Search

Sepsis is the most feared complications of chemotherapy-induced cytopenias and the main cause of early mortality in patients with hematological malignancies. Neutrophils and platelets play critical roles in the host response to sepsis: on the one hand, they contribute to pathogen removal; on the other hand, they contribute to tissue damage ascellular players of immunothrombosis. The association of neutropenia with mortality in critically-ill cancer patients is not a consistent finding, andremainscontroversial in the literature. In addition, given the critical role of neutrophils and platelets for sepsis-associated organ damage, the mechanisms that mediate sepsis-related tissue damage in post-chemotherapy severe febrile neutropenia (FN) have not been elucidated. Here we explored the association of neutrophil and platelet counts, and of the neutrophil:platelet ratio (NPR) in the first 48 hs after FN, with sepsis complications. Patients were retrospectively identified using the database of CBC results from an academic hospital. Selection criteria was an absolute neutrophil count (ANC) < 500/mL at any time during admission, from 2018 to 2021. The study population was then filtered using administrative and clinical data, to obtain a cohort of patients with hematological malignancies who developed chemotherapy-associated FN. Clinical and laboratory data were obtained from the electronic health records. The study population consisted of 111 consecutive in-patients with severe neutropenia and fever. Median age was 50.1, and 46.9% had a diagnosis of acute leukemia. Mean neutrophil and platelet counts at the time of FN onset were 129 ± 175/mL and 51.2 ± 78.2 *109/mL, respectively. Mean variation (D) in cell counts in the first 48 hs after FN onset was -14 ± 183 neutrophils/mL and 0.7 ± 104.9*109 platelets/mL. Sepsis-related 30-day mortality (primary outcome) occurred in 19/111 patients (17.1%), with 30/111 (27.0%) and 26/111 (23.4.5%) developing septic shock or requiring mechanical ventilation, respectively. ANC at fever onset was lower in patients who later died from sepsis (p = 0.005), while platelet counts were lower in the same group, 48 hours after fever onset (p = 0.027). Median NPR followed different trajectories according to mortality, oscillating from 1.32 to 1.12 among survivors (p = 0.39), and increasing from 0.62 to 3.3 among non-survivors (p = 0.012). This increase was mainly due to a significant rise in ANC from 23/mL at FN onset to 99/mL 48h thereafter (p = 0.008), compared to an oscillation from 152/mL to 120/mL in surviving patients in the same period. Platelet counts remained stable in this time window in both subroups. In multivariate analysis, qSOFA and D ANC in the first 48h were independently associated with 30-day sepsis-related mortality. D ANC was also independently associated with the need for mechanical ventilation. Our results suggest that despite a marked reduction of ANC in patients with hematological malignancies and chemotherapy-induced FN, higher neutrophil counts in the immediate hours after fever is associated with a worse prognosis. Additional studies are warranted to address whether neutrophils and platelets contribute to sepsis-related tissue damage in these patients, as shown in non-neutropenic sepsis.

Pacientes com neutropenia febril (NF) secundária à quimioterapia, com contagem de neutrófilos e plaquetas frequentemente em torno de zero, desenvolvem complicações como sepse e choque séptico. Desenvolver modelos baseados em Redes Neurais Artificiais (RNA) para a predição do desfecho baseado em variáveis clínicas e laboratoriais em pacientes com NF e sepse. O estudo foi baseado numa análise retrospectiva de dados de uma coorte de pacientes com neoplasias hematológicas em tratamento antineoplásico assistidos no Hemocentro e Hospital das Clínicas da Unicamp. Dados extraídos, no período de 2018 e 2021, do sistema informatizado da instituição (AGHuse) permitiram a seleção de pacientes sob contagem de neutrófilos < 1,000 /mm3 e temperatura ≥ 37,5 °C, e que necessitaram de internação por NF. Dados clínicos e laboratoriais foram avaliados através da Análise de Componentes Principais (ACP) e a identificação de 16 fatores significativos foram empregados na Inteligência Artificial do tipo Rede Neural (RNA) para a predição da mortalidade nos trinta dias seguintes a internação na UTI. A RNA foi desenvolvida usando o software Matlab, com scripts personalizados. Dados de 108 pacientes com idade média de 50,2 (40,0-60,0) anos e majoritariamente do sexo feminino (53:55) foram incluídos ao estudo. Da ACP, os fatores foram divididos de acordo com as componentes principais (CP): na 1ªCP os fatores significativos foram a contagem de neutrófilos; o número mais baixo de neutrófilos; os neutrófilos segmentados e a contagem de plaquetas. Na 2ªCP, os fatores foram o Índice de Comorbidade de Charlson (ICC); a contagem de células brancas e vermelhas; linfócitos e monócitos. E, na 3ª CP observamos a idade do paciente e comorbidades como a hipertensão arterial e dislipidemia. Nas CPs restantes, foi considerado VCM (volume globular médio); escala ECOG (Eastern Cooperative Oncology Group); foco de infecção no trato gastrointestinal e o sexo do paciente. Esses fatores contribuíram com 75% de influência na mortalidade. Ainda, foi desenvolvido uma RNA com uma camada oculta com cinco neurônios nela. Ela foi capaz de predizer com uma acurácia de 97% a mortalidade dos pacientes trinta dias após a internação. O desenvolvimento de um modelo preditivo baseado em RNA para a mortalidade em pacientes com NF e sepse é uma contribuição inédita que visa a melhoria do manejo clínico. A acurácia de 97% obtida pelo modelo sugere um potencial elevado para a aplicação prática, permitindo que os profissionais de saúde identifiquem precocemente os pacientes com maior risco de mortalidade e implementem intervenções preventivas focadas e mais eficazes. A divisão dos dados em 33% para treino, teste e validação reduz o risco de overfitting e assegura maior generalização dos resultados. Apesar disso, a RNA desenvolvida neste estudo é limitada pela natureza retrospectiva dos dados e pelo baixo número amostral. Estudos futuros são necessários para validações externas em coortes maiores e mais diversificadas, além de considerar a integração de novas variáveis que possam emergir. A utilização de Inteligência Artificial em coorte de pacientes NF e sepse nos permitiu a identificação de fatores preditivos de desfecho clínicos e os resultados promissores destacam o potencial das RNA na melhoria do manejo clínico de pacientes vulneráveis.

