Complete response to chemotherapy in primary hepatic lymphoma

Primary hepatic lymphoma is an uncommon lymphoid tumor with varied clinical presentations and treatment outcomes. The median age of involvement is 50 years (male preponderance) with median survival as 8-16 months. Here we report a 68-years-old female who presented with right hypochondriac pain and anorexia with hepatomegaly on physical examination. Ultrasonography (USG) with subsequent contrast enhanced computed tomography (CECT) of abdomen depicted a hypoechoic mass in the left lobe of liver. CECT of chest and neck showed no abnormality. Liver biopsy proved to be Non-Hodgkin lymphoma (NHL) diffuse large B cell type, CD20 positive. Bone marrow examination showed no infiltration by NHL. The patient was started on three weekly R-CHOP, given a total of 8 cycles. Patient attained a complete remission documented by negative computed tomography (CT) and positron emission tomography (PET) scans.     

Prevalence of internet addiction among college students in the Indian setting: a systematic review and meta-analysis

BackgroundThe internet is an integral part of everyone’s life. College going adolescents are highly vulnerable to the misuse of the internet.AimsTo estimate the pooled prevalence of internet addiction (IA) among college students in India.MethodsLiterature databases (PubMed, Web of Science, Scopus, EMBASE, PsycINFO and Google Scholar) were searched for studies assessing IA using the Young Internet Addiction Test (Y-IAT) among adolescents from India, published in the English language up to December 2020. We included studies from 2010 to 2020 as this is the marked era of momentum in wireless internet connectivity in India. The methodological quality of each study was scored, and data were extracted from the published reports. Pooled prevalence was estimated using the fixed-effects model. Publication bias was evaluated using Egger’s test and visual inspection of the symmetry in funnel plots.ResultsFifty studies conducted in 19 states of India estimated the prevalence of IA and the overall prevalence of IA as 19.9% (95% CI: 19.3% to 20.5%) and 40.7% (95% CI: 38.7% to 42.8%) based on the Y-IAT cut-off scores of 50 and 40, respectively. The estimated prevalence of severe IA was significantly higher in the Y-IAT cut-off points of 70 than 80 (12.7% (95% CI: 11.2% to 14.3%) vs 4.6% (95% CI: 4.1% to 5.2%)). The sampling method and quality of included studies had a significant effect on the estimation of prevalence in which studies using non-probability sampling and low risk of bias (total quality score ≥7) reported lower prevalence. The overall quality of evidence was rated as ‘moderate’ based on the Grading of Recommendations Assessment, Development and Evaluation criteria.ConclusionsOur nationally representative data suggest that about 20% to 40% of college students in India are at risk for IA. There is a need for further research in the reconsideration of Y-IAT cut-off points among Indian college students.PROSPERO registration numberCRD42020219511.     

Reduced glomerular filtration rate but sustained virologic response in HIV/hepatitis B co-infected individuals on long-term tenofovir

Summary.  Reports have described a decrease in glomerular filtration rate (eGFR) associated with tenofovir disoproxil fumarate (TDF) use in HIV positive individuals. However, no study has examined renal function over a prolonged period in HIV/hepatitis B virus (HBV) co-infected patients. We assessed the long-term durability and toxicity of TDF in a cohort of 39 e antigen (eAg) positive co-infected patients commenced on TDF 245 mg daily either in addition to or as part of standard antiretroviral therapy. Immunological and virological parameters were followed to 260 weeks, with the median follow-up period being 251 weeks (range 69–290 weeks). eGFR was calculated using the Modification in Diet in Renal Disease equation. On treatment at 260 weeks, 88% (14/16) had HIV viral load <50 copies/mL, median CD4 count rose from 318 to 532 cells/mm³, median alanine aminotransferase (ALT) fell from 61 IU/L to 42 IU/L, with 35% (7/20) having a normal ALT, median HBV DNA fell from 69 × 10⁶ copies/mL to 500 copies/mL, with 75% (12/16) having an undetectable HBV DNA level and 55% (6/11) becoming eAg negative. Of those with detectable HBV DNA, none had TDF resistance mutations. The eGFR declined by 22.19 mL/min/1.73 mm² from baseline ( P  =   0.023) over this period, which was unaffected by protease inhibitor use, baseline CD4 count, ALT or HBV DNA level. Three patients discontinued TDF therapy due to renal dysfunction. In conclusion, TDF has sustained efficacy but is associated with a significant decline in eGFR. Further larger studies are required to clarify this observation.     

