bluuebunny/crossref_metadata_2025 huggingface dataset:
Densification Behaviours of TiC/Ni Metal Ceramic Alloys Produced by Powder Metallurgy
Authors: Mebarki Lahcene , Boukhobza Abdelyamine , Fedaoui Kamel , Lazhar BAROURA
Published: April 2024

Ceramic Metallic Alloys of TiC/Ni, Comprising Titanium Carbide with Nickel Contents of 5%, 15%, 30%, and 50%, were Fabricated through Solid-Phase Sintering at 1400°C with a 2-hour Holding Time and a Pressure of 50MPa. This Study Explores the Impact of Nickel Content on the Mechanical and Structural Properties. The Solidification Mechanism between TiC and Ni is Governed by Carbon Diffusion through TiC Particles, Affecting the Morphology of TiC and Carbon Particles in Ni Samples. The Reaction Behavior within the TiC/Ni Alloys was Analyzed, and Microstructural and Mechanical Characteristics were Examined to Evaluate the Influence of Varying Nickel Contents. Results indicate that in all samples, the TiC matrix exhibited a solid solution of the FCC phase. The reaction mechanism of Ti-C-Ni reveals the evolution of solid phase formation with increasing nickel content. As nickel content increases, the mass and size of nickel particles grow, leading to a more uniform and homogeneous structure. At a nickel content of 15%, the samples displayed a bending strength of 1200 ± 50 N, a microhardness of 800 ± 20 (HV 0.1), and a density of 5.6 ± 0.2.
Analysis of the Fracture Behavior of Orthopedic Cement Using Submodeling Technique
Authors: Gasmi Bachir , Aour Benaoumeur , Benbarek Smail , Talha Abderrahim
Published: April 2024

Orthopedic cement is an essential component of cemented Total Hip Replacements (THR). It must ensure three essential functions: very good implant-cement adhesion, good bone-implant load transfer, and good antibiotic transport. The main objective of the present work is to study the fracture behavior of orthopedic cement in total hip replacements. The analysis is performed using the submodel technique. Two cases are being considered. The first case involves ordinary cracks, while the second case involves cracks emanating from cavities in the cement of the THR acetabular part. The effects of crack position and implant orientation on the variation of stress intensity factors (SIF) in the three failure modes are discussed. It has also been shown that the circumferential positions of cracks present a major risk of loosening of the prosthesis, especially when the defect is aligned with its axis.
Possibilities of Indirect Techniques for Prestressing Analysis of Existing Structures and Bridges
Authors: Moravcik Martin , Kralovanec Jakub
Published: April 2024

Determining the load-carrying capacity of existing bridges is a crucial task in assessing the current reliability and remaining service life of prestressed concrete structures and bridges. Nowadays, prestressed bridge structures that have been in operation for more than sixty years are proving to be problematic from the reliability point of view. If we want to comprehensively assess the reliability level of these structures, it is necessary to determine the current level of the prestressing as accurately as possible. This fact leads to the need to apply different methods that can determine these values. The paper is focused on the analysis of prestressing using indirect or analytical-experimental methods. Specifically, the Structural Response Method and the Saw-Cut Method. These techniques were tested both on prestressed members, in laboratory conditions, but mainly directly in-situ on a post-tensioned bridge. Finally, the experimental results are compared with the theoretically determined levels of prestressing.
Mass and heat transfer in the boundary layer region of modified second-grade fluid flow over a linearly stretched sheet embedded in porous media
Authors: Karunathilake N. G. A. , Fernando L. M. N.
Published: April 2024

Here, we have improved a model to describe the flow variables, velocity, mass and heat transfer in the boundary layer region of modified second-grade fluid flow over a linearly stretched sheet in a porous media. The modified model is used to study the qualitative impact of buoyancy parameter, second-grade fluid parameter, magnetic parameters, porous parameter, power-law index, and chemical reaction parameter on the flow profiles, radial and axial velocities, temperature, and concentration. Starting with the steady-state governing equations of mass, momentum, heat, and concentration of the fluid flow, we obtained the boundary layer approximations of the flow near the linearly stretched sheet with the no-slip boundary condition. Similarity transformation has been used to convert the partial differential equations system into a nonlinear ordinary differential equations system. The radial velocities, temperature, and concentration profiles have been solved numerically, and the qualitative influence of the flow parameters on the flow variables has been simulated and graphically presented for comparison. We have observed that radial and axial velocities were increasing for the shear-thinning and shearthickening fluids with solutal Grashof number, thermal Grashof number and second-grade fluid parameters. In contrast, the porous and chemical reaction parameters slow down both fluids’ radial and axial velocities. The temperature and concentration increase with the porous and magnetic parameters. However, thermal and solutal Grashof and second-grade fluid parameters suppress temperature and concentration. In shear-thickening fluids, chemical reaction parameters enhance concentration but suppress in shear-thinning fluids.
Variation in plant morphology and leaf essential oil composition of a representative Cinnamomum verum collection from Sri Lanka
Authors: Prathibhani M.R. , Azad R. , Ranaweera S. , Jayasekara L. , Ranawaka R.A.A.K. , Senanayake G. , Abeynayake S. , Geekiyanage S.
Published: April 2024

