams incorporate other elements through an iterative process.

Practical recommendation for rash and diarrhea management in Indian patients treated with tyrosine kinase inhibitors for the treatment of non-small cell lung cancer

Tyrosine kinase inhibitors (TKIs) are a pharmaceutical class of small molecules, orally available with manageable safety profile, approved worldwide for the treatment of several neoplasms, including lung, breast, kidney and pancreatic cancer as well as gastro-intestinal stromal tumours and chronic myeloid leukaemia. In recent years, management of lung cancer has been moving towards molecular-guided treatment, and the best example of this new approach is the use of the tyrosine kinase inhibitors (TKIs) in patients with mutations in the epidermal growth factor receptor (EGFR). The identification of molecular predictors of response can allow the selection of patients who will be the most likely to respond to these tyrosine kinase inhibitors (TKIs). Gastrointestinal (GI) adverse events (AEs) are frequently observed in patients receiving EGFR tyrosine kinase inhibitor therapy and are most impactful on the patient's quality of life. Dermatologic side effects are also relatively common among patients treated with EGFR inhibitors. Evidence has emerged in recent years to suggest that the incidence and severity of rash, positively correlated with response to treatment.These skin disorders are generally mild or moderate in severity and can be managed by appropriate interventions or by reducing or interrupting the dose. Appropriate and timely management make it possible to continue a patient's quality of life and maintain compliance; however if these adverse events (AEs) are not managed appropriately, and become more severe, treatment cessation may be warranted compromising clinical outcome. Strategies to improve the assessment and management of TKI related skin AEs are therefore essential to ensure compliance with TKI therapy, thereby enabling patients to achieve optimal benefits. This article provides a consensus on practical recommendation for the prevention and management of diarrhoea and rash in Non-Small Cell Lung Cancer (NSCLC) patients receiving TKIs.

The microbial etiology and antimicrobial susceptibility of bloodstream infections in patients with cancer at a private tertiary care hospital in Mumbai, India

BACKGROUND

Knowledge of the etiology and antimicrobial susceptibility of blood stream infections in patients with cancer is crucial to design empirical therapy regimes.

METHODS

This is a prospective observational study at a tertiary care private hospital in Mumbai, India from Nov 2009 - Dec 2014.

RESULTS

A total of 62 episodes of blood stream infections in 57 patients with cancer were recorded during the study period. Analysis was limited to 52 isolates from 49 episodes in 45 patients. Gram negative pathogens caused 77% of these infections; commonest pathogens were E. coli and Klebsiella. High prevalence of antimicrobial resistance was noted. Susceptibility in E. coli, Klebsiella, Acinetobacter and Pseudomonas to 3rd generation cephalosporins, beta lactam beta lactamase inhibitor combinations, carbapenems and amikacin was 4%, 56.5%, 70% and 86% respectively.

CONCLUSION

The high rates of antimicrobial resistance in gram negative isolates is alarming.

Survival effect of laparoscopic para-aortic staging in locally advanced cervical cancer: a retrospective cohort analysis

OBJECTIVE

This study compares two methods of evaluating para-aortic node involvement in locally advanced cervical cancer (LACC) in order to define external radiotherapy treatment fields: laparoscopic surgical para-aortic lymphadenectomy or PET-CT imaging.

POPULATION

We selected 187 patients with LACC who had been treated by chemoradiation therapy in two comprehensive cancer centres from January 2001 to December 2013. A total of 98 underwent para-aortic evaluation by PET-CT (Centre 1) and 89 received surgical laparoscopic excision (Centre 2).

METHODS

All patients with LACC were retrospectively collected in each centre. OS and DFS were calculated using the Kaplan-Meier's method and survival curves were compared using log-rank test.

MAIN OUTCOME MEASURES

Outcomes were the comparison of patients' disease-free (DFS) and overall survival (OS) between the two centres.

RESULTS

Patients had a significantly better disease-free survival in cohort 1 than in cohort 2, at 2 years [80.9% (71.7-87.5) versus 57.1% (46.1-67.3)] and at 5 years [70.5% (58.8-79.9) versus 49.2% (38.2-60.4)] (P = 0.009). These results are confirmed by multivariate analysis model [hazard ratio (HR) 1.93; 95% CI 1.03-3.61; P = 0.04]. The overall survival was also better in cohort 1, both at 2 and 5 years [93.5% (86.5-97.0) versus 78.5% (68.5-86.0) and 85.1% (73.2-92.2) versus 63.8% (51.9-74.2), respectively; P = 0.006]. The multivariate analysis model found concordant results with an increased relative risk of death for patients treated in cohort 2 (HR 2.55; 95% CI 1.09-5.99; P = 0.01).

