Immunohistochemical Assessment of BAP1 Protein in Mucoepidermoid Carcinomas

Abstract

Mucoepidermoid carcinomas are common malignant salivary gland tumors. Despite recent advances in diagnosis and treatment, there has not been much improvement in outcome of these patients, necessitating identification of novel targeted therapeutic agents. Genomic profiling of mucoepidermoid carcinomas has recently revealed aberrations in BAP1 gene. Therefore, we conducted this study to identify BAP1 loss by immunohistochemistry in these tumors. Mucoepidermoid carcinoma cases were retrieved; hematoxylin-and-eosin stained sections were reviewed. Immunohistochemistry for BAP1 was performed. Forty cases were assessed, including 25 salivary gland and 15 pulmonary mucoepidermoid carcinomas. There were 19 cases in the parotid (76%), two in submandibular gland (8%), and remaining 16% from minor salivary gland locations. Ten (40%) were low grade, nine (36%) were intermediate grade, and six (24%) were high grade mucoepidermoid carcinomas. Thirteen (86.7%) pulmonary mucoepidermoid carcinomas were tracheobronchial, while two (13.3%) were intraparenchymal; all were low grade mucoepidermoid carcinomas. On immunohistochemistry, BAP1 nuclear staining was retained in all cases (100%), irrespective of tumor location or grade. Therapeutic connotations necessitate the identification of readily applicable techniques to detect BAP1 loss in mucoepidermoid carcinomas. Using immunohistochemistry, loss of BAP1 staining was not seen in any of our cases, suggesting insensitivity of BAP1 IHC to detect aberrations at genomic level in these tumors. Analysis of BAP1 alterations by targeted sequencing may therefore be performed prior to excluding the possibility of response to BAP1-targeted therapeutics based on immunohistochemistry alone.

https://ift.tt/2BslOgD

Unilateral Sudden Sensorineural Hearing Loss: A Rare Presentation of Cerebral Venous Thrombosis

Abstract

Sudden sensorineural hearing loss (SNHL) is postulated to be caused due to a multitude of factors, but a definitive cause is seldom found despite extensive investigations. We present a rare case of sudden SNHL in which central venous thrombosis was found on magnetic resonance imaging. The case highlights the importance of neuroimaging in all cases of sudden SNHL before being labelled as "idiopathic" so that targeted therapy can be given.

https://ift.tt/2QIUxAP

Impact of Classroom Determinants on Psychosocial Aspects of Voice Among School Teachers of Indore, India: A Preliminary Survey

Abstract

Teaching voice is the professional voice; often different in quality from our day-to-day speaking voice, and is supposed to be subjected to vocal abuse, misuse and overuse. This paper aims towards highlighting  the various classroom determinants that may impact teacher's voice and how these impacts can affect the daily activities in terms of functional emotional and psychosocial aspects. To understand the same, a cross sectional prospective study was conducted across eight English medium institutions of Indore (a city in central India) region. The study was carried out in three phases: formulation of a questionnaire, data collection (through administration of the questionnaire and VHI among sixty school teachers) followed by data analysis, to determine whether any association exists between the various classroom determinants and voice impairment. Significant association was found between determinants like teaching experience; number of classes, duration of breaks, use of any alternate method of teaching and alternate use of any amplification device with physical, emotional and functional aspects of life. The findings holistically indicate that various factors within the classroom environment only has a significant bearing on the voice disturbances of a school teacher's life thus deteriorating their quality of life. Thus it is substantial to begin a training programme by speech language pathologists in order to heighten awareness among teachers. After all voice disturbances are a real and treatable condition and with the right amount of training can be avoided.

https://ift.tt/2Bxp2j0

Correction to: Photobiomodulation with single and combination laser wavelengths on bone marrow mesenchymal stem cells: proliferation and differentiation to bone or cartilage

In the originally published article, the name of the 3rd and 4th authors were labeled incorrectly. The correct names are Mohammadreza Baghaban Eslaminejad and Leila Taghiyar. Also, affiliation 4 has been corrected.

https://ift.tt/2Brs8ET

Evaluation of lung transplant perfusion using iodine maps from novel spectral detector computed tomography

p. 436
Nils Große Hokamp, Amit Gupta
DOI:10.4103/ijri.IJRI_35_18  
We report the case of a 51-year-old patient who underwent bilateral lung transplantation and presented with an unstable condition and sepsis 6 days after transplantation. The performed contrast enhanced spectral detector computed tomography (CT) using a dual-layer detector showed absence of perfusion in the left lung on iodine maps, although branches of the pulmonary artery were patent. This prompted retrospective evaluation of CT images and total venous occlusion of the left pulmonary veins was found. Here, iodine maps helped in raising conspicuity of loss of lung perfusion.
http://www.ijri.org/currentissue.asp?sabs=y

Pulmonary atresia and ventricular septal defect,Coronary artery as the primary source of pulmonary blood flow

Collateral or fistula? Coronary artery as the primary source of pulmonary blood flow in a patient with pulmonary atresia and ventricular septal defect p. 433
Anurag Yadav, Salil Bhargava, T B S Buxi, Krishna Sirvi
DOI:10.4103/ijri.IJRI_489_17  
In patients with pulmonary atresia and ventricular septal defect (PA/VSD), a coronary artery being the primary source of pulmonary blood flow is a rare entity. We describe two cases of PA/VSD with coronary-to-pulmonary artery fistula with emphasis on the role of Computed Tomographic Angiography (CTA) in depicting all the sources of pulmonary blood supply, to predict surgical management and need for unifocalization of Major Aortopulmonary Collateral Arteries (MAPCA's).
http://www.ijri.org/currentissue.asp?sabs=y

An accurate tool to detect cardiac amyloidosis

Myocardial nulling pattern in cardiac amyloidosis on time of inversion scout magnetic resonance imaging sequence – A new observation of temporal variability p. 427
Harshavardhan Mahalingam, Binita Riya Chacko, Aparna Irodi, Elizabeth Joseph, Leena R Vimala, Viji Samuel Thomson
DOI:10.4103/ijri.IJRI_84_18  
Context: The pattern of myocardial nulling in the inversion scout sequence [time of inversion scout (TIS)] of cardiac magnetic resonance imaging (MRI) is an accurate tool to detect cardiac amyloidosis. The pattern of nulling of myocardium and blood at varying times post gadolinium injection and its relationship with left ventricular mass (LVM) in amyloidosis have not been described previously. Aims: The aim is to study the nulling pattern of myocardium and blood at varying times in TIS and assess its relationship with LVM and late gadolinium enhancement (LGE) in amyloidosis. Materials and Methods: This was a retrospective study of 109 patients with clinical suspicion of cardiac amyloidosis who underwent MRI. Of these, 30 had MRI features of amyloidosis. The nulling pattern was assessed at 5 (TIS5min) and 10 (TIS10min) minutes (min) post contrast injection. Nulling pattern was also assessed at 3min (TIS3min) in four patients and 7min (TIS7min) in five patients. Myocardial mass index was calculated. Mann-Whitney U test was done to assess statistical difference in the myocardial mass index between patients with and without reversed nulling pattern (RNP) at TIS5min. Results: RNP was observed in 58% at TIS5minand 89.6% at TIS10min. Myocardial mass index was significantly higher in patients with RNP at TIS5min[mean = 94.87 g/m2; standard deviation (SD) =17.63) when compared with patients with normal pattern (mean = 77.61 g/m2; SD = 17.21) (U = 18; P = 0.0351). Conclusion: In cardiac amyloidosis, TIS sequence shows temporal variability in nulling pattern. Earlier onset of reverse nulling pattern shows a trend toward more LVM and possibly more severe amyloid load.
http://www.ijri.org/currentissue.asp?sabs=y

Gujarati hypertensives

: A cross-sectional study p. 153
Jayesh Dalpatbhai Solanki, Hemant B Mehta, Sunil J Panjwani, Hirava B Munshi, Chinmay J Shah
DOI:10.4103/jpp.JPP_59_18  
Objective: To study the effect of different classes and combinations of antihypertensive agents on arterial stiffness and central hemodynamic parameters. Materials and Methods: A cross-sectional study was conducted in 446 treated apparently healthy hypertensives. Oscillometric PWA was performed by Mobil-o-Graph (IEM, Germany) to derive cardiovascular parameters that were further analyzed in groups stratified by antihypertensive used. Study parameters were brachial hemodynamics (blood pressure (BP), heart rate, and rate pressure product); arterial stiffness (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, and pulse pressure amplification); and central hemodynamics (central BP, cardiac output, and stroke work). Statistical significance was kept at P < 0.05. Results: All groups were selected by matching of age, gender, and body mass index. They were comparable with major confounding factors. There was no difference between study parameters in hypertensives taking exclusive angiotensin-converting enzyme inhibitor (ACEI), calcium channel blocker (CCB), or angiotensin II receptor blocker. Multitherapy showed better hemodynamics and monotherapy showed better stiffness parameters. Addition of CCB to ACEI did not make a difference except with diastolic BP. For most comparisons, most of the results lacked statistical significance. Conclusion: Discrete PWA parameters showed no class difference in hypertensives, treated by conventional monotherapy or combination, ACEI appears to be the best drug. This also indicates that early diagnosis and blood pressure control are more important than antihypertensive used.
http://www.jpharmacol.com/currentissue.asp?sabs=y

contrast media-induced nonrenal adverse drug reactions

contrast media-induced nonrenal adverse drug reactions over the last three decades: A systematic review p. 131
Maurizio Sessa, Claudia Rossi, Annamaria Mascolo, Antonella Scafuro, Rosanna Ruggiero, Gabriella di Mauro, Salvatore Cappabianca, Roberto Grassi, Liberata Sportiello, Concetta Rafaniello
DOI:10.4103/jpp.JPP_92_18  
The aim of this study was to investigate the scientific contribution of Italian clinical research for contrast media-induced nonrenal adverse drug reactions over the last three decades. Ovid Embase, Ovid MEDLINE, Web of Science, and Cochrane Methodology Register were used as data sources to identify Italian descriptive studies, observational studies, meta-analyses, and clinical trials assessing contrast media-induced nonrenal adverse drug reactions as a safety outcome. The population of interest was men and women exposed to a contrast medium. Between 1990 and 2017, 24 original articles investigating contrast-induced nonrenal adverse drug reactions were identified. The cohort study was the most representative study design (10/24; 41.7%). The 24 studies were conducted mainly as monocenter studies (14/24; 58.3%) and without receiving funding (17/24; 70.8%). Seventeen out of 24 studies provided a level of evidence ranging from III-2 (11/24; 45.8%) to IV (6/24; 25.0%) on a Merlin scale. In total, 14 of 24 (58.3%) studies were published in a scientific journal ranked in the first quartile of their subject area. The 24 original articles mainly focused on adverse drug reactions already observed during clinical trials (i.e., idiosyncratic systemic reactions). In conclusion, during the last three decades and a burst was not observed in the Italian clinical research investigating contrast-induced nonrenal adverse drug reactions. High-quality clinical research is needed especially for procedures to prevent the onset of the aforementioned events, to identify risk factors, to minimize the risk of their occurrence, and to optimize their related prognosis.
http://www.jpharmacol.com/currentissue.asp?sabs=y

