bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Credit Risks on Profitability of the Systematically Important Licensed Commercial Banks in Sri Lanka
Authors: Mithila G. , Kengatharan L.
Published: June 2024

Purpose: This paper focuses on analyzing the impact of credit risks on the profitability of six major licensed commercial banks in Sri Lanka which account for around 53% of the market share from 2017 to 2021.Design/Methodology/Approach: Return on Equity (ROE) was considered to measure the profitability while measuring the credit risks and it was carried out through Non-Performing Loan ratio (NPL), Capital Adequacy Ratio (CAL), Total Loan to Assets ratio (LTA), and Total Loan to Deposit ratio (LTD). STATA is used to analyze the data. To test the hypothesis, Pooled OLS, random, and fixed effect models are employed, and the most suitable model is picked through the Breusch and Pagan LM test and Hausman tests. Based on the results pooled OLS is selected for the interpretation with an Adjusted R2 of 74%.Findings: The study reveals a significant negative impact of NPL on profitability, suggesting that increased NPL proportions heighten credit risk, potentially leading to losses and reduced profitability. Conversely, the LTD shows a negative relationship, potentially exposing banks to higher default risks despite boosting interest income. However, LTA demonstrates a positive relationship with ROE within a certain limit, suggesting enhanced interest income without significant default risk escalation. CAR, however, does not directly impact profitability, emphasizing its role in ensuring capital adequacy and regulatory compliance.Originality: This study only focuses on the systematically important licensed commercial banks as they represent more than 50% of the market share and have a significant influence on the Sri Lankan economy. Hence, managing their credit risk exposures is significantly important for the country.
Management of an elderly patient with retention of a steel nail in the scrotum: a case report
Authors: Meneghetti Iacopo , Cesta Novella , Mosillo Luca , Belli Simone , Bianchi Daniele , De Maria Maurizio
Published: June 2024

Background: The retention of foreign bodies inside the body during ludic/sexual procedures or for traumatism represents one of the causes of visits to accident and emergency departments that often requires surgical removal of the foreign body. However, there are cases where the discovery of such foreign bodies takes place after many years, as in patients that are slightly compromised from a neuro-sociological point of view.
Case presentation: A 76-year-old male presented to an outpatient urological examination due to an increase in scrotal volume. At the ultrasound check, an acoustic interference from a solid object was detected, for which computed tomography was requested. The computed tomography scan revealed the presence of an elongated metal body in the perineum. The removal of the foreign body in the operating theatre was then scheduled. A 10 cm long stainless-steel nail located within an abscessed foreign body granuloma was identified and removed via a scrotal access. Four days later, a new surgical toilet was performed due to minimal necrosis of the skin flaps. The patient then performed three more dressings in the operating theatre during the following week. Healing took place by secondary intention until a perfect healing of the surgical wound was obtained.
Conclusions: Removal of foreign bodies from the perineum in case of infection can be challenging. Careful attention and postoperative dressings are crucial for the success of the case.
Development of a food detector using image processing through camera sensor innovation
Authors: Adam Adriyani , Asikin Hijrah , Ipa Agustian , Sahrir Sahrir , Imran Ali
Published: June 2024

Indonesia is currently struggling with stunting, wasting, obesity, and micronutrient deficiencies. Nutritional imbalance, which varies by gender, age, and activity level, contributes to these issues. This research developed a food detector with an innovative camera sensor to accurately measure food calories. The study adopted a developmental approach, using a pre-experimental design and “post-test only” research. The study included various food ingredients with calorie counts. Camera sensors were used instead of load cell sensors to weigh food and convert it to calories. Camera sensory testing was done on processed food samples. A number of food image data tests showed high accuracy. With test results close to real data, the device showed promising accuracy. This model system used camera resolution to detect calories, helping people measure and manage their diets in quality and quantity. We hope this technology will continue to improve, making it more accessible and aiding nutritional management.
Studies in the history of Cape Town
Authors: Hattingh J.L.
Published: June 2024

No abstract available.
Uncommon elegance: Nephrotic surprises in adult immunoglobulin A vasculitis
Authors: Gökten Dilara Bulut , Mercan Rıdvan
Published: June 2024

Henoch–Schönlein purpura (HSP) is a form of small-vessel vasculitis caused by the accumulation of immune complexes containing immunoglobulin A antibodies. It is usually seen in childhood. When the disease is considered in terms of nephritis, its incidence in children is reported to be between 20% and 54%. Hematuria and nephritic proteinuria are common in the course of the disease. However, nephrotic proteinuria is extremely rare. This article presents the case of an individual who was diagnosed with HSP as an adult, characterized by vasculitis. The patient did not present with arthritis or arthralgia during follow-up but developed gastrointestinal bleeding. In particular, nephrotic proteinuria was observed during follow-up.
Achilles tendinopathy following severe acute respiratory syndrome coronavirus 2 infection and COVID-19 vaccination
Authors: Adwan Marwan , Asfour Hasan , Abuhelal Ayman
Published: June 2024