Objetivo: Analisar o perfil clínico-epidemiológico dos pacientes com Trombocitopenia Imune Primária (PTI) e propostas terapêuticas adotadas no Hospital Universitário do Piauí (HU-UFPI). Materiais e métodos: Foi realizado um estudo observacional, transversal, retrospectivo com abordagem qualitativa e quantitativa, no qual foram coletados dados em prontuários médicos do HU-UFPI de todos os pacientes que tiveram diagnóstico de PTI com contagem plaquetária < 100 × 109/L durante a internação respeitando os critérios de inclusão e exclusão. Resultados: Da amostra total de 114 prontuários analisados, observou-se a predominância de adultos (≤ 40 anos) em 62,3% (n = 71), do gênero feminino de 66,7% (n = 76), da raça parda com 86% (n = 98), de outras cidades do estado do Piauí advinham 63,2% (n = 72). Quando avaliado o perfil dos pacientes ao diagnóstico e terapias instituídas, 98,2% (n = 112) apresentavam o critério de Plaquetas < 30000 (indicação de tratamento medicamentoso), 44,7% (n = 51) apresentavam sangramentos ao diagnóstico, 39,3% (n = 44) responderam a terapia de primeira linha isolada (corticoterapia), 75% (n = 51) dos não respondedores foram encaminhados para esplenectomia, nestes a resposta a terapia foi de 84,3% (n = 33). Os que realizaram Imunoglobulina Humana para melhor “status plaquetário”pré-operatório, 52,7% (n = 10) não responderam. Discussão: A avaliação epidemiológica de raça e gênero foram em consonância com literatura em geral, no entanto, da idade, a tendência atual de aumento de incidência em idosos, não foi vista neste estudo. Da análise clínica, as taxas de sangramento relatadas são variáveis, dependendo da população, da definição de sangramento e dos métodos de notificação, quando considerado sangramentos leves os estudos são compatíveis com a amostra deste estudo. Pouco mais de 1/3 dos pacientes tiveram resposta sustentada a Corticoterapia, mostrando melhor resposta a literatura. E a esplenectomia se mostrou uma boa opção como terapia de segunda linha, porém este benefício potencial deve ser equilibrado com o risco cirúrgico e risco aumentado a longo prazo de infecção/sepse e trombose, especialmente acidente vascular cerebral. Na análise do uso de imunoglobulina humana como terapia alça para esplenectomia, cerca de metade dos pacientes com terapia recomendada não responderam e em estudos anteriores a resposta é em média 75%. Conclusão: As descrições e resultados do estudo poderão contribuir para uma melhor abordagem terapêutica e de seguimento dos pacientes com diagnóstico de PTI no HU-UFPI.