Phosphodiesterase 7B1 as therapeutic target for treatment of cognitive dysfunctions in multiple sclerosis

 p. 126

Arthi Balsundaram, Darling Chellathai
DOI:10.4103/jpp.JPP_77_18  
Multiple sclerosis (MS) is an autoimmune, chronic degenerative neuroinflammatory disorder affecting younger age groups of the United States of America and Europe. MS prevalence studies in India have shown that India is no longer a low-risk zone. Many studies have shown the seriousness of cognitive impairments (CIs) and its types caused in MS. In this review, the pathological basis for CI in various stages of MS was reviewed and revealed to provide a basis for the treatment. Role of phosphodiesterase 7B1 (PDE7B1) inhibitors in treating CI related to MS were also stated in this review. The literature for this review was collected from PubMed and Embase.
http://www.jpharmacol.com/currentissue.asp?sabs=y

Understanding the effect of indoor air pollution on pneumonia in children under 5 in low- and middle-income countries: a systematic review of evidence

Abstract

Exposure to indoor air pollution increases the risk of pneumonia in children, accounting for about a million deaths globally. This study investigates the individual effect of solid fuel, carbon monoxide (CO), black carbon (BC) and particulate matter (PM)_2.5 on pneumonia in children under 5 in low- and middle-income countries. A systematic review was conducted to identify peer-reviewed and grey full-text documents without restrictions to study design, language or year of publication using nine databases (Embase, PubMed, EBSCO/CINAHL, Scopus, Web of Knowledge, WHO Library Database (WHOLIS), Integrated Regional Information Networks (IRIN), the World Meteorological Organization (WMO)-WHO and Intergovernmental Panel on Climate Change (IPCC). Exposure to solid fuel use showed a significant association to childhood pneumonia. Exposure to CO showed no association to childhood pneumonia. PM_2.5 did not show any association when physically measured, whilst eight studies that used solid fuel as a proxy for PM_2.5 all reported significant associations. This review highlights the need to standardise measurement of exposure and outcome variables when investigating the effect of air pollution on pneumonia in children under 5. Future studies should account for BC, PM₁ and the interaction between indoor and outdoor pollution and its cumulative impact on childhood pneumonia.

https://ift.tt/2EthaSC

Intermediate type of Gerbode defect: rare type of the left to right shunt

https://ift.tt/2EClDmW

Clostridium difficile colitis in the setting of subacute thyroiditis: the chicken or the egg

Subacutethyroiditis is a self-limited inflammatory condition commonly of viral aetiology, that manifests through phases of thyroid hormone changes over a 6–8 month period. A 24-year-old active duty military man, undergoing treatment for recurrent Clostridiumdifficile infection, presented for clinical evaluation and was found to have a thyroid stimulating hormone level of 0.003 mg/dL. Further labs revealed a normal T4, elevated T3 at 5.0 pg/mL and elevated C reactive protein at 3.69 mg/L. The patient was followed with monthly labs and the abnormal thyroid stimulating hormone and triiodothyronine levels resolved after the completion of his C. difficile treatment. While subacute thyroiditis has historically been due to viral causes, rarely do we see this condition associated with an intestinal bacterial source.

https://ift.tt/2ExydCP

Persistent primitive olfactory artery: a hairpin easy to miss!

https://ift.tt/2EF1T27

Splenectomy for breast carcinoma diffusely metastatic to the spleen presenting as severe transfusion-dependent anaemia and thrombocytopaenia

We report a 48-year-old woman with metastatic infiltrating lobular carcinoma of the breast. Though her metastatic disease remained stable, she was repeatedly admitted for symptomatic anaemia and treated by red blood cell and platelet transfusions with increasing frequency as time elapsed. Abdominal examination and ultrasound revealed splenomegaly (27 cm span). A bone marrow biopsy showed fibrosis and foci of metastatic carcinoma. Splenectomy ameliorated her transfusion-dependent anaemia and thrombocytopaenia. Histopathology revealed multiple foci of metastatic carcinoma and scattered foci of extramedullary haematopoiesis. Differential diagnosis of anaemia and thrombocytopaenia in patients with cancer include bone morrow involvement by cancer cells, iron-deficiency anaemia, microangiopathies and chemotherapy suppression of haematopoiesis. Splenic involvement with cancer is common in patients with multivisceral disease. Many may regard transfusion-dependent severe anaemia and thrombocytopaenia as an end-stage disease in these patients. Nevertheless, palliative splenectomy should be considered in patients with possible hypersplenism who will otherwise survive for a relatively prolonged period of time.

https://ift.tt/2EtOBV6

Role of the body mass index in the genesis of ascites in ovarian cancer: a forensic case and review of the literature

The ovarian tumour is the seventh female cancer for incidence. In the advanced stages of cancer, tumour cells nourish on the peritoneal serous causing carcinomatosis and peritoneal function abnormalities with liquid build-up inside it. Ascites from peritoneal carcinomatosis is common in patients with ovarian cancer. An obese woman suffering from ovarian cancer was found dead in her home from secondary cardio-respiratory arrest due to Multiple Organ Failure (MOF). An autopsy was performed. The abdominal incision showed an ascitic fluid outflow about 20 litres in volume and a flood about one metre and half. An association between obesity and intraperitoneal fluid volume secondary to peritoneal carcinomatosis has been demonstrated. This finding could improve the prognosis of patients through actions aimed to reduce body weight.

https://ift.tt/2EDciej

Prenatal diagnosis of cervical ribs by three-dimensional ultrasound in a foetus with a herniated Dandy-Walker cyst

We present a case report of a foetus with a herniated Dandy-Walker cyst and bilateral rudimentary cervical ribs. The cervical ribs were visualised prenatally by three-dimensional ultrasound and confirmed by post-termination radiography. The prevalence of cervical ribs is higher in deceased fetuses and neonates with or without structural abnormalities compared with healthy individuals and might be regarded as a marker of disadvantageous fetal development. We demonstrate that evaluation of the fetal vertebral pattern by three-dimensional ultrasonography, including the cervical region, is feasible and could provide valuable information regarding fetal and neonatal prognosis.

https://ift.tt/2EtOqco

Complication of dislodged gastrostomy Foley catheter: antegrade migration into small bowel

A 65-year-old man with dysphagia underwent placement of a percutaneous endoscopic gastrostomy tube. He was cared for at a nursing facility where the tube became dislodged and was replaced with similar size Foley catheter. Patient was brought to the hospital with dislodged feeding Foley but none was found at the bedside. Diagnostic workup revealed antegrade migration of the catheter into the small bowel. Push enteroscopy was unsuccessful in retrieving the catheter because it was too far distal. Patient was observed for a total of 7 days. Due to lack of progress with conservative measures, a colonoscopy was performed to extract the catheter, thus avoiding the need for more invasive surgical measures. If a Foley catheter is used as a gastrostomy tube, it should be replaced with a dedicated feeding tube as quickly as possible and should always be affixed to the skin to prevent antegrade migration and associated complications.

https://ift.tt/2EDp8JU

Immune cell infiltration as a biomarker for the diagnosis and prognosis of stage I–III colon cancer

Abstract

Tumour-infiltrating immune cells are a source of important prognostic information for patients with resectable colon cancer. We developed a novel immune model based on systematic assessments of the immune landscape inferred from bulk tumor transcriptomes of stage I–III colon cancer patients. The "Cell type Identification By Estimating Relative Subsets Of RNA Transcripts (CIBERSORT)" algorithm was used to estimate the fraction of 22 immune cell types from six microarray public datasets. The random forest method and least absolute shrinkage and selection operator model were then used to establish immunoscores for diagnosis and prognosis. By comparing immune cell compositions in samples of 870 colon cancer patients and 70 normal controls, we constructed a diagnostic model, designated the diagnostic immune risk score (dIRS), that showed high specificity and sensitivity in both the training [area under the curve (AUC) = 0.98, p < 0.001] and validation (AUC 0.96, p < 0.001) sets. We also established a prognostic immune risk score (pIRS) that was found to be an independent prognostic factor for relapse-free survival in every series (training: HR 2.23; validation: HR 1.65; entire: HR 2.01; p < 0.001 for all), which showed better prognostic value than TNM stage. In addition, integration of the pIRS with clinical characteristics in a composite nomogram showed improved accuracy of relapse risk prediction, providing a higher net benefit than TNM stage, with well-fitted calibration curves. The proposed dIRS and pIRS models represent promising novel signatures for the diagnosis and prognosis prediction of colon cancer.

https://ift.tt/2S7EhpN

Temporal and climate characteristics of respiratory syncytial virus bronchiolitis in neonates and children in Sousse, Tunisia, during a 13-year surveillance

Abstract

This study established the correlation between respiratory syncytial virus (RSV) bronchiolitis and climate factors in the area of Sousse, Tunisia, during 13 years (2003–2015), from neonates and children <= 5 years old and hospitalized in Farhat Hached University-Hospital of Sousse. The meteorological data of Sousse including temperature, rainfall, and humidity were obtained. RSV detection was carried out with the direct immunofluorescence assay. The impact of climate factors on viral circulation was statistically analyzed. From 2003 to 2015, the total rate of RSV bronchiolitis accounted for 34.5% and peaked in 2007 and 2013. RSV infection was higher in male cases and pediatric environment (p<0.001) and was detected in 47.3% of hospitalizations in intensive care units. The epidemic of this pathogen started in October and peaked in January (41.6%). When the infectivity of RSV was at its maximum, the monthly average rainfall was high (31 mm) and the monthly average temperature and the monthly average humidity were at their minimum (11 °C and 66%, respectively). RSV activity was negatively correlated with temperature (r = − 0.78, p = 0.003) and humidity (r = − 0.62, p = 0.03). Regression analysis showed that the monthly average temperature fits into a linear model (R² = 61%, p < 0.01). No correlation between RSV activity and rainfall was observed (p = 0.48). The meteorological predictions of RSV outbreaks with specific Tunisian climate parameters will help in determining the optimal timing of appropriate preventive strategies. In the area of Sousse, preventive measures should be enhanced since October especially, when the temperature is around 11 °C and humidity is above 60%.

https://ift.tt/2LrFwxt

Occurrences and patterns of residual organochlorine pesticides (OCPs) in cultured Chinese mitten crab ( Eriocheir sinensis ) in China: concentrations, sources, and a human health risk assessment

Abstract

Seventy Chinese mitten crab samples, encompassing a total of 2100 individuals, were collected from the main production areas in China. The objective was to assess the occurrences and patterns of 23 selected organochlorine pesticides (OCPs) in the edible tissues and assess the associated dietary risk. Concentrations of total residual OCPs in the mitten crabs ranged from 0.72 to 51.51 μg kg⁻¹, which was comparable to other global aquatic species. Dichlorodiphenyl trichloroethanes (DDTs) and hexachlorocyclohexanes (HCHs) were the two main contributors of total OCPs, with the detected values ranging from 0.14 to 30.89 μg kg⁻¹ and 0.23 to 4.04 μg kg⁻¹, respectively. Source analysis indicated the coexistence of both residual and recent DDT inputs, while there was no indication of HCH usage in the main production area of mitten crab. In terms of dietary risk, at least eight individual mitten crabs per day are permissible for consumption by local residents, indicating low risk from consumption. The results presented herein should guide the production and consumption of mitten crab, as well as promote the sustainable development of aquaculture in China.

