bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevention of Destructive Fishing Practices: Prospects and Challenges in Law Reform
Authors: De Silva A. G. S. D. , Samarasekara M. A. , Thusyanthini R. , De Silva A. K. D. D.
Published: September 2023

Destructive fishing practices have been identified as a common problem in the Northern Province, Sri Lanka. The major causes for destructive fishing in Northern region are increasing the demand for fish consumption, lack of alternative jobs for early dropout schoolchildren, increased gear efficiency, policy failure of existing laws, and poaching by Indian and Southern migratory fishers. The dynamiting, bottom trawling, monofilament net, stake net, brush pile fisheries, purse seines and scuba diving have been identified as the most common destructive fishing practices in the Northern region. Consequences of destructive fishing practices include unintentional killing of target and non-target fish and other marine organisms, hampering local fishing activities such as operations of gill nets and fiber plastic boats and threatening environmentally sensitive marine ecosystems in Sri Lanka. The entire fishing sector in Sri Lanka is regulated by mainly the Fisheries and Aquatic Resources Act No. 2 of 1996 and the Fisheries Act No. 59 of 1979 enacted by the Department of Fisheries and Aquatic Resources (DFAR). The Fisheries Act No. 59 of 1979 prohibits fishing by foreign boats in Sri Lankan waters with provisions to impose penalties for any violations. However, major loopholes which are not included in the act comprise of type of fishing gear, methods and harmful material that are prohibited and specific penalty system for usage of banned fishing gear, materials and methods. At the international level, Sri Lanka has ratified the United Nations Convention on the Law of the Sea (UNCLOS) established to outline a legal framework for all marine and maritime activities. Furthermore, the major international instruments ratified by Sri Lanka are “The International Union for Conservation of Nature (IUCN), The Conservation of Biological Diversity (CBD), and The Conservation on International Trade in Endangered species (CITES). However, these legal instruments have not been regulated in the Sri Lankan fishing sector. Therefore, it is necessary to revise the existing laws with proper law enforcement while considering geographical regions, type and abundance of marine resources, oceanography, ecology, social aspects and regular monitoring system of fishing practices to maintain the sustainability of marine resources.
Comments on: Effect of physical activity on long COVID fatigue
Authors: Coscia Francesco , Di Filippo Ester Sara , Gigliotti Paola Virginia , Fanò-Illic Giorgio
Published: September 2023

The authors of the Comments on: Effect of physical activity on long COVID fatigue by Daungsupawong F. and Wiwanitkit V. (2023) have highlighted certain aspects of future research that need to be considered before any conclusions can be drawn regarding the effect of previous physical activity and/or fitness on the course of long-COVID. We can only agree with this need, although we hope that the effects of SARS-CoV-2 infection will become less and less burdensome to manage. As we hypothesise in the last part of the article by Coscia et al. (2023), we think it is crucial to identify the molecular mechanism underlying the atrophic effect (if any) of the described disease states, which could originate from a local inflammatory storm induced by Spike binding to the ACE-2 receptor in muscle. When studies on muscle from patients will be available in sufficient numbers, we will be able to try to answer the still open questions.
Lake Maggiore: geomorphological genesis, lake-level evolution, and present and future ecosystems importance
Authors: Scapozza Cristian , Patocchi Nicola
Published: September 2023

Lake Maggiore, the second deeper and larger south alpine lake, was selected as a model system to detect the potential damages on water resources, biodiversity and ecosystem health caused by different water levels during the lake-level regulation period (March to November). With a drainage basin exceeding an altitude difference of 4400 m, Lake Maggiore fills a deep valley floor whose bedrock reaches up to 700 m below the present sea level. The cryptodepression occupied by the lake was probably formed during the end of the Miocene and the Pliocene and was shaped successively during the Pleistocene glaciations. Lake Maggiore originated following the Last Glaciation, when it reached its maximum lake-level and extension just after its deglaciation. The mean secular lake-level progressively decreased throughout the Holocene, causing a gradual shrinkage of the lake because of the constant depositional input that created the fluvio-deltaic plains at the mouth of the main tributaries of the lake. The regime of the tributaries is of mixed type, with a spring maximum mainly due to snowmelt and an autumn maximum exclusively of pluvial origin. Water levels naturally tend to reflect the amount of rain or snow precipitation and are expressed through a double cycle: winter and summer characterised by low waters, and spring and autumn by high waters. In 1943, the need to use the waters of the great lakes to have water available in the less favourable periods, led to the construction of a dam at the Lake Maggiore outlet. This structure allows to store water during heavy rainfall or snowmelt periods. The accumulated water is then supplied during the irrigation periods to agriculture (spring and summer) and to industrial users (mainly in autumn and winter). The geomorphological genesis and the ecosystems description was focused on riparian, fluvio-deltaic, and ephemeral systems. For these ecosystems, their evolution considering the hydrological regime of the tributaries, the anthropogenic activities in the watershed and the effects of lake-level management since 1943, was also described. Considering the summer increase, between April and July, to +1.25 m (with possible peaks to +1.50 m) experimentally tested between 2015 and 2020, and the approval of the proposal to continue the test for the next five-year period (2022-2026), we finally emphasise the potential further reduction of reeds and natural habitats and the subsequent loss of biodiversity related to the plan of raise the lake-level to +1.50 m all year round.
An assessment of serum magnesium levels in critically ill patients: A prospective observational study
Authors: Laddhad Deepak S. , Hingane Vinayak , Patil Tushar Ramrao , Laddhad Dhruv Deepak , Laddhad Aishwarya Dhruv , Laddhad Shantanu Deepak
Published: September 2023

Background:

A specific magnesium level is essential to be maintained to ensure appropriate neuromuscular excitability and cardiac function; an increase or decrease in its levels usually leads to critical abnormality. Hypomagnesemia in critically ill patients has many potential ramifications and is found to be an important factor in hindering their recovery. Thus, the study aimed to assess the serum magnesium levels in critically ill participants and explore its effect on their condition.

