Severe intravascular hemolysis after transcatheter closure of a large patent ductus arteriosus using the Amplatzer duct occluder: successful resolution by intradevice coil deployment.

A 21-year-old female developed severe unremitting intravascular hemolysis following closure of a large patent ductus arteriosus using an Amplatzer duct occluder. Percutaneous deployment of fibered platinum coils within the nitinol wire cage of the Amplatzer duct occluder abolished the residual shunt through the device and resulted in cessation of intravascular hemolysis and reversal of its adverse sequelae.     

Near-infrared (NIR) surface-enhanced Raman spectroscopy (SERS) study of novel functional phenothiazines for potential use in dye sensitized solar cells (DSSC)

Phenothiazines are of potential use as dye sensitizers in Grätzel-type dye sensitized solar cells (DSSC). Plasmonic nanoparticles like gold nanoparticles can enhance the power conversion efficiency of these solar cells. In this work near-infrared surface-enhanced Raman spectroscopy (NIR-SERS) is used to investigate the interaction between six novel phenothiazine-merocyanine dyes containing the three different functional groups rhodanine, 1,3-indanedione and cyanoacylic acid with plasmonic nanomaterials, to decide if the incorporation of plasmonic nanoparticles could enhance the efficiency of a Grätzel-type solar cell. The studies were carried out in the solution state using spherical and rod-shaped gold nanostructures. With KCl induced agglomerated spherical gold nanoparticles, forming SERS hot spots, the results showed low detection limits between 0.1 μmol L⁻¹ for rhodanine containing phenothiazine dyes, because of the formation of Au–S bonds and 3 μmol L⁻¹ for cyanoacrylic acid containing dyes, which formed H-aggregates in the watery dispersion. Results with gold nanorods showed similar trends in the SERS measurements with lower limits of detection, because of a shielding effect from the strongly-bound surfactant. Additional fluorescence studies were carried out to determine if the incorporation of nanostructures leads to fluorescence quenching. Overall we conclude that the addition of gold nanoparticles to rhodanine and 1,3-indanedione containing phenothiazine merocyanine dyes could enhance their performance in Grätzel-type solar cells, because of their strong interactions with plasmonic nanoparticles.

Phenothiazines are of potential use as dye sensitizers in Grätzel-type dye sensitized solar cells (DSSC).     

Germ-line GATA2 p.THR354MET mutation in familial myelodysplastic syndrome with acquired monosomy 7 and ASXL1 mutation demonstrating rapid onset and poor survival

While most myelodysplastic syndrome/acute myeloid leukemia cases are sporadic, rare familial cases occur and provide some insight into leukemogenesis. The most clearly defined familial cases result from inherited mutations in RUNX1 or CEBPA. Recently, novel germline mutations in GATA2 have been reported. We, therefore, investigated individuals from families with one or more first-degree relatives with myelodysplastic syndrome/acute myeloid leukemia with wild-type RUNX1 and CEBPA, for GATA2 mutations. Screening for other recurrent mutations was also performed. A GATA2 p.Thr354Met mutation was observed in a pedigree in which 2 first-degree cousins developed high-risk myelodys-plastic syndrome with monosomy 7. They were also observed to have acquired identical somatic ASXL1 mutations and both died despite stem cell transplantation. These findings confirm that germline GATA2 mutations predispose to familial myelodysplastic syndrome/acute myeloid leukemia, and that monosomy 7 and ASXL1 mutations may be recurrent secondary genetic abnormalities triggering overt malignancy in these families.     

Appraisal of gastric stump carcinoma and current state of affairs

Gastric stump carcinoma, also known as remnant gastric carcinoma, is a malignancy arising in the remnant stomach following gastrectomy for a benign or malignant condition. Enterogastric reflux and preexisting risk factors in a patient with gastric cancer are the major contributors to the development of gastric stump carcinoma. The occurrence of gastric stump carcinoma is time-dependent and seen earlier in patients operated on for malignant rather than benign diseases. The tumor location is predominantly at the anastomotic site towards the stomach. However, it can occur anywhere in the remnant stomach. The pattern of lymph node involvement and the type of surgery required is distinctly different compared to primary gastric cancer. Gastric stump carcinoma is traditionally considered a malignancy with a dismal outcome. However, recent advances in diagnostic and therapeutic strategies have improved outcomes. Recent advances in molecular profiling of gastric stump carcinoma have identified distinct molecular subtypes, thereby providing novel therapeutic targets. Also, reports of gastric stump carcinoma following pancreatoduodenectomy and bariatric surgery highlight the need for more research to standardize the diagnosis, staging, and treatment of these tumors. The present review aims to provide an overview of gastric stump carcinoma highlighting the differences in clinicopathological profile and management compared to primary gastric carcinoma.     

Resource utilization and cost effectiveness of treating acute promyelocytic leukaemia using generic arsenic trioxide

Arsenic trioxide (ATO)-based regimens are the standard of care for treating acute promyelocytic leukaemia (APL) and have replaced chemotherapy-based approaches. However, the cost of “patented” ATO is prohibitive because of patent rights. “Generic” ATO has been used in a few countries, but its implications for health resource utilization (HRU) and cost of treatment are unknown. We hypothesized that treating APL patients using generic ATO (APL-ATO) will be cost effective compared to the chemotherapy-based regimen (APL-CT). In a single-centre retrospective study, we used a bottom-up costing method to compare the direct medical cost of treatment and HRU between APL-ATO and APL-CT. These costs and the survival and relapse probabilities were imputed in a three-state Markov decision model to estimate the cost effectiveness of APL-ATO compared to APL-CT. The mean cost of treatment for APL-ATO (n = 30, $8500 ± 2078) was significantly less than for APL-CT (n = 30, $22 600 ± 5528) (P < 0·001). APL-ATO reduced hospitalization, antibiotic and antifungal usage (P < 0·001). In the Markov model, five-year treatment costs were significantly lower for APL-ATO ($11 131) than for APL-CT ($17 926) (P < 0·001). Treatment cost and health resource utilization were significantly lower for generic ATO-treated APL patients compared to the chemotherapy-based regimen.     

Utility of absolute lymphocyte count as a surrogate marker of CD4 cell counts: Is it useful?

Background

Human immunodeficiency virus (HIV) management has witnessed paradigm changes over the past decade. In the early era, Absolute lymphocyte counts (ALC) were used as an inexpensive, indirect marker of immunity status. With time, CD4 lymphocyte counts and HIV RNA levels have become a standard of care for follow up of people living with HIV/AIDS (PLHA). Wide disparities between resource rich and poor countries, rekindles the need for an inexpensive surrogate marker for CD4 lymphocyte counts. Multiple studies in the past including one by Sen S et al, in 2011 did not validate ALC as a surrogate marker of CD4 lymphocyte counts and had recommended a similar study at another centre to validate the same.¹ Recently few publications have suggested that ALC may be used as a proxy marker to CD4 lymphocyte counts in resource poor areas.² With this backdrop we decided to evaluate the association if any, of ALC as a surrogate marker to CD4 lymphocyte counts.

Methods

ALC and CD4 lymphocyte counts measurements of 241 patients at our HIV/AIDS referral centre were assessed over a period of 13 months.

Results

Pearson correlation coefficient, coefficient of determination and standard statistical methods revealed modest linear correlation between ALC and CD4 lymphocyte counts which was statistically significant but did not have clinical significance.

Conclusion

We recommend that time has come to call curtains down on ALC as a surrogate marker for CD4 lymphocyte count.