O linfoma linfoplasmocítico é uma neoplasia de células B pequenas, linfócitos plasmocitoides e plasmócitos, que envolve a medula óssea e, por vezes, os linfonodos, não fechando critério para nenhuma outra neoplasia de linfócitos B pequenos. Trata-se de um linfoma não-Hodgkin de baixo grau que possui características de doença linfoproliferativa e/ou neoplasia de plasmócitos. Alguns sinais e sintomas como perda de peso, febre, sudorese noturna, anemia, esplenomegalia e aumento de tamanho dos linfonodos assemelham-se aos dos pacientes que desenvolvem outros tipos de linfoma não-Hodgkin. Em poucos casos, a produção anormal de IgM pelas células neoplásicas pode levar à ocorrência da macroglobulinemia de Waldenström. O número de hemocomponentes eleva-se na circulação resultando na síndrome de hiperviscosidade cujas complicações incluem o sangramento de mucosas, déficit neurológico e alterações visuais. Este relatório apresenta o caso raro de um paciente diagnosticado com linfoma linfoplasmocítico à partir do desenvolvimento da síndrome de hiperviscosidade. Homem negro, com 30 anos, compareceu ao atendimento clínico do nosso projeto de extensão universitária em onco-hematologia (nº 2023/1699, PROEC-UNESP, COB/FOA-UNESP e CTO/Sta. Casa de Araçatuba) para o diagnóstico de um sangramento intenso e generalizado do tecido gengival que apresentava dois meses de evolução. Durante a anamnese, o paciente relatou ser ex-tabagista e alcoolista e queixou-se de cefaleia, dor nas pernas e redução da capacidade visual e auditiva. O paciente apresentou significativo déficit cognitivo na entrevista e precisou do auxílio de sua esposa para responder aos questionamentos. As alterações visuais e auditivas foram confirmadas no exame físico. No exame intrabucal, notou-se hiperplasia gengival generalizada com áreas hemorrágicas e formação de coágulos sanguíneos em ambos os arcos dentários. Os achados clínicos foram consistentes com síndrome de hiperviscosidade secundária ao desenvolvimento de uma neoplasia onco-hematológica. Assim, a biópsia da medula óssea foi realizada. No entanto, foi inconclusiva. A fenotipagem revelou doença linfoproliferativa crônica B (DLPC-B) CD5neg com as reações imunofenotípicas negativas para CD3, CD5, CD10 e CD23 e positivas para CD19, CD20, CD38, CD43+, CD79b+ e CD200. Estes resultados levaram ao diagnóstico de linfoma linfoplasmocítico. Os exames complementares de imagem demonstraram hepatoesplenomegalia homogênea e descartaram a ocorrência de massas nodais e/ou extranodais. Os níveis de IgM foram mensurados no soro e o valor alto obtido (1230 mg/dL) foi relacionado à macroglobulinemia de Waldenström, a qual resultou na síndrome de hiperviscosidade. Após o diagnóstico da doença linfoproliferativa (estágio IVB), o paciente foi internado devido à piora do sangramento gengival, do déficit visual e auditivo e para início do tratamento onco-hematológico. O paciente foi submetido ao protocolo com rituximab, ciclofosfamida, doxorrubicina, vincristina e prednisona (R-CHOP) e, após seis ciclos de quimioterapia, apresentou remissão dos sinais e sintomas relacionados à síndrome de viscosidade e da atividade da doença linfoproliferativa. Atualmente, segue em acompanhamento pelas equipes interdisciplinares do COB e do CTO.

O linfoma de células do manto (LCM) é uma neoplasia maligna caracterizada pela proliferação de células B maduras na medula óssea, tecidos linfóides e/ou em sítios extranodais. O LCM representa apenas 2-10% de todos os linfomas não-Hodgkin e é frequentemente diagnosticado em homens idosos. Geralmente os pacientes desenvolvem linfadenopatias como principal sinal da doença. No entanto, também pode ocorrer perda de peso, febre persistente, sudorese noturna, fraqueza e hepatoesplenomegalia. Este relatório apresenta o caso de um paciente diagnosticado com recidiva do LCM no Ambulatório do Centro Tratamento Oncológico (CTO/Sta. Casa de Araçatuba) pela equipe do nosso projeto de extensão universitária em onco-hematologia (nº2023/09, PROEC-UNESP, COB/FOA-UNESP). Homem branco, com 64 anos de idade, foi encaminhado para avaliação de uma extensa lesão em orofaringe com três meses de evolução. Durante a anamnese relatou ser ex-fumante e ex-alcoolista. Em seu histórico médico, o paciente apresentou LCM (estágio IIB) com manifestação da doença em nasofaringe há quatro anos e foi submetido à quimioterapia convencional para controle. O paciente obteve a remissão completa do LCM após tratamento e foi mantido em monitoramento oncológico. Na entrevista, queixou-se de cansaço ao menor esforço, lacrimejamento no olho esquerdo e perda auditiva do ouvido esquerdo. O exame físico intrabucal revelou uma tumefação com coloração arroxeada no palato mole à esquerda. A lesão apresentava consistência fibroelástica e estendia-se inferiormente para o arco palatoglosso. Com a hipótese de recidiva do LCM, foi realizada a biópsia incisional da lesão em orofaringe. O exame anatomopatológico revelou infiltrado de células linfóides com núcleo apresentando endentações e nucléolo excêntrico. As reações imunohistoquímicas foram negativas para CD3 (policlonal) e positivas para CD20 (clone: L26), Ciclina D1 (clone: EP12), CD5 (clone: 4C7) e Ki-67 (clone: MIB-1). Estes resultados levaram ao diagnóstico da variante pleomórfica do LCM. Assim, a Tomografia por Emissão de Pósitrons associada à Tomografia Computadorizada (PET/CT) foi solicitada para avaliação da extensão da doença. Os achados mostraram imagens com densidades de partes moles na região palatina esquerda medindo 5,66 × 4,00 cm em seus maiores eixos estendendo-se superiormente à base da língua e medialmente ao espaço nasofaríngeo. Linfadenopatias cervicais foram observadas nas cadeias cervicais IIA, III e IV à esquerda. Todos os achados foram compatíveis com a doença linfoproliferativa em atividade. Após o diagnóstico, o paciente foi submetido à quimioterapia seguida de radioterapia local para o tratamento da lesão palatina. O PET/CT revelou a regressão completa da lesão em orofaringe e também demonstrou remissão das linfadenopatias cervicais. O paciente recuperou a capacidade auditiva e relatou interrupção do lacrimejamento do olho esquerdo. Atualmente, segue em monitoramento pelas equipes interdisciplinares do COB e do CTO.

Vildagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor is effective in reducing HbA1c levels in patients with type 2 diabetes (T2DM) when administered as monotherapy, dual or triple combination therapy. In India, Vildagliptin is commonly prescribed in T2DM patients because it reduces mean amplitude of glycemic excursion (MAGE), has lower risk of hypoglycemia and is weight neutral. Early combination therapy with vildagliptin and metformin is effective and well-tolerated in patients with T2DM, regardless of age or ethnicity. In view of already existing data on vildagliptin and the latest emerging clinical evidence, a group of endocrinologists, diabetologists and cardiologists convened for an expert group meeting to discuss the role and various combinations of vildagliptin in T2DM management. This practical document aims to guide Physicians and Specialists regarding the different available strengths and formulations of vildagliptin for the initiation and intensification of T2DM therapy.

This study aimed to observe the lingual morphology of the domesticated Asian small-clawed otter, Aonyx cinereus (A. cinereus), from Yogyakarta, Indonesia. Six domesticated A. cinereus adults were obtained from a local otter breeder in Yogyakarta, without regard to gender. The animals were acclimated to the laboratory for one day, followed by macroscopy identification and scanning electron microscopy (SEM) and light microscopy (LM) analysis. Macroscopically, the tongue of domesticated A. cinereus is divided into three parts: the apex, corpus and radix. The apex is the shortest part and can move freely. A median groove is bent along the corpus. Typically, the radix contains circumvallate papillae and the valleculae epiglottis. SEM and LM observations revealed that the lingual morphology of A. cinereus consisted of two types of papillae: mechanic papillae (horny filiform, leaf-like filiform, bifid filiform, trifid filiform, elongated leaf-like filiform, triangular filiform and conical papillae) and gustatory papillae (fungiform and circumvallate papillae). The lingual glands consists of Weber's glands and von Ebner's glands, which secrete acid and neutral mucins. Collagen fibre is found in the lamina propria and muscular layer. In conclusion, the papillae of the Asian short-clawed otter have the same structure as those of other Mustelidae family members.

Linfomas de Hodgkin são neoplasias onco-hematológicas, que podem ser classificadas em dois tipos: Linfoma de Hodgkin com predomínio linfocitário nodular e linfoma de Hodgkin clássico (LHC). Na maioria dos casos, os pacientes com linfomas de Hodgkin são diagnosticados a partir de manifestações nodais, como linfonodomegalias. Outros sintomas comuns incluem sudorese, febre e emagrecimento, também chamados de sintomas B. Este relatório apresenta o caso raro de um paciente diagnosticado com LHC a partir de extensa lesão primária da doença em orofaringe. Homem branco, com 58 anos, compareceu ao atendimento clínico do nosso projeto de extensão universitária em onco-hematologia (nº 2023/1699, PROEC-UNESP, COB/FOA-UNESP e CTO/Sta. Casa de Araçatuba) para o diagnóstico de uma lesão em orofaringe com cerca de três meses de evolução. Durante a anamnese, o paciente negou vícios e comorbidades. No entanto, relatou fraqueza, indisposição e disfagia no momento da consulta. No exame intrabucal, foi observado nódulo ulcerado em tonsila palatina esquerda estendendo para os arcos palatoglosso e palatofaríngeo, medindo aproximadamente 4 cm em seu maior diâmetro. Com a hipótese de neoplasia maligna linfoproliferativa, foi realizada biópsia incisional. O exame anatomopatológico revelou infiltrado de células linfoides grandes e atípicas. As reações imuno-histoquímicas foram negativas para CD3 (RBT-CD3), CD20 (L26) e CD246 (ALK1) e positivas para CD30 (Ber-H2), CD15 (Carb-3), PAX5 (DAK-Pax5) e LMP1, oncoproteína do vírus Epstein-Barr (EBV). Os resultados levaram ao diagnóstico de LHC. Exames complementares descartaram outros sítios da doença em um primeiro momento. Antes de iniciar o tratamento, lesões nodais se desenvolveram no pescoço. No exame extrabucal, extensas tumefações bilaterais, endurecidas e dolorosas à palpação, foram identificadas envolvendo toda região cervical alta, média e baixa. Além disso, observou-se um linfonodo aumentado e dolorido à palpação na região supraclavicular esquerda, medindo cerca de 1,5 cm no seu maior diâmetro. A tomografia computadorizada cervical mostrou formações expansivas na região de orofaringe associadas à linfonodomegalias coalescentes. Após avaliação dos exames complementares, o LHC foi estadiado como IIB e o paciente iniciará o tratamento onco-hematológico. O paciente será submetido inicialmente ao protocolo quimioterápico com doxorrubicina, bleomicina, vimblastina e dacarbazina (ABVD), e acompanhado pelas equipes interdisciplinares do COB e do CTO.

Chronic Obstructive Pulmonary Disease (COPD), a progressive disease of the airways is associated with chronic inflammation of respiratory passages that leads to irreversible lung dysfunction and distinct morphological changes. The progressive increase in airflow limitation that is seen in COPD is associated with systemic inflammation with the development of extra-pulmonary complications like muscle atrophy, cachexia and osteoporosis. Several biomarkers like C-Reactive Protein (CRP), fibrinogen and Interleukin have been used as an adjunct tool to diagnose COPD. Soluble Urokinase Plasminogen Activator Receptor (suPAR) has been used as a diagnostic marker for congestive heart failure, sepsis, adult respiratory distress syndrome and acute exacerbation COPD. The present narrative review gives a brief overview on clinical significance of suPAR in the diagnosis and prognosis of COPD. The articles quoted in this review were taken from search engines like PubMed Central, Crossref, Web of Science and Google Scholar for articles published from 1991 to 2016, by using domain words like “COPD”, “suPAR”, “inflammation” and “prognosis”. The relevant references cited in these articles were also reviewed.