Musculoskeletal symptoms are commonly reported following SARS-CoV-2 infection, with fatigue, arthralgia, and myalgia being the most common manifestations. Severe cases may include conditions like arthritis and rhabdomyolysis. Similarly, post-vaccination musculoskeletal symptoms have been documented. However, tendinopathy, particularly Achilles tendinopathy, remains underreported in both contexts. We present two cases of Achilles tendinopathy, one following SARS-CoV-2 infection and the other post-vaccination, to highlight potential musculoskeletal complications associated with COVID-19 and vaccination. In the first case, a 48-year-old male developed bilateral ankle pain eight weeks after a confirmed COVID-19 infection. The second case involves a 27-year-old male who experienced sudden, intense left Achilles tendon pain following SARS-CoV-2 vaccination. Case 1: The 48-year-old patient exhibited bilateral ankle pain and swelling, with MRI confirming Achilles enthesitis. Laboratory tests showed elevated ESR and CRP, with other parameters within normal ranges. Treatment with sulfasalazine led to significant improvement. Case 2: The 27-year-old patient demonstrates Achilles tendon rupture post-vaccination. Detailed findings and treatment outcomes were discussed to emphasize the rarity and significance of this condition. These two cases underscore the need for awareness and further research on the relatively serious musculoskeletal complications like Achilles tendinopathy following COVID-19 infection and vaccination. Enhanced medical understanding is crucial for optimizing patient care and addressing potential side effects effectively.
Adenocarcinoma of the colon in a patient with Behçet’s disease
Authors: Khudadah Mohammad , Jawad Ali S.
Published: June 2024

There is a possible increase in solid neoplasms in patients with Behçet’s disease (BD). We describe a 31-year-old woman, of Turkish origin, with mucocutaneous BD, who developed abdominal pain and rectal bleeding soon after the birth of her second baby. Colonoscopy and biopsy lead to a diagnosis of adenocarcinoma of the sigmoid colon. The association between BD and neoplasms is discussed, emphasizing the importance of cancer surveillance in this patient population.
Efficacy of intravitreal injection of Ziv-aflibercept before vitrectomy for proliferative diabetic retinopathy
Authors: Nawar Amin E. , Alagorie Ahmed R.
Published: June 2024

Purpose

The aim of this study was to evaluate the efficacy of intravitreal injection of Ziv-aflibercept before small-gauge pars plana vitrectomy compared to pars plana vitrectomy alone in eyes with advanced diabetic eye disease.

Patients and methods

This is a prospective, randomized, interventional study that enrolled 60 eyes of 46 patients with advanced diabetic eye disease between February 2019 and December 2020. Intravitreal Ziv-aflibercept injection was given in 30 eyes before vitrectomy, while the other 30 eyes served as the control group (without intravitreal injection). The recorded data included intraoperative bleeding, surgical time, endodiathermy use, iatrogenic retinal breaks, and incidence of postoperative vitreous hemorrhage at 1 week, 1 month, 3, 6, and 12 months postoperatively.

Results

Intraoperative bleeding was noted in 18 (60%) eyes in the study group compared to 26 (86.66%) eyes in the control group, with no statistically significant difference (P=0.39). However, grade 2 intraoperative bleeding was reported significantly less in the study group (eight eyes, 26.66%) than in the control group (20 eyes, 66.66%) (P=0.004). At least one intraoperative iatrogenic retinal break was detected in 10 (33.33%) eyes in the study group compared to 18 (60%) eyes in the control group (P=0.44). The mean surgical time was significantly shorter (51.67±7.30 min) in the study group than in the control group (63.17±10.16 min) (P<0.001). However, there was no statistically significant difference in the rate of postoperative vitreous hemorrhage between the study group and the control group at 1 week, 1, 3, 6, and 12 months, postoperatively (P>0.05).

Conclusion

Preoperative intravitreal Ziv-aflibercept significantly decreased the surgical time and reduced the rate of severe intraoperative bleeding during diabetic vitrectomy.
Treatment outcome in refractive accommodative esotropia
Authors: Al-Morsy Osama A. , Ramadan Ahmed E. , Abd-Elaal Asmaa I. , Dawoud Manar F.
Published: June 2024

Background

Accommodative esotropia (ET) usually presents in preschool years. It is often intermittent, and the deviation is typically eliminated by controlling the accommodative effort with optical correction of hypermetropia.

Objective

The aim of this study was to document the clinical features and to assess the functional outcome in patients with refractive accommodative esotropia (RAE) in terms of amblyopia and binocular vision and to analyze the possible risk factors involving the development of amblyopia.

Patients and methods

We retrospectively reviewed the records of 60 patients diagnosed with fully accommodative esotropia (FAET). Multiple parameters were reviewed, including age of onset, age of initiation of treatment, initial and final cycloplegic refraction, distance and near deviation with and without glasses, stereoacuity, presence of anisometropia, and change in hyperopia.

Results

The mean age of onset and age of initiation of treatment were 2.53±1.42 and 2.73±1.25 years, respectively. The mean spherical equivalent refraction at the initial visit was +5.36±1.48 diopters (D) in the right eyes and +5.62±1.43 D in the left eyes. Anisometropia was present in 33.33% of the patients. Fusion was achieved in 90% of the patients, with 38 (63.33%) patients having stereopsis ranging from 40–100 sec/arc and 22 (36.67%) having stereopsis between 100 and 200 sec/arc with the Titmus fly test. Amblyopia was reduced from 50% to 16.67%. Anisometropia was found to be the only statistically significant risk factor for the development of amblyopia (P<0.001). Hypermetropia showed a tendency either to remain stable or to increase over the first seven years of life and then tended to decrease.