https://ift.tt/2rLP8tQ

Comparative analysis of duration of postoperative analgesia between levobupivacaine and levobupivacaine with clonidine after ultrasound-guided transversus abdominis plane block in patients undergoing lower segment cesarean section

Ranjita Acharya, Ranjita Baksi, Pratik Mohapatra

Anesthesia: Essays and Researches 2018 12(4):943-948

Background: Transversus abdominis plane (TAP) block in cesarean section is carried out by local anesthetics such as bupivacaine or ropivacaine with a limited duration of analgesia. The addition of adjuvants such as clonidine and dexmedetomidine has increased the duration of postoperative analgesia. Aims, Settings and Design: The aim of this study was to compare the duration of postoperative analgesia between clonidine and levobupivacaine (0.25%) versus levobupivacaine (0.25%) alone in the bilateral TAP block after lower segment cesarean section (LSCS). Materials and Methods: In this prospective randomized double-blind interventional study, 100 parturients undergoing elective LSCS were included in the study. Patients were randomly divided to receive either 20-ml levobupivacaine 0.25% (Group A; n = 50) or 20-mL levobupivacaine (0.25%) +1-μg/kg clonidine bilaterally (Group B; n = 50) in TAP block in a double-blind fashion. The total duration of analgesia, patient satisfaction score, postoperative visual analog scale score, total requirement of analgesics in the first 24 h, and the side effects of clonidine were observed. Statistical Analysis: Statistical tests were conducted using SPSS. P < 0.05 was considered as statistically significant. Results: A total of 92 patients were analyzed. Duration of analgesia was significantly longer in Group B (17.94 ± 0.76 h) compared to Group A (7.16 ± 0.41 h) (P < 0.001). Mean consumption of tramadol was 197.77 ± 14.90 mg and 8.889 ± 28.77 mg in Groups A and B (P < 0.001), respectively. All patients in Group B were extremely satisfied while those in Group A were satisfied (P < 0.01). None of the patients experienced hypotension or bradycardia. Conclusion: The addition of clonidine 1 μg/kg to 20-ml levobupivacaine 0.25% in TAP block bilaterally for cesarean section significantly increases the duration of postoperative analgesia, decreases postoperative rescue analgesic requirement, and increases maternal comfort compared to 20 ml of levobupivacaine 0.25% alone.

https://ift.tt/2EEzGbD

Comparative evaluation of different doses of intravenous dexmedetomidine on hemodynamic response during laryngoscopy and endotracheal intubation in geriatric patients undergoing spine surgeries: A prospective, double-blind study

Ravi Kumar Keshri, Mukesh Kumar Prasad, Amit Kumar Choudhary, Gurdeep Singh Jheetay, Yashowardhan Singh, Kali Kapoor

Anesthesia: Essays and Researches 2018 12(4):897-902

Background: Dexmedetomidine, a selective alpha 2 (α2)-adrenergic receptor agonist, has been used to blunt the hemodynamic response associated with laryngoscopy and tracheal intubation, which is a common concern for the anesthesiologist, especially in high-risk patients and geriatric age group. Aim and Objectives: The current study is to evaluate and compare the effects of different doses of dexmedetomidine in controlling hemodynamic response during tracheal intubation in geriatric patients. Materials and Methods: After getting approval from the Ethical Committee, 90 patients of the American Society of Anesthesiologist Physical Status Classes I and II, aged ≥60 years, were randomly assigned into three groups: Group I (normal saline, n = 30), Group II – dexmedetomidine (0.50 μg/kg, n = 30), and Group III – dexmedetomidine (1.00 μg/kg, n = 30). Dexmedetomidine was infused for 10 min before induction. Data were recorded as before infusion (T0), at the end of infusion (T1), before tracheal intubation (T2), at the moment of tracheal intubation (T3) 5 min after tracheal intubation (T4), and 10 min after tracheal intubation (T5). Modified observer's assessment of alertness/sedation scale score was observed at the time of T0 and T1. All statistical analyses were done using SPSS version 22. Results: Mean systolic blood pressure was statistically significantly (P < 0.05) more among Group I compared to Group II and III at T2, T3, and T4. Mean heart rate (HR) value was significantly (P < 0.05) more among Group I compared to Group III from T1 to T5, whereas there was no significant change in HR between Group I and Group II and at T4 and T5 h was comparable in Group II and Group III. Conclusion: This study concluded that more acceptable hemodynamic changes were seen with 0.50 μg/kg dexmedetomidine when compared with 1.0 μg/kg dexmedetomidine during intubation. A lower dose besides being cost-effective is also free of side effects associated with the higher dose of 1 μg/kg dexmedetomidine.

https://ift.tt/2EwgWKh

Comparison between multisite infiltration analgesia versus adductor canal block for pain management in total knee arthroplasty: A prospective study

AV Gurava Reddy, Mohammed Shafeekh, Sukesh Rao Sankineani, Khubchand Jhakotia, Muralidhar Sagi, Deepesh Daultani, Vishesh Khanna, Krishna Kiran Eachempati

Anesthesia: Essays and Researches 2018 12(4):774-777

Background: Severe acute postoperative pain after total knee arthroplasty (TKA) may cause significant morbidity to patients. Recent techniques such as peripheral nerve blocks have shown promising hope in providing appropriate pain control without systemic side effects. Adductor canal block (ACB) and multisite infiltration analgesia (MIA) are two techniques that are proven to be effective individually. Aim: This study aims to compare the efficacy of ACB versus MIA in postoperative analgesia and functional recovery after unilateral knee arthroplasty. Settings and Design: A prospective study was conducted between July 2016 and December 2016 involving 200 patients undergoing unilateral TKA. Materials and Methods: Patients were either administered MIA (Group I, n = 100 patients) or ACB (Group II, n = 100 patients). All the patients were assessed for severity of pain by visual analog scale (VAS) at 8, 24, and 48 h postoperatively and knee range of motion (ROM) at 48 h after surgery. Statistical Analysis: The Statistical Package for the Social Sciences (SPSS 19.0, SPSS Inc., Chicago, IL, USA) was used for descriptive and inferential analysis. Results: Patients who received MIA showed significantly better VAS scores 8, 24, and 48 h after surgery. Furthermore, this subset of patients showed a marginally better ROM postoperatively. However, there was no difference number of patients requiring rescue analgesia for breakthrough pain or technique-related problems between both groups. Conclusion: This study demonstrates that MIA is a safe technique that provides effective analgesia at 8, 24, and 48 h postoperatively. This leads to faster rehabilitation compared to ACB in patients undergoing TKA.

https://ift.tt/2EBOvLX

Intravenous low dose fentanyl versus lignocaine in attenuating the hemodynamic responses during endotracheal intubation: A randomized double-blind study

Ranjithkumar R Thippeswamy, Supreeth R Shetty

Anesthesia: Essays and Researches 2018 12(4):778-785

Background: The laryngotracheal stimulation is known to cause reflex sympathoadrenal response with a marked increase in heart rate and blood pressure. Arrhythmias can be precipitated. The harmful nature of this response has been noted in patients at risk. Therefore, it is important to find an effective means of attenuating sympathetic response to laryngoscopy and intubation. The present study is undertaken to determine the efficacy of intravenous low dose fentanyl (2 μg/kg) and lignocaine (1.5 mg/kg) in attenuating hemodynamic response to laryngoscopy and tracheal intubation. Aim: The aim of this study is to compare the efficacy of intravenous low dose fentanyl (2 μg/kg) versus lignocaine (1.5 mg/kg) in attenuating the hemodynamic responses during endotracheal intubation. Settings and Design: This was double-blinded randomized controlled study. Materials and Methods: After obtaining institutional ethical clearance and informed consent, a total of 90 patients, with the American Society of Anaesthesiologists Physical Status I and II scheduled for elective surgeries, were selected randomly and divided into three groups of 30 each. The general anesthesia technique was standardized for all three groups as follows: Group 1 (control-received normal saline), Group 2 (Lignocaine 1.5 mg/kg), and Group 3 (Fentanyl 2 μg/kg). Heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure were recorded preinduction, postinduction and 1,3,5,7, and 10 min after endotracheal intubation. Statistical Analysis: Descriptive data presented as mean ± standard deviation and in percentage. Multiple group comparisons were made using one-way ANOVA followed by unpaired "t" test for pairwise comparison. "P" <0.05 was considered for statistical significance. Results: The fentanyl group showed significantly lesser rise (26%) in heart rate compared to lignocaine (33%) (P = 0.018) and control group (42.5%) (P = 0.000). The lignocaine group showed lesser rise in systolic blood pressure (14.5%) compared to control group (20%) (P = 0.000) at intubation. The fentanyl group showed a significant decrease in systolic blood pressure after administration, which came back to normal at 7 min following intubation and again decreased 10 min after intubation. Conclusion: Lignocaine and fentanyl both attenuated the rise in heart rate, though fentanyl was better. Lignocaine attenuated the rise in blood pressure with intubation whereas fentanyl prevented it totally. Of the two drugs low dose fentanyl 2 μg/kg i. v. bolus provides a consistent, reliable, and effective attenuation as compared to lignocaine 1.5 mg/kg i. v. bolus.

https://ift.tt/2ECXaO6

A comparative study of transversus abdominis plane block versus quadratus lumborum block for postoperative analgesia following lower abdominal surgeries: A prospective double-blinded study

G Dilip Kumar, N Gnanasekar, Pranjali Kurhekar, T Krishna Prasad

Anesthesia: Essays and Researches 2018 12(4):919-923

Context: Traditional truncal blocks are devoid of visceral analgesia. Quadratus lumborum (QL) block has shown greater efficacy in providing the same. Aims: This study was done to compare the efficacy of transversus abdominal plane (TAP) block versus QL block in providing postoperative analgesia for lower abdominal surgeries. Settings and Design: This was a prospective, randomized, double-blinded study. Subjects and Methods: Seventy adult patients were randomly allocated into two groups, where Group A received TAP block with 20 ml of 0.25% ropivacaine on each side (n = 35) and Group B received QL block with 20 ml of 0.25% ropivacaine on each side (n = 35). The time of block, duration of surgery, Numerical Pain Intensity Scale (NPIS) score at the 1st, 2nd, 4th, 8th, 12th, 16th, and 24th postoperative hours, and the total analgesic drug requirements were noted and compared between the two groups. Statistical Analysis Used: Data were analyzed with SPSS version 23 (IBM corporation, Armonk, NY, USA) with independent t-test and Chi-square test as appropriate. P < 0.05 was considered statistically significant. Results: The time for first analgesic requirement was 243.00 ± 97.36 min and 447.00 ± 62.52 min and the total analgesic consumption (morphine in mg) was 5.65 ± 1.55 and 3.25 ± 0.78 in Group A and Group B, respectively, both of which were statistically significant (P < 0.01). There was a significant difference in postoperative pain scores (NPIS scale 0–10) at rest, between the two groups, up to 16 h. Conclusions: Patients who received QL block had a significant improvement in postoperative pain relief with reduced consumption of opioids.