Sri Lankan cinnamon germplasm is an underexploited genetic resource of high breeding potential. A representative collection of a cultivated cinnamon germplasm with 48 accessions, is established at the University of Ruhuna, Sri Lanka. From that collection, 40 three-year-old vegetative-propagated accessions, were used in this study to study the variations in plant morphology and leaf oil composition. Flush colour was determined as four main categories of pink, red, brown, and green in all 48 accessions. Leaf length, leaf width, leaf length to width ratio and petiole length varied from 7.9 to 14.5 cm, 3.8 to 7.3 cm, 1.8 to 3.07 cm, and 1 to 2.2 cm, respectively, in the selected 40 accessions. Both the good fragrant aroma category of bark fragrance and the sweet pungent category of bark taste were recorded in 21 of the 40 accessions. Twenty (20) accessions from above collection were selected for leaf oil analysis. Gas chromatography-mass spectrometry (GC-MS) of leaf oil revealed the presence of 146 chemical compounds. Eugenol was the major compound of 17 accessions (52.2% to 79.5%). Two accessions with zero eugenol contained 86.8% and 91.9% of benzyl benzoate (BB), in contrast to that of 0%-0.65% from other accessions. One accession produced 16.6% eugenol and 22.3% BB. A green flush colour associated with a higher BB percentage suggested a potential morphological marker for BB. The PCA for 20 accessions explained 88.11% of total variance. The cinnamon accessions with high BB, KA11 and GB17, were clustered together, and HB12 was isolated on a different cluster. Positive correlations were detected between linalool and β-caryophyllene (0.649), linalool and BB (0.770) (p < 0.01), and negative correlations between eugenol and linalool (-0.630) and eugenol and BB (-0.886) (p <0.01).
The culture of laziness
Authors: Abeysekera Ajit
Published: April 2024

The development of science and technology has enabled humans to carry out more or less effortlessly many activities which previously would have entailed much physical effort and expenditure of time. While this development enables people to enjoy more time for leisure, it has also encouraged a culture of physical laziness.
The same trend appears in the intellectual field as well. Modern computers can in a few moments, carry out tasks which would have entailed an enormous amount of time and mental effort, earlier. Again, this saving of time enables one to focus on the more creative and insightful activities that are specific to human beings.
However, the culture of laziness is widespread. It would appear that there is at the present time, a tendency to even attempt to transfer creative intellectual efforts to machines, through the use of generative AI. The writing up of a good piece of research for publication is one of the creative and enjoyable activities afforded to a scientist. While the use of generative AI to obtain help in deciding the most effective way of “saying what one has to say” can be considered acceptable in situations where the writer’s language skills are not well developed, to attempt to use generative AI to decide on the content of the paper, “what to say”, is to attribute to generative AI an ability it does not have.
Recently, scientists and sociologists have written about the deficiencies and dangers of this approach to creating knowledge and understanding. To be meaningful, any generative AI output needs to be moderated and evaluated by human intelligence.
A new possible breeding site of Alosa fallax (Lacépède 1803) (Actinopterygii: Clupeiformes: Alosidae) on the Tyrrhenian coast of Central Italy
Authors: Ferri Vincenzo , Crescia Paolo , Soccini Christiana , Celletti Stefano
Published: April 2024

The River Mignone (Tarquinia, Viterbo, central Italy) is one of the best preserved watercourses in Lazio. Here, in April and May of the years 2020-2023, a conspicuous contingent of Alosa fallax (Lacépède 1803) was reported. The frenetic behaviour of the individuals observed, some of which showed swollen bellies and considerable size, suggested that this watercourse may represent a potential new breeding station for this threatened migratory euryhaline fish species. The correct recognition of the sex of A. fallax in the field, problematic during the breeding season, is crucial for understanding its population structure as indicators of possible reproduction. To this end, statistical analysis (Mann-Whitney U-test) of 20 morphometric measurements made on individuals captured and subsequently released revealed significant differences between the sexes for seven morphometric characters, confirming a sex ratio compatible with reproduction. However, the presence of a transverse dam with no fish ladder and the dispersion of biocides from farmland in the final stretch may represent a serious threat to effective reproduction.
Commento a ‘Per una psicoterapia d’ispirazione sociale’
Authors: Mistrali Maurizio
Published: April 2024

La lettura di questo articolo è stata avvincente e complessa, ha mosso in me valutazioni contrastanti. Avvincente perché tratta di temi ormai rilevanti e sui cui tutti dovremmo prendere un momento di riflessione, complessa in quanto ricca di una densità contenutistica frutto dell’ampiezza delle visioni, delle indagini accurate in un panorama molto ampio. [...]
Diagnostic Diversities of Pus-like Aspirates Encountered during Fine-needle Aspiration Cytology: An Observational Study in a Tertiary Medical Center in Eastern India
Authors: Adhikari Anindya , Sardar Ashis , Das Tripti , Dey Goutam , Bhunia Prantick Kumar , Chakraborty Debasish
Published: April 2024

Background:

Pus-like aspirates (PLAs) are not uncommon in day-to-day cytology practice. An apparently looking simple pus may yield a diagnostic diversity ranging from simple suppurative inflammation to a carcinomatous lesion. Proper processing followed by patient examination may be lifesaving for a patient. Very few cytological studies on PLAs have been conducted in Eastern India.

Materials and Methods:

One hundred and four PLAs from 104 patients (53 males, 51 females) received during 6 months (January 2022–June 2022) were included in this study.