Background and Objective: Smoking is one of the important risk factors for many diseases and increases the premature death.Transtheoretical models is one of the behavioral models for behavior understanding specifically in addictive behaviors. This study was done to evaluate the application of transtheoretical model to determination of smoking behavior among smokers. Methods: This descriptive - analytical study conducted on 450 male smokers in Gorgan, northern Iran during 2014. Data gathering instruments were Diclemente smoking stages of change, Velicer decisional balance and temptation, Prochaska processes of change measurements along Fagerstrom test for nicotine dependency. Results: Based on the stages of changes, 39.1%, 13.8%, 42.4%, 2.7% and 2% of subjects were in precontemplation, contemplation, preparation, action and maintenance stage, respectively. There was a significant relationship between stages of change with all transtheoretical model variables and nicotine dependency (P

Abstract Introduction: Professional duties are regarded as a base for developing the curriculum in a new course. The purpose of this study is to determine the professional duties of postgraduates of family health major according to the viewpoints of stakeholders. Methods: In this cross sectional study, five type one universities (high quality universities) and four type two and three universities were randomly selected using Delphi technique. The participants were directors of health departments, the vice chancellor of public health authorities, the assistance and managers of health and treatment networks, the employees of family health units, and also public health undergraduate students. We developed a questionnaire to gather data. The questionnaire consisted of an open ended and some demographic questions. Data was analyzed using the content analysis technique. In this case duties were defined. Then they were prioritized and finalized in a focus group. Results: In the first step of Delphi 190 duties were extracted. Then we classified them, based on priority in the second Delphi, into 102 duties. Finally 16 items were grouped under the domain of providing services to families, 35 items were in the domain of planning, 50 items were in the domain of supervision, 5 items were in the domain of research, 13 items were in the domain of management, and 28 items in the domain of education. Conclusion: In order to plan for the education of required family health experts there is a need to define the duties of family health postgraduates. The results of this study can be used in the planning of the curriculum of this major.

Background: Silymarin, extracted from the seeds of milk thistle (Silybum marianum (L.) Gaertn) is mostly used for liver disease treatment. Hairy root cultures derived from S. marianum are able to produce silymarin. Objective: Elicitation of hairy root cultures is an important strategy for improving the production of secondary metabolites. The elicitors could be changed metabolite biosynthesis pathway and are useful for study of cell signaling pathway. Methods: In this study after preparation of S. marianum hairy root cultures, the effects of various levels of Fusarium oxysprum and Phytophtora meloni extract (0, 10 and 20 mg 50 ml-1 culture) in 4 different exposure times (0, 24, 48 and 72 h) have been investigated on flavonolignans production. The flavonolignans were analyzed by High Performance Liquid Chromatography method. Results: Our results showed that hairy root cultures of S. marianum were consisted of a large number of flavonolignans including silychristin, silydianin, silybin, isosilybin and taxifolin. The highest production of silymarin (0.32 mg g-1 DW) was observed in F. oxysprum elicited root cultures (10 mg/50 ml culture) after 72h (2.28- fold that of the control). In Ph. meloni treated root cultures (20 mg/50 ml culture), the maximum silymarin production (0.13 mg g-1 DW) was obtained after 72 h (1.9- fold that of the control). Conclusion: In this experiment it has been concluded that hairy root cultures of S. marianum are susceptible to elicitation by fungal elicitors and is useful for efficient large-scale production of silymarin by hairy root cultures of S. marianum.

Introduction: The pituitary gland is also called the master gland of the body and its tumours represent 10- 15% of all intracranial tumors, with an annual incidence of 0.2-2.8 cases per 100,000 persons.Most are benign adenomas arising from the anterior pituitary (adenohypophysis), and most commonly present due to hormonal effects(includes hyperprolactinomia,Cushings Syndrome, acromegaly..),mass effect, as an incidental finding or infrequently with pituitary apoplexy. Objective: To describe the features of the patients with pituitary adenoma, different surgical approaches, and its outcome. Methodology: This is a prospective study of data of all patients operated from 2013 to 2015(3 years).The demographic factors of age, sex is studied along with the the size of adenoma, clinical symptoms before and after surgery, type of surgery, complications and final outcome. Result: The total number of cases was 18, with predominantly males (10 cases) than females (8 cases).The most common mode of presentation was with headache in 7 cases (39%), followed by visual changes in 6(33%). Hormonal changes was found in 10(56%) with pituitary apoplexy in 4 cases (22%). Tumour resection was complete in 92% of the cases and subtotal in the rest. There were no mortalities. Conclusion: Sublabial transphenoidal surgery is a effictive technique with low procedure related morbidity.

Background & aim: Increase of metabolism and production of free radicals during physical activity may lead to several diseases by creating the oxidative stress in the body. The aim of this study was to investigate the oxidative stress index and total antioxidant capacity among athletic and non athletic females. Methods: Subjects of this descriptive - analytical study were 15 healthy female athletes playing handball who regularly had at least 3 training sessions per week, from 6 months before the study, and 15 healthy non athelete females who in the same period had not participated in regular physical activities.The subjects were of 18 -25 years of age. Levels of oxidative stress index were determined by malondialdehyde (MDA) method. The FRAP (Ferric Reducing antioxidant power) method was used to determine the levels of serum total antioxidant capacity. Statistical analyisis of data was performed in both descriptive and inferential statistics. Data were analyzed by using t-test at P 0.05. Results: The results showed that malondialdehyde (MDA) oxidative stress index of handball's athletic girls is significantly (P< 0.01) lower than the non athletes and total antioxidant capacity of the athletes is higher than non athletes, despite the fact that this difference was not significant. Conclusion: The results indicated that continuous and regular exercise can reduce oxidative stress and provide a more healthy life for the female athletes.