https://ift.tt/2Es3IhT

Comparison of two different volumes of ropivacaine used in nerve stimulator guided inter-scalene block for arthroscopic shoulder surgery – A randomized controlled trial

Ghanshyam Kumar Sahu, Dharam Singh Meena, Suman Saini, Ajisha Aravindan, Priyankar Kumar Datta

Anesthesia: Essays and Researches 2018 12(4):786-791

Background: This study was conducted to compare the analgesic efficacy of 10 ml versus 20 mL of 0.5% ropivacaine in nerve stimulator guided interscalene brachial plexus block, in patients undergoing arthroscopic shoulder surgery. Methods: A total of 70 American Society of Anesthesiologists physical status classes 1 and 2 patients, aged 18–65 years, undergoing unilateral arthroscopic shoulder surgery, were randomized into two groups. Group A received single shot inter-scalene block with 20 mL of 0.5% ropivacaine whereas Group B received the same with 10 mL. The primary outcome was difference in the total postoperative fentanyl consumption over 24 h. Secondary outcomes were difference in block onset, intra-operative hemodynamic parameters, intra-operative fentanyl consumption, duration of effective analgesia, visual analogue scale (VAS) scores at various time intervals, duration of motor block, and incidence of hemidiaphragmatic (HD) palsy. Results: Total 24 h fentanyl consumption was significantly higher in Group B (558 ± 112 mcg) compared to Group A (296 ± 88 μg). Block onset was slower in Group B than Group A. There was no difference in intra-operative fentanyl consumption. Postoperative VAS scores were significantly higher in Group B compared to Group A, at 6 h and thereafter. Duration of motor block was significantly shorter in Group B (6.25 ± 1.25 h) compared to Group A. HD palsy was seen in all the cases in both the groups. Conclusion: Single shot nerve stimulator guided interscalene block with 10 ml of 0.5% ropivacaine was inferior to 20 mL of 0.5% ropivacaine with respect to postoperative analgesic efficacy.

https://ift.tt/2EEcXfM

Erratum: Assessment of relationship between vitamin D deficiency and pain severity in patients with low back pain: A retrospective, observational study

Anesthesia: Essays and Researches 2018 12(4):970-970



https://ift.tt/2EvfdF5

Evaluation and comparison of clonidine and dexmedetomidine for attenuation of hemodynamic response to laryngoscopy and intubation: A randomized controlled study

Sana Yasmin Hussain, Abhijit Karmarkar, Dhruv Jain

Anesthesia: Essays and Researches 2018 12(4):792-796

Background: Laryngoscopy and tracheal intubation are noxious stimuli which evoke a transient but marked sympathetic response. Alpha-2 adrenoceptor agonists attenuate the sympathoadrenal responses by inhibiting noradrenaline release. Aim: This study aims to evaluate and compare the effect of intravenous dexmedetomidine and clonidine on cardiovascular response resulting from laryngoscopy and endotracheal intubation. Settings and Design: This was a prospective randomized controlled study carried out in the operating room. Materials and Methods: Ninety American Society of Anesthesiologists Physical Status I and II patients were randomly allocated into three groups, that is, Group C (clonidine 2 μg/kg), Group D (dexmedetomidine 1 μg/kg), and Group S (normal saline) infused over 10 min. Blood pressures – systolic (SBP) and diastolic (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded after drug administration and intubation at subsequent intervals. Statistical Analysis Used: Quantitative data were analyzed using ANOVA test (with post hoc Bonferroni correction for intragroup comparison). Qualitative data were analyzed using Chi-square test. P < 0.05 was considered statistically significant. Results: HR, SBP, DBP, and MAP were lower in Group C and D compared to Group S at all times measured. HR was significantly lower in Group D compared to Group C after drug infusion. At 1 min after intubation, SBP and MAP were lower in Group D compared to Group C. At 3, 5, and 10 min after intubation, SBP, DBP, and MAP were lower in Group D compared to Group C. Conclusion: There was significant reduction in hemodynamic response by dexmedetomidine and clonidine as compared to controls. Furthermore, attenuation of the pressor response to intubation was better following premedication with dexmedetomidine than with clonidine.

https://ift.tt/2EzRC7j

Comparison of nebulized ketamine with nebulized magnesium sulfate on the incidence of postoperative sore throat

Sivakumar Segaran, Arish T Bacthavasalame, Ranjan R Venkatesh, Mamie Zachariah, Sagiev Koshy George, Ravichandran Kandasamy

Anesthesia: Essays and Researches 2018 12(4):885-890

Background: Postoperative sore throat (POST) is a known complication following general anesthesia requiring endotracheal intubation. Its incidence ranges from 21% to 65% and remains the eighth most undesirable postoperative event. Various measures have been tried to decrease the incidence of sore throat with various success rates. Aim: This study aimed at reducing the incidence of POST with ketamine and magnesium sulfate nebulization. Settings and Design: This study is a prospective randomized, double-blinded study. Materials and Methods: After Institutional Ethics Committee approval and written informed consent, 80 patients who fulfilled the inclusion and exclusion criteria were randomly divided into two groups to receive magnesium sulfate 250 mg in 5 ml saline in Group A and ketamine 50 mg in 5 ml saline nebulization in Group B before the start of general anesthesia. All patients received standard anesthesia protocol. After extubation, all patients were enquired about the incidence and severity of sore throat at 0, 2, 4, 6, and 24 h. Statistical Analysis Used: Paired t-test and Wilcoxon signed-rank test were used to compare hemodynamic variables and Chi-square test to compare the incidence and severity of sore throat. Results: There were no differences in the demographic profile, duration of laryngoscopy, time taken to intubate, and duration of surgery between the two groups. The incidence and severity of sore throat were significantly decreased in ketamine group at 4 and 6 h when compared to magnesium sulfate group. Conclusion: Nebulization with ketamine 50 mg significantly decreases the incidence of POST when compared to magnesium sulfate 250 mg.

https://ift.tt/2EwaPpp

A prospective study on operation theater utilization time and most common causes of delays and cancellations of scheduled surgeries in a 1000-bedded tertiary care rural hospital with a view to optimize the utilization of operation theater

Shraddha Vidyadhar Naik, Vithal Krishna Dhulkhed, Rewa Hemant Shinde

Anesthesia: Essays and Researches 2018 12(4):797-802

Background: The operation theater (OT) complex is a costly component of a hospital budget expenditure. This area of hospital activity requires maximum utilization to ensure optimum cost benefit. To achieve a high level of utilization in the OT, it is necessary to efficiently coordinate number of activities and personnel. Methods: This study was conducted in a 1000-bedded tertiary care teaching hospital in rural maharashtra over aperiod of two months. The OT complex consists of eight major OTs. Normal working hours for routine scheduled cases on all working days except Sundays and public holidays. Results: Total study period consisted of 96 working days. There were a total of eight OT tables of various specialties, and parameters were observed during the routine hours excluding Sundays and holidays. The total procedure time was maximum for ENT followed by orthopedics and least for obstetrics. Room turnover time was maximum for obstetrics followed by general and oncosurgery. Case delays were maximum in general surgery and least for ophthalmology. The most common reason for delay in starting the operation table was patient getting shifted late from the ward and administrative causes. The most prominent reasons for cancellation were lack of operating room time followed by medical reasons of the patient. Conclusion: We concluded that most of the causes of delays and cancellations of surgeries were avoidable with proper preoperative planning and optimization of patients and resources and good communication between surgeon anesthesiologists and the nursing staff.

https://ift.tt/2EFUKym

Practice pattern of fresh gas flow and volatile agent choices among anesthesiologists working in different Indian hospitals: An online survey

Mayank Kumar, Mamta Sinha, Habib Md Reazaul Karim, Chinmaya Kumar Panda, Subrata Kumar Singha

Anesthesia: Essays and Researches 2018 12(4):907-913

Background: Fresh gas flow (FGF) during volatile inhalational agent-based anesthesia is a concern for many reasons. Advancement in anesthesia workstation (WS) and monitoring of anesthesia gas concentrations has led to the feasibility of lower flow safely. However, the practice pattern is not yet well known. The information can help us in better protocol formation. Aim: The survey was aimed to know the prevailing practice pattern of FGF and volatile agent choices and compare them among anesthesiologists of different working setups and experiences. Materials and Methods: With approval, the present cross-sectional survey was conducted using SurveyMonkey® software from January 2018 to May 2018. Anesthesiologists working in different organizations across India were approached through E-mail and WhatsApp. Anonymous responses were collected, expressed in number and percentage scale, as well as compared using INSTAT software and appropriate tests; P < 0.05 was considered statistically significant. Results: A total of 251 (15.2%) responses were received and 249 were analyzed. Overall, 87% of respondents were using anesthesia WS and 71% were using nitrous oxide as balance gas. The FGF of <600 mL/min was highest with desflurane. Minimum alveolar concentration (MAC) monitoring was very poor in nonteaching (NT) hospitals as compared to teaching hospitals; P < 0.0001. The Boyle's machine was more common in use in NT hospitals as compared to medical colleges and corporate hospitals; P < 0.0001. Conclusion: Low-flow anesthesia (LFA) use is still suboptimal, and there are ample opportunities to increase and optimize the FGF used. The use of Boyle's machine is associated with higher flow use. MAC monitoring and LFA use are poor in NTs.

https://ift.tt/2EwmMeY

The effect of intravenous dexamethasone on intraoperative and early postoperative pain in lumbar spine surgery: A randomized double-blind placebo-controlled study

Mamta Sharma, Shikha Gupta, Shobha Purohit, Amit Kumar Goyal

Anesthesia: Essays and Researches 2018 12(4):803-808

Background: The surgical procedures of spine are generally associated with intense pain in the postoperative period. Opioids are commonly used for perioperative analgesia but are associated with many side effects. Co-analgesic drugs are used to decrease these side effects. One such supplemental drug is dexamethasone. Its strong anti-inflammatory effect contributes to perioperative analgesia. Aim: This study was done to evaluate the effect of intravenous (i.v.) dexamethasone on intraoperative and early postoperative pain in lumbar spine surgery. Settings and Design: This was a hospital-based randomized, double-blind, placebo-controlled study, done between June 2016 and December 2016 after permission of institutional ethical committee. Materials and Methods: This Study was conducted on 60 patients undergoing lumbar spine surgery, and randomization was done in two groups. Group A (study) received dexamethasone 2 ml (8 mg) i.v. and Group B (control) received 2 ml normal saline. Anesthesia technique and rescue analgesia regimen were standardized. Intraoperative pain was assessed by hemodynamic variability and postoperative pain by verbal rating score. All the quantitative data were analyzed using Student's t-test and all the qualitative data using Chi-square test. Results: Heart rate in the control group was significantly higher than the study group during intraoperative period. Mean pain scores in the early postoperative period were significantly higher in control group than the study group (P < 0.001). Mean time of first rescue analgesic in the postoperative period was 149.17 min and 34.33 min in the study group and control group, respectively (P < 0.001). Conclusion: Hence, we conclude that administration of 8 mg of preoperative i.v dexamethasone was effective in reducing intraoperative and early postoperative pain in the lumbar spine surgery.