Methods:

A prospective observational study was conducted for 21 months, from February 2019 to October 2020, among all critically ill participants admitted to the medical intensive care unit (ICU) of a tertiary care hospital. The Acute Physiology and Chronic Health Evaluation II score questionnaire was used to determine the severity of their condition and blood samples were collected within 24 h of their ICU admission for analysis.

Results:

One hundred participants were enrolled, of which 40% were between the age group of 46 and 65 years and 71% were males. Among all participants with hypomagnesemia, 52% were diabetic, 19% had a history of alcohol use disorder, and 27% had normal calcium and potassium levels. Hypomagnesemia significantly correlated with a longer duration of ICU stay among participants.

Conclusion:

A significant correlation was observed between hypomagnesemia and increased ICU length of stay and mortality but not the duration of mechanical ventilation. Monitoring and appropriate supplementation of serum magnesium is recommended to limit further comorbidity and mortality in the critical care setting.
What is the right gentamicin dose for multiple trauma patients? A Monte Carlo simulation exploration study
Authors: Abbasi Mohammad Yaseen , Wiwattanawongsa Kamonthip , Chaijamorn Weerachai , Charoensareerat Taniya , Doungngern Thitima
Published: September 2023

Background:

The appropriate dose of gentamicin is important to prevent and treat infections. The study aimed to determine the optimal dose of gentamicin to achieve the probability of pharmacokinetic/pharmacodynamic (PK) targets for efficacy and safety in multiple trauma patients.

Methods:

PK parameters of gentamicin in multiple trauma patients were gathered to develop a one-compartment PK model for prediction. The Monte Carlo simulation method was performed. The 24-h area under the concentration time curve to the minimum inhibitory concentration ratio (AUC24h/MIC) ≥50 was defined for the infection prevention target. AUC24h/MIC ≥110 or the maximum serum concentration to MIC ratio ≥8–10 was for the treatment of serious Gram-negative infection target. The risk of nephrotoxicity was the minimum serum concentration ≥2 mg/L. The optimal dose of gentamicin was determined when the efficacy target was >90% and the risk of nephrotoxicity was lowest.

Results:

The optimal gentamicin dose to prevent infection when the MIC was <1 mg/L was 6–7 mg/kg/day. A higher dose of gentamicin up to 10 mg/kg/day could not reach the target for treating serious Gram-negative infection when the expected MIC was ≥1 mg/L. The probability of nephrotoxicity was minimal at 0.2–4% with gentamicin doses of 5–10 mg/kg/day for 3 days.

Conclusions:

Once daily gentamicin doses of 6–7 mg/kg are recommended to prevent infections in patients with multiple trauma. Gentamicin monotherapy could not be recommended for serious infections. Further clinical studies are required to confirm our results.
S100B as a predictor of delirium in critically ill obstetric patients: A nested case–control study
Authors: Shyam Radhey , Solanki Monam , Patel Munna Lal , Sachan Rekha , Ali Wahid
Published: September 2023

Background:

Delirium is a neuropsychiatric illness that lasts for a short period of time. The incidence of delirium in the intensive care unit (ICU) varies from 20% to 80%.

Methods:

A nested case–control study was carried out in the obstetric ICU. Individuals were divided into three groups: critically ill obstetric women who had delirium on admission (Group A), women who developed delirium within follow-up of 7 days (Group B), and women who did not develop delirium after follow-up of 7 days (Group C). The APACHE II score was used to assess critical illness severity. The Richmond Agitation-Sedation Scale was used to assess the alertness or sedation level of patients, and the Confusion Assessment Method (ICU scale) was used to assess the presence of delirium. S100B was measured by human S100B calcium-binding protein B ELISA kit (Elabscience Biotechnology, Houston, USA).

Results:

Severe preeclampsia and antepartum eclampsia were significantly associated with delirium. S100B levels in Group B were found to be significantly higher than those in Group C. S100B levels were higher in patients with >2 morbidities in comparison to patients with two morbidities. At a cutoff value of >169.25 pg/ml, S100B had a sensitivity of 74% and a specificity of 87.2% to discriminate cases of delirium from nondelirium.

Conclusion:

The rise in S100B levels was approximately three times greater in those who developed delirium as compared to those who did not. It is a more specific predictor of delirium.
The optimal time for endotracheal intubation in subjects with coronavirus disease 2019 pneumonia: A retrospective observational study
Authors: Nadeem Rashid , Nadeem Nadia , Albwidani Rawan Mohamad , Falih Fatima Hakim , Husain Hatim Riyaz , Krrak Ahmad Zouhir , Mathews Manoj Pazhampallil , Hussein Karim Said Hammouda , Abdulkarim Fatema , Dar Farooq
Published: September 2023

Background:

The optimal timing of intubation has been debated among healthcare professionals, current studies do not show any differences between early and late intubation. most studies failed to show any significant difference in clinical outcomes between early or late intubation.