Introduction : Zinc deficiency decreases appetite, stunts the growth and increases incidence of infection and if zinc deficiency persists it may cause short stature and delay in puberty. The aim of this research is to specify the level of serum zinc in children with growth disorder and weight gaining. Methods : This cross sectional descriptive study was done on 460 children under 5 years who were underweight. After doing necessary examinations and recording the information, 5 cc of blood was drawn from children. The samples were sent to the chemistry college of S&B university and serum zinc levels were measured by spectrometry method of atomic absorption. The obtained information was analyzed using SPSS software and Fisher test. Results : In this research on 460 children, 232 (50.43%) were boys and 228 (49.56 %) were girls. The average age was 2.5 years. Zinc deficiency was confirmed in 89.3 % of children who had mild malnutrition and all of children who had moderate or severe malnutrition had zinc deficiency. Conclusion : This research indicated that serum zinc levels in most of children with malnutrition was less than standard , and the more severe the malnutrition, the lower the serum zinc levels will be. 100% of the girls and 85.77% of the boys had zinc deficiency.

Central nervous system (CNS) infections are a rare complication of epidural steroid injections and without strong clinical suspicion, fungal organisms may be overlooked among the long differential of causes of meningitis. Rare sequela of fungal meningitis is the development of stroke. To our knowledge, we present the first case of post epidural steroid injection (ESI) fungal meningitis leading to a basilar artery stroke, otherwise known as “top of the basilar” syndrome. We present a 49-year-old female with a history of ESIs who presented to the emergency department with headache, neck stiffness, and abdominal pain. She was discharged after her labs and symptoms were deemed inconsistent with meningitis. She was eventually admitted and twelve days after her original ED visit, she was diagnosed with meningitis and started on anti-fungal treatment. She was discharged 88 days later but was readmitted due to left sided weakness and mental status changes. She quickly lost motor and bulbar functions. An MRA showed diminished distal flow through the basilar artery, suggesting near complete occlusion. Although appropriate long term anti-fungal treatment was started, the patient still succumbed to a rare vascular event. Physicians who are treating patients for ESI meningitis should be aware of the potential for vasculitic and encephalitic complications.

Recent epidemiological and laboratory-based studies suggest that the anti-diabetic drug metformin prevents cancer progression. How metformin diminishes tumor growth is not fully understood. In this study, we report that in human cancer cells, metformin inhibits mitochondrial complex I (NADH dehydrogenase) activity and cellular respiration. Metformin inhibited cellular proliferation in the presence of glucose, but induced cell death upon glucose deprivation, indicating that cancer cells rely exclusively on glycolysis for survival in the presence of metformin. Metformin also reduced hypoxic activation of hypoxia-inducible factor 1 (HIF-1). All of these effects of metformin were reversed when the metformin-resistant Saccharomyces cerevisiae NADH dehydrogenase NDI1 was overexpressed. In vivo, the administration of metformin to mice inhibited the growth of control human cancer cells but not those expressing NDI1. Thus, we have demonstrated that metformin's inhibitory effects on cancer progression are cancer cell autonomous and depend on its ability to inhibit mitochondrial complex I.

NA

Posterior fossa extradural haematoma is known for the vague signs and symptoms and a notorious course that varies from recovery to sudden death. The incidence of posterior fossa epidural hematomas among intracranial epidural hematomas has been reported from 4% to 7%. Subsequently, PFEDH with low GCS or the haematoma of more than 10ml were subjected to evacuation. Since the volume of the posterior fossa is limited, patients deteriorate early with the development of obstructive hydrocephalus, which is visible in the CT scan in only thirty percent of cases. A retrospective study of 43 cases was done in this Institute from May 1999 to December 2005. The males (98%) have a clear predominance over female patients (2%). Road traffic accidents accounted for the majority of the cases (80%), fall for the rest (17%) and one case due to a bullhorn injury. Vomiting was the most common symptom accounting for 67% of cases followed by transient loss of consciousness in 48% and headache in 34%. On arrival to the hospital 67% presented with a GCS more than 13, 28% with score of 9-12 and the rest 5% with GCS of less than 8. Out of the total 43 cases of PFEDH surgical evacuation was done in 33(76%) and conservative management in 10 cases (23%). A dichotomised Glasgow outcome score was used to measure the outcome. This was favorable in 27 of the 33 cases operated (81%), and 7 out of the 10 conservatively managed group (70%). Overall favorable outcome was found in 34 cases (79%) with overall mortality of the study being 7%. Key words: extradural, haematoma, posterior fossa, trauma