Conclusion

Most of the patients with FAET have an excellent outcome in terms of visual acuity and binocular vision. Amblyopia is common among patients with RAE and the current management strategies resulted in marked reduction in the prevalence of amblyopia.
Efficacy and Safety of Osilodrostat in Managing Cushing’s Syndrome: A Systematic Review and Meta-Analysis
Authors: Nagendra Lakshmi , Dutta Deep , Raizada Nishant , Surana Vineet , Selvan Chitra , Bhattacharya Saptarshi
Published: June 2024

No meta-analysis has holistically analysed and summarized the efficacy and safety of osilodrostat, a novel dual 11β-hydroxylase (cytochrome P450 family 11 subfamily B member 1 [CYP11B1]) and 18-hydroxylase (aldosterone synthase, CYP11B2) inhibitor in managing Cushing’s syndrome (CS). We undertook this meta-analysis to address this knowledge gap. Electronic databases were searched for randomized controlled trials (RCTs) involving patients with CS receiving osilodrostat in the intervention arm. The primary outcome was to evaluate changes in urine free cortisol (UFC) levels. Secondary outcomes were to evaluate alterations in cortisol levels, androgen levels, mineralocorticoid levels, and adverse events. From initially screened 109 articles, data from 2 RCTs involving 144 patients was analysed. After 8–12 weeks of therapy, the odds of achieving a normal 24-hour UFC was higher in patients receiving oslidrostat as compared to placebo. [odds ratio (OR) 21.94 (95% CI: 8.53–56.43); P < 0.00001; I2 = 0%]. The occurrence of adverse events [OR 1.35 (95% CI: 0.52–3.53); P = 0.54; I2 = 0%; low heterogeneity (LH); High certainty of evidence (HCE)], serious adverse events (SAEs) [OR 1.32 (95% CI: 0.30–5.79); P = 0.72; I2 = 0%; LH; HCE], adrenal insufficiency [OR 5.38 (95% CI: 0.91–31.78); P = 0.06; I2 = 0%; LH; HCE], headache [OR 0.98 (95% CI: 0.35–2.76); P = 0.97; I2 = 0%; LH; HCE], hyperandrogenism [OR 3.68 (95% CI: 0.59–22.80); P = 0.16; I2 = 0%; LH; HCE] and deaths [OR 0.32 (95% CI: 0.01–8.00); P = 0.48; I2 = 0%; LH; HCE] was comparable among the groups. The occurrence of nausea [OR 4.25 (95% CI: 1.26–14.30); P = 0.02; I2 = 0%; LH] and arthralgia [OR 6.54 (95% CI: 1.64–26.13); P = 0.008; I2 = 0%; LH; HCE] was significantly higher in the osilodrostat group as compared to placebo. Osilodrostat has good efficacy and safety in CS and was well tolerated over 48 weeks of use.
Cardiovascular Risk Factors in Sheehan’s Syndrome: A Case-Control Study
Authors: Agrawal Mayur , Yadav Subhash C. , Singh Swish K. , Kumar Sheo , Chatterjee Krishnarpan , Garg Naveen K.
Published: June 2024

Introduction:

Obesity, dyslipidaemia and insulin resistance are associated with hypopituitarism. The association between these conditions and Sheehan’s syndrome (SS) caused by post-partum pituitary gland necrosis is poorly understood. This study aimed to assess cardiovascular risk surrogate markers in SS patients, and we compared clinical, biochemical and radiological testing with healthy controls.

Methods:

In this cross-sectional study, we studied 45 patients with SS on standard replacement therapy and compared them with healthy controls. All subjects underwent anthropometric, inflammatory marker and hormonal measurement (adrenocorticotropic hormone (ACTH), stimulated cortisol, insulin-like growth factor-1 (IGF-1), thyroxine (T4), follicle-stimulating hormone (FSH), luteinising hormone (LH), oestradiol (E2), prolactin (Prl), insulin, interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP)). Carotid intima-media thickness (CIMT), flow-mediated dilation (FMD) and echocardiography were also performed.

Results:

The mean age and body mass index (BMI) of SS patients were 48.1 ± 10.0 years and 24.3 ± 4.3 kg/m2, respectively, while those of controls were 44.6 ± 12.0 years and 24.6 ± 3.2 kg/m2, respectively. Systolic blood pressure was significantly higher in SS (124.6 ± 20.8 vs. 117.0 ± 18.6 mm of Hg, P < 0.05). All SS patients were hypothyroid, and all except one were hypocortisolaemic. Triglyceride (TG) levels were significantly higher in SS patients (165.6 ± 83.3 vs. 117.2 ± 56.1, P < 0.01), but no difference in the prevalence of metabolic syndrome (MetS) was found. hs-CRP (9.1 (5.2–18.5) vs. 1.5 (0.6–2.8), P < 0.001) and IL-6 (4.9 (3.7–7.3) vs. 3.1 (2.0–4.2), P < 0.001) were significantly higher in SS patients. CIMT was significantly increased in SS patients, but no difference in FMD was found. Echocardiography revealed no significant difference in left ventricular (LV) dimensions, interventricular thickness, posterior wall thickness, ejection fraction, LV mass and diastolic function.

Conclusion:

SS patients show increased cardiovascular risk with hypertension, dyslipidaemia and increased atherosclerotic and inflammatory markers.
A Lower Prevalence of Central Nervous System and Higher Prevalence of Cardiac Symptoms Characterises Indian Patients with Thyrotoxic Storm: A Retrospective Analysis
Authors: Lath Devraj , Nandipati Venkata S. , Jebasingh Felix , Cherian Kripa E. , Kapoor Nitin , Asha Hesarghatta S. , Paul Thomas V. , Thomas Nihal
Published: June 2024

Introduction:

Thyroid storm is an uncommon but life-threatening presentation of thyrotoxicosis with a mortality rate of 10%. Our objective was to study the demographics, clinical and biochemical characteristics, and outcomes of inpatients diagnosed with thyroid storm in the Indian context.