Methods:

The study was conducted as a retrospective review of subjects with confirmed coronavirus disease 2019 admitted to the Dubai Hospital intensive care unit (ICU). Study variables included time to intubation, duration of supplemental oxygen requirement >15 L/min, and cumulative duration of tachypnea and tachycardia while on the aforementioned oxygen requirement on this oxygen usage level. Each time duration was assessed for correlation with clinical variables including mortality and length of stay in ICU and hospital.

Results:

Subjects who require endotracheal intubation within 4 h after the start of oxygen >15 L/min have lower survival (P = 0.03). Subjects who have tachypnea on the aforementioned oxygen requirement for 6–19.5 h (P = 0.01) before they require intubation have better survival. No duration of tachycardia has any significant effect on survival. Only the duration of invasive mechanical ventilation (MV) correlated with the hospital length of stay.

Conclusions:

Subjects who require endotracheal intubation within 4 h after the start of oxygen >15 L/min have lower survival. The optimal time for intubation is after tachypnea of 6 h but before 19.5 h. No duration of tachycardia has any significant effect on survival. Only the duration of invasive MV correlated with the hospital length of stay.
Relationship between the rate of fluid resuscitation and acute kidney injury: A retrospective cohort study
Authors: Reddy Swetha , Hu Bo , Kashani Kianoush
Published: September 2023

Background:

Septic shock is the leading cause of acute kidney injury (AKI) in critically ill patients. The foundation of early septic shock management includes early fluid resuscitation, but the association between fluid resuscitation rates and kidney outcomes remains unclear. This investigation examines the association between fluid resuscitation rate and AKI recovery.

Methods:

In the medical intensive care unit of Mayo Clinic Rochester, adult patients with AKI and septic shock were retrospectively studied from January 1, 2006 to May 31, 2018. The surviving sepsis campaign recommends an initial fluid bolus of 30 ml/kg for sepsis resuscitation. The cohort of patients was divided into three groups based on the average fluid resuscitation time (<1 h, 1.1–3 h, >3 h) and the corresponding fluid rate ≥0.5, 0.17–0.49, and <0.17 ml/kg/min, respectively. The primary outcome was the recovery of AKI on day 7. To account for potential confounders, multivariable regression analyses were conducted.

Results:

After meeting the eligibility, 597 patients were included in the analysis. The AKI recovery was considerably different among the groups (P = 0.006). Patients in group 1 who received fluid resuscitation faster had a higher rate of AKI recovery (53%) compared to group 2 and group 3 (50% and 37.8%).

Conclusion:

In septic shock patients with AKI, a higher fluid resuscitation rate of 30 ml/kg IV fluids within the 1st-h sepsis diagnosis (i.e., >0.50 ml/kg/min) lead to higher AKI recovery compared with slower infusion rates.
Cross-Sectional Study of Self-Concept and Alexithymia among Hijra Community of Rohtak, Haryana
Authors: Singh Himanshi , Kumar Pradeep
Published: September 2023

Introduction:

The Indian Hijra community encompasses persons with a variety of gender identities and sexual orientations, thus forming culturally unique gender group. The sociocultural aspects of Hijras have frequently been the subject of research by anthropologists and sociologists, but there is a dearth of data regarding the mental health problems in them.

Methodology:

The aim of the study was to assess the self-concept and alexithymia in Hijra community using Self-Concept Inventory and Toronto Alexithymia Scale-20 Hindi.

Results:

The study on thirty Hijras indicated that most of the individuals of Hijra community (96.7%) have low self-concept and only one had average self-concept. While 30% of the sample was nonalexithymics, 26.7% individuals had possible alexithymia and 43.3% were alexithymics. Self-concept was seen to be negatively correlated with alexithymia among individuals of Hijra community.

Conclusion:

The findings can help clinicians and policymakers to focus on the mental health awareness among these individuals.
Distal Factors of Suicidal Behavior among Patients with Substance Use Disorder: A Comparative Study
Authors: Verma Aparna , Gupta Preeti , Kumar Vikas
Published: September 2023

Background:

According to the World Health Organization, substance dependence is persistent or sporadic drug use inconsistent with or unrelated to acceptable medical practice. Substance dependence is showing a rising trend all over the world, and these disorders are rapidly recognized throughout in India. It is considered as a major cause of preventable ill health, social harm, and premature death throughout the population. As compared to the general population, those with substance use disorders are 5.3% more likely to die from suicide. There are several distal or predisposing risk factors associated with suicidal behavior such as personality traits, childhood trauma, and family history of suicide. Therefore, the present study is to compare and examine the distal factors of suicidal ideation (SI) and suicidal attempt (SA) with patients without SI and SA (WS) in patients with substance dependence.

Materials and Methods:

This was a cross-sectional observational study conducted at the inpatient departments of Central Institute of Psychiatry, Ranchi. Purposive sampling of sixty patients was done to further divide them into Group 1 (SI), Group 2 (SA), and Group 3 (WS). The sample was purposively collected to include sixty patients with substance dependence. They were screened by using the Addiction Severity Index scale, and Beck Scale for Suicidal Ideation (BSSI), Suicide Intent Scale, Childhood Trauma Questionnaire (CTQ), and the NEO five-factor inventory-3 (NEO-FFI-3) were administered to assess SI, SA, childhood trauma and personality traits, respectively.

