There is no weekend effect in hip fracture surgery – A comprehensive analysis of outcomes

Background

Previous studies have shown that some patient groups suffer adverse outcomes if they are acutely admitted to hospital over a weekend. We aimed to investigate this ‘weekend effect’ at our centre in patients presenting with a hip fracture.

Hemodynamic characteristics of suspected stroke in the emergency department

Background

Systemic hemodynamic characteristics of patients with suspected acute ischemic stroke are poorly described. The objective of this study was to identify baseline hemodynamic characteristics of emergency department (ED) patients with suspected acute stroke.

Frequency distribution of autoimmunity associated FCGR3B gene copy number in Indian population

Amongst several human genome variations, copy number variations (CNVs) are considered as an important source of variability contributing to susceptibility to wide range of diseases. Although CNV is scattered for genes throughout the human genome, several of autoimmunity related genes have CN variation and therefore play an important role in susceptibility to autoimmune diseases. The association of the Fc gamma receptor 3B (FCGR3B) gene copy number in autoimmunity is well characterized in various populations studied. The Fc gamma receptor is a low affinity, glycosylphosphatidylinositol‐linked receptor for IgG molecule predominantly expressed on human neutrophils. The variable gene copy number of FCGR3B is found to be involved in the impaired clearance of immune complexes, which significantly contribute to the pathogenesis of several autoimmune diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), type‐1 diabetes and others. The FCGR3B copy number ranged from 0 to ≥2 copies per diploid genome in other populations, but yet not explored in Indian population. Hence, this study aims to evaluate the variation in the frequency distribution of FCGR3B CNV in Indian population. FCGR3B gene copy number varied significantly when compared to other population of the world. This observation will help us in exploring the potential role of CNV in FCGR3B gene and its association to autoimmune disorders in Indian population.     

Rituximab for treatment of refractory/relapsing thrombotic thrombocytopenic purpura (TTP)

Plasma exchange is the standard treatment for thrombotic thrombocytopenic purpura (TTP). For patients refractory to plasma exchange, treatment options are limited and often unsuccessful. The platelet thrombi that form in acquired TTP are believed to result from the presence of procoagulant ultralarge multimers of von Willebrand factor (VWF) in the circulation due to autoantibody inhibition of VWF cleaving protease (ADAMTS-13), the enzyme that normally cleaves the ultralarge multimers. Rituximab, a chimeric monoclonal antibody against CD20, has been recognized as a useful therapy for antibody-mediated autoimmune disease. We therefore treated four patients with recurrent TTP with 2 or 4 weekly doses of rituximab in addition to corticosteroids, vincristine, plasma, or continuing plasma exchange. Three patients responded with prompt improvement in microangiopathic hemolytic anemia and thrombocytopenia, which allowed plasma exchange to be discontinued or avoided and prednisone to be rapidly discontinued. Two of the 3 responders have remained in unmaintained complete remission for 13+ months. The third patient relapsed at 13 months; a second course of rituximab and prednisone resulted in an unmaintained remission for 6+ months. All four patients were tested for ADAMTS-13 activity and its inhibitor at a point in their course when samples were available. Low ADAMTS-13 activity was noted in 3 patients tested at relapse, and the inhibitor activity was detectable in 2 patients. ADAMTS-13 activity increased during remission in one of these 2 patients although the patient had a persistence of the inhibitor. One patient tested only during remission had a normal ADAMTS-13 level. We conclude that rituximab may have a role and deserves further study in the treatment of patients with relapsing TTP.     

Taxonomic and Biochemical Composition and Digestive Enzyme Activity of Periphyton and Plankton: A Comparative Study

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - Periphyton grown on sugarcane bundles was analyzed for major digestive enzymes in order to quantify their...     

Infective endocarditis: report of a prospective study in an Indian hospital

Forty-six patients who fulfilled the Duke's clinical diagnostic criteria for infective endocarditis (IE) were evaluated. Thirty-five (76%) patients were below 40 years of age with rheumatic heart disease being the most common underlying heart lesion affecting 26 (56%). An obvious predisposing cardiac lesion could not be ascertained in 22%. Blood culture positivity was 44% with streptococcus heading the list. The incidence of the staphylococcal (25%) and gram negative bacillary endocarditis (15%) were found to be increasing. Streptococci were susceptible to penicillin with minimum bactericidal concentration: minimum inhibitory concentration within acceptable limits. However, the appearance of methicillin resistant staphylococcus aureus and high level gentamicin resistant enterococcus as aetiological agents of infective endocarditis were found to add to the complexity of the problem. With the emergence of drug-resistant organisms as causative agents of IE, whenever medical therapy is the primary method of treatment of this condition, the selection of antibiotics should depend upon extensive in vitro testing and in vivo monitoring of clinical efficacy.     