CONCLUSION

In this retrospective cohort analysis, para-aortic surgical staging in LACC is more deleterious for patients than is radiological staging in terms of OS and DFS.

TWEETABLE ABSTRACT

Para-aortic surgical staging in LACC is more deleterious for patients than clinical staging.

Lobed spleen: an autopsy case report with emphasis on surgical anatomy

During the medico-legal autopsy of a male aged 45 years, a bilobed morphology of the spleen was observed. An oblique fissure was located longitudinally at the mid-region of the diaphragmatic surface of the spleen. The fissure was partially deep and observed throughout the diaphragmatic surface. The clinician should be aware of the developmental anomalies of the spleen; as such anomalies may cause confusion during the procedures like splenic biopsy and splenectomy. We believe that, the present case report is important to the radiologists and clinicians involved in the diagnosis and management of splenic pathology. The knowledge is also enlightening to the morphologists and embryologists. The radiologist and clinician should make sure that the fissure in a spleen is not misinterpreted as a laceration or rupture.

Genomic profiling in a homogeneous molecular subtype of non-small cell lung cancer: An effort to explore new drug targets

BACKGROUND

Patients' who are positive for kinase domain activating mutations in epidermal growth factor receptor (EGFR) gene, constitute 30-40% of non-small cell lung cancer (NSCLC), and are suitable candidates for Tyrosine Kinase Inhibitor based targeted/personalized therapy. In EGFR non-mutated subset, 8-10% that show molecular abnormalities such as EML4-ALK, ROS1-ALK, KIP4-ALK, may also derive the benefit of targeted therapy. However, 40% of NSCLC belong to a grey zone of tumours that are negative for the clinically approved biomarkers for personalized therapy. This pilot study aims to identify and classify molecular subtypes of this group to address the un-met need for new drug targets in this category. Here we screened for known/novel oncogenic driver mutations using a 46 gene Ampliseq Panel V1.0 that includes Ser/Thr/Tyr kinases, transcription factors and tumor suppressors.

METHODS

NSCLC with tumor burden of at least 40% on histopathology were screened for 29 somatic mutations in the EGFR kinase domain by real-time polymerase chain reaction methods. 20 cases which were EGFR non-mutated for TK domain mutations were included in this study. DNA Quality was verified from each of the 20 cases by fluorimeter, pooled and subjected to targeted re-sequencing in the Ion Torrent platform. Torrent Suite software was used for next generation sequencing raw data processing and variant calling.

RESULTS

The clinical relevance and pathological role of all the mutations/variants that include SNPs and Indels was assessed using polyphen-2/SIFT/PROVEAN/mutation assessor structure function prediction programs. There were 10 pathogenic mutations in six different oncogenes for which annotation was available in the COSMIC database; C420R mutation in PIK3CA, Q472H mutation in vascular endothelial growth factor receptor 2 (VEGFR2) (KDR), C630W and C634R in RET, K367M mutation in fibroblast growth factor receptor 2 (FGFR2), G12C in KRAS and 4 pathogenic mutations in TP53 in the DNA binding domain (E285K, R213L, R175H, V173G).

CONCLUSION

Results suggest, a potential role for PIK3CA, VEGFR2, RET and FGFR2 as therapeutic targets in EGFR non-mutated NSCLC that requires further clinical validation.

Prevalence of KRAS mutations in metastatic colorectal cancer: A retrospective observational study from India

BACKGROUND

One of the genetic alterations implicated in tumor progression in colorectal cancers (CRCs) are abnormalities in Kristen Rat Sarcoma (KRAS) gene. Evaluation of KRAS mutation status is an important prognostic factor and has predictive value in deciding first line therapy based on monoclonal antibodies such as Cetuximab and Panitumumab in metastatic CRCs.