https://ift.tt/2EElQ8S

Tunneling does not prevent dislodgment of epidural catheters: A randomized trial

Hussein Y Abukhudair, Esam N Farhoud, Khalid M Abufarah, Abdullah T Obaid, Ola A Yousef, Aqel M Aloqoul

Anesthesia: Essays and Researches 2018 12(4):930-936

Background: Epidural analgesia is preferred in postoperative pain control, but dislodgment is a major factor for failure. Tunneling is well known to control displacement of catheters. In this study, we evaluated if we can depend on tunneling in preventing dislodgment of epidural catheters. Aims: The aim is to study if tunneling is effective and safe in reducing the rate of epidural catheters' dislodgment. Setting and Design: The study was carried out at a single tertiary cancer center. The trial was parallel, simple randomized, controlled, and single blind. Allocation of treatments was generated using random number tables. Subjects and Methods: Two hundred patients undergoing major surgeries were randomized. Epidural catheters were affixed to the skin through subcutaneous tunneling to a length of 5 cm or using standard adhesive tape without tunneling. Patients were on follow-up for 6 days postsurgery according to policy. Statistical Analysis Used: Categorical variables were analyzed by Chi-square and Fisher's exact test. Student t-test was used for continuous variables. Results and Conclusion: A total of 200 patients were randomized, 92 patients received tunneled catheters and 108 received nontunneled catheters. Patients were between 20 and 85 years; 63% were male. The mean days of epidural analgesia were similar in both groups (2.7 compared to 2.5 days). About 7.6% of epidurals were dislodged in the tunneled group compared to 10.2% in the nontunneled group (P = 0.699). No differences were identified in the incidence of pain or adverse events between the groups. Tunneling did not improve the rates of dislodgment in epidural catheters. There were no safety concerns associated with tunneling epidural catheters.

https://ift.tt/2Evfd83

Addition of dexmedetomidine to ropivacaine in subcostal transversus abdominis plane block potentiates postoperative analgesia among laparoscopic cholecystectomy patients: A prospective randomized controlled trial

B Sarvesh, BT Shivaramu, Kanchan Sharma, Amit Agarwal

Anesthesia: Essays and Researches 2018 12(4):809-813

Context: Laparoscopic cholecystectomy is associated with moderate intensity postoperative pain especially in the early postoperative period. Transversus abdominis plane (TAP) block has been shown to reduce pain scores and analgesic requirements after abdominal surgery. Aims: We hypothesized that a subcostal TAP block with ropivacaine and dexmedetomidine will prolong the duration of postoperative analgesia following laparoscopic cholecystectomy. Settings and Design: This prospective, randomized study was done in 60 patients undergoing laparoscopic cholecystectomy surgery done at a tertiary care institution. Subjects and Methods: Sixty patients undergoing laparoscopic cholecystectomy were randomized into two groups to receive either bilateral ultrasonography-guided subcostal TAP blocks with 18 mL 0.375% ropivacaine and 2 ml of normal saline (n = 30, Group R) or 18 ml. 375% ropivacaine with 0.5 μg/kg dexmedetomidine 2 mL (n = 30, Group RD). Numerical rating scale was measured postoperatively to primarily assess the pain severity and analgesic requirement for the first 24 h, hemodynamic parameters, and adverse effects were recorded. Statistical Analysis Used: Categorical data were analyzed using Chi-square test/Fisher's exact test and quantitative data were analyzed using Student's t-test and the Mann–Whitney U-test. Results: The study group (Group RD) had significantly prolonged postoperative analgesia (485.6 min) as compared to Group R (289.83 min). Moreover, consumption of morphine over 24-h period is significantly less in Group RD (14.5 mg) as compared to Group R (28.5 mg). Conclusions: Addition of dexmedetomidine to ropivacaine in TAP block prolongs postoperative analgesia and reduces opioid consumption without any major adverse effects.

https://ift.tt/2EFUxLA

Pantoea dispersa it the next emerging “monster” in our intensive care units? A case report and review of literature

Mridul Panditrao, Minnu Panditrao

Anesthesia: Essays and Researches 2018 12(4):963-966

Hospital-acquired infections and their consequences are the main cause of morbidity/mortality in critically ill and immunocompromised patients. It becomes interesting when an unusual and uncommon microorganism is found to be the causative agent, rather than the known commensals and opportunists. We present such a case, when a multiparous female, in post lower uterine segment cesarean section period presented with fulminant septic shock, hepatic failure, coagulopathy, and ventilator-associated pneumonitis. The organism grown in the tracheal secretions turned out to be an uncommon, unusual Gram-negative Coccobacillus by the name of Pantoea dispersa, resistant to almost all the conventional antimicrobial agents. In spite of all the efforts, the patient could not be saved. However, the case has opened up a virtual "Pandora's box" of questions. Are these microorganisms, known plant pathogens, really harmful to humans? Are they commensals or virulent opportunists? Are we once again on the way to a new "Acinetobacter," like near-epidemic? This is an attempt to try and find some insight about this presently uncommon and not well known genus of Pantoea! We have tried to trace and review the related available literature in the clinical medicine.

https://ift.tt/2Ewmzsc

Topographic sonoanatomy of infraclavicular brachial plexus: Variability and correlation with anthropometry

Abhyuday Kumar, Ajeet Kumar, Chandni Sinha, Chhavi Sawhney, Rajnish Kumar, Debesh Bhoi

Anesthesia: Essays and Researches 2018 12(4):814-818

Objective: The aim of the study was to assess the effectiveness of ultrasound in analyzing topographic relationship of nerve cords with axillary artery at lateral infraclavicular level, their variations, and the distance from the skin and to correlate findings with anthropometric parameters. Materials and Methods: Two hundred patients aged 18–75 years were enrolled for the study after informed written consent. A 7–12 MHz linear ultrasonic transducer was used for scanning of the brachial plexus at lateral infraclavicular fossa. The results of the cord positions were expressed on a 12-section pie chart, and the number of arteries and veins was reported. Measurements included the vertical distance from the upper part of the artery to the skin, diagonal distance to the apical corner of the ultrasound image, and distances from center of cords to the center of artery. Age, sex, weight, height, body mass index, and biceps girth were recorded. Data were expressed as mean with standard deviation or frequency and percentage for categorical variables, and statistical analysis was done using correlation analysis and two-sample t-test. Results: The most frequent positions of the cords were observed in 2–4 sections (92%) for the medial cord, 6–7 sections (92%) for the posterior cord, 10–11 sections (89%) for the lateral cord, and 4–5 sections (95%) for the axillary vein. More than one axillary vein was seen in 12.5% and two axillary arteries were seen in 1.5% of cases. Cord visibility and distance between artery and apical corner of the ultrasound image correlated with anthropometric parameters. Conclusions: A topographical study of brachial plexus at lateral infraclavicular fossa showed anatomical variations and abnormal vascular formations. This sonoanatomic knowledge can be helpful in improving safety and success of nerve blocks.

https://ift.tt/2EDi4Nm

Effect and safety of labor epidural analgesia with intermittent boluses of 0.1% bupivacaine with fentanyl on fetal and maternal outcomes and wellbeing

Rajesh Kesavan, Sunil Rajan, Lakshmi Kumar

Anesthesia: Essays and Researches 2018 12(4):769-773

Background: Labor analgesia has been shown to have few undesirable effects on the course and outcome of the labor as well as on the fetal well-being. Aims: This study aims to assess neonatal outcome following lumbar epidural analgesia with intermittent boluses of 0.1% bupivacaine with fentanyl. The secondary objectives included assessment of maternal analgesia, complications, and outcome of labor. Setting and Design: Prospective observational study conducted at a tertiary care teaching institute. Subjects and Methods: Sixty-three patients for labor epidural analgesia were recruited. Epidural catheter was inserted in L4–L5 or L3–L4 interspace. After confirmation of the position of catheter, 3 mL of 0.5% bupivacaine with 20 μg of fentanyl made to 15 mL was administered. After 30 min, efficacy of analgesia was assessed by visual analog scale (VAS). The same bolus dose was repeated after 90 min if the patient complained of pain. A maximum of five top-up doses were allowed. Statistical Test Used: Mean and standard deviation, number and percentage Results: After 30 min of first bolus dose, 93.3% had VAS score of <4. More than 90% patients had adequate analgesia till 4th epidural bolus. During contraction stress test, only two fetuses had late deceleration. About 80% and 98.3% newborns had Apgar of >7 at 1 and 5 min, respectively. Umbilical cord blood pH was ≥7.1 in 98.3% neonates with base excess of >−12. 58.3% delivered normally, 23.3% had instrumental vaginal delivery, and 18.3% required cesarean section. Conclusion: Lumbar epidural analgesia with 0.1% bupivacaine with fentanyl provides optimal neonatal outcome, labor analgesia, and labor outcome.

https://ift.tt/2EtSWHP

Clinical audit on the practice of documentation at preanesthetic evaluation in a specialized university hospital

Yophtahe B Woldegerima, Semira D Kemal

Anesthesia: Essays and Researches 2018 12(4):819-824

Background: Performing preanesthetic evaluation, documenting, and keeping readily accessible record are responsibilities of anesthetists. Documentation can improve overall patient outcome. It also has an irreplaceable role in medico-legal aspects. Documentation is one of the challenges of providing quality care. Aim: The aim of this study was to evaluate the quality of documentation practice during preanesthetic visits. Materials and Methods: This clinical audit was conducted in the University of Gondar Hospital. Predefined 22 practice quality indicators were prepared according to modified global quality index. Statistical Analysis: Descriptive statistics was performed using SPSS version 20. Results: A total of 122 preanesthetic evaluation tools (PAETs) were reviewed. None of PAETs found fully completed according to the indicators. Trends differ between elective and emergency conditions. Indicators with high completion rate (>90%) were signed a consent, medical history, history of medication, allergy, anesthesia and surgery, cardiopulmonary examination, airway examination, preoperative diagnosis, and planned procedure. Anesthetic plan, vital signs, a name, per-oral status, premedication, and age were found with below average (<50%) completion rate. Conclusions: Documentation practice during the preanesthetic visit was below the standard. Unclear instructions should be replaced with standardized contents. Providing regular trainings on clinical documentation for students and staffs, and introducing modern electronic-based documentation system and preanesthetic clinics may improve the practice.

https://ift.tt/2EFUlvQ

Comparison between colloid preload and coload in bone cement implantation syndrome under spinal anesthesia: A randomized controlled trial