Methods:

This retrospective study was conducted by analysing the institutional electronic medical records (EMR) of all patients admitted with thyroid storm from 2004 to 2020 with a Burch–Wartofsky score (BWS) of ≥45.

Results:

Thirty-five patients with a BWS ≥45 were included, of whom 71.4% were women, with a mean age of 44.9 ± 10.2 years. 43% did not have any prior history of thyrotoxicosis. Graves’ disease was the most common underlying aetiology (71.4%), followed by toxic multinodular goitre (14.3%). Cardiovascular (94.3%) and gastrointestinal-hepatic dysfunction (88.6%) were the most common clinical manifestations. Features of Central nervous system (CNS) dysfunction were seen in only 42.3% of patients diagnosed with a thyroid storm. The Japanese Thyroid Association (JTA) criteria diagnosed only 26 patients (74.3%) with “definite” thyroid storm. The mortality rate was 8.6%, and all three patients expired within 48 hours of admission.

Conclusion:

Nearly one in every two patients with thyroid storm had previously undiagnosed thyrotoxicosis. Toxic multinodular goitre is a notable aetiology in Indians. Features of CNS dysfunction, considered relatively specific for thyroid storm, were less prominent in our series. The JTA criteria might alter the classification of some patients diagnosed with a thyroid storm, when compared to the BWS score due to fewer CNS features among Indian patients.
Different Effects of Obesity and Fasting on the Expression of Type 3 Deiodinase and Thyroid Hormone Receptors in the Liver and Visceral Adipose Tissue of C57BL/6 Male Mice
Authors: Muazzez Alireza , Shimi Ghazaleh , Balam Farinaz H. , Ghorbani Arman , Zand Hamid
Published: June 2024

Introduction:

Energy status can alter thyroid hormone signalling in different tissues. Little is known about the effect of fasting on the local thyroid hormone metabolism under high-fat diet (HFD)-induced obesity. We aimed to investigate the fasting effect on deiodinase type 3 (DIO3) and thyroid hormone receptors (TRs) expression in liver and visceral adipose tissue (VAT) of HFD-induced obese mice.

Methods:

The 30 male C57BL/6 mice were divided into three groups (n = 10/group): control (CON) group, obese (OB) group, and fasted obese (OBF) group.

Materials:

In a 14-week study, the expression levels of DIO3 and TRs in the liver and VAT of mice were measured by real-time polymerase chain reaction. Gene expression results were shown as fold changes defined by 2−ΔΔct. Comparison between groups was performed by using one-way-ANOVA or Kruskal-Wallis ANOVA test.

Results:

In the liver, there was a significantly lower expression of DIO3 and higher expression of TRs in obese fasted mice compared to obese mice. Compared to the lean mice, OBF mice had significantly lower expression of DIO3 and higher expression of TRβ. In the VAT, mRNA expression of DIO3 was significantly increased in OBF and OB groups compared to the CON group. There were no significant differences in the mRNA expression of TRs between groups.

Conclusion:

Our findings suggest that fasting may be more effective in improving thyroid hormone metabolism in the liver rather than the VAT of obese mice.
Study of Correlation between Serum Vitamin B12 Level and Aberrant DNA Methylation in Infertile Males
Authors: Kumar Dharmendra , Agrawal Neeraj K.
Published: June 2024

Introduction:

Altered DNA methylation pattern in sperms has been associated with infertility in males demonstrating defective spermatogenesis or low semen quality. Vitamin B-12, by affecting 1-carbon metabolism pathways, might alter the DNA methylation pattern. We aimed to study the correlation of serum vitamin B12 levels with aberrant DNA methylation in infertile male patients.

Methods:

A cross-sectional study was conducted on 17 oligozoospermic infertile males (WHO criteria, 2010) and 10 healthy fertile males. Serum vitamin B12 levels were estimated using the chemiluminescence method. Global methylation was determined using the ELISA system (Imprint Methylated DNA Quantification Kit, Sigma–Aldrich). The levels of global DNA methylation were calculated and compared relative to the methylated (100%) control DNA provided with the kit.

Results:

Mean serum vitamin B12 concentration in the control group was higher than that of the case group. This difference in serum vitamin B12 concentration in both groups was found statistically significant. Although the results of this study show that oligozoospermic men have relatively lower global DNA methylation as compared to normozoospermic control, the values could not reach a statistically significant level. A small positive correlation was found between serum vitamin B12 levels and percent methylation defect (r = 0.14) but was statistically insignificant.

Conclusion:

Our study concludes that oligozoospermic infertile males have a significant deficiency of vitamin B12 as compared to normozoospermic fertile males. This study did not find any significant difference in global DNA methylation between the two groups. The present study does not suggest any correlation between serum vitamin B12 level and percent DNA methylation.
Adjuvant Concurrent Chemoradiotherapy (CRT) plus Docetaxel–Cisplatin–Fluorouracil (DCF) versus CRT plus Fluorouracil–Folinic Acid (FUFA) in Stage III Gastric Cancer
Authors: Alkan Ali , Mızrak Dilşa , Yaşar Arzu , Karcı Ebru , Köksoy Elif Berna , Ürün Muslih , Özyurt Neslihan , Kuştaş Ali Aytuğ , Kütük Tuğçe , Ürün Yüksel , Şenler Filiz Çay , Akyürek Serap , Utkan Güngör , Demirkazık Ahmet , Gökçe Şaban Çakır , Akbulut Hakan
Published: June 2024

Introduction:

Adjuvant chemoradiotherapy (CRT) is the optimal management strategy in resectable gastric cancer. There is a debate about the efficacy of more aggressive CRT plus chemotherapy regimens in adjuvant setting. This study aimed to compare the efficacy of adjuvant CRT plus docetaxel–cisplatin–fluorouracil (DCF) versus CRT plus fluorouracil–folinic acid (FUFA) in stage III gastric cancer.