Results:

The adult age group (19–60 years) and involvement of the head-and-neck area were most common in this study. The sex ratio (male: female) was almost equal. Simple pyogenic abscess is the most common diagnosis, followed by granulomatous and tuberculous abscess. Some special diagnoses were revealed, such as fungal infection, lymphoma, and carcinoma.

Conclusion:

This study emphasizes the importance of careful examination of PLAs as it may unmask some special diagnoses, even malignancy too. As a simple and quick outdoor-based study, prompt diagnosis and timely intervention may be lifesaving for some patients.
Ropivacaine with Fentanyl versus Bupivacaine with Fentanyl for Caudal Epidural in Pediatric Infraumbilical Surgeries – A Prospective Randomized Double-blinded Trial
Authors: Divya S , Govindan Dilip Kumar , Priyadharsini K. Soundarya , Prasad T. Krishna
Published: April 2024

Background:

Caudal epidural block is widely used in the pediatric age group. This study aims to determine that ropivacaine with fentanyl provides a shorter duration of motor blockade than the comparable sensory blockade, which can be used as an effective alternative to bupivacaine in caudal epidural anesthesia.

Objective:

The objective of this study was to assess the efficacy of ropivacaine versus bupivacaine when combined with fentanyl in single-shot caudal epidural anesthesia in pediatric infraumbilical surgeries in terms of time taken for motor regression.

Subjects and Methods:

This was a prospective randomized double blinded study done among the pediatric population of 1-12years, undergoing infraumbilical surgeries under general anaesthesia. Efficacy of caudal epidural anaesthesia assessed with fentanyl+bupivacaine 30 patients (50%) and fentanyl+ ropivocaine 30 patients (50%). Group 1 received 0.25% of 0.7 mL/kg bupivacaine + 1 mg/kg of fentanyl with normal saline in a caudal epidural. Group 2 received 0.25% of 0.7 mL/kg ropivacaine + 1 mg/kg of fentanyl with normal saline in a caudal epidural. The demographic details and anthropometry were compared. The hemodynamic parameters were compared both intraoperatively and postoperatively. Bromage scale and Face, Legs, Activity, Cry, and Consolability pain score were compared postoperatively between both the groups.

Results:

The hemodynamic parameters, sedation, and pain were not statistically different between the groups. Among the bupivacaine group, there was a statistically significant, higher Bromage scale (P = 0.001), decreased time to rescue analgesia (P = 0.001), and higher duration of motor blockade (P = 0.001).

Conclusion:

We conclude that ropivacaine (0.25%) with fentanyl provides less intense motor nerve blockade with a shorter duration of analgesia, hence facilitating early ambulation.
Factors Influencing Utilization of Health and Wellness Centers (HWCs) in Odisha: A Mixed Method Study from Beneficiaries’ Perspective
Authors: Dandsena Amitosh , Panda Paramjot , Rath Jyotirmayee , Panigrahi Akash Kumar
Published: April 2024

Background:

According to the National Family Health Survey-5 report, Odisha’s population with hypertension has a 5% noncommunicable disease (NCD) burden, and only 40% of people in Odisha use primary health-care facilities to treat their NCDs, despite the Government of India having developed these facilities through the health and wellness centre (HWC) initiative.

Aim and Objective:

The aim of the study is to evaluate the utilization of Health and Wellness Centers (HWCs) in Odisha from the perspective of beneficiaries, and to identify factors influencing their low utilization, using a mixed-method approach.

Materials and Methods:

The study utilized a mixed-method approach, with a sample size of 400 participants. Quantitative data were collected through structured interviews, analysed using frequency and percentage calculations, and assessed for associations using logistic regression. Qualitative data were obtained via in-depth interviews, and thematic analysis was applied to identify major themes and subthemes related to HWC utilization and beneficiaries’ perceptions. Ethical clearance and informed consent were obtained before data collection.

Results:

In this study with 400 participants, only 31% utilized Health and Wellness Centers (HWCs) in Odisha. Factors associated with utilization included no formal education, proximity to HWCs within 2 km, low household income, experiencing general illness, and availing allopathic treatment which is statically significant with p<0.05. In-depth interviews revealed positive influences for utilization, such as nearby distance to HWCs, free testing and medicine, and positive expectations from government hospitals. Barriers to utilization included negative experiences, transportation challenges, lack of awareness, and poor beliefs or perceptions about HWCs.

Conclusion:

The study on Health and Wellness Centre (HWC) utilization in Odisha conclude that only 31% of beneficiaries access these facilities. Education, distance, and household income influence utilization. Proximity, free services, and awareness campaigns can improve utilization and foster preventive healthcare. The study recommends the policy makers to take action to bridge gaps and unleash the true potential of HWCs, creating a healthier future for Odisha.
Etiological Profile of Dyspepsia in Difficult-to-reach Tribal Population of Himachal Pradesh
Authors: Sharma Brij , Norbu Tenzin , Sharma Rajesh , Bodh Vishal , Chauhan Ashish , Bhateja Anshul , Sharma Dikshant
Published: April 2024

Background:

Dyspepsia exhibits a diverse range of underlying causes, with functional dyspepsia (FD) surpassing organic etiologies in prevalence. However, there exists a noticeable absence of prior research delineating the etiological spectrum of dyspepsia among the tribal regions of Himachal Pradesh (HP). The present study was carried out to determine the etiological profile of dyspepsia within this specific population.