Ayca T Dumanlı Özcan, Elvin Kesimci, Cemile Altın Balcı, Orhan Kanbak, Hülya Kaşıkara, Abdulkadir But

Anesthesia: Essays and Researches 2018 12(4):879-884

Background: Bone cement implantation syndrome (BCIS) is characterized by hypoxia hypotension cardiac arrest. There is not any research that investigated the hemodynamic effects of colloid use during and before cement implantation regarding BCIS development. Aims: We aimed to compare the effects of colloid preloading before or coloading simultaneously at cement implantation on BCIS development and hemodynamic parameters in patients who underwent total knee arthroplasty. Settings and Design: This is a prospective, randomized, clinical trial with the participation of 109 patients over 60 years of age and patients physical status American Society of Anesthesiologists Classes I and II to undergo knee surgery. The patients were administered spinal anesthesia, divided into three groups. Subjects and Methods: The patients in Group I were infused 8 mL/kg hydroxyethyl starch (130/0.4) 20 min before the cement implantation, those in Group II were infused the same simultaneously during cement implantation. Group III was infused 8 mL/kg/h sodium chloride during the anesthesia management. Hemodynamic parameters of the patients were recorded at before and after cement implantation and once the tourniquet was removed. Statistical Analysis Used: The descriptive statistics were presented as the mean ± standard deviation for normally distributed variables, as the median for nonnormally distributed variables, and as the number of cases and (%) for nominal variables. Pearson's Chi-square test and Fisher's exact test were used in the analysis of categorical variables. Results: Compared to the control group, Groups I and II were hemodynamically more stable. The development of moderate hypoxia during cement implantation was significantly different between the study groups (P < 0.05). Conclusions: We suggest that avoiding intravascular volume depletion by using the colloids, particularly in elderly patients, is important for preventing from the BCIS.

https://ift.tt/2EstvX0

In vitro antioxidant activity and solar protection factor of blackberry and raspberry extracts in topical formulation

Abstract

Background

Berries are known for their antioxidant activity due to the presence of flavonoids. Antioxidants' usage guarantees skin protection against free radicals and, flavonoids, especially, can act as sunscreen. The aim of this paper was to evaluate solar protection factor (SPF) and antioxidant activity in vitro of blackberry and raspberry extracts incorporated in topical formulation and study their stability.

Results

Raspberry presented 29.93 mg of anthocyanins/100 g of fruit and blackberry 65.58 mg of anthocyanins/100 g of fruit. In vitro solar protection factor was 54.57 to blackberry and 37.32 to raspberry. When incorporated in O/W emulsions, final formulations showed light pink color, creamy aspect, and typical fruity odor. Formulations submitted to indirect light and stove showed odor and color alterations.

Conclusions

Based on the results, formulations containing extracts should be kept under refrigeration in opaque package to ensure stability due to the presence of flavonoids. In addition, blackberry and raspberry extracts are potential natural alternatives to be used as sunscreen and to prevent skin aging.

https://ift.tt/2rMaAPj

In vitro antioxidant activity and solar protection factor of blackberry and raspberry extracts in topical formulation

Abstract

Background

Berries are known for their antioxidant activity due to the presence of flavonoids. Antioxidants' usage guarantees skin protection against free radicals and, flavonoids, especially, can act as sunscreen. The aim of this paper was to evaluate solar protection factor (SPF) and antioxidant activity in vitro of blackberry and raspberry extracts incorporated in topical formulation and study their stability.

Results

Raspberry presented 29.93 mg of anthocyanins/100 g of fruit and blackberry 65.58 mg of anthocyanins/100 g of fruit. In vitro solar protection factor was 54.57 to blackberry and 37.32 to raspberry. When incorporated in O/W emulsions, final formulations showed light pink color, creamy aspect, and typical fruity odor. Formulations submitted to indirect light and stove showed odor and color alterations.

Conclusions

Based on the results, formulations containing extracts should be kept under refrigeration in opaque package to ensure stability due to the presence of flavonoids. In addition, blackberry and raspberry extracts are potential natural alternatives to be used as sunscreen and to prevent skin aging.

https://ift.tt/2rMaAPj

Congenital Hypothyroidism due to Oligogenic Mutations in Two Sudanese Families

Thyroid, Ahead of Print.


https://ift.tt/2ClLygh

National Trends in Incidence, Mortality, and Clinical Outcomes of Patients Hospitalized for Thyrotoxicosis With and Without Thyroid Storm in the United States, 2004–2013

Thyroid, Ahead of Print.


https://ift.tt/2SZ57R4

Clinical Applicability of Low Levels of Thyroglobulin Autoantibodies as Cutoff Point for Thyroglobulin Autoantibody Positivity

Thyroid, Ahead of Print.


https://ift.tt/2CmPJZa

Incidence of Neonatal Hyperthyroidism Among Newborns of Graves' Disease Patients Treated with Radioiodine Therapy

Thyroid, Ahead of Print.


https://ift.tt/2SZ4ZB4

Regeneration of a Bioengineered Thyroid Using Decellularized Thyroid Matrix

Thyroid, Ahead of Print.


https://ift.tt/2CmyJCn

Correction to: Cardiovascular Morbidity and Mortality After Treatment of Hyperthyroidism with Either Radioactive Iodine or Thyroidectomy by Ryödi E, Metso S, Huhtala H, Välimäki M, Auvinen A, and Jaatinen P. Thyroid 2018;28:1111–1120. DOI: 10.1089/thy.2017.0461

Thyroid, Volume 28, Issue 12, Page 1731-1731, December 2018.


https://ift.tt/2SWlfTq

Decreased Thyroid Peroxidase Antibody Titer in Response to Selenium Supplementation in Autoimmune Thyroiditis and the Influence of a Selenoprotein P Gene Polymorphism: A Prospective, Multicenter Study in China

Thyroid, Volume 28, Issue 12, Page 1674-1681, December 2018.


https://ift.tt/2CmyBCT

Future Meetings

Thyroid, Volume 28, Issue 12, Page 1729-1730, December 2018.


https://ift.tt/2SYqphM

Morbidity and mortality in patients undergoing fecal diversion as an adjunct to wound healing: a NSQIP comparison study

Abstract

Background

Fecal diversion for chronic, non-healing wounds improves quality of life, assists in wound healing, and helps to prepare for reconstructive surgery. While commonplace, little has been published regarding the safety of diversion in this patient subgroup. The purpose of this study is to elucidate the morbidity and mortality of fecal diversion for chronic wounds and to identify those patients with disproportionately high perioperative risk.

Methods

Retrospective analyses were performed using the American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database and an institutional database. The primary outcome analyzed was 30-day mortality and secondary outcomes included 30-day morbidity and readmission rate.

Results

Eight hundred fifty-nine patients were identified in the NSQIP database who underwent diversion compared to 3990 who did not. In unmatched data, there were no significant differences in substantial 30-day morbidities. In matched data, diverted patients had a significantly lower perioperative mortality. Fifty-six patients were identified in the institutional review who were diverted for non-healing wounds. Fifty percent of patients with a preoperative ejection fraction of less than 30% died within 30 days of surgery (LR 6.58, p = 0.045).

Conclusions

The NSQIP review indicates that fecal diversion does not inherently increase 30-day perioperative morbidity or mortality. While 30-day morbidity remains high, the institutional review suggests that patients with cardiac dysfunction contribute to the majority of complications. As such, an ejection fraction less than 30% may be a relative contraindication to immediate diversion. Medical optimization and elective diversion should be considered whenever feasible.

Level of Evidence: Level III, risk / prognostic study.

https://ift.tt/2CmywPB

A Clinical Trial Using Methylation Age to Evaluate Current Antiaging Practices

Rejuvenation Research, Ahead of Print.


https://ift.tt/2Sb97xB

Comparison of two different laser photobiomodulation protocols on the viability of random skin flap in rats

Abstract

To identify the best low level laser photobiomodulation application site at the same irradiation time to increase the viability of the skin flap in rats. Eighteen male rats (Rattus norvegicus: var. Albinus, Rodentia Mammalia) were randomly distributed into three groups (n = 6). Group I (GI) was submitted to simulated laser photobiomodulation; group II (GII) was submitted to laser photobiomodulation at three points in the flap cranial base, and group III (GIII) was submitted to laser photobiomodulation at 12 points distributed along the flap. All groups were irradiated with an Indium, Galium, Aluminum, and Phosphorus diode laser (InGaAlP), 660 nm, with 50 mW power, irradiated for a total time of 240 s in continuous emission mode. The treatment started immediately after performing the cranial base random skin flap (10 × 4 cm² dimension) and reapplied every 24 h, with a total of five applications. The animals were euthanized after the evaluation of the percentage of necrosis area, and the material was collected for histological analysis on the seventh postoperative day. GII animals presented a statistically significant decrease for the necrosis area when compared to the other groups, and a statistically significant increase in the quantification of collagen when compared to the control. We did not observe a statistical difference between the TGFβ and FGF expression in the different groups evaluated. The application of laser photobiomodulation at three points of the flap cranial base was more effective than at 12 points regarding the reduction of necrosis area.

https://ift.tt/2BshX3a

Multi-response optimization to obtain better performance and emission level in a diesel engine fueled with water-biodiesel emulsion fuel and nanoadditive

Abstract

The present study aims to investigate the optimum condition of stationary diesel engine's operating parameters to obtain better performance and emission level, where the diesel engine is fueled with different concentrations of soybean biodiesel (SB), water, and alumina (Al) nanoadditive. Taguchi method coupled with gray relational analysis has been implemented in this study to obtain the optimum concentration of SB, water, and Al nanoparticle, and statistical analysis of variance (ANOVA) is applied to obtain the individual response of operating parameters on overall engine performance and emission level. Various concentration of SB (10%, 20%, and 30%), water (10%, 20%, and 30%), and Al nanoparticle (50 ppm, 100 ppm, and 150 ppm) are mixed with base diesel (BD) by mechanical agitation and followed by an ultra-sonication process. The fuel properties are measured based on EN590 standards, and the experiments are conducted in a single-cylinder, four-stroke, natural aspirated stationary diesel engine based on an L₉ orthogonal array fuel combination. From the obtained gray relational co-efficient (GRC) and signal-to-noise (S/N) ratio, the optimum concentration of SB, water, and nanoadditive are identified as 20%, 10%, and 100 ppm, respectively, and a confirmation experiment has also been carried out to confirm the improvements at optimum condition. The ANOVA results imply that water concentration (WC) has the maximum influence on overall diesel engine's performance and emission level followed by nanoparticle and SB concentrations. Overall, it can be concluded that the engine exhibits better performance and greener emissions at optimal condition.