Methods:

Patients with a diagnosis of stage III gastric cancer treated with adjuvant therapy after curative resection were analyzed. Patients’ disease characteristics and impacts of the regimens on median disease-free survival (DFS) and median overall survival (OS) were analyzed retrospectively.

Results:

One hundred sixty-one patients (102 in FUFA arm and 59 in DCF arm) with a median age of 56.0 (29–79) were evaluated. In the DCF arm, there were more renal toxicities (31.6% vs 6.4% P < 0.001), emergency department admissions (64.9% vs 23.7%, P < 0.001), and dose reductions/treatment modifications in the DCF arm (51.6% vs 37.2, P < 0.001). The median follow-up was 23 months (1–124) in the FUFA arm and 26.0 months (1–77) in the DCF arm. The median DFS was 25.0 months (%95 CI, 12.7–37.2) in the DCF arm and 17.0 months (%95 CI, 2.6–31.3) in the FUFA arm, P = 0.66. The median OS was 28.0 months (%95 CI, 17.0–38.9) in the DCF arm and 25.0 months (%95 CI, 11.9–36.0) in the FUFA arm, P = 0.70.

Conclusion:

In conclusion, when compared with FUFA regimen, more aggressive therapy with DCF was more toxic and did not improve OS in adjuvant setting of stage III gastric cancer.
Histiocytic lesion masquerading as papillary carcinoma thyroid-A case report
Authors: Kumar Bipin , Chadha Prerna , Singh Tanwi , Kumar Deepak
Published: June 2024

Langerhans cell histiocytosis (LCH) is a rare clonal neoplasm derived from Langerhans-type cells that express CD 1a, langerin, and S 100 on immunohistochemistry. LCH usually involves multiple sites and multiple systems or multiple sites in a single system. Solitary LCH commonly involves the bones (especially the skull), lymph nodes, skin, and lungs. Solitary LCH of the thyroid is an extremely rare disease with a few reported cases in the indexed literature and poses a diagnostic dilemma for both the clinician and pathologist. Histopathology along with ancillary tests forms the gold standard for diagnosis. Surgical resection alone offers a good prognosis once multisystemic involvement has been ruled out. Herein is reported one such case of solitary LCH in a young male patient who remains disease-free after 2 years of follow-up.
Diagnostic efficacy of dynamic contrast-enhanced magnetic resonance perfusion imaging in detecting local tumor recurrence in patients with head and neck malignancies after definitive treatment
Authors: Lathika Anand G. , Jayasankaran Sandya C. , Chelakkot Prameela G. , Thankappan Krishnakumar , Moorthy Srikanth
Published: June 2024

Background and Aim:

Accurate interpretation of post-treatment imaging in head and neck malignancies poses a challenge due to treatment sequelae. Magnetic resonance (MR) perfusion helps in this scenario by evaluating the hemodynamic characteristics of lesions. This study aimed to elucidate the diagnostic efficacy of dynamic contrast-enhanced (DCE)-MR perfusion imaging in detecting recurrence in patients after they underwent definitive treatment for head and neck tumors.

Materials and Methods:

Thirty patients who had received definitive curative-intent treatment for histopathology-proven malignant head and neck tumors and in whom recurrent tumor was detected on precontrast MR imaging (MRI) were accrued in the study. Patients underwent DCE-MR perfusion imaging. Time to peak (TTP), relative maximum enhancement (RME), and relative washout (RWO) ratio were calculated by using time–intensity curve (TIC). The diagnostic accuracy was compared with histopathology.

Results:

A cut-off value of ≥125.3 for RME showed a sensitivity of 76.2% and specificity of 66.7% for differentiating post-radiation changes and recurrence. The optimal cut-off for RWO ratio was ≥−6.24 with a sensitivity of 76.2% and specificity of 55.6%. The optimal cut-off of TTP was ≤45.8 s with a sensitivity of 61.9% and specificity of 77.8%. Diagnostic accuracies of RME, RWO, and TTP were 73.3%, 70%, and 66.7%, respectively.

Conclusions:

DCE-MRI had significant diagnostic accuracy in detecting and differentiating recurrences. TIC analysis of high-temporal resolution DCE-MRI can provide information regarding microcirculation of tumors, and hence can be considered as an imaging modality of choice for assessment of early local tumor recurrence in head and neck tumors.
p16, p53 and EGFR expression in head and neck squamous cell carcinoma and their correlation with clinicopathological parameters
Authors: Gupta Shalini , Pandey Pinki , Verma Sakshi , Verma Abhishek
Published: June 2024

Introduction:

Oral squamous cell carcinoma is a major cause of death throughout the developed world. Human papillomavirus (HPV) type 16 has also been suggested to play a role in etiology of head and neck squamous cell carcinoma (HNSCC). p16 expression is now being used as a surrogate marker of HPV infection in squamous cell carcinoma. Dysfunction in the p53 tumor suppressor gene is implicated in many cancers, including head and neck cancer. Overexpression or mutation of EGFR is found in 80%–100% of the patients with HNSCC, and is associated with poor prognosis and decreased survival.

