Paraneoplastic syndromes associated with classic Hodgkin lymphoma, a systematic literature review

PNS are uncommon manifestations of cancer. The current literature about these syndromes in the setting of cHL is disintegrated. A systematic literature review of all published literature was conducted. One hundred twenty-eight patients from 115 publications met the inclusion/exclusion criteria. Eight-five patients were of the NS subtype (66.4%). The most frequent clinical presentation of the PNS was CNS manifestation (25.8%). The majority of patients were diagnosed with the cHL and PNS simultaneously (42.2%). In 33.6% of patients, the lymphoma diagnosis preceded the PNS diagnosis. In 16.4% of patients, the PNS diagnosis preceded the lymphoma diagnosis. The presence of PNS antibodies was reported in 35 patients (27.3%). Age older than 18 was associated with higher prevalence of PNS. The CR rate of the lymphoma was 77.3%. The complete resolution rate of the PNS was 54.7%. Relapse of lymphoma was reported in 13 patients, and recurrence of the PNS upon relapse was reported in 10/13 patients.

Information Seeking Practices and Availability of Smart Devices Among Healthcare Professionals in a Lower-Middle-Income Country: An Analysis From Pakistan

Introduction Evidence-based medicine (EBM) is a principle that integrates clinical experience with relevant information available to provide adequate healthcare. It requires access to current medical literature. This paper analyzes the information requirements of a lower-middle-income country (LMIC) and the resources available and preferred by medical professionals. Methods A survey-based cross-sectional study was carried out among 160 participants, ranging in expertise from students to attending physicians in Karachi, Pakistan. The survey comprised questions to assess the clinical background, technology access, need for health-related information, and the preference for resources to obtain that information in different scenarios. They were also asked if they use PubMed and their recommended methods to improve information access. Statistical Package for the Social Sciences (SPSS; IBM, NY, USA) software was used for all analyses. Results A basic mobile phone (with limited internet connectivity) was the most common device used at home (n=159; 99.4%) and work (n=141; 88.1%). No smart devices were available to 28 (17.5%) participants at work. Internet connectivity was available for 155 (96.9%) participants at home but only for 118 (73.7%) participants at work. About one-third (n=49; 30.6%) experienced questions arising in practice two to four times a day, and half of the participants (n=80; 50%) were very likely to look up a reference. The most common resource for the majority of given clinical scenarios was a senior colleague. At the same time, medical websites (Medscape, Up-to-Date, WebMD) were the first choice for a non-specific general medical query. About 68.75% (n=110) of participants claimed to use PubMed in daily practice. The most common reason for not using PubMed was the ease of using other search engines (like Google). Conclusions Improved access to the internet and well-reputed journals can enhance the practice of EBM in Pakistan. Limitations of technological access must be considered while designing information resources in lower-middle-income countries.

The Frequency of Refractory Status Epilepticus and Its Outcome in a Tertiary Care Hospital in Pakistan: A Retrospective Study

Background

Refractory status epilepticus (RSE) is a common neurologic emergency with refractory cases leading to increased rates of morbidity and mortality in patients. The lack of previous studies on the incidence, causes, and management of refractory status epilepticus in the pediatric population from our region prompted us to investigate further in this study.

Methods

We included retrospective data of all patients admitted to the pediatric intensive care unit (PICU) with a provisional diagnosis of RSE at a tertiary care hospital in Karachi from February 2019 to February 2021. No personal identification data was used, and confidentiality of the data was maintained throughout the analysis. The Statistical Package for the Social Sciences (SPSS) software version 22.0 (IBM SPSS Statistics, Armonk, NY, USA) was used to pool data and perform a descriptive analysis.

Results

Among the 687 patients who presented to the PICU with seizures, 50 (7.27%) patients were eventually diagnosed with RSE during the two-year period. The majority of the patients were male and less than one year of age. Infectious causes predominated our data cohort, and a four-drug regimen consisting of phenytoin, levetiracetam, valproic acid, and midazolam was able to terminate RSE in the majority of the patients in our setting (70%). The mortality rate was noted to be 22% among patients with RSE.