Results:

The present study reveals that all the personality domains except conscientiousness on NEO-FFI 3 may have importance in differentiating the substance-dependent patients with SI/SA from WS patients. Only physical and emotional abuse on CTQ may be a significant distal factor for suicidal thoughts and behavior, whereas physical abuse may have more significance for SAs in substance dependence patients. Family history of suicide was not significant in patients with SI/SA.

Conclusions:

These findings may assist in formulation of therapeutic strategies for suicidal patients of substance dependence.
Urinary microRNA-10a levels in diagnosis and prognosis of urinary bladder cancer
Authors: Zaidi Noorin , Siddiqui Zainab , Sankhwar Satya N. , Srivastava Anand N.
Published: September 2023

Background:

Urinary bladder cancer (UBC) is a disease quite common in developed countries; however, its incidence is increasing in developing countries as well. The diagnosis of UBC is generally based on a number of methods, of which urinary cytology is a very commonly used one. But it is not very reliable. Therefore many new markers and methods are being investigated to make non-invasive diagnosis of UBC easy and reliable.

Objective:

This study was carried out to find the usefulness of microRNA (miRNA)-10a as a diagnostic and prognostic marker in non-muscle-invasive urinary bladder carcinoma.

Material and Method:

Twenty patients with UBC were taken as cases with 20 controls. Urine cytological examination was done, as well as histopathological examination of tumor tissue of cases. Urinary miRNA-10a estimation of both the cases and controls were done.

Result and Conclusion:

It was found that miRNA-10a is significantly high in urine of patients with UBC. Its value also significantly correlated with the grade and stage of the tumor. Hence it can be concluded that urinary miRNA-10a is a potential candidate in the diagnosis and prognosis of UBC.
Warthin-like papillary carcinoma thyroid
Authors: Kalantri Suman H. , D’Cruze Lawrence , Barathi G. , Singh Balaji K.
Published: September 2023

Solitary thyroid nodule should raise a suspicion of malignancy, which is very common in middle-aged females. Papillary carcinoma thyroid is the most common thyroid malignancy. Warthin-like papillary carcinoma is one of its rare variants. It has a frequent association with Hashimoto’s thyroiditis. Here, we report a case of 43-year-old female who presented with swelling in the anterior aspect of neck for 1 month. Fine-needle aspiration cytology features were suggestive of papillary carcinoma thyroid and biopsy confirmed the diagnosis of Warthin-like papillary carcinoma thyroid. This variant is of great clinical and prognostic significance as it carries an excellent prognosis.
A rare case of cerebellar anaplastic pleomorphic xanthoastrocytoma
Authors: Agrawal Krati , Verma Kartavya Kumar , Hussain Nighat , Sarangi Sujata
Published: September 2023

Pleomorphic xanthoastrocytoma (PXA) is a low-grade glioma comprising 1% of all astrocytomas with an extremely rare anaplastic counterpart usually found in young adults. These tumors are most often cerebral in origin and their presentation in the elderly signifies poor prognosis. As these tumors are an important differential of glioblastoma, diagnosing them accurately is essential for management. We present a 68-year-male with positive cerebellar signs and clinico-radiological impression of cerebellar metastatic deposits, subsequently diagnosed as cerebellar PXA with anaplastic features. The case in discussion is unique in its age, site, and grade of presentation, with key histological features rebuking the clinical and radiological diagnosis of metastasis. The rarity and ambiguous management protocol of these tumors make their documentation an important addition to the existing literature with emphasis on possibility of late presentation and at sites other than the cerebrum.
Clinicopathological and prognostic characteristic features of triple negative and nontriple negative breast cancer at a tertiary care hospital
Authors: Mohapatra Manisha
Published: September 2023

Context:

Carcinoma breast is a complex disease having diverse clinical, histopathological, and immunohistochemical features. Basing on estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 receptor (HER2) status, these tumors are divided into triple-negative breast cancers (TNBC) where tumor cells are negative for all three receptors and nontriple negative breast cancer (non-TNBC) where tumor cells are positive for one or two or all. The clinicopathological and characteristic prognostic features are highlighted here.

Aim:

The aim of this study is to evaluate the clinicopathological and prognostic features of TNBC and non-TNBC cases diagnosed in our hospital setting.

Settings and Design:

Single institution, retrospective study conducted over 7 and half years.

Subjects and Methods:

Histopathologically confirmed breast cancer cases with ER, PR, and HER2 receptor assessment were categorized into TNBC and non-TNBC. Detailed study on clinicopathological and prognostic features including pathological prognostic stage as per 8th AJCC was done in cases who underwent modified radical mastectomy.

Statistical Analysis Used:

Data were analyzed in percentage and presented in tables and charts.

Results:

The present study included 794 cases consisting of 253, 31.9% TNBC and 541, 68.1% non-TNBC cases. The mean age of TNBC and non-TNBC cases was 50.4 years and 51.7 years, respectively. Coagulative necrosis, lymphovascular invasion, lymph nodal metastasis, higher histopathological tumor grade, and NPI were observed in higher percentage of TNBC cases, i.e., 19 (10.9%), 21 (11.6%), 105 (57.7%), 127 (69.8%), and 149 (81.9%) cases, respectively, than non-TNBC seen in 18 (6.6%), 24 (8.8%), 135 (49.6%), 165 (60.7%), and 194 (71.3%) cases, respectively. Further, 25 (13.7%) TNBC and 1 (0.4%) non-TNBC case were upstaged, whereas 130 (47.8%) non-TNBC and 2 (1.1%) TNBC cases were downstaged by the pathological prognostic stage.