Materials and Methods:

In this cross-sectional observation study, total of 100 cases of HNSCC were taken. p16, p53, and EGFR expression was determined by immunohistochemical staining and correlated with clinicopathological parameters. p16 expression was also correlated with expression of p53 and EGFR. The obtained results were analyzed and evaluated using Chi-square test, value of P < 0.05 was taken significant.

Results:

p16, p53, and EGFR were positive in 60%, 44%, and 58% cases, respectively. A statistically significant association was observed between p16 with age, site of the tumor, abnormal sexual habits and lymph node involvement. Significant expression also seen between p53 with age and abnormal sexual habits and immunohistochemical expression of p16 with p53 and EGFR.

Conclusion:

Immunohistochemical expression of p16 can be used as a surrogate marker of HPV. Study of p16, p53, and EGFR expression may provide clinicians with more exact information in order to evaluate tumor aggressiveness and treatment modalities.
Basaloid squamous cell carcinoma in the mandibular alveolus: A rare case report with differential diagnosis
Authors: Vasu Sivanandini , Thankappan Prasanth , Prabhakar Girish S. , Angelin D.
Published: June 2024

Basaloid squamous cell carcinoma (BSCC) is a distinct, high-grade variant of oral squamous cell carcinoma (OSCC) with a poor prognosis. In the head and neck region, the most common sites are the epiglottis, piriform sinus, and tongue base. Other less common sites include the floor of the mouth, oral mucosa, palate, tonsils, nasopharynx, and trachea. In the present report, the unusual case of a 69-year-old male is presented; the patient exhibited ulceroproliferative growth involving the lower alveolus. Incisional biopsy was done and the hematoxylin and eosin-stained sections revealed tumor islands with dysplastic oral epithelial cells invading the underlying connective tissue as islands, cords, and nests. The presence of palisading basaloid cells with a central area of comedo necrosis and keratin formation on the islands revealed the diagnosis of BSCC. Immunohistochemistry demonstrated positive staining for proliferative cell nuclear antigen (PCNA) and pan-cytokeratin. The patient is still under treatment and follow-up.
Cytological diagnosis of cutaneous granular cell tumor: Rare tumor with rare presentation
Authors: Verma Nidhi , Tomar Reena , Khurana Nita , Vindal Anubhav
Published: June 2024

Granular cell tumors (GCTs) are uncommon soft tissue tumors, which are difficult to diagnose merely by clinical examination. Fine-needle aspiration cytology (FNAC), being an effective first-line investigation, plays a significant role in the preoperative diagnosis of GCT. However, the tumor can mimic certain other lesions; hence, a cytopathologist needs to be aware of its characteristic morphology. We report here a case of GCT, presented as a subcutaneous nodule in the first finger web. A differential diagnosis of lipoma/neurofibroma was made clinically. FNAC was done and showed characteristic features of granular cell tumor along with intranuclear inclusions and subsequently, it was confirmed on histopathology.
Serum and salivary interleukin-1β level in oral precancer: An observational study
Authors: Selvan T Thamarai , Patil Ranjit K. , Singh Vandana , Verma Saurabh , Tripathi Anurag , Khanna Vikram , Chaurasia Akhilanand , Shetye Akanksha G.
Published: June 2024

Background and Aim:

Precancer biomarkers help in early detection and management of oral potentially malignant disorders (OPMDs). Interleukin-1β (IL-1β), a biomarker, is known to be altered in oral submucous fibrosis (OSMF) and oral leukoplakia (OL). Therefore, we evaluated and compared the serum and salivary IL-1β levels in patients with OSMF/oral leukoplakia and in gender- and age-matched healthy individuals.

Materials and Methods:

An in vivo, prospective, observational study was conducted on 40 subjects. Subjects were divided into two groups with 20 individuals in each group, that is, Group I: OSMF/oral leukoplakia and Group II: control group. Salivary and serum IL-1β levels were quantitatively estimated using enzyme-linked immunosorbent assay (ELISA). The statistical tests used were unpaired t-test and Chi-square test.

Results:

The serum IL-1β levels were significantly (P 0.001) lesser in Group I in comparison to Group II. The salivary IL-1β levels remained insignificant between both the groups. However, in both the groups, the salivary IL-1β levels were significantly higher compared to the serum IL-1β levels.

Conclusion:

We found that the serum IL-1β level can be considered as a prospective biomarker for dysplasia, whereas salivary IL-1β alone needs more elaborated studies to account for its application as a potential biomarker in OPMD.
Clinicopathological analysis of patients with dual malignancies: A retrospective study
Authors: Thakur Niketa , Kaur Harkirat , Sudan Meena , Jain Neeraj
Published: June 2024

Background:

This study aims to report the increasing incidence of second primary malignancies to better understand the association of multiple primary cancers and the duration of their occurrence. Keeping in view the current trends in dual malignancies and to further emphasize the importance of screening and follow-up diagnosis, we reviewed the records of patients who were diagnosed with dual malignancies.

Material and Methods:

This is a retrospective observational study. We collected data from the hospital database, of patients presenting with either histologically proven synchronous or metachronous double primaries between January 1, 2017, and December 31, 2021. The time interval to differentiate between synchronous and metachronous has been taken as 6 months.

Results:

During the period of five years, twenty-three patients presented with dual malignancy. Out of 23 cases, seven were synchronous (30.43%), and 16 were metachronous (69.56%). In the synchronous malignancy group, the most common site of first and second primary malignancy was breast [5 cases (71.4%) and 3 cases (42.8%), respectively]. In the metachronous malignancy group, the most common site of the first primary was breast (7 cases; 43.75%), followed by the head and neck (4 cases; 25%), and the most common site of the second primary was also the breast (6 cases; 37.5%), followed by the lung (5 cases; 31.25%).