Conclusion

Morbidity and mortality among pediatric RSE patients are high in our settings. Urgent emergency services and timely cause-directed intervention could improve outcomes.

Influence of processing conditions on rheological properties of aqueous extract chia (Salvia hispanica L.) mucilage

The purpose of this study was to determine the effects of soaking temperature (25 and 80° C) and different processing conditions on the rheological properties of chia seeds (Salvia hispanica L.) mucilage. In this study, chia mucilage was first extracted using a ratio of seed to water at 1:10 for 4 hrs for control (25°C) and treated mucilage (80°C). Both extracted mucilage were evaluated in terms of yield, color, solubility, and water holding capacity. Then, the mucilage were subjected to different processing conditions including temperatures (5, 25, 45, and 65°C), pH (3, 5, 7, 9), sucrose concentrations (10, 20, 30, 40%), and salts (NaCl and KCl from 0 to 0.172 M; CaCl2 and MgCl2 from 0 to 0.049 M) to determine their rheological properties. Results show that high extraction temperature (80°C) significantly affected the mucilage yield higher than control. However, lightness (L*), solubility and water holding capacity of the treated sample were lower compared to control. Apparent viscosity of the 3% of mucilage for both extracts increases with temperatures and sucrose concentration. The high apparent viscosity of the treated mucilage at MgCl2 (0.049 M) and CaCl2 (0.049 M) concentration were found higher than 0.01 M. Meanwhile, NaCl (>0.069 M), KCl (>0.035 M), and CaCl2 (<0.03 M) had decreased the apparent viscosity value of the control sample. Thus, the treated mucilage could be suitable for application as a thickening agent in food.

Development of foam mat dried soursop powder using arabic gum and fish gelatin as foaming agent

Soursop is also known as Annona muricata from Annonaceae family. Soursop flavour has been described as a combination of strawberry and pineapple, with sour citrus flavor. The foam mat drying is a process in which the transformation of products from liquid to stable foam followed by air drying. The foam mat drying process is reported to be considerably cheaper than vacuum, freeze and spray drying methods. Foam mat drying was done using different foaming agents at various concentration: fish gelatin (FG: 5, 10, 15, 20%) and arabic gum (AG: 2, 4, 6, 8%). Foam properties and physicochemical properties such as bulk density, tap density, pH, moisture content, water activity, total phenolic content, color and flowability of powder were analyzed. Increasing the concentration of foaming agents showed a decreasing trend of the total phenolic contents and the value ranges from 222 to 453 mg GAE/100 g. Soursop powder with fish gelatin has higher total phenolic content compared to sample with Arabic gum. Soursop powder with both foaming agents showed an excellent flowability.

First Report of Lasiodiplodia theobromae Causing Stem Canker of Jatropha curcas in Malaysia