Materials and Methods:

Conducted as a cross-sectional observational study centered around an endoscopy health camp, this investigation took place at the community health center in Kaza – a pivotal administrative hub in the remote Spiti Valley of the Lahaul and Spiti tribal district in HP. The study encompassed consecutive patients above 18 years of age presenting with gastrointestinal complaints. Those predominantly reporting dyspepsia were selected and subsequently underwent thorough endoscopic examination. Data analysis incorporated factors such as age, gender, history of smoking, alcohol consumption, nonsteroidal anti-inflammatory drug usage, and endoscopic findings.

Results:

Encompassing a total of 187 patients with an average age of 48.5 ± 13.4, the study found that endoscopy yielded normal results in 59.9% of cases (categorized as FD), whereas 40.1% displayed abnormal findings (categorized as organic dyspepsia). Among the latter, the most prevalent organic lesions were peptic ulcer disease (PUD) (62.7%) and erosive esophagitis (22.7%). Furthermore, gastric malignancy was detected in 4% of the cases.

Conclusion:

The primary organic causes of dyspepsia within the tribal areas of HP appear to be dominated by PUDs, closely followed by erosive esophagitis. Gastric malignancy, although less frequent, was identified in approximately 4% of the dyspeptic cases studied.
A Case–control Study on Risk Factors for Development of Tuberculous Meningitis in Adults
Authors: Kharkongor Meban Aibor , Muliyil Jaya Prakash , Thangakunam Balamugesh , Christopher Devasahayam Jesudas , Lakshmanan Jeyaseelan , Chandiraseharan Vignesh Kumar , Prabhakar Appaswamy Thirumal , Aaron Sanjith , Hansdak Samuel George , Manesh Abi , Jaganautti Manjeera , Zachariah Anand , Sudarsanam Thambu David
Published: April 2024

Introduction:

Tuberculous meningitis remains the most severe and devastating form of tuberculosis with relatively severe morbidity and mortality. Risk factors for TB meningitis have not focused on the role of the BCG vaccine or social and food insecurity which are known to have a role in pulmonary TB.

Methods:

We prospectively conducted a Case-Control study among 65 patients with TB meningitis and 41 controls with other forms of meningitis. We evaluated the role of the BCG vaccine, the Household Food Insecurity Access Scale (HFIAS) and the Social Readjustment Rating Scale (SRRS) to look for food and social stress respectively. We also evaluated the known risk factors for TB meningitis including age, HIV co-infection, alcoholism, malignancies, use of immunosuppression, head injury among others. A bivariate followed by multivariate regression analysis was performed.

Results:

The presence of BCG scar was seen in 64.6 percent of patients with Tuberculous meningitis and 61.0 percent of control (P= 0.71). There was no difference in the size of the scars (P= 0.45) . Household food insecurity using the Household Food Insecurity Access Scale (HFIAS) ( a positive answer in any of the 9 items) was present in 16.9% of the patients in the TBM group and in 14.6% of the patients in the control group. (P= 0.75). Social stress assessed using the Social Readjustment Rating Score (< 150 suggest no social stress, 150 – 300 moderate social stress,> 300 high social stress) showed that a majority of the patients in both the groups reports no social stress. Only 9.8% of patients in the TBM group and 18.5% in the control group reports moderate presence of social stress whereas none of the patients had severe social stress. Logistic regression analysis suggested that only higher BMI was associated with lesser incidence of Tuberculous meningitis, odds ratio 0.83 (95% confidence interval of 0.73 – 0.930) and individuals performing clerical and unskilled and under-skilled jobs- odds ratio 0.13 (95% confidence interval of 0.02 – 0.93) had lower risk for TB Meningitis.

Conclusions:

In our sample of TB meningitis patients the BCG vaccine, food insecurity nor social stress appear to be risk factors. Bigger BMI and certain occupations appear to be possibly protective.
Nurse’s Attitude and Acceptance of Coronavirus Disease 2019 Vaccination in Maitma District Hospital, Abuja, Nigeria
Authors: Olorunfemi Olaolorunpo , Uwabunkeonye Francisca Ogochukwu , Adebiyi Joseph Adekunle , Akindipe Adewole Peter , Abiodun Oluwaseun Oluwafunmilayo
Published: April 2024

Background:

The development of coronavirus disease 2019 (COVID-19) vaccines is a major challenge; and after clinical development, another critical problem is the acceptance of the vaccine among health workers, particularly nurses, who are expected to persuade other members of the community to be vaccinated against the virus. As a result, if success is to be recorded, it is necessary to examine nurse’s attitudes and acceptability level for proper policy in Nigeria’s health sector.

Aim:

The aim of study was to determine the attitude and acceptance of COVID-19 vaccination among nurses.

Methodology:

A cross-sectional design was used, and data were collected using a validated self-structured questionnaire. The IBM SPSS Statistics 23 software was used to analyze the data, and the results were presented using frequency tables, percentages, means, standard deviations, and Chi-square analysis.

Results:

According to the findings of this study, most of the respondents feel that COVID-19 vaccination is good for them (3.2 ± 4.0), but this does not translate to acceptance due to concerns about side effects, which results in a lack of trust in the vaccine’ safety, with a mean of 3.4 ± 4.3. Furthermore, the findings revealed a mean acceptance score of 2.96 ± 2.6, indicating that just above average number of the participants welcomed COVID-19 vaccination.