MATERIALS AND METHODS

In this retrospective study, we analyzed 7 different somatic mutations in Exon 2 of KRAS gene in 299 unselected incidental CRC patients who visited the hospital for clinical management during the period 2009-2013. Most of the tumors were primarily originating from colon and rectum; nevertheless, there were a few from rectosigmoid, sigmoid, ceacum and anal canal in the study group. Genomic DNA extracted from paraffin embedded tumor tissues was screened for 7 point mutations located in Codons 12 and 13 of KRAS gene, using Scorpions amplified refractory mutation system real time polymerase chain reaction technology. Statistical analysis was performed to assess bivariate relationship between different variables that includes: mutation status, mutation type, tumor location, tumor morphology, age and sex.

RESULTS

Prevalence of mutation in Codons 12 and 13 was 42.8% in the study group. Well-differentiated tumors had significantly more mutation positivity than moderately and poorly differentiated tumors (P = 0.001). 92% of the mutations were from Codon 12 and 8% in Codon 13. Glycine to Arginine was relatively more common in rectosigmoid followed by ceacum, while Glycine to Alanine mutation was relatively more prevalent in sigmoid, followed by rectum and rectosigmoid.

CONCLUSION

The results suggest a prevalence of KRAS mutation at 42.8% in Indian population indicating that this testing is very crucial for targeted therapy management in metastatic CRC in India. Further analysis on mutation status of other homologues such as NRAS and downstream partner, v-raf murine sarcoma viral oncogene homolog B1, would add value to understanding the role of anti-epidermal growth factor receptor therapy in CRC management.

Synthesis, Characterization and Exploration of Multiferroic Properties in Nano-Crystalline Tb1-xYxMnO3 (0 ≤ x ≤ 0.4)

We report the synthesis and electric properties of nano-crystalline Tb1-xYxMnO3 (x = 0, 0.1, 0.2, 0.3 and 0.4) compounds prepared by gel-combustion method. These samples were characterized by a number of techniques including X-ray diffraction (XRD), Raman spectroscopy, specific-heat measurement, neutron diffraction, and magnetic field dependent pyrocurrent measurement. All the samples crystallize in the orthorhombic structure with space group Pnma at room temperature. Anomalies were observed in low temperature specific-heat measurement corresponding to magnetic and electric phase transitions. The magnetic phase transitions occurred at ~35, ~22-28 and ~7 K for all the samples. Signatures of coupling between magnetic and electric order parameters were revealed by pyrocurrent measurements carried out in presence of magnetic fields.

Outbreak of Burkholderia cepacia complex bacteremia in a chemotherapy day care unit due to intrinsic contamination of an antiemetic drug

BACKGROUND

In the end of 2009, a large number of patients with cancer undergoing chemotherapy at the day care unit of a private hospital in Mumbai, India developed Burkholderia cepacia complex (BCC) blood stream infection (BSI).

OBJECTIVE

The objectives were to identify the source of the outbreak and terminate the outbreak as rapidly as possible.

MATERIALS AND METHODS

All infection control protocols and processes were reviewed. Intensive training was started for all nursing staff involved in patient care. Cultures were sent from the environment (surfaces, water, air), intravenous fluids, disinfectants and antiseptics and opened/unopened medication.

RESULTS

A total of 13 patients with cancer with tunneled catheters were affected with BCC BSI. The isolates were of similar antimicrobial sensitivity. No significant breach of infection control protocols could be identified. Cultures from the prepared intravenous medication bags grew BCC. Subsequently, culture from unused vials of the antiemetic granisetron grew BCC, whereas those from the unopened IV fluid bag and chemotherapy medication were negative. On review, it was discovered that the outbreak started when a new brand of granisetron was introduced. The result was communicated to the manufacturer and the brand was withdrawn. There were no further cases.

CONCLUSIONS

This outbreak was thus linked to intrinsic contamination of medication vials. We acknowledge a delay in identifying the source as we were concentrating more on human errors in medication preparation and less on intrinsic contamination. We recommend that in an event of an outbreak, unopened vials be cultured at the outset.

Enhancement of dielectric, ferroelectric and magneto-dielectric properties in PVDF–BaFe12O19 composites: a step towards miniaturizated electronic devices

Appreciable increase in the dielectric permittivity in PVDF has been achieved in BaFe₁₂O₁₉ composites.

Association between occupational history of exposure to tobacco dust and risk of carcinoma cervix: A case-control study

CONTEXT

Cervical cancer is the second most common malignancy among women in India. There is thus a need to identify unexplored risk factors such as occupational exposure to tobacco dust to justify its increasing trend so as to recommend suitable preventive measures.