Conclusions:

TNBC is more aggressive having a poor prognosis than non-TNBC.
Prolonged response to Tyrosine Kinase Inhibitors followed by Immunotherapy in metastatic hepatocellular carcinoma: A rare case report
Authors: Roy Parag , Parthasarathy K.M.
Published: September 2023

The overall prognosis of hepatocellular carcinoma (HCC) is dismal and 5-year survival rate is 14.8%. We report a case of HCC coinfected with hepatitis C virus (HCV) and tumor thrombosis in the portal vein that was initially started on sorafenib followed by lenvatinib and nivolumab. On radiological imaging, there was a good partial response (PR) after starting nivolumab. A female 56 years of age presented with HCC coinfection with HCV, tumor thrombosis growing to the right portal vein. She received 6 months of sorafenib starting from April 2019 and was then switched to lenvatinib due to progressive disease. She continued lenvatinib for 11 months following which she developed new metastatic lesions where she was started on nivolumab. After 4 months of nivolumab, her alpha-fetoprotein decreased and there was a radiological PR. She is currently on nivolumab, with a total duration of response of 24 months on sorafenib followed by lenvatinib and lastly on nivolumab. Hence, tyrosine kinase inhibitors and immunotherapy can be effective lines treatment for advanced HCC and can give durable response duration, and probable radiological PR can be achieved with Nivolumab.
Molecular targeted therapy, advanced treatment for cancers of the head-and-neck region: A systematic review
Authors: Shaikh Firdous , Sodhi Sonia Kaur , Kale Lata M. , Farooqui Zeenat Fatema , Farooqui Aamena
Published: September 2023

Introduction:

The foundation of oncology treatment as a single modality approach as well as the “multimodality” concept has been studied by statistical evaluation pre, during, and posttreatment to rule out their efficacy, expected prognosis, toxicity reactions, and overall survival for the patient. Such studies have also provided an appreciable amount of data for future custom utility. “Targeted therapy” is a cancer treatment that uses drugs but is different from traditional chemotherapy. It works by targeting cancer-specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. Researchers are developing drugs that target specific molecular changes. The drugs can block or turn off signals that tell cancer cells to grow and divide, keep cells from living longer than usual, and destroy the cancer cells.

Aim:

The aim of the study is to carry out a systematic review of clinical trials of molecular targeted therapy in the treatment of cancer.

Objective:

The objective of the study is to evaluate the efficacy of molecular targeted therapy in the treatment of head-and-neck cancers.

Materials and Methods:

A group of keywords was preselected to search for scientific articles on a web-based database of PubMed. Only completed randomized controlled trials published in the past 5 years in the English language were included with open access. All the selected articles were subjected to the Cochrane bias tool and PRISMA guidelines to extract results.

Results:

Among 4 studies specifying the progression-free survival (PFS) for comparing the groups treated either using targeted therapy or other modality/placebo, 50% of studies show a slight increase in PFS in the group treated with TT and other 50% show PFS increase in the non-TT group. Thus, insufficient evidence is furnished to provide a statement and acknowledged the expectancy of a disease-free period with or without the use of TT in the treatment of head-and-neck cancer.

Conclusion:

Considering very little information on enhanced effect and presence of evidence supporting an increased risk of adverse events, the addition of TT to treatment is a question to the dilemma. A systematic review intends advantageous in providing foresight for oncologists concerning patient assessment and evaluation to defend inclination proceeding toward the treatment defined.
Comparison of RECIST and iRECIST criteria in patients with advanced lung cancer treated with nivolumab
Authors: Singla Rishu , Jajodia Ankush , Agrawal R K , Rao Avinash , Pasricha Sunil , Batra Ullas
Published: September 2023

Background:

Systemic therapy in lung cancer is mainstay of treatment as most patients present in advanced stages, with rising importance of new immunotherapy agents.

Purpose:

To compare the RECIST 1.1 and the immunotherapy Response Evaluation Criteria in Solid Tumors (iRECISTs) criteria for response assessment in lung cancer patients on immunotherapy. To find the incidence of pseudoprogression and associated imaging patterns.

Material and Methods:

Retrospective study in 28 patients treated with immunotherapy for advanced metastatic NSCLC. End points were progression-free survival (PFS) and overall survival (OS). Response assessments were separately tabulated according to RECIST 1.1 and iRECIST and classified into dichotomous groups of responders and nonresponders. Agreement in assessments between RECIST 1.0 and iRECIST examined using Cohen kappa (κ) coefficient with 95% confidence intervals. Kaplan–Meier survival analysis was done for PFS and OS. Differences between RECIST 1.1 and iRECIST for both responder and nonresponder were evaluated by the log rank test, Breslow (Generalized Wilcoxon) test, and Tarone–Ware test.

Results:

Incidence of pseudoprogression was 7% (2/28). The RECIST1.1 and iRECIST were in disagreement in two patients. The agreement between RECIST and iRECIST was almost perfect. The PFS and the OS are significantly longer in duration for responders in comparison to nonresponders for both RECIST and iRECIST and the difference between two assessment criteria is not significant.