Opium alkaloid noscapine is an antitumor agent that arrests metaphase and induces apoptosis in dividing cells

An alkaloid from opium, noscapine, is used as an antitussive drug and has low toxicity in humans and mice. We show that noscapine binds stoichiometrically to tubulin, alters its conformation, affects microtubule assembly, and arrests mammalian cells in mitosis. Furthermore, noscapine causes apoptosis in many cell types and has potent antitumor activity against solid murine lymphoid tumors (even when the drug was administered orally) and against human breast and bladder tumors implanted in nude mice. Because noscapine is water-soluble and absorbed after oral administration, its chemotherapeutic potential in human cancer merits thorough evaluation.     

Prognostic Value of Dynamic Susceptibility Contrast-Enhanced and Diffusion-Weighted MR Imaging in Patients with Glioblastomas

BACKGROUND AND PURPOSE:Prediction of survival in patients with glioblastomas is important for individualized treatment planning. This study aimed to assess the prognostic utility of presurgical dynamic susceptibility contrast and diffusion-weighted imaging for overall survival in patients with glioblastoma.MATERIALS AND METHODS:MR imaging data from pathologically proved glioblastomas between June 2006 to December 2013 in 58 patients (mean age, 62.7 years; age range, 22–89 years) were included in this retrospective study. Patients were divided into long survival (≥15 months) and short survival (<15 months) groups, depending on overall survival time. Patients underwent dynamic susceptibility contrast perfusion and DWI before surgery and were treated with chemotherapy and radiation therapy. The maximum relative cerebral blood volume and minimum mean diffusivity values were measured from the enhancing part of the tumor.RESULTS:Maximum relative cerebral blood volume values in patients with short survival were significantly higher compared with those who demonstrated long survival (P < .05). No significant difference was observed in the minimum mean diffusivity between short and long survivors. Receiver operator curve analysis demonstrated that a maximum relative cerebral blood volume cutoff value of 5.79 differentiated patients with low and high survival with an area under the curve of 0.93, sensitivity of 0.89, and specificity of 0.90 (P < .001), while a minimum mean diffusivity cutoff value of 8.35 × 10⁻⁴mm²/s had an area under the curve of 0.55, sensitivity of 0.71, and specificity of 0.47 (P > .05) in separating the 2 groups.CONCLUSIONS:Maximum relative cerebral blood volume may be used as a prognostic marker of overall survival in patients with glioblastomas.

Glioblastomas (GBMs) are the most common malignant tumors of the central nervous system in adults, representing 50% of all gliomas and 20% of all intracranial solid lesions.¹ The prognosis of GBM is poor, and median overall survival is <1 year.² Even in optimal conditions (young patients treated by radical surgery, radiation therapy, and chemotherapy), death usually occurs within 2 years.^3,4 Several factors, both clinical (age, performance status) and therapeutic (extent of surgery, radiation therapy, chemotherapy), as well as specific tumor characteristics such as location and nature (de novo or secondary from a low-grade glioma)^5,6 have been studied as potential prognostic markers of overall survival with variable degrees of sensitivity and specificity. Recently, tumor genetics is also being investigated as a prognostic index.^7,8Conventional MR imaging is widely used as the technique of choice for GBM diagnosis and also has an important role in monitoring disease progression and response to therapy for patients with GBM. Additional advanced imaging techniques, such as relative cerebral blood volume (rCBV) obtained from dynamic susceptibility contrast perfusion imaging, have been used to predict glioma grade^9–11 and assess treatment response.¹² A recent report¹⁰ indicated that maximum relative cerebral blood volume (rCBV_max) can be used as a predictive marker of progression-free survival in patients with gliomas, regardless of the tumor grade.Similar to perfusion imaging, diffusion-weighted imaging has also been used for diagnosis of tumors. Tumors with high cellularity demonstrate restricted diffusion and thus low mean diffusivity (MD) or apparent diffusion coefficient, which inversely correlates with tumor cellularity.^13,14 Areas with minimum mean diffusivity (MD_min) reflect the sites of highest cellularity, and tumors with a low MD tend to have a poor prognosis.^15–18Radiation therapy and chemotherapy with temozolomide have become the standard of care in the treatment of GBM and have demonstrated increased survival benefits in patients with newly diagnosed GBM.¹⁹ However, several clinical trials, including blocking the tyrosine kinase activity of epidermal growth factor receptor (EGFR),^20,21 using competitive and noncompetitive kinase inhibitors in combination with radiation and temozolomide,^20,21 and using monoclonal antibodies,²⁰ are also investigating the treatment of GBMs. The exact value of each of these therapeutic strategies remains investigative though. The overall survival of patients with glioblastomas varies significantly,^17,18 and it is imperative to know which patients will do better or worse, preferably before initiation of treatment, by using a noninvasive imaging method, so as to tailor fit the therapy for the best management and hopefully increased survival. We have evaluated the role of DSC-MR imaging and DWI as potential prognostic imaging markers in patients with GBM with an eventual goal of using these parameters in the selection of the optimal treatment option for these patients.