Angioneurotic edema with risperidone: a case report and review of literature

Angioedema is characterised by oedema of the deep dermal and subcutaneous tissues and is reported as a rare adverse cutaneous reaction with risperidone, clozapine, ziprasidone, droperidol and chlorpromazine. Here we report a case of angioedema with risperidone. A 15-year-old boy diagnosed with schizophrenia was started on risperidone 1 mg/day, which was increased to 2 mg/day after 2 weeks. Within a week of increasing risperidone, he developed swelling over the face and feet. On examination he was found to have periorbital oedema and swollen lips. Following this, risperidone was stopped. Over the period of 1 week his oedema subsided, following which he was started on Haloperidol 5 mg/day, with which his psychosis improved significantly.     

Midline suboccipital burr hole for posterior fossa craniotomy

Background

Posterior fossa craniotomy is generally done starting with two lateral burr holes. Single midline burr hole is often avoided for the fear of injury to the venous sinuses. In this paper, we retrospectively evaluated the risk of dural tear or venous sinus injury with the latter approach.

Methods

Patients who had a posterior fossa craniotomy at the Children’s Hospital of Michigan between 2003 and 2009 were analyzed. Seventy-one patients had been operated for a posterior fossa lesion, and 154 had a Chiari I decompression. Suboccipital craniotomy was performed utilizing a starting midline suboccipital burr hole. The craniotomy was completed using Midas Rex with B1 foot plate starting laterally from the burr hole and then over to the foramen magnum including the foramen magnum lip. In patients who had a tumor resection, the bone flap was replaced and secured with plates on both sides.

Results

One patient had a dural tear along the inferior aspect of the craniotomy not extending into the foramen magnum. There was no instance of venous sinus injury or undue bleeding from the burr hole. None of the patients had an infection requiring removal of the bone flap.

Conclusion

This paper confirms the safety of utilizing midline burr hole for starting a posterior fossa craniotomy.     

The mannose-binding lectin (MBL2) haplotype and breast cancer: an association study in African-American and Caucasian women

Common genetic variants in cancer-related genes contribute to breast cancer. The innate immune system plays a crucial role in the immune surveillance against malignancies, thus it is plausible that genetic variations in key genes of the innate immunity such as the mannose-binding lectin (MBL), MBL2, could influence the risk for breast cancer. We investigated the association of MBL2 genotypes with breast cancer and conducted a comprehensive genotype and haplotype analysis of 26 MBL2 single nucleotide polymorphisms (SNPs) in a case-control study of breast cancer [166 African-American (AA) case patients versus 180 controls and 127 Caucasian (CAU) case patients versus 137 controls]. We observed that the A allele of the 3'-UTR SNP Ex4-1067 (NCBI SNP ID: rs10824792) was significantly associated with a decreased disease risk in AA women [odds ratio (OR) = 0.47, 95% confidence interval (CI) = 0.27-0.81]. Haplotype analysis of MBL2 showed that the frequency of the corresponding 3' haplotype TATAAC (Ex4-1483, Ex4-1067, Ex4-1047, Ex4-901, Ex4-710, 3238bp 3' STP) was lower in cases than controls among AA women (0.15 versus 0.21; P = 0.02) suggesting a protective effect after adjusting for covariates (OR = 0.51, 95% CI = 0.29-0.88, P = 0.018). In conclusion, this study presents preliminary evidence that common genetic variants in the 3'-UTR of MBL2 might influence the risk for breast cancer in AA women, probably in interaction with the 5' secretor haplotypes that are associated with high concentrations of MBL.     

Cognitive-behavioral therapy to prevent relapse in pediatric responders to pharmacotherapy for major depressive disorder

ObjectiveWe present results of a feasibility test of a sequential treatment strategy using continuation phase cognitive-behavioral therapy (CBT) to prevent relapse in youths with major depressive disorder (MDD) who have responded to acute phase pharmacotherapy. Method: Forty-six youths (ages 11-18 years) who had responded to 12 weeks of treatment with fluoxetine were randomized to receive either 6 months of continued antidepressant medication management (MM) or antidepressant MM plus relapse prevention CBT (MM+CBT). Primary outcome was time to relapse, defined as a Childhood Depression Rating Scale-Revised score of 40 or higher and 2 weeks of symptom worsening or clinical deterioration warranting alteration of treatment to prevent full relapse.ResultsCox proportional hazards regression, adjusting for depression severity at randomization and for the hazard of relapsing by age across the trial, revealed that participants in the MM treatment group had a significantly greater risk for relapse than those in the MM+CBT treatment group (hazard ratio = 8.80; 95% confidence interval 1.01-76.89; X² = 3.86, p = .049) during 6 months of continuation treatment. In addition, patient satisfaction was significantly higher in the MM+CBT group. No differences were found between the two treatment groups on attrition rate, serious adverse events, and overall global functioning.ConclusionsThese preliminary results suggest that continuation phase CBT reduces the risk for relapse by eightfold compared with pharmacotherapy responders who received antidepressant medication alone during the 6-month continuation phase. J. Am. Acad. Child Adolesc. Psychiatry, 2008;47(12): 1395–1404.