Conclusion:

Although iRECIST aims to monitor treatment more precisely than conventional response criteria, this must be weighed against how infrequent pseudoprogression is and the cost of this therapy, both financially and in the potential delay in changing to a more effective treatment.
Low albumin-to-alkaline phosphatase ratio is associated with inferior prognosis in patients with head and neck cancer underwent concurrent chemoradiation: A propensity score-matched analysis
Authors: Kim Donghyun , Ki Yongkan , Kim Wontaek , Park Dahl , Joo Jihyeon , Jeon Hosang , Nam Jiho
Published: September 2023

Background:

Low albumin-to-alkaline phosphatase ratio (AAPR) is associated with tumor progression and poor survival outcome in some malignancies.

Purpose:

We aimed to determine the prognostic value of AAPR in head and neck cancer (HNC) patients underwent concurrent chemoradiotherapy (CCRT).

Materials and Methods:

We retrospectively reviewed medical records of 342 patients with HNC treated with definitive or adjuvant CCRT from 2007 to 2017. Receiver-operator characteristic curve assessed the cut-off value and predictive accuracy of AAPR for disease progression. Propensity score-matched (PSM) method was performed to balance baseline characteristics. Multivariate Cox regression analyses screened the independent prognostic factors for progression-free survival (PFS) and overall survival (OS).

Results:

The median follow-up duration was 40 months. The optimal cut-off level of AAPR was 0.523. In the PSM cohort, an AAPR < 0.523 was related to worse PFS and OS (PFS: Hazard ratio [HR], 1.936; 95% confidence interval [CI], 1.212 to 3.249; P = 0.001 and OS: HR, 1.832; 95% CI, 1.117 to 3.478; P = 0.02) compared with those with an AAPR ≥ 0.523. AJCC stage IVA-B also showed poor survival outcome compared with patients with AJCC stage II--III (PFS: HR, 1.855; 95% CI, 1.173 to 2.933; P = 0.008 and OS: HR, 1.905; 95% CI, 1.131 to 3.211; P = 0.015).

Conclusions:

HNC patients with low AAPR independently have worse survival outcomes than do high AAPR patients. These findings might help physicians predict treatment outcome and guide treatment strategy in patients with HNC underwent CCRT.
Outlook of Gleason score in prostate carcinoma and correlation with PSA levels: A study in a tertiary care hospital
Authors: Rani Ekta , Nibhoria Sarita , Nagpal Nitin
Published: September 2023

Introduction:

In India, prostate carcinoma is the fifth most common cause of carcinoma in men, and the fourth in cancer mortality. Incidence of prostate malignancy is increasing in India by one percent every year. Prostate carcinoma is graded using the Gleason scoring system. The Gleason score is very useful for predicting the prognosis of prostate carcinoma. The collaborative use of clinical features, combined with the size of the prostate, prostate-specific antigen levels, and histopathological features helps in making an accurate and early diagnosis of the patients.

Material and Method:

This present prospective study included all histologically proven cases of prostate carcinoma in the Department of Pathology, Guru Gobind Singh Medical Hospital over a period of one year. A detailed histopathological examination of the H and E stained sections is carried out under light microscope including histological typing, Gleason scoring and grading. The Gleason grade was correlated with serum PSA levels.

Results:

Out of 80 cases, 28 (35%) were reported as Gleason grade group 3 with a Gleason score of 7 (4 + 3). 12 cases (15%) showed a Gleason grade group 2 with a Gleason score of 7 (3 + 4). Grade group 4 (Gleason score 8) and grade group 5 were observed in 22 cases (27.5%) and 18 cases (22.5%), respectively. Whereas, no case of Gleason grade group 1 with Gleason score of 6 (3 + 3) was seen.

Conclusion:

Gleason’s Group Grade 3 outnumbered all the group grades, contributing 35% (28 cases) of the total cases of prostatic adenocarcinoma. Serum PSA levels were raised (>10 ng/ml) in 100% of cases. Henceforth, it signifies the importance of serum PSA levels in prostate carcinoma. Lymphovascular invasion was associated with higher group grade of prostatic adenocarcinoma.
Single perforator-based anterolateral thigh flap, the workhorse flap, in oral cancer reconstruction: A tertiary care institution experience
Authors: Shetty Deepthi , Kumar Niranjan , Desai Anil Kumar , Anehosur Venkatesh
Published: September 2023

Background:

Ablative procedures of the oral cavity require composite removal of tissues, which results in compromise of both functional activities and esthetic mutilation and proves to be a reconstructive challenge. This paper focuses on the reliability and versatility of a single perforator-based anterolateral thigh (ALT) flap in oral cancer reconstruction.

Materials and Methods:

All patients who underwent reconstruction with a single perforator-based ALT for oral cancer defects at our center were included in the study.

Results:

Forty-seven patients who underwent reconstruction with a single perforator-based ALT flap were included in our study. The average flap size in our series was 111 cm2, with the largest measuring 375 cm2. They was a complete loss of flap in two patients; both of them underwent salvage procedure and were reconstructed with pectoralis major myocutaneous flap. One had a partial loss that underwent re-exploration.