Conclusion:

Second primary malignancies are not rare and can occur at any age. Regular follow-up and screening procedures by the treating oncologist can play a major role in early detection followed by appropriate treatment of second primary tumors.
Presentation, treatment, and outcomes of chondrosarcoma in young adult patients less than age 50: A case series of ten patients
Authors: Miller Justin , Fitzpatrick Brendan , Begley Brian , Frank Samantha , Mazzei Christopher , Giacalone Joseph , Wittig James
Published: June 2024

Chondrosarcoma is an aggressive bone tumor typically affecting older adults in the 6th and 7th decade. These tumors often present as painful masses in the pelvis, ribs, and long bones and have certain characteristic features on the imaging leading to the diagnosis. The occurrence of these tumors in the young adult population is a rare condition that is not well described. Often, they may be confused with benign counterparts, enchondroma or osteochondroma, which does not require any treatment and are very common. The aim of this case series was to analyze the patient presentation and radiographic image findings as well as surgical treatment and outcomes of ten young adults with chondrosarcoma over a three-year period. Overall, imaging of these tumors in young adults did not necessarily demonstrate all typical features of chondrosarcomas such as endosteal scalloping, calcifications, lobular growth, and high uptake on whole-body bone scans. One patient in the case series passed away from complications from dedifferentiated chondrosarcoma, and nine patients have recovered with no local recurrence.
Clinical and toxicity outcomes with 3D based-HDR surface mold brachytherapy in skin cancer
Authors: Yadavalli Purnachandrarao , Pareek Vibhay , Barthwal Mansi , Bharat Rampukar , Mullassery Shreejesh , Aashita  , Patil Preeti , Sharma Aman , Sharma Daya Nand , Mallick Supriya
Published: June 2024

Introduction:

Surface mold brachytherapy (SMBT) is an established treatment modality in skin cancer, especially in accessible areas, and has shown comparable outcomes to surgery. We have presented our results for the skin tumor treatment with SMBT treated with high-dose-rate (HDR) brachytherapy in terms of clinical outcomes and toxicity at our institute.

Materials and Methods:

In this retrospective analysis, 15 patients with skin cancer were treated with customized tube-based SMBT at our institute between January 2019 and July 2021. The patients were treated using HDR-brachytherapy using Iridium-192. The median dose was 40 Gy in 10 fractions. The dosimetric parameters were assessed, and patients were followed up as per the institutional protocol. All patients underwent individualized CT-based planning. Skin toxicity was assessed using the Dermatology Life Quality Index (DLQI).

Results:

With the majority of the patients being male, the median age was 59 years and the most common site affected was the face (8/15; 53.3%). Among the 15 cases, five were squamous cell carcinoma, nine were basal cell carcinoma, and a single case of sebaceous cell carcinoma. The median depth of invasion was 4 mm, and the median catheter-to-surface distance was 1 mm. The complete response rate among the 10 definitive cases was 90% and partial response in one case. The treatment was well-tolerated with no grade 3-5 toxicities. The median V95% and V90% were 94.8% and 97.1%, respectively. The mean coverage index (C.I.), dose non-uniformity ratio (DNR), and overdose volume index (ODI) were 0.97, 0.13, and 0.05, respectively. After a median follow-up of 12 months, none of the patients had recurrence. On assessment of DLQI, the scores were found to be significant in association with the tumor size and tumor site with scores favoring <2 cm and non-exposed area lesions.

Conclusion:

SMBT is a safe and effective treatment modality for skin tumors providing excellent response and cosmetic outcomes. It is well-tolerated and a non-invasive option for elderly patients with comorbidities and lesions in inoperable areas.
Giant cell tumor of femur with single pulmonary metastasis – yet another curative oligometastasis
Authors: Abraham Abraham P. , Kingsley Pamela A. , Negi Preety , Bedi Harinder S.
Published: June 2024

Giant cell tumor of bone (GCT) is a benign tumor of bone that is known to be locally aggressive rarely metastasizing to distant sites, most commonly to the lungs. The reported pulmonary metastasis incidence is 1 – 9%. We report a case of GCT with solitary pulmonary metastasis who had significant clinical benefit and disease control with sequential application of surgical resection of pulmonary metastasis, local external beam radiation therapy (EBRT), and systemic Denosumab. We wish to highlight that even in metastatic GCT, there is significant clinical benefit in aggressive treatment.
Pneumothorax as a rare presentation in a case of phyllodes tumor of breast with cavitating lung metastasis
Authors: Kaur Tejinder , Chandrashekhara Sheragaru Hanumanthappa , Rastogi Sameer
Published: June 2024

The lung is the most common site of metastases in the case of phyllodes tumor of the breast followed by bone. However, pneumothorax as a presenting complaint in a patient of bilateral cavitating lung metastases from malignant phyllodes tumor of the breast has never been reported to our knowledge. We herein report a case of a 34-year-old female presenting with sudden onset of chest pain in already existing lung metastases who on imaging showed the development of bilateral pneumothorax. We should, therefore, be on the lookout for the potential development of spontaneous pneumothorax in such cases.
Low-dose radiation therapy for COVID-19 pneumonia: Comparison of dosimetry and life-time attributable risk of cancer with conventional AP-PA fields and bone marrow sparing VMAT
Authors: Sharma Daya Nand , Sharma Seema , Gupta Anil , Saini Surendra Kumar , Subramani Vellaiyan
Published: June 2024

Purpose:

Low-dose radiation therapy (LDRT) to lungs did show encouraging results in COVID-19 patients in some clinical trials. However, there has been some concern regarding the long-term risk of radiation-induced cancer (RIC). Compared to the conventional AP-PA field technique, volumetric modulated arc therapy (VMAT) can potentially reduce the dose to the marrow and other organs at risk (OARs) and thus minimize the risk of cancer. We designed a dosimetry study to study if VMAT can reduce the exposure to the marrow and other OAR doses and curtail the estimated life-time attributable risk (LAR) of cancer.