Arachnoid cysts represent benign cysts that occur in the cerebrospinal axis in relation to the arachnoid membrane and do not communicate with the ventricular system. We report a case of a years right handed lady, who presented to the emergency department with the complaints of headache and vomiting for one week CT scan showed extraaxial cystic lesion in the left fronto-parietal region. On the fifth day of admission, patient had sudden onset of severe headache associated with loss of consciousness for about 3-4 minutes with neck rigidity. A CT scan of head was repeated, which showed left fronto-parietal cystic lesion with intracystic bleed and SAH. Intraoperatively, there was intradural cystic lesion containing xanthochromic fluid with normal brain surface and there were no evidence of any vascular malformations. Marsupilization of the cystic lesion was carried out and she improved. The literature regarding arachnoid cyst with spontaneous intracranial haemorrhage is reviewed. Key word: arachnoid cyst, haemorrhage, intracycstic

Herein we present new occurrences of sites of Dendropsophus minusculus in Brazil adding information about reproductive biology and colour patterns of the species. Such information is fundamental for characterising the species that we believe has been neglected due to its morphological similarity with other congeneric species. Dendropsophus minusculus may be found in different morphoclimatic domains, being one of the most generalist species of the genus in this aspect. The species plasticity is not restricted to its occurrence, but also related to aspects of its reproductive biology, and we hypothesised that the latter feature could explain the wide geographical range of the species. We highlight the importance of further in-depth studies and the use of D. minusculus as a model to understand the historical events responsible for the current geographical distribution of the morphoclimatic domains in Brazil.

Introduction Bronchiolitis poses a significant challenge in pediatric critical care. It is an acute illness affecting the lower respiratory tract in children under the age of two. The most common cause of bronchiolitis is the seasonal respiratory syncytial virus, with influenza and adenovirus also notable contributors. It is characterized by various clinical symptoms and indicators, such as an upper respiratory prodrome, increased respiratory effort, and wheezing in younger children under two years old. This study primarily examines the clinical profile, risk factors, severity, and outcomes of bronchiolitis in children under two years, excluding the neonatal age group.  Materials and methods Children under two years of age who presented with upper respiratory symptoms and their first episode of wheezing were evaluated. Those with pre-existing systemic conditions such as cardiac, respiratory, or immunodeficiency disorders were excluded. A detailed history was gathered using a questionnaire, and risk factors were analyzed. The severity of the condition was measured using the Wood-Downes-Ferres score. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). The relationship between risk factors, severity, and outcomes was examined using the chi-squared test. A two-sided probability of p<0.05 was considered statistically significant for all tests. Results Among 54 children aged 1-24 months with bronchiolitis, the average age was 10.18 months, with a standard deviation of 4.8 months. The severity of the condition was greater in younger children (1-12 months) and tended to decrease with age. Bronchiolitis was more common in males (33 cases) than females (21 cases). Approximately 50 children (92.6%) exhibited signs of respiratory distress, and 45 children (83.3%) showed cough as an initial symptom. Severity was notably higher in children with a history of irritability, which was statistically significant (chi-squared value: 8.169; p-value: 0.017). Only 16 children (29.65%) had a history of poor feeding. Bronchiolitis was more prevalent among infants with a birth weight under 1500 grams (63%). Non-exclusive breastfeeding and early bottle feeding were significant risk factors for bronchiolitis and its severity (chi-squared values: 18.794; p-value: 0.000 and 7.795; p-value: 0.020, respectively). Only two children (3.7%) had been exposed to passive smoke, and the severity was slightly higher in these cases. There was also a statistically significant association between socioeconomic status and bronchiolitis (chi-squared value: 11.917; p-value: 0.018). Conclusion This study aims to raise awareness among parents and clinicians about the high-risk age group for bronchiolitis, its typical presentations, and predictors of severity. It underscores the impact of both biological and environmental risk factors, such as bottle feeding, non-exclusive breastfeeding, and socioeconomic status, on the severity of the condition., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethical Committee (IEC) of Trichy Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Centre issued approval 1136/TSRMMCH&RC/ME-1/2023-IEC No: 170. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, B et al.)

Background: Malnourished pregnant women are at increased risk of micronutrient deficiency. We assessed the vitamin B12 status in both malnourished and normally nourished pregnant women and their neonates. Additionally, we studied the association between maternal B12 levels, cord B12 levels and neonatal anthropometry., Methods: This cross-sectional study enrolled 63 malnourished and 63 normally nourished mothers and neonates. Maternal and cord blood samples were collected at the time of delivery for estimation of vitamin B12 levels. Maternal and cord vitamin B12 levels were compared using the Mann-Whitney U test. Neonatal anthropometry was correlated with maternal and cord B12 levels using Spearman's correlation. Data were analyzed using SPSS version 25., Results: Mean maternal age was 26.58 yrs. The median cord B12 levels were lower than the maternal B12 levels. Maternal B12 levels showed a strong positive correlation with cord B12 levels (rho = 0.879; p < 0.001). Maternal (p < 0.001) and cord (p < 0.001) vitamin B12 levels were significantly lower in the malnourished group than in the normally nourished group. In malnourished group, 66.8% mothers and 95.2% neonates were Vitamin B12 deficient, whereas 1.5% mothers and 4.7% neonates were vitamin B12 deficient in normally nourished group. In the malnourished group, maternal B12 levels were positively correlated with birth weight (rho 0.363, p = 0.003) and length (rho 0.330, p =0.008), whereas cord B12 levels were positively correlated with birth weight in the normally nourished group. (rho 0.277 p= 0.028)., Conclusion: High rates of vitamin B12 deficiency were observed in malnourished mothers and neonates. There was a positive correlation between birth weight, length, and maternal vitamin B12 levels in malnourished mothers. These findings emphasize the need to address maternal malnutrition and vitamin B12 deficiency to improve neonatal health., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 GR S et al.)