Conclusion:

We conclude that a single perforator-based ALT is a very safe, reliable, and versatile flap for head and neck reconstruction. The microvascular anastomosis may be expensive and technically a limitation; however, it has found a permanent place in our head and neck reconstructive toolkit and is the workhorse flap for head and neck reconstruction.
The adherence to the American Association for the Study of Liver Diseases 2018 guidelines in the management of hepatocellular carcinoma and its impact on survival
Authors: Manne Ashish , Mulekar Madhuri , Escobar Daisy , Prodduturvar Pranitha , Fahmawi Yazan , Henderson Phillip , Abdul-Rahim Osama , Hussain Zeiad , Liles Spencer , Fonseca Annabelle , Howard John Harrison , Mneimneh Wadad , Gilbert Robert , Alkharabsheh Omar , Pai Sachin , White Zachary B , Nelson Cindy , Khushman Moh’d
Published: September 2023

Introduction:

In two Korean and Italian studies, the adherence rate (AR) to ASSLD 2005 guidelines in the management of hepatocellular carcinoma (HCC) was 60%. In a US study, the AR to American Association for the Study of Liver Disease (AASLD) 2005 guidelines was 73.3%, 26.8%, 25.3%, and 58.8% for patients with Barcelona Clinic Liver Cancer (BCLC) Stage A, B, C, and D, respectively, and nonadherence to guidelines was associated with longer overall survival (OS) in patients with BCLC Stage D. Here, we explored the AR to AASLD 2018 guidelines and its impact on OS.

Methods:

Between 2017 and 2019, 148 unique treatment-naïve patients with HCC were identified. Patients were staged according to the BCLC staging system and their AR to AASLD 2018 guidelines was noted. OS was estimated using Kaplan–Meier method. Survivals among patients from different groups was compared using Log-rank test.

Results:

The overall AR to AASLD 2018 guidelines was 83%. The AR for BCLC Stages 0, A, B, C, and D were 100%, 97%, 77%, 77%, and 38%, respectively. In patients with BCLC Stage D, the OS of patients treated with modalities adherent versus nonadherent to AASLD 2018 guidelines was 0.03 vs. 5.2 months (P = 0.0005). Otherwise, adherence versus nonadherence to AASLD 2018 guidelines showed no statistically significant differences in OS for patients with BCLC Stages 0, A, B, and C.

Conclusion:

The overall AR to AASLD 2018 guidelines was 83%. Nonadherence to AASLD 2018 guidelines in patients with BCLC Stage D translated into better OS.
Molecular epidemiology and clinical characteristics of epidermal growth factor receptor mutations in NSCLC: A single-center experience from India
Authors: Thomas Renjan , Balaram Gautam , Varayathu Hrishi , Ghorpade Suhas N. , Kowsik Prarthana V , Dharman Baby , Thomas Beulah Elsa , Ramaswamy Veena , Nanjaiah Tejaswini , Patil Shekar , Naik Radheysham , Basavalinga Ajai Kumar , Ghosh Mithua
Published: September 2023

Background:

The genetic profiling of non-small cell lung cancer (NSCLC) has contributed to the discovery of actionable targetable mutations, which have significantly improved outcomes in disease with poor prognosis. Molecular epidemiological data of driver mutations in Indian populations have not been extensively elaborated compared to western and eastern Asian NSCLC populations. This study assessed the prevalence and clinical outcomes of EGFR (epidermal growth factor receptor) mutations among the Indian NSCLC cohort in South India.

Patients and Methods:

Retrospective analysis of 2,003 NSCLC patients who had undergone EGFR mutational analysis from 2013 to 2020 was performed. Clinical analysis was performed for 141 patients from 2013 to 2017 using Kaplan–Meier and Chi-square methods. Descriptive and survival statistics were performed using IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.

Results:

EGFR-sensitizing mutations were detected in 41.6% (834/2003) in the study cohort with compound mutations detected in 7.55% (63/834) of EGFR-positive cases. A significant relationship with regard to female gender and EGFR mutation status (P <.001) was observed. Exon 18 G719X (8.7%) mutations and exon 20 T790M point mutation (3.1%) were the most frequently isolated uncommon EGFR mutations. In the clinical cohort, EGFR mutations were detected at a significantly higher prevalence in females (P =0.002) and never-smokers (P < 0.001). EGFR mutation demonstrated a significant relationship with regard to brain metastasis (P = 0.011). EGFR mutated individuals had significantly longer median overall survival compared to EGFR wild type (26 months vs. 12 months, P = 0.044).

Conclusion:

We reports the highest number of EGFR mutation analysis performed from India and mutational analysis indicated a loco-regional variation in India with regard to EGFR mutation frequency and its subtypes.
A machine learning approach for prediction of auditory brain stem response in patients after head-and-neck radiation therapy
Authors: Amiri Sepideh , Abdolali Fatemeh , Neshastehriz Ali , Nikoofar Alireza , Farahani Saeid , Firoozabadi Leila Alipour , Askarabad Zahra Alaei , Cheraghi Susan
Published: September 2023

Objective:

The present study aimed to assess machine learning (ML) models according to radiomic features to predict ototoxicity using auditory brain stem responses (ABRs) in patients with radiation therapy (RT) for head-and-neck cancers.

Materials and Methods:

The ABR test was performed on 50 patients having head-and-neck RT. Radiomic features were extracted from the brain stem in computed tomography images to generate a radiomic signature. Moreover, accuracy, sensitivity, specificity, the area under the curve, and mean cross-validation were used to evaluate six different ML models.

Results:

Out of 50 patients, 21 participants experienced ototoxicity. Furthermore, 140 radiomic features were extracted from the segmented area. Among the six ML models, the Random Forest method with 77% accuracy provided the best result.