Conclusion:

This study concluded that the respondents had a positive attitude toward COVID-19 vaccination and acceptance is relatively low and this was as a result of their concerns over vaccine safety and side effects. Sociodemographic variables such as religion, level of education, and ethnic group were also implicated. Therefore, to increase nurses’ acceptability, we advocate a constant and devoted effort to improve political commitment, increase awareness, and disseminate information regarding the safety, side effects, and effectiveness of the COVID-19 vaccination.
The economic burden of esophageal cancer in Iran
Authors: Daroudi Rajabali , Nahvijou Azin , Arab Mohammad , Faramarzi Ahmad , Kalaghchi Bita , Sari Ali Akbari
Published: April 2024

Background:

Studies on economic burden demonstrate the impacts of some diseases and provide invaluable information for specifying priorities and resource needs when designing cancer control strategies. The current study aimed to estimate the cost of esophageal carcinoma (EC) in Iran in 2018.

Methods:

This study was conducted on the prevalence approach to estimate the economic burden of EC in Iran from a social perspective. The direct cost was estimated by summing the diagnosis, treatment, follow-up, terminal care, and transport costs. Additionally, a human capital approach was adopted to estimate productivity losses. Various resources were used for data collection, including the GLOBOCAN 2018 report, and the medical record in the Cancer Institute of Iran. Also, data such as exchange rates, employment, and housekeeping rates were extracted from the Central Bank of Iran Statistics.

Results:

The economic burden of EC in Iran was $69.2 million in 2018, of which $38.7 million is caused by indirect costs and $30.5 million by direct costs. The mortality cost accounted for 49% of the economic burden, followed by 34% direct medical cost, 10% direct non-medical cost, and 7% morbidity cost.

Conclusions:

Mortality and medical cost appeared to be the main contributor to the economic burden. Therefore, policy-makers are recommended to adopt early detection and effective treatment as a highly cost-effective strategy for controlling costs.
Medulloblastoma outcomes in tertiary care set-up in India using contemporary treatment protocols - A retrospective study
Authors: Hazarika Nandini , Tiwari Priya , Munshi Anusheel , Patir Rana , Vaishya Sandeep , Ahlawat Sunita , Chaudhoory Amal Roy , Goel Vineeta
Published: April 2024

Background:

Medulloblastoma is the commonest embryonal brain tumor in children. It has shown improved outcomes with combined modality treatment. We aimed to study patient characteristics and survival outcomes of patients with this disease across two tertiary care centers in India.

Methods:

We analyzed data of patients with histological diagnosis of medulloblastoma treated from January 2010 to January 2016. Patient characteristics and follow-up data were retrieved from hospital records. Descriptive statistics were used to describe clinical and pathological characteristics. Overall survival (OS) was calculated from date of diagnosis to death due to any cause. Relapse-free survival (RFS) was calculated from date of diagnosis to occurrence of relapse or death.

Result:

Out of 26 patients treated, 24 were children and 2 were adults. Median age was 10 years (range = 0.8–22 years). Twenty (76.9%) patients were male. Fifteen (57.7%) patients were stratified as high-risk (HR), rest 11 (42.3%) were categorized as average risk (AR). Histopathology showed classical variety in majority of patients except for 4 (15%) cases, 3 with desmoplastic and 1 with anaplastic subtype. Median follow-up was 49.7 months (range= 4.2–102.5 months). Overall, eight (30.8%) patients relapsed and six (23%) deaths occurred. Five (33.3%) patients in HR category and 3 (27.3%) patients in AR group showed relapse. Median RFS and OS were not yet reached. Five-year RFS was 69.2% whereas five-year OS was 76.9%.

Conclusion:

This study highlighted patient characteristics and treatment outcomes in Indian patients. With adherence to standard treatment, high remission rates and improvement in mortality rates were achieved.
Leptomeningeal carcinomatosis presenting with acute motor axonal neuropathy
Authors: Koc Ismail , Temel Musa , Kokoglu Serap , Boyraz Ozgur , Karadas Omer , Odabasi Zeki
Published: April 2024

Leptomeningeal carcinomatosis is a rare, devastating, and mostly late-stage complication of various solid tumors and hematologic malignancies. The diagnosis can be challenging especially if malignancy is not in active phase or treatment was discontinued. A literature search revealed various unusual presentations of leptomeningeal carcinomatosis including cauda equina syndrome, radiculopathies, acute inflammatory demyelinating polyradiculoneuropathy, and others. To the best of our knowledge, this is the first case of leptomeningeal carcinomatosis presenting with acute motor axonal neuropathy variant of Guillain-Barré Syndrome and unusual cerebrospinal fluid findings known as Froin’s syndrome.
Looking beyond the obvious
Authors: Verma Ridhi , Shivadeva Manu , Bhupal Divya Priya , Veluswamy Sundar Kumar
Published: April 2024

Pain is considered as one of the most debilitating symptoms of cancer and its treatment. Owing to the limited efficacy of traditional pharmacological interventions to address cancer pain in its entirety, an avenue exists for exploration into nonpharmacological therapies. Analgesia using non-invasive electrotherapeutic modalities such as transcutaneous electrical nerve stimulation (TENS) and scrambler therapy emerges as a viable option to address cancer pain. The inability of these modalities to find a place within the recommended clinical guidelines has possibly resulted in the paucity of application of the same within the clinical setup. This perspective article aims at stimulating a discussion surrounding the inclusion of non-invasive neuromodulatory treatment techniques such as TENS and scrambler therapy to combat cancer pain and explore the benefits and pitfalls of using these techniques as an adjunct to the pre-existing treatment strategies. It is envisioned that this opinion piece will open a dialogue about a possible home for non-invasive electroanalgesia within the clinical treatment pathway for cancer pain.
Bleeding per rectum during induction chemotherapy
Authors: Bhattacharjee Sukrita , Ghosh Shouriyo , Bhattacharyya Maitreyee
Published: April 2024