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Higher Serum Uric Acid is a Risk Factor of Vertebral Fractures in Postmenopausal Women with Type 2 Diabetes Mellitus

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0815-4954

Purpose Serum uric acid (UA) level may affect bone metabolism because it has an anti-oxidative effect. However, whether serum UA level is associated with a fracture risk in type 2 diabetes mellitus (T2DM) is unclear. We thus aimed to clarify the association between serum UA and bone parameters in T2DM. Methods We conducted a cross-sectional study to investigate the association of serum UA with bone mineral density (BMD) at lumbar spine (LS) and femoral neck (FN), bone turnover markers such as osteocalcin and urine type I collagen cross-linked N-telopeptide (uNTX), and the prevalence of vertebral fractures (VF) in 356 postmenopausal women and 512 men with T2DM. Results Multiple regression analyses adjusted for age, duration of diabetes, hemoglobin A1c, body mass index and log (serum creatinine) showed that serum UA level was significantly and negatively associated with uNTX in postmenopausal women with T2DM, whereas it was not associated with osteocalcin or BMD at each site. In men, serum UA was not associated with BMD or bone turnover markers. Because postmenopausal women with VF were significantly older and had longer duration of diabetes, higher serum creatinine level and lower BMD than those without it, logistic regression analyses adjusted for these confounding factors were performed. Higher serum UA level was significantly associated with the presence of VF. Conclusions The present study showed that higher serum UA is a risk factor for VF independently of BMD in postmenopausal women with T2DM.
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© Georg Thieme Verlag KG Stuttgart · New York

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Depression and Diabetic Peripheral Neuropathy: Birds of a Feather, But When do They Flock Together?

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0808-4269

The association between diabetes and depression is well recognised. Similarly, diabetic peripheral neuropathy (DPN) is a frequent complication of diabetes. Given the high prevalence of these conditions individually, it is hardly surprising they frequently interact, conferring additional morbidity and a higher mortality risk. Despite this, the specific clinical characteristics that underpin co-morbid depression and DPN remain unclear. Additionally, there is insufficient insight into causal pathways and temporal trends. High-quality epidemiological data is limited, but they suggest that these conditions may share certain common risk factors, although there are also distinct differences such as gender. Improved insights into the risk factors for the co-existence of DPN and depression may help towards improved screening for and treatment of these conditions.
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© Georg Thieme Verlag KG Stuttgart · New York

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An Update on Addison’s Disease

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0804-2715

Addison's disease – the traditional term for primary adrenal insufficiency (PAI) – is defined as the clinical manifestation of chronic glucocorticoid- and/or mineralocorticoid deficiency due to failure of the adrenal cortex which may result in an adrenal crisis with potentially life-threatening consequences. Even though efficient and safe pharmaceutical preparations for the substitution of endogenous gluco- and mineralocorticoids are established in therapy, the mortality in patients with PAI is still increased and the health-related quality of life (HRQoL) is often reduced.PAI is a rare disease but recent data report an increasing prevalence. In addition to the common "classical" causes of PAI like autoimmune, infectious, neoplastic and genetic disorders, other iatrogenic conditions – mostly pharmacological side effects (e. g., adrenal haemorrhage associated with anticoagulants, drugs affecting glucocorticoid synthesis, action or metabolism and some of the novel anti-cancer checkpoint inhibitors) are contributing factors to this phenomenon.Due to the rarity of the disease and often non-specific symptoms at least in the early stages, PAI is frequently not considered resulting in a delayed diagnosis. Successful therapy is mainly based on adequate patient education as a cornerstone in the prevention and management of adrenal crisis. A focus of current research is in the development of pharmacokinetically optimized glucocorticoid preparations as well as regenerative therapies.
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© Georg Thieme Verlag KG Stuttgart · New York

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Surgical “Safe Zone”: Rapid Anatomical Identification of the Lesser Occipital Nerve

J reconstr Microsurg
DOI: 10.1055/s-0038-1676601

Background Surgical intervention has established a vital role in the management of chronic headaches. The lesser occipital nerve (LON) is a common target in patients suffering from occipital neuralgia and is often resected as a first-line option. We endeavored to define the relationships of the LON in the posterolateral neck to facilitate its safe and rapid intraoperative identification. Methods Seven fresh cadavers (14 nerves) were dissected, and their relationships to the mastoid prominence and nearby spinal accessory nerve (SAN) and greater auricular nerve were noted. Results The distance from the mastoid to the emergence of the LON along the posterior sternocleidomastoid ranged from 36 to 51 mm (mean: 45.2 mm), with relative symmetry between the two nerves in the same cadaver. The SAN emerged an average of 54 mm from the mastoid prominence. Conclusions Exploration for the LON should begin at a point 40 mm from the mastoid prominence along the posterior border of the sternocleidomastoid muscle. If the point of exit of the LON is not identified within 10 mm of this exposure, our dissection continues cranially along the posterior border of the sternocleidomastoid, anterior to the trapezius. In rare cases the nerve may pierce the fibers of the muscle and ascend directly on top of the muscle belly. By limiting the caudal extend of the dissection, we can avoid exposure of the SAN and minimize the risk of iatrogenic nerve injury.
[...]

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Amendment of Caulerpa sertularioides marine alga with sulfur-containing materials to accelerate Cu removal from aqueous media

Abstract

This study reports a new approach of alga amendment in a live mode. The Caulerpa sertularioides alga was modified with sulfur-containing materials of methionine (C₅H₁₁NO₂S) and sodium sulfate (Na₂SO₄) to more concentrate the sulfur content of the yielded biomass (adsorbent). The simple and amended C. sertularioides alga was fully characterized with FTIR, SEM, EDX, BET, BJH, and pH_zpc techniques. The copper adsorption from aqueous media was done by three adsorbents of C. sertularioides-simple (CSS), C. sertularioides-Na₂SO₄ (CSN), and C. sertularioides-C₅H₁₁NO₂S (CSC). The parameters of pH (2–6), adsorbent dosage (2–10 g/L), and contact time (3–80 min) were optimized at 5, 5 g/L, and 60 min, respectively. According to Langmuir isotherm (the best-fitted model), the maximum adsorption capacity of CSN (98.04 mg/g) was obtained 2.4 times higher than CSC (40.73 mg/g) and 9.5 times higher than CSS (10.29 mg/g). The Cu adsorption process by the adsorbents was best-fitted pseudo-second-order kinetic model. The CSN, CSC, and CSS biomasses were successfully reused 5, 4, and 4 times, respectively. The thermodynamic study revealed that the copper adsorption process by CSN is exothermic and non-spontaneous. Finally, the suitability of adsorbents prepared from algae was tested by cleaning a simulated wastewater.

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How autochthonous microorganisms influence physiological status of Zea mays L. cultivated on heavy metal contaminated soils?

Abstract

The aim of this study was to investigate the effect of autochthonous microorganisms present in soil collected from heavy metal (HM) uncontaminated (Pb ≈ 59 mg kg⁻¹, Cd ≈ 0.4 mg kg⁻¹, Zn ≈ 191 mg kg⁻¹), moderately (Pb ≈ 343 mg kg⁻¹, Cd ≈ 12 mg kg⁻¹, Zn ≈ 1876 mg kg⁻¹), and highly (Pb ≈ 1586 mg kg⁻¹, Cd ≈ 57 mg kg⁻¹, Zn ≈ 3280 mg kg⁻¹) contaminated sites on Zea mays elemental composition, physiological status, and growth parameters. For this purpose, half of the collected soil was sterilized and soil characterization was performed. After 45 days of cultivation, the presence of HM in the soil negatively affected photosynthesis and transpiration rates, relative chlorophyll content, anthocyanins index, chlorophyll fluorescence parameters, and content of oxidative stress products (H₂O₂ and Malondialdehyde) of Zea mays, while soil sterilization had a positive effect on those parameters. Average percentage of colonization of root segments by arbuscular mycorrhiza fungi decreased with an increase of HM contamination in the soil. The increase in shoot concentration of HMs, particularly Cd and Zn, was a result of contaminated soils sterilization. Aboveground biomass of maize cultivated on sterilized soil was 3-fold, 1.5-fold, and 1.5-fold higher for uncontaminated, moderately contaminated and highly contaminated soils respectively when compared to nonsterilized soils. Contrary to our expectation, autochthonous microflora did not improve plant growth and photosynthetic performance; in fact, they had a negative effect on those processes although they did reduce concentration of HMs in the shoots grown on contaminated soils.

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The distribution and accumulation of mercury and methylmercury in surface sediments beneath the East China Sea

Abstract

China is a massive mercury emitter, responsible for a quarter of the world's mercury emissions, which transit the atmosphere and accumulate throughout its watercourses. The Changjiang (Yangtze) River is the third largest river in the world, integrating mercury emissions over its 1.8 × 10⁶ km² catchment and channelling them to the East China Sea where they can be buried. Despite its potential global significance, the importance of the East China Sea as a terminal mercury sink remains poorly known. To address this knowledge gap, total mercury and methylmercury concentrations were determined from 51 surface sediment samples revealing their spatial distribution, whilst demonstrating the overall pollution status of the East China Sea. Sedimentary mercury distributions beneath the East China Sea are spatially heterogeneous, with high mercury concentrations (> 25 ng g⁻¹) corresponding to areas of fine-grained sediment accumulation. In contrast, some sites of fine-grained sediment deposition have significantly lower values of methylmercury (< 15 ng g⁻¹), such as the Changjiang estuary and some isolated offshore areas. Fine-grained particles and organic matter availability appear to exert the dominant control over sedimentary mercury distribution in the East China Sea, whereas in situ methylation serves as an additional control governing methylmercury accumulation. Estimated annual sedimentary fluxes of mercury in the East China Sea are 51 × 10⁶ g, which accounts for 9% of China's annual mercury emissions.

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Tall Cell Variant of Papillary Thyroid Carcinoma: Impact of Change in WHO Definition and Molecular Analysis

Abstract

The morphologic criteria for tall cell variant (TCV) of papillary thyroid carcinoma (PTC) were modified in the 2017 WHO Classification of Tumors of Endocrine Organs, with a decrease in the requirements for both the height of cells and in the percentage of tumor demonstrating a tall cell morphology. The aim of this study was to determine if the change in criteria would result in a significant increase in the percentage of tumors that meet criteria for TCV. In addition, we evaluated the correlation between morphology, molecular alterations, and clinical behavior of TCV. We studied three cohorts to evaluate the above stated questions. The first cohort was comprised of 97 PTC consecutively resected over a 12-month period that were originally diagnosed as classic PTC, PTC with tall cell features, or TCV. Tumor slides of each case were reviewed to determine the percentage of the tall cell component (< 30%, 30–49%, and > 50%) and the height of the cells in this component. This cohort was evaluated to determine if the change in WHO criteria would result in a significant increase in the percentage of tumors that meet criteria for TCV. Our second cohort consisted of nine consecutively resected PTC with a tall cell component > 30% (with tall cells defined as at least 2–3× as tall as wide) that had molecular characterization through a targeted, next-generation sequencing (NGS) assay. The molecular characteristics were correlated with the percentage of the tall cell component. Finally, a third cohort comprised of seven clinically aggressive TCV (defined as those with T4 disease, disease recurrence, or subsequent tumor dedifferentiation) was evaluated to determine histologic and molecular characteristics. In cohort 1, the number of cases classified as TCV increased significantly with the change in definition of TCV: 8 (8%) cases met the previous criteria for TCV (cells 3× as tall as wide in > 50% of the tumor), whereas 24 (25%) cases met the new 2017 WHO criteria (cells 2–3× as tall as wide in > 30% of the tumor) (p = 0.0020). Molecular analysis of cohort 2 revealed that all 9 cases harbored a BRAF V600E mutation. Pathogenic secondary mutations were absent in cases with < 50% tall cells, but they were detected in 2 (33%) of 6 cases with > 50% tall cells (2 cases with TERT promoter mutations, including 1 that also had an AKT2 mutation). Histologic and molecular analysis of the clinically aggressive cohort (cohort 3), revealed that all cases had > 50% tall cells and 3 (43%) had secondary oncogenic mutations (all TERT promoter mutations). We found that the modified morphologic criteria put forth in the 2017 WHO tripled the number of cases that would be classified as TCV. Moreover, clinically aggressive tumors and those harboring secondary oncogenic mutations all had a tall cell component > 50%. Additional large multi-institutional studies incorporating clinical outcome and molecular data would be valuable to determine the best histologic definition of TCV.