Conclusion:

According to the ML approach, we showed the relatively high prediction power of the radiomic features in radiation-induced ototoxicity. To better predict the outcomes, future studies on a larger number of participants are recommended.
Solitary fibrous tumor of the seminal vesicle
Authors: Goyal Shikha , Madan Renu , Mukherjee Urmi , Kumar Rajender
Published: September 2023

Solitary fibrous tumors (SFTs) are mesenchymal neoplasms with variable clinical behavior depending on age, tumor site, and size, and pathologic factors such as mitoses and necrosis. Imaging features on computed tomography (CT) or magnetic resonance imaging (MRI) are not specific, and the diagnosis relies on histopathology with immunohistochemistry. SFTs arising from seminal vesicles is rare and reported in only eight earlier cases. We discuss the clinical, histopathologic and positron emission tomography (PET) imaging characteristics of a 54-year-old patient with SFT of the seminal vesicle. The patient was treated with robot-assisted seminal vesiculotomy and is doing well on follow-up at two years.
Clear cell variant of pediatric renal cell carcinoma: Rare and challenging
Authors: Banerjee Soirindhri , Paul Souvik , Dastidar Aloke Ghosh
Published: September 2023

We report a very rare case of clear cell variant of renal cell carcinoma (RCC) in a 3-year-old male child, who presented to us with a left-sided lump in his abdomen. Computed tomography (CT) scan and technetium-99 Dimercapto succinic acid (DMSA) scan revealed a large left renal mass with compromised left renal function. Left-sided nephroureterectomy was done and histopathology demonstrated clear cell carcinoma, possibly translocation-associated RCC (miT family) staged as pT2NxMx. Postoperative CT scans of the thorax and whole abdomen showed secondaries in the lungs and liver. We discussed treatment options in a multidisciplinary tumor board but meanwhile the child succumbed to respiratory failure.
Evaluation of crystallization patterns in oral potentially malignant disorders and oral malignancies: A prospective study
Authors: Prakash A Jacob , Surendra K. Sai , Lakshmi M. Vijaya , Shetty VishwaPrakash , Reddy M. Murali Jogi , Thomas Vara Joy
Published: September 2023

Background:

Oral cancers are often detected at late stages, and patients usually had a 50% chance of a 5-year survival rate. Oral cancer usually has an early precancerous stage before its actual malignant transformation. Although there are various approaches to diagnose the early stages of cancer, there is one less explored, cost-effective, and simple technique known as the crystallization test. The aim of the study was to evaluate the crystallization patterns in tobacco users, oral potentially malignant disorders (OPMDs), and oral malignancies.

Materials and Methods:

Fifteen patients with oral malignancies, 15 patients with oral potentially malignant disorders, 15 tobacco users, and 15 healthy individuals participated in the crystallization test. Single blood drop was used to perform this test and the obtained crystal patterns were analyzed.

Results:

This test had a sensitivity of 93.3%, 80.0%, and 20.0% for oral malignancies, oral Potentially Malignant Disorders (PMDs), and tobacco users, respectively. Chi-square analysis revealed a highly significant transverse form between OPMDs and oral malignancies (P < 0.05).

Conclusion:

Crystallization test was found to be a sensitive, reliable, economical, and less invasive procedure for screening of oral PMDs and oral malignancies under strictly maintained physical conditions.
Leukemia-associated aberrant immunophenotype: A flow cytometry-based experience of 110 cases from a tertiary care center in Northern India
Authors: Venugopalan Radhika K. , Singh Neha , Anthony Michael L. , Kunnumbrath Arathi , Gupta Arvind K. , Nath Uttam K. , Chowdhury Nilotpal , Chandra Harish
Published: September 2023

Background:

Leukemic cells express a characteristic set of “cluster of differentiation” (CD) markers, which forms the basis of the current WHO classification. Leukemia-associated aberrant immunophenotype (LAIP) refers to expression of unusual CD markers by leukemic cells, which are not normally expressed by their respective lineage. The incidence of LAIP varies considerably, and its clinical implications, prognostic relevance, and sensitivity to therapy are still debatable. This study was conducted to identify the immunophenotypic aberrancies in newly diagnosed leukemias in our Institute.

Method:

This was an observational study, which included newly diagnosed leukemias on flow cytometry. Aberrant immunophenotypic expressions were recorded whenever present and were correlated with prognostic factors like age, gender, and total leucocyte count (TLC).

Results:

The study included 110 newly diagnosed cases of leukemias (85 acute and 25 chronic) over 1.5 years. Immunophenotypic aberrancies were detected in 40.4% of the cases. The highest incidence of aberrations was detected in acute myeloid leukemia (60.7%). LAIPs were detected in 50% of T-acute lymphoblastic leukemia and 25% cases of in B-cell acute lymphoblastic leukemia (B-ALL). Aberrant CD33 and CD56 expression in B-ALL correlated with poor prognostic factors like higher age and higher TLC, respectively. Immunophenotypic aberrancies were present in 28% cases of chronic lymphocytic leukemia.

Conclusion:

The results of this study have generated valuable baseline data on the incidence of LAIPs in this region. This information is vital because establishing LAIPs at the time of diagnosis is crucial for disease monitoring. Some LAIPs are associated with underlying cytogenetic abnormalities and hence impact the management and prognosis.