The study aims to identify and validate a potential α-Amylase inhibitor from the leaf extract of the Parthenium hysterophorus. Molecular docking and dynamics analyses were performed to test the anti-diabetic efficacy of the compound by focusing on α-Amylase inhibition. The molecular docking study using AutoDock Vina (PyRx) and SeeSAR tools identified β-Sitosterol as an effective α-Amylase inhibitory compound. Among the analysed fifteen phytochemicals, β-Sitosterol demonstrated the most appreciable binding energy (-9.0 Kcal/mol) and is comparatively higher than the binding energy of the standard α-Amylase inhibitor, the Acarbose (-7.6 Kcal/mol). The significance of the interaction between β-Sitosterol and α-Amylase was further investigated using Molecular Dynamics Simulation (MDS) for 100 ns via GROMACS. The data reveals that the compound could exhibit the highest stability with α-Amylase regarding RMSD, RMSF, SASA and Potential Energy analysis. The key residue of α-Amylase (Asp -197) shows a significantly low fluctuation of 0.7 Å while interacting with β-Sitosterol. The data obtained from MDS results strongly suggested the potential inhibitory impact of β-Sitosterol on α-Amylase. In addition, the proposed phytochemical was purified from the leaf extracts of P.hysterophorus using the silica gel column chromatography and identified by GC-MS analysis. The purified β-Sitosterol demonstrated a significant 42.30% in-vitro α-Amylase enzyme inhibition property under 400 µg/ml concentration and thus supported the in-silico predictions. Further in-vivo investigations are necessary to analyse the efficiency of β-Sitosterol on α-Amylase inhibition to help the anti-diabetic potential of the phytocompound.Communicated by Ramaswamy H. Sarma.

Plant-mediated nanoparticle synthesis is a revolutionary technique with numerous applications in fields, such as agriculture, food processing, and medicine. This study reports that Punica granatum leaf extract is capable of the green and eco-friendly synthesis of silica nanoparticles that provides a simple, cost-effective, and efficient methodology. P. granatum leaf extract was employed as a capping and stabilizing agent for the formation of silica nanoparticles, which were synthesized by a biological method using tetra ethyl ortho silicate. Biosynthesized silica nanoparticles are characterized by X-ray diffraction analysis, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and Fourier transform infrared spectroscopy. All the analyses and characterization determined that the particles were spherical in shape and amorphous in nature with an average size of 12 nm. P. granatum-assisted silica nanoparticles were tested for antibacterial activity by a well-diffusion method against two-gram negative bacterial pathogens (E. coli and Salmonella sp.). The antibacterial studies prove that P. granatum-assisted silica nanoparticles have good antibacterial properties. These studies will help us find a new nano-drug or medicine against multidrug-resistant bacteria., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Aim: Melanin has been linked to pathogenesis in several fungi. They often produce melanin-like pigments in the presence of L-dihydroxyphenylalanine (L-DOPA), but this is poorly studied in Candida glabrata . Methods & materials: C. glabrata was grown in minimal medium with or without L-DOPA supplementation and submitted to a chemical treatment with denaturant and hot acid. Results: C. glabrata turned black when grown in the presence of L-DOPA, whereas cells grown without L-DOPA supplementation remained white. Biophysical properties demonstrated that the pigment was melanin. Melanized C. glabrata cells were effectively protected from azoles and amphotericin B, incubation at 42°C and macrophage killing. Conclusion: In the presence of L-DOPA, C. glabrata produces melanin, increases antifungal resistance and enhances host survival.

Drug repurposing is an unconventional drug discovery approach to explore new therapeutic benefits of existing, shelved and the drugs in clinical trials. This approach is currently emerging to overcome the bottleneck constraints faced during traditional drug discovery in grounds of financial support, timeline and resources. In this direction, several efforts were made for the construction of stratagems based on bioinformatics and computational tools to intensify the repurposing process off-late. Further, advanced research has succeeded in widening its boundaries in identification of gene targets and subsequent molecular interactions of the drugs depending on available omics data. Currently, the advent of data repositories like Connectivity Map (CMap), Library Integrated Network based Cellular Signatures (LINCS), Genome Wide Association Studies (GWAS), Side Effect Resource (SIDER), and Directionality Map (DMAP) has bestowed great oppurtunity to the researchers in improving their drug repurposing research exponentially. On the otherhand, in silico approaches like pharmacophore modelling and docking techniques circumvent the routine tedious in vitro and in vivo techniques involved in former screening phases of the drugs and disease specific targets. This review elaborates on currently designed contemporary tools, databases and strategies with relevant case studies., (Copyright © 2018 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Hands basic function is to grasp, hold and manipulate items. Hand gesture is perhaps the most blatant example of non-verbal communication. Finger and partial finger amputations are most frequently encountered forms of partial hand loss. Common causes are traumatic injuries, congenital absence or malformations present great clinical challenges. In addition to immediate loss of grasp strength, finger absence may cause marked psychological trauma. Individuals who desire finger replacement usually have high expectation for the appearance of prosthesis. This clinical report portrays simple method to retain acrylic finger prosthesis.