Methods and Materials:

We retrieved the computed tomography scan data of 10 patients (aged 40–60 years, median 48 years) who have been already treated for any malignancy in the region of the thorax. A dose of 1.0 Gy in single fraction was prescribed to both lungs. All the organs were delineated as per the established guidelines. The dosimetry achieved by the two plans was compared to find the difference. Mean OAR doses were used to estimate the LAR for both plans and compared.

Results:

Planning target volume coverage parameters like conformity index and homogeneity index were significantly better with VMAT (P value < 0.05 for all). The mean dose to most OARs was significantly lower with VMAT (P value < 0.05 for all). The mean dose to the marrow was significantly lower with VMAT (59.05 vs 81.9 cGy with P value < 0.05). The overall LAR was significantly lower with VMAT as compared to the conventional plan (0.357% vs 0.398%, P value < 0.05).

Conclusion:

Compared to the conventional technique, VMAT provides better OAR dosimetry for lung irradiation (a prescription dose of 1.0 Gy or more) in COVID-19 pneumonia. VMAT significantly reduces the risk of RIC. We therefore suggest if lung LDRT is used for COVID-19 patients, VMAT is the preferred technique for a prescription dose of ≥1.0 Gy.
Role of external radiation in benign tumors: A clinical outcome and safety audit of 7 years from a tertiary care center in India
Authors: Kapoor Rakesh , Bora Devangana , Khosla Divya , Kumar Narendra , Bahl Amit , Kumar Divyesh , Madan Renu , Chandran Vigneshwaran
Published: June 2024

Purpose:

Radiotherapy (RT) is a well-established modality for treating malignancies, but its role in treatment of benign lesions has not been well explored. Herein, we present a retrospective analysis of a 7-year data regarding the benefit and the safety profile of RT for treating benign tumors in our institute.

Materials and Methods:

Data of 23 patients who received RT for benign tumors from January 2015 to April 2022 were retrieved, and a retrospective analysis was conducted. All the pertinent demographic data, treatment and follow-up data were retrieved. The most common presentations were nasopharyngeal angiofibroma, vertebral hemangioma, paraganglioma, and others. The most common sites of occurrence were head and neck (43%) and paravertebral region (22%). Volumetric modulated arc therapy was the most commonly employed RT technique (39%), followed by three-dimensional conformal RT (34%) and two-dimensional conventional radiotherapy (26%). The median RT dose delivered was 36 Gy (range: 20–54 Gy).

Results:

The median follow-up duration was 53 months (range: 3–120 months). Nine (39%) patients had progressive disease with a median time to progression of 8 months (range: 1–30 months). The median disease-free survival (DFS) was 70 months, while the 1-, 3-, and 5-year DFS rates were 97%, 88%, and 62%, respectively. Four patients (17%) died, all due to disease progression. The 1-, 3-, and 5-year overall survival rates was 97%, 85%, and 50%, respectively. The rate of radiation-induced cancer (RIC) was 0% as none of the patients had developed RIC secondary to radiation.

Conclusion:

RT is a safe and an effective option to manage benign tumors either in an adjuvant setting or in inoperable patients requiring definitive treatment, as well as in a setting to alleviate symptoms, providing excellent survival benefits. However, further prospective studies with much higher sample size are required to establish the absolute benefit and to estimate the risk of RIC, which will further direct for a better utilization of RT in treating benign tumors.
Expression and analysis of CX3CL1 chemokine and CD57+ lymphocytes in oral squamous cell carcinoma and their correlation with clinicopathologic features
Authors: Singh Shivani , Urs Aadithya B. , Kumar Priya
Published: June 2024

Introduction:

CX3CL1 exhibits chemoattraction for T-cells, monocytes, and CD57+ natural killer cells mediating antitumor immunity. The role of CX3CL1 has been studied in tumors of the breast, lung, colon, pancreas, prostate, etc. The current study was undertaken to understand the importance of CX3CL1 and its correlation with CD57+ cells in oral squamous cell carcinoma (OSCC).

Material and Methods:

Seventy-five primary OSCC were staged and histopathologically graded, followed by immunohistochemistry for CX3CL1 and CD57. Mann–Whitney U-test, Kruskal–Wallis test, Post hoc Bonferroni test, and Pearson’s correlation coefficient were applied.

Results:

CX3CL1 assessment within the tumor cells was high in 62.66% of cases, and the CD57 Labeling Index (LI) varied over a wide range of 8.2–111.6. A statistically significant reduction in expression of both CX3CL1 and CD57 was observed with an increase in histologic grade (p = 0.021 and 0.038, respectively).

Discussion:

It is concluded that CX3CL1 and CD57 may be important players in the immune surveillance of OSCC. Further studies with detailed follow-up for the overall survival of patients will help in studying the diagnostic, prognostic, and therapeutic roles of CX3CL1 in OSCC.