Synchronous malignancies involving acute leukemia and a solid organ are rare. Bleeding per rectum is a common manifestation of acute leukemia during induction chemotherapy and might mask the presence of synchronous colorectal adenocarcinoma (CRC). Here we present two rare cases of acute leukemia with synchronous CRC. We also review previously reported synchronous malignancies to investigate demographics, diagnosis, and treatment modalities. Management of these cases requires a multispecialty approach.
Expression of mismatch repair proteins in urothelial carcinoma of the urinary bladder
Authors: Mohamedali Rasheeda , Adhya Amit K , Mandal Swarnendu , Mitra Suvradeep
Published: April 2024

Background:

Urothelial carcinoma of the urinary bladder (UCUB) is a frequently diagnosed malignancy. Mismatch repair (MMR), a proofreading machinery of the DNA, prevents tumorigenesis. The role of MMR deficiency in UCUB in eastern Indian population is not known.

Methods:

Immunohistochemistry panel for MLH1, PMS2, MSH2, and MSH6 (MMR proteins) was performed on the biopsy specimens of UCUB (N=100).

Results:

MMR deficiency by immunohistochemistry was demonstrated in two cases (2%). One case showed deficiency of MSH2 and MSH6 and the other case showed the deficiency of all four mismatch proteins. Both cases showed high-grade invasive urothelial carcinoma by histomorphology.

Conclusion:

The prevalence of MMR deficiency by immunohistochemistry is 2% in eastern Indian population.
What is the best method for long-term survival analysis?
Authors: Bekiroglu G Nural , Avci Esin , Ozgur Emrah G
Published: April 2024

In the Cox proportional hazards regression model, which is the most commonly used model in survival analysis, the effects of independent variables on survival may not be constant over time and proportionality cannot be achieved, especially when long-term follow-up is required. When this occurs, it would be better to use alternative methods that are more powerful for the evaluation of various effective independent variables, such as milestone survival analysis, restricted mean survival time analysis (RMST), area under the survival curve (AUSC) method, parametric accelerated failure time (AFT), machine learning, nomograms, and offset variable in logistic regression. The aim was to discuss the pros and cons of these methods, especially with respect to long-term follow-up survival studies.
Therapeutic approaches for relapsed/refractory adult acute lymphoblastic leukemia (ALL), a review on monoclonal antibodies and targeted therapies
Authors: Hosseini Maryam S , Jafari Leila , Yami Amir , Gharehbaghian Ahmad
Published: April 2024

Acute lymphoblastic leukemia (ALL) is the malignant transformation of lymphoid progenitors that affects both children and adults. Although the outcome of pediatric patients has been improved dramatically, there are still many challenges in the treatment of adults. Patients with primary resistant or relapsed disease have the worst outcome and despite the administration of intensified multi-agents chemotherapies, the outcome of this group remains very poor. Accordingly, the development of novel therapeutic options is considered necessary. Having a comprehensive insight into the pathophysiology of ALL and aberrant signaling pathways is crucial for introducing effective targeted therapies. Combination therapies with new drugs and innovative targeted therapies with the aim of affecting the main aberrant signaling pathways in the disease are considered as new approaches. Here we tried to have a comprehensive review on the potential molecular targets in the treatment of refractory/relapsed ALL and the current therapeutic agents.
Langerhans cell sarcoma with BRAF-V600E mutation and hemophagocytosis
Authors: Madakshira Manoj G. , Sharma Navneet , Malhotra Pankaj , Bal Amanjit
Published: April 2024

Langerhans cell sarcoma (LCS) is a rare high-grade neoplasm of langerhans cell phenotype having unambiguous malignant cytological features. We report such a rare case in a 20-year-old man who presented with dyspnea and high-grade fever. On evaluation, he had generalized lymphadenopathy, hepatosplenomegaly, and a large anterior mediastinal mass. Fine needle aspiration from the mediastinal mass and bone marrow aspirate showed numerous atypical cells, many of which showed grooved nuclei. In addition, the bone marrow showed prominent hemophagocytosis. The patient had a stormy hospital stay and succumbed to the illness. The autopsy revealed a rare multisystem involvement by LCS involving the lymph nodes, liver, spleen, lungs, and intestine, which harbored a BRAFV600E mutation and was associated with hemophagocytosis.
A clinical study of serum human epididymis protein 4 (HE4) in the diagnosis of pancreatic cancer
Authors: Liu Weiqi , Liu Weiling , Lin Keng , Liu Yuhua , Hu He , Yang Lina
Published: April 2024

Background:

Pancreatic cancer (PC) has poor early diagnosis rates due to its insidious onset. Since human epididymis protein 4 (HE4) is highly expressed in patients with PC, we assessed whether serum HE4 could be a marker for the detection 3 of PC.