AIMS

The aim was to study the association between occupational exposure to tobacco dust with development of carcinoma cervix.

SETTINGS AND DESIGN

Case-control study done in two tertiary care hospitals in Mangalore.

METHODOLOGY

239 histologically confirmed new cases of cervical cancer and the equivalent number of age-matched controls from 2011 to 2012 were interviewed about occupational history of beedi rolling and related factors.

STATISTICAL ANALYSIS

Chi-square test, unpaired t-test, logistic regression.

RESULTS

Exposure rate to tobacco dust following beedi rolling was 63 (26.4%) among cases and 38 (15.9%) among controls (P = 0.005, odds ratio [OR] =1.893). The latent period from occupational exposure of tobacco dust subsequent to beedi rolling and development of cervical cancer was found to be 26.5 ± 8.5 years. Adjusted OR of beedi rolling with development of cervical cancer was found to be 1.913 (P = 0.005) after controlling the confounding effect of tobacco usage and was 1.618 (P = 0.225) after controlling the effects of all confounders. Three-quarters of beedi rollers were working in conditions of inadequate ventilation and hardy anybody used face mask during work. About a quarter of participants underwent voluntary screening for cervical cancer.

CONCLUSION

Occupational exposure to tobacco dust was found to be associated with risk of developing cervical cancer. Measures to promote awareness, timely screening of this disease along with the improvement in working conditions is required for improving the health status of beedi rollers and to minimize the incidence of carcinoma cervix in the community.

The microfluidics of the eccrine sweat gland, including biomarker partitioning, transport, and biosensing implications

Non-invasive and accurate access of biomarkers remains a holy grail of the biomedical community. Human eccrine sweat is a surprisingly biomarker-rich fluid which is gaining increasing attention. This is especially true in applications of continuous bio-monitoring where other biofluids prove more challenging, if not impossible. However, much confusion on the topic exists as the microfluidics of the eccrine sweat gland has never been comprehensively presented and models of biomarker partitioning into sweat are either underdeveloped and/or highly scattered across literature. Reported here are microfluidic models for eccrine sweat generation and flow which are coupled with review of blood-to-sweat biomarker partition pathways, therefore providing insights such as how biomarker concentration changes with sweat flow rate. Additionally, it is shown that both flow rate and biomarker diffusion determine the effective sampling rate of biomarkers at the skin surface (chronological resolution). The discussion covers a broad class of biomarkers including ions (Na(+), Cl(-), K(+), NH4 (+)), small molecules (ethanol, cortisol, urea, and lactate), and even peptides or small proteins (neuropeptides and cytokines). The models are not meant to be exhaustive for all biomarkers, yet collectively serve as a foundational guide for further development of sweat-based diagnostics and for those beginning exploration of new biomarker opportunities in sweat.

Prospective study of sickle cell trait and venous thromboembolism incidence

BACKGROUND

Sickle cell trait may increase risk of venous thromboembolism, but this is not fully established.

OBJECTIVES

We sought to determine the association of sickle cell trait with deep vein thrombosis and pulmonary embolism.

METHODS

Middle-aged African Americans participating in a prospective, population-based cohort investigation, the Atherosclerosis Risk in Communities Study, were followed from 1987 through 2011 for incident hospitalized pulmonary embolism (n = 111) or isolated deep vein thrombosis (n = 138), verified by physician review of medical records. Sickle cell trait (heterozygosity for hemoglobin S, n = 268) was compared with no sickle cell trait (n = 3748).

RESULTS

Over a median of 22 years of follow-up, 249 participants had an incident venous thromboembolism. The hazard ratio of venous thromboembolism was 1.50 (95% confidence interval [CI] 0.96-2.36) for participants with vs. without sickle cell trait, after adjustment for age, sex, ancestry, hormone replacement therapy (women), body mass index, diabetes, and estimated glomerular filtration rate. This hazard ratio was 2.05 (95% CI 1.12-3.76) for pulmonary embolism and 1.15 (95% CI 0.58-2.27) for deep vein thrombosis without pulmonary embolism.

CONCLUSIONS

Sickle cell trait in African Americans carries a 2-fold increased risk of pulmonary embolism but does not elevate deep vein thrombosis risk. Because neonatal screening for sickle hemoglobin is being conducted in the United States, consideration should be paid to the increased pulmonary embolism risk of individuals with sickle cell trait.