Physic nut (Jatropha curcas L.) is an important biofuel crop worldwide. Although it has been reported to be resistant to pests and diseases (1), stem cankers have been observed on this plant at several locations in Peninsular Malaysia since early February 2008. Necrotic lesions on branches appear as scars with vascular discoloration in the tissue below the lesion. The affected area is brownish and sunken in appearance. Disease incidence of these symptomatic nonwoody plants can reach up to 80% in a plantation. Forty-eight samples of symptomatic branches collected from six locations (University Farm, Setiu, Gemenceh, Pulau Carey, Port Dickson, and Kuala Selangor) were surface sterilized in 10% bleach, rinsed twice with sterile distilled water, air dried on filter paper, and plated on water agar. After 4 days, fungal colonies on the agar were transferred to potato dextrose agar (PDA) and incubated at 25°C. Twenty-seven single-spore fungal cultures obtained from all locations produced white, aerial mycelium that became dull gray after a week in culture. Pycnidia from 30-day-old pure cultures produced dark brown, oval conidia that were two celled, thin walled, and oval shape with longitudinal striations. The average size of the conidia was 23.63 × 12.72 μm with a length/width ratio of 1.86. On the basis of conidial morphology, these cultures were identified as Lasiodiplodia theobromae. To confirm the identity of the isolates, the internal transcribed spacer (ITS) region was amplified with ITS1/ITS4 primers and sequenced. The sequences were deposited in GenBank (Accession Nos. HM466951, HM466953, HM466957, GU228527, HM466959, and GU219983). Sequences from the 27 isolates were 99 to 100% identical to two L. theobromae accessions in GenBank (Nos. HM008598 and HM999905). Hence, both morphological and molecular characteristics confirmed the isolates as L. theobromae. Pathogenicity tests were performed in the glasshouse with 2-month-old J. curcas seedlings. Each plant was wound inoculated by removing the bark on a branch to a depth of 2 mm with a 10-mm cork borer. Inoculation was conducted by inserting a 10-mm-diameter PDA plug of mycelium into the wound and wrapping the inoculation site with wetted, cotton wool and Parafilm. Control plants were treated with plugs of sterile PDA. Each isolate had four replicates and two controls. After 6 days of incubation, all inoculated plants produced sunken, necrotic lesions with vascular discoloration. Leaves were wilted and yellow above the point of inoculation on branches. The control plants remained symptomless. The pathogen was successfully reisolated from lesions on inoculated branches. L. theobromae has been reported to cause cankers and dieback in a wide range of hosts and is common in tropical and subtropical regions of the world (2,3). To our knowledge, this is the first report of stem canker associated with L. theobromae on J. curcas in Malaysia. References: (1) S. Chitra and S. K. Dhyani. Curr. Sci. 91:162, 2006. (2) S. Mohali et al. For. Pathol. 35:385, 2005. (3) E. Punithalingam. Page 519 in: CMI Descriptions of Pathogenic Fungi and Bacteria. Commonwealth Mycological Institute, Kew, Surrey, UK. 1976.

The neuropathy of Dejerine and Sottas: report of an Indian family

We report here a family in which 4 out of 11 sibs of unrelated parents showed the typical clinical features of Dejerine-Sottas disease. Sensory disturbance was present in only one case and age at onset was delayed to 4 years in another. The others all conformed to the infantile form of the disease. This is the first time in which mental retardation has been reported in this disorder.

Inhibition of protein synthesis by trimethyltin

The effects of trimethyltin chloride (TMT) on protein synthesis, measured as the incorporation of [3H]valine into trichloroacetic acid-precipitable material, were investigated in mice. One hour after intraperitoneal administration of a 3.0 mg/kg dose, TMT decreased brain protein synthesis by 47% and also caused a significant decrease (4.2 degrees C) in body temperature. When hypothermia was prevented by maintaining the animals at 35 degrees C, TMT decreased protein synthesis by 20%. Twenty-four hours following administration of TMT, protein synthesis was decreased in brain and liver; however, only a reduction of brain protein synthesis was observed at 48 hr. No hypothermia was present at either time point. A regional study in brain showed that at 24 and 48 hr after TMT administration, protein synthesis was decreased by 18-23% in cerebral cortex and hippocampus but not in cerebellum. TMT also inhibited protein synthesis in vitro in mouse brain homogenates with an IC50 of about 100 microM. Neither SnCl2, nor dimethyltin or monomethyltin had any effect on protein synthesis in vitro. These results suggest that, as for other neurotoxicants such as methyl mercury or acrylamide, inhibition of protein synthesis might be involved in TMT neurotoxicity.