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A New Model for Congenital Vestibular Disorders

Abstract

Many developmental disorders of the inner ear are manifested clinically as delayed motor development and challenges in maintaining posture and balance, indicating involvement of central vestibular circuits. How the vestibular circuitry is rewired in pediatric cases is poorly understood due to lack of a suitable animal model. Based on this, our lab designed and validated a chick embryo model to study vestibular development in congenital vestibular disorders. The developing inner ear or "otocyst" on the right side of 2-day-old chick embryos (E2) was surgically rotated 180° in the anterior–posterior axis, forming the "anterior–posterior axis rotated otocyst chick" or ARO chick. The ARO chick has a reproducible pathology of a sac with truncated or missing semicircular canals. A sac is the most common inner ear defect found in children with congenital vestibular disorders. In E13 ARO chicks, the sac contained all three cristae and maculae utriculi and sacculi, but the superior crista and macula utriculi were shortened in anterior–posterior extent. Also, the number of principal cells of the tangential vestibular nucleus, a major avian vestibular nucleus, was decreased 66 % on the rotated side. After hatching, no difference was detected between ARO and normal chicks in their righting reflex times. However, unlike normal chicks, ARO hatchlings had a constant, right head tilt, and after performing the righting reflex, ARO chicks stumbled and walked with a widened base. Identifying the structure and function of abnormally developed brain regions in ARO chicks may assist in improving treatments for patients with congenital vestibular disorder.

https://ift.tt/2QZyJjV

☆Comparison of transcutaneous laryngeal ultrasound with video laryngoscope for assessing the vocal cord mobility in patients undergoing thyroid surgery

We evaluated the accuracy and feasibility of transcutaneous laryngeal ultrasonography as an alternative to videolaryngoscopy for assessing vocal cord mobility to rule out recurrent laryngeal nerve injury following thyroidectomy.

https://ift.tt/2SY017l

Objective and subjective sinonasal and pulmonary outcomes in aspirin desensitization therapy: A prospective cohort study

Aspirin exacerbated respiratory disease (AERD) patients are challenging to manage with sinonasal and pulmonary symptoms refractory to maximal medical and surgical therapies. Our objective was to comprehensively examine objective and validated, disease-specific subjective sinonasal and pulmonary outcomes of aspirin (ASA) desensitization therapy in this patient population.

https://ift.tt/2Clz9cg

TNF-α Inhibitor-Induced psoriasis: A decade of experience at the Cleveland Clinic

TNF-induced psoriasis is a well-known reaction associated with TNF-α inhibitors and our 102-patient cohort revealed similarities to other published cohorts. Topical medications controlled disease more often than in other cohorts, suggesting dermatologists should be involved in treating patients with TNF-induced psoriasis; Cyclosporine may represent an underutilized TNF-induced psoriasis treatment.

https://ift.tt/2QCgmCa

Wide area digital dermoscopy

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Tumor mutational burden and response to PD-1 inhibitors in a case series of patients with metastatic desmoplastic melanoma

Desmoplastic melanoma (DM) represents an infrequently occurring and distinct histologic pattern of melanomas, often lacking mutations in genes typically altered in conventional melanomas including BRAF, NRAS, and KIT.We aimed at better characterizing the genetic profile of this subgroup of melanomas to match patients with available therapies.Pathology reports were reviewed for 1,240 consecutive melanoma cases sequenced by comprehensive genomic profiling (CGP) using a hybrid-capture based next generation sequencing during the course of clinical care.

https://ift.tt/2EEZ14Y

Superior effect of MP-AzeFlu than azelastine or fluticasone propionate alone on reducing inflammatory markers

MP-AzeFlu, intranasal formulation of azelastine hydrochloride (AZE) and fluticasone propionate (FP), is superior to AZE or FP alone for treatment of allergic rhinitis (AR). However, the precise anti-inflammato...

https://ift.tt/2rLMVyJ

Serum periostin levels in adults of Chinese descent: an observational study

Periostin has been shown to be a marker of Type 2 airway inflammation, associated with airway eosinophilia. It has a potential role in identifying asthmatics who may be responsive to treatment with monoclonal ...

https://ift.tt/2Lp2nK7

Review of cold-induced urticaria characteristics, diagnosis and management in a Western Canadian allergy practice

Cold-induced urticaria is a significant condition, especially among young females. Despite the morbidity of this disease, studies that fully characterize the disease are limited.

https://ift.tt/2rLnvkC

VACTERL association – Ultrasound findings and autopsy correlation

Naman Kumar Gaur, Sudheer Gokhale

Indian Journal of Radiology and Imaging 2018 28(4):452-455

VACTERL (vertebral, anal, cardiac, tracheoesophagus, renal, and limbs) is an abbreviation for the congenital group of abnormalities, including vertebral or vascular anomalies, anal atresia, cardiac defects, tracheoesophageal – fistula/esophageal atresia, renal defects, and limbs defects. It is a rare association and not accidental event where several organs are affected by developmental defects during blastogenesis. The exact cause is unknown; however, several environmental and genetic factors are included in literature. Three components out of seven are used to label as VACTERL. The combination is necessary, but the patient may have other congenital malformations as well. We present here an antenatal scan with autopsy correlation of one of the forms of VACTERL association spectrum.

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Author's Reply

Babu Peter Sathyanathan, Ravi Ranganathan, Bharathi Priya Raju, Kailasanathan Natarajan

Indian Journal of Radiology and Imaging 2018 28(4):482-482



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Precontrast T1 signal measurements of normal pituitary and microadenoma: A retrospective analysis through DCE MRI signal time curves

Ishan Kumar, Tanya Yadav, Ashish Verma, Ram C Shukla, Surya K Singh

Indian Journal of Radiology and Imaging 2018 28(4):380-384

Background: The dynamic contrast enhanced magnetic resonance imaging (DCE MRI) has currently become the most utilized technique for the detection of pituitary microadenoma. However, owing to differential enhancement of normal pituitary, high rate of false positivity remains a concern in its interpretation. Purpose: Our aim was to assess the utility of precontrast T1 signal intensity ratio (SIR) of the lesions suspected on DCE MRI, in prediction of presence of microadenoma. Materials and Methods: We retrospectively reviewed MRI of 23 patients referred for DCE MRI of pituitary (group 1, 15 patients with diagnosis of pituitary microadenoma; and group 2, patients not clinically labeled as microadenoma). STC were plotted and T1-SIR at t = 0 s was obtained at the suspicious zone of differential enhancement (SIR T) and normal pituitary (SIR P). SIR difference (SIR P − SIR T) and relative SIR difference (SIR P − SIR T/SIR P) were calculated for each patient and was compared between the two groups. Results: Mean T1 SIR is lower in patients with microadenoma than those without (P = 0.065). SIR difference and relative SIR difference was higher in patients with microadenoma (P = 0.003 and 0.005, respectively). Receiver-operated characteristic curve analysis demonstrated that a cut-off of 26 and 0.107 for SIR difference and relative SIR difference, respectively, could diagnose microadenoma with 100% specificity and reasonable sensitivities. Conclusion: The baseline precontrast T1 SIR evaluation of the lesion suspected to be microadenoma on DCE MRI, derived through STC curve, can increase diagnostic confidence in diagnosis of microadenoma.

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A case series of metastases to the breast from extramammary malignancies

Tanvi Vaidya, Subhash Ramani, Ashita Rastogi

Indian Journal of Radiology and Imaging 2018 28(4):470-475

Metastases to the breast from extra-mammary malignancies are extremely uncommon. The discovery of a breast mass in a patient with a known primary tumor elsewhere poses a diagnostic challenge to the clinician. An awareness of the various malignancies that can metastasize to the breast and accurate diagnosis of the same is essential to avoid an unnecessary mastectomy and to guide further therapy. In this case series, we describe such clinical scenarios with an emphasis on the imaging features of metastases to the breast, which will enable radiologists to recognize this entity with greater ease.

https://ift.tt/2SUklGU

Role of 3D SPACE sequence and susceptibility weighted imaging in the evaluation of hydrocephalus and treatment-oriented refined classification of hydrocephalus

Amarnath Chellathurai, Komalavalli Subbiah, Barakath Nisha Abdul Ajis, Suhasini Balasubramaniam, Sathyan Gnanasigamani

Indian Journal of Radiology and Imaging 2018 28(4):385-394

Objective: The aim of our study was to evaluate the diagnostic utility of three-dimensional sampling perfection with application optimized contrast using different flip angle evolution (3D SPACE) sequence and Susceptibility Weighted Imaging (SWI) in hydrocephalus and to propose a refined definition and classification of hydrocephalus with relevance to the selection of treatment option. Materials and Methods: A prospective study of 109 patients with hydrocephalus was performed with magnetic resonance imaging (MRI) brain using standardized institutional sequences along with additional sequences 3D SPACE and SWI. The images were independently read by two senior neuroradiologists and the etiopathogenesis of hydrocephalus was arrived by consensus. Results: With conventional sequences, 46 out of 109 patients of hydrocephalus were diagnosed as obstructive of which 21 patients showed direct signs of obstruction and 25 showed indirect signs. In the remaining 63 patients of communicating hydrocephalus, cause could not be found out in 41 patients. Whereas with 3D SPACE sequence, 88 patients were diagnosed as obstructive hydrocephalus in which all of them showed direct signs of obstruction and 21 patients were diagnosed as communicating hydrocephalus. By including SWI, we found out hemorrhage causing intraventricular obstruction in three patients and hemorrhage at various sites in 24 other patients. With these findings, we have classified the hydrocephalus into communicating and noncommunicating, with latter divided into intraventricular and extraventricular obstruction, which is very well pertaining to the selection of surgical option. Conclusion: We strongly suggest to include 3D SPACE and SWI sequences in the set of routine MRI sequences, as they are powerful diagnostic tools and offer complementary information regarding the precise evaluation of the etiopathogenesis of hydrocephalus and have an effective impact in selecting the mode of management.

https://ift.tt/2ClomyM