Method:

Between May 2017 and October 2018, 127 patients with PC were recruited for the study along with 108 healthy controls who underwent health examinations. Serum HE4 concentrations were determined together with levels of carcinoembryonic antigen (CEA) and carbohydrate antigens (CA) 242 (CA242), CA19-9, CA15-3, and CA72-4 by electrochemiluminescence immunoassay (ECLIA) or chemiluminescence immunoassay (CLIA). Correlations between these biomarkers were assessed.

Results:

Serum levels of all six biomarkers were higher in patients with PC than in controls (P < 0.05). No correlation was observed between the serum levels of HE4 and the five other tumor markers, although there were strongly significant positive correlations between CA19-9 and CA15-3, and between CA242 and CA72-4. The lack of correlation indicates that HE4 has independent value in the diagnosis of PC. The combined assessment of serum HE4 levels and the other tumor markers improved the sensitivity of diagnosis. In particular, HE4 combined with CA19-9 performed significantly better than HE4 alone, or CA19-9 combined with the other markers. The HE4/CA19-9 combination resulted in 94.49% sensitivity and 99.07% specificity (95% confidence interval: 96.9–100).

Conclusion:

HE4 is a biomarker associated with PC with a high specificity, either used alone, or evaluated with other biomarkers together improving the detection of PC. This study may provide a new clinical diagnostic approach for PC detection.
Stage migration and treatment outcome in carcinoma tongue – A comparison of seventh and eighth AJCC pathological staging systems
Authors: George Rebecca , Prakasan Aparna , Anila KR , Krishna KM Jagathnath , Iype Elizabeth Mathew , Jayasree K , Ramadas Kunnambath
Published: April 2024

Background:

The eighth edition of the American Joint Committee on Cancer (AJCC) for oral cancer has incorporated additional pathological features like depth of invasion (DOI) and extranodal extension (ENE) into T and N staging. The incorporation of these two factors will impact the staging and, hence, the treatment decisions. The aim of the study was to clinically validate the new staging system in predicting the outcome in patients treated for carcinoma oral tongue. The study also examined the correlation of pathological risk factors with survival.

Methods:

We studied 70 patients with squamous cell carcinoma of the oral tongue who underwent primary surgical treatment at a tertiary care center in the year 2012. All these patients were restaged pathologically according to the new AJCC eighth staging system. The 5-year overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan–Meier method. Akaike information criterion and concordance index were calculated between both staging systems to identify a better predictive model. Log-rank test and univariate Cox regression analysis were conducted to find out the significance of different pathological factors on outcome.

Results:

Incorporation of DOI and ENE resulted in 47.2% and 12.8% stage migration, respectively. DOI less than 5 mm was associated with a 5-year OS and DFS of 100% and 92.9%, respectively, compared to 88.7% and 85.1%, respectively, when the DOI was more than 5 mm. Presence of lymph node involvement, ENE, and perineural invasion (PNI) were associated with inferior survival. The eighth edition had lower Akaike information criterion and improved concordance index values compared with the seventh edition.

Conclusion:

The eighth edition of AJCC allows better risk stratification. Restaging of cases based on the eighth edition AJCC staging manual resulted in significant upstaging with difference in survival.
Incidence of cancers of unknown primary origin in India and their trends during 1986–2014
Authors: Labani Satyanarayana , Asthana Smita , Vohra Parul , Kailash Uma , Srivastava Abhinav
Published: April 2024

Background:

Cancer of unknown primary (CUP) origin is cancer in which malignant cancer cells are in the body but the site of cancer where it began is unknown. Detailed incidence and time trends of these cancers, specific to various regions in India is needed. This paper aims to summarize and report the incidence of other and unknown (O&U) cancers across India in 27 population-based cancer registries (PBCRs) and to study the trends among these cancers using joinpoint regression analysis.

Methods:

Data on the incidence of CUP were obtained from the published reports on 27 PBCRs of the National Cancer Registry Programme (NCRP) of the Indian Council of Medical Research (ICMR). A joinpoint regression model was used to analyze the long-term trends of incidence related to CUP based on published data from PBCRs between 1986 and 2014. Annual Percent Change (APC) in incidence rate was estimated for various registries.

Results:

The northeast region had the highest age-adjusted rate (AAR) for both men (1.76–29.7) and women (1.99–14.68). Age-specific rate (ASR) for both men (39.8–855.7) and women (48.2–470.4) was highest in the northeast region. There is an increase in the incidence rate for all six major registries over the past decade with an exception of women in the Delhi Cancer Registry. There is a decline in incidence rate by 0.14 during 1990–2012 in the female population of the Delhi registry.

Conclusion:

The increasing incidence trends of CUP is a matter of concern for the healthcare professionals and researchers. There is a need for research and advanced and improved diagnostic tools for the improvement of the status of O&U cancers.
Does perceived social support, psychological problems, and fatigue impact quality of life of geriatric patients with cancer?
Authors: Rajagopal Revathi , Ganesan Prasanth , Veeraiah Surendran
Published: April 2024

Background:

Health-related comorbidities often increase due to cancer among the ageing population. However, thed omains of psychological functioning of geriatric patients remain undetected especially in the Indian scenario. This study aimed to evaluate psychological problems, perceived social support, fatigue, and quality of life among geriatric patients with cancer.

Methods:

A cross sectional study was conducted in a tertiary cancer center. Geriatric patients with cancer (n = 130) having solid malignancies categorized as older patients (>65 years) and younger geriatric patients (60–65 years) were included in the study. Depression, anxiety, perceived social support, fatigue, and quality of life was assessed using the Geriatric Depression Screening Scale, Geriatric Anxiety Scale, Multidimensional Scale of Perceived Social Support, Symbolic Assessment of Fatigue Extent, and the Old People Quality of life Scale, respectively. Descriptive and inferential statistics such as cross tab analysis, correlation and regression analysis.