Plasma prolactin concentrations during conception and the first ten weeks of human pregnancy

Plasma prolactin concentrations were measured daily throughout 20 cycles in which conception occurred and for several weeks during early pregnancy. Thirteen of the pregnancies were 'spontaneous' (i.e. without exogenous pharmacological stimulation) and 7 occurred during either clomiphene or bromocriptine treatment. Prolactin concentrations were fairly stable throughout the conception cycles until shortly after the time of the first missed menses. From this time concentrations rose gradually to reach a mean concentration of 1250 mU/l 60 days after ovulation. However, there were marked fluctuations from day to day within individuals and considerable variation in the magnitude of the prolactin rise between subjects. Three subjects were mildly hyperprolactinaemic and although prolactin levels remained slightly elevated throughout the study period, this did not affect the outcome of pregnancies.

Plasma concentrations of human chorionic gonadotropin from the time of implantation until the second week of pregnancy

A systematic study of the daily concentrations of human chorionic gonadotropin (hCG) in maternal circulation following the time of probable implantation in 19 normal pregnancies was carried out. With the use of a specific antiserum to hCG beta-subunit, significant increases in circulating hCG were observed by day 8 following the luteinizing hormone (LH) peak in 5.3% of cycles. by day 9 in 15.8%, by day 10 in 53.2%, and by day 11 in 100% of the cycles resulting in a normal pregnancy. After an initial rapid rise, mean plasma concentrations rose exponentially, with a doubling time of 1.3 days, to reach concentrations between 50 and 250 IU/l at the time of the first missed period. The time of detection of hCG was in close agreement with the anticipated time for this event estimated from morphologic studies. In three abnormal pregnancies, all of which ended in spontaneous abortion, hCG concentrations became progressively more abnormal from within 2 to 5 days of the appearance of this hormone in maternal plasma. Despite this, actual abortion did not occur for several days, or in one case for several weeks, after the divergence of hCG concentration from the normal range.

The human menstrual cycle: plasma concentrations of prolactin, LH, FSH, oestradiol and progesterone in conceiving and non-conceiving women

Hormonal profiles were obtained throughout 26 conception cycles and 27 non-conception control cycles. The pregnancies followed treatment (clomiphene or bromocriptine) in 12 women but were spontaneous in the remaining 14. No sustained significant difference between the various types of conception cycle was found for LH, FSH, oestradiol or progesterone concentrations. Prolactin concentrations varied widely, suggesting that mean cycle prolactin concentrations ranging from 45 to 760 mi.u./l are compatible with conception. Although there were no significant differences in progesterone secretion within the conception cycles, there were highly significant differences between the conception cycles and the non-pregnant control cycles. Mean progesterone concentrations in the conception group were higher (P less than 0.005) than those in the control women over Days 3-8 following the LH peak. This difference could only be partly accounted for by heterogeneity within the control group (15-20% of the control cycles had low progesterone concentrations and were probably subfertile. It is suggested that the higher conception cycle progesterone concentrations during the early part of the luteal phase may constitute a preimplantation component of the maternal recognition of pregnancy in women.

The cervical factor in patients with ovulatory infertility

Thirty patients with ovulatory infertility had two consecutive postcoital tests. Couples with inconclusive or abnormal results had in vitro sperm penetration tests, using donor mucus and donor sperm. The quality of the cervical mucus, the concentration of plasma oestradiol and luteinising hormone and the result of the post-coital test were assessed each day. After two consecutive cycles, the postcoital test was normal in 84 per cent, inconclusive in 12 per cent and abnormal in 4 per cent of the women. The in vitro cross reaction test showed that two couples had definite abnormality in the sperm-cervical mucus interaction and one couple were having inadequate coitus. Normal post coital tests should not be expected with an Insler cervical mucus score of less than 8. Normal postcoital tests were found between days -2 and +1 with respect to the luteinising hormone peak. There is a direct relation between the plasma oestradiol concentration and the individual cervical score but the predictability of plasma oestradiol values for a given cervical score is very poor. The plasma oestradiol concentration was significantly different between groups having cervical scores less than 7 and 8-10 or 11-12 (p less than 0.01).