Results:

A majority of patients 80 (61.5%) had low perceived social support, moderate-severe depression 61 (47.7%) and mild-moderate anxiety 55 (43.1%). Half of the patients were found to have poor quality of life. Further, psychological problems were higher among older geriatric patients (p = 0.000). Very few patients had a higher impact of fatigue on their daily functioning 17 (13.3%). There was a positive correlation between perceived social support, depression, anxiety, extent of fatigue, and quality of life (r = 0.256, P = 0.003).

Conclusion:

Psychological problems are higher among older geriatric patients with cancer undergoing treatment. Clinical implications could aim at regular screening to identify specific psychological issues and provide appropriate interventions. Future research warrants the efficacy of such therapeutic interventions for better quality of life outcomes.
Relapse of pemphigus foliaceus initiating at the site of irradiation in an elderly male with laryngeal carcinoma
Authors: Chhabra Namrata , Raut Saurabh , Ganguly Satyaki , Hussain Nighat
Published: April 2024

Radiotherapy-induced or -aggravated pemphigus is not a common occurrence with only a few cases reported so far. The radiation disrupts the local immune regulation and alters the antigenicity of keratinocytes, but the exact etiology is not clear. We report a case of an elderly man operated for laryngeal carcinoma who presented with recurrence of pemphigus foliaceus lesions starting at the irradiation site. The appearance of vesiculobullous lesions at the site of irradiation should be evaluated thoroughly to rule out immunobullous diseases.
Dosimetric evaluation of the effect of dental restorative materials in head and neck radiotherapy
Authors: Oktay Elif A , Zerener Tamer , Dırıcan Bahar , Yıldız Selda , Sager Omer , Karaoglanoglu Serpil , Beyzadeoglu Murat
Published: April 2024

Background:

The aim of our study is to assess the dose enhancement from scattered radiation due to dental restorative materials used for occlusal and mesio-occlusal-distal (MOD) cavity filling during simulated head and neck radiotherapy.

Methods:

We have studied the dose enhancement ratio (DER) of conventional amalgam, high-copper amalgam, and resin composite dental restorative materials at cadaver mandible teeth using 2 therapeutic photon energies of 1.25 MeV (Co-60 gamma ray) and 6 MV (Linac X-ray) for irradiation.

Results:

DER values at buccal position for Co-60 and 6 MV X-ray were 1.250 ± 0.013 and 1.151 ± 0.012, respectively. For dental cavity fillings, DER values for 6 MV X-ray were 1.065 ± 0.021, 1.100 ± 0.014, and 1.162 ± 0.016 for resin composite filling, low-copper amalgam filling, and high-copper amalgam filling, respectively. Our results revealed that DER regarding irradiation energy was minimum for 6 MV X-rays. With respect to dental restorative filling material, DER was minimum for resin composite filling. Regarding the cavity type, our results with standard deviation (SD) calculations revealed that DER was slightly but not significantly different for both Co-60 gamma ray (1.25 MeV) and 6 MV X-ray energies for both occlusal and MOD cavities.

Conclusion:

Our dosimetric results for a single beam geometry suggest that, among the three types of filling, resin composite filling is an ideal restorative filling material with minimal morbidity-inducing radiation dose enhancement that may result in increased osteoradionecrosis and secondary caries risk. There is a need for further dosimetric studies with actual clinical beam arrangements.
Radiation-induced hypothyroidism in patients of oral squamous cell carcinoma
Authors: Jain Prateek V , Das Avipsa , Manikantan Kapila , Sharan Rajeev , Mallick Indranil , Chatterjee Sanjoy , Arun Pattatheyil
Published: April 2024

Background:

Radiation-induced hypothyroidism (RIH) is common after neck irradiation, and biochemical evaluation of thyroid function is recommended periodically for early diagnosis and treatment. This study aimed to evaluate the predictors of RIH after completion of adjuvant radiotherapy (RT) for primary oral squamous cell carcinoma (OSCC).

Methods:

This is a retrospective study involving 195 patients who received RT after surgery for OSCC between August 2011 and December 2016. Thyroid function tests were obtained every 6 months and patients were considered to be hypothyroid if thyroid-stimulating hormone level was >5 mIU/mL.

Results:

The study cohort comprised 130 men with a median age of 52 years (range 21–77 years). About 107 (54.87%) patients developed hypothyroidism, with a median of 21 months (range 2–67 months) for the development of RIH. Women [41 (63.1%) versus 66 (50.8%), p=0.035], addition of chemotherapy [36 (63.2%) versus 71 (51.4%), p= 0.019], and higher cumulative dose to the thyroid gland (median dose 4690 cGy versus 2981 cGy, P < 0.001) resulted in higher incidence of RIH on univariate analysis. On multivariate Cox regression analysis, female sex (P = 0.042), bilateral irradiation (P = 0.046), and cumulative dose to the thyroid (P = 0.001) were factors associated with increased risk of developing RIH.

Conclusion:

The addition of chemotherapy, high dose of radiation to the thyroid gland, bilateral irradiation, and female sex were at higher risk of developing RIH. However, more studies are required to identify the dose-volume constraints of the thyroid gland.