Search

Background: Antipsychotics are associated with sexual dysfunction. However, studies selectively exploring the sexual impact of atypical antipsychotics in a standardized male population are limited, and further more in the Indian context. Thus, a need was felt to understand, explore and assess the impact of atypical antipsychotics on sexual wellness in a standardized male population suffering from Schizophrenia. Objective: To study the effect of Atypical Antipsychotics on Sexual functions in sexually active male patients of Schizophrenia treated with Atypical Antipsychotics. Materials and Methods: 150 sexually active freshly diagnosed treatment naïve males with Schizophrenia were administered atypical antipsychotics. Their sexual functions were assessed after 1 month using Arizona Sexual Experience Questionnaire (ASEX). Results: Olanzapine, risperidone, and clozapine had maximum incidence of sexual dysfunction (SD) while quetiapine and aripiprazole were having the least. 54% had one or more SD, prominent ones being low sexual desire (54%), dissatisfaction with their sexual drive (41.3%), dissatisfaction with orgasm (39.3%) and inability to reach orgasm (32%). Conclusion: SD rates are higher among patients of Schizophrenia treated with Atypical Antipsychotics. All the domains of sexual functioning are affected. Clinicians should routinely assess the sexual functioning in patients on treatment with antipsychotics and should incorporate sexual health as a dimension in their treatment plan. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE) in pregnancy and resulting thrombotic disorders are increasingly being recognized as an important cause of maternal morbidity and mortality. The diagnosis of VTE during pregnancy has an impact on current as well as future foeto-maternal outcomes. Whereas algorithms to manage VTEs during pregnancy in developed countries exist, these are difficult to implement in resource-constraint settings. In this narrative review, we discuss strategies that can be applied in daily clinical practice by obstetricians and haematologists dealing with these disorders in the country. [ABSTRACT FROM AUTHOR]

Summary: Arsenic trioxide (ATO) and all‐trans retinoic acid (ATRA) form the backbone of the treatment of acute promyelocytic leukaemia (APL), with the addition of chemotherapy for high‐risk patients. We describe our experience of treating patients with APL of all risk classes with ATO and ATRA without chemotherapeutic agents. Patients received induction with ATO and ATRA followed by three cycles of consolidation with ATO and ATRA (each 1 month apart) after achieving morphological remission. Patients with intermediate‐ and high‐risk disease received a further 2 years of maintenance with ATRA, 6‐mercaptopurine and methotrexate. A total of 206 patients were included in the study. The majority of the patients were intermediate risk (51.9%), followed by high risk (43.2%). Differentiation syndrome was seen in 41 patients (19.9%). Overall, 25 patients (12.1%) died within 7 days of initiating therapy. Seven patients relapsed during follow‐up. The mean (SD) estimated 5‐year event‐free survival (EFS) and overall survival (OS) in the entire cohort was 79% [5.8%] and 80% [5.8%] respectively. After excluding patients who died within 7 days of therapy initiation, the mean (SD) estimated 5‐year EFS and OS was 90% [5.8%] and 93% [3.9%] respectively. Our study shows that treatment of all risk classes of APL with ATO and ATRA without chemotherapy is associated with excellent long‐term outcomes in the real‐world setting. [ABSTRACT FROM AUTHOR]

The article focuses on a study which described the safety and efficacy of high-dose hydroxyurea (HDH) for cytoreduction in acute promyelocytic leukemia (APL). Ultra-high-risk patients with APL were analyzed between 2016 and 2021. It was observed that study participants who received HDH has lower early mortality and that none of them developed mucositis. Overall survival of the patients were compared using the Kaplan-Meier technique.

Introduction: The role of pre‐HCT chest high‐resolution computed tomography (HRCT) and serum galactomannan index (GMI) in predicting the post‐allogeneic hematopoietic cell transplant (HCT) invasive pulmonary aspergillosis (IPA) is debatable. Methods: This was a single‐center, prospective study from 2014 to 2019. The primary objective was to study if pre‐HCT chest HRCT and serum GMI predicted IPA post‐HCT. The secondary objective was day +100 mortality. All consecutive, consenting patients of ≥12 years of age undergoing allo‐HCT were included and had pre‐HCT chest HRCT and serum GMI. All patients received mold active antifungal prophylaxis. The EORTC/MSG criteria were used for the diagnosis of IPA. Results: A total of 82 patients with median age 27 years (12‐59 years) were included. The underlying diagnoses included hematological malignancies (79%) and aplastic anemia (21%). Fifteen percent of patients was treated for prior history of probable IPA (>6 weeks before HCT). Pre‐HCT chest HRCT satisfied EORTC clinical criteria in 24% patients. Serum GMI ≥0.5 was seen in 27% of patients. Post‐HCT probable IPA was seen in 24% of patients. There were more patients with pre‐HCT chest HRCT findings satisfying EORTC clinical criteria (45% vs. 18%, P =.014) and GMI ≥0.5 (45% vs. 21%, P =.03) in the group with post‐HCT IPA compared to those without IPA. There was higher day+100 mortality in patients with post‐HCT IPA (55% vs. 18%, P =.001). Conclusions: The presence of EORTC clinical criteria on pre‐HCT chest HRCT, serum GMI ≥0.5, and prior history of IPA predicted post‐HCT IPA. [ABSTRACT FROM AUTHOR]

Acute Promyelocytic Leukemia (APL) is associated with excellent long-term outcomes. However, early mortality due to coagulopathy remains a challenge. In this study we examined the bleeding and thrombotic manifestations, as well as incidence of Early Death secondary to thrombosis/hemorrhage (ED-TH) in patients with APL. Early death (ED) was defined as death occurring within 30 days of induction therapy. Two-hundred forty-eight patients were included in the study. Overall, 57 patients had evidence of a major bleed/thrombosis at presentation or during induction therapy, including 44 patients with a major bleed, 8 patients with thrombosis and 5 patients with both evidence of thrombosis and a major bleed. Forty patients (16.1%) had ED, of which 21 had ED-TH. The cumulative incidence of death due to thrombo-hemorrhagic complications at 30 days was 8.4%. On univariate analysis, increasing Prothrombin time (PT)(p-<0.001), white blood cell count (p < 0.001) and activated Partial thromboplastin time (aPTT) (p < 0.001) were statistically significantly associated with increased risk of ED-TH. However, on multivariate analysis, only increasing PT (p-0.025) and aPTT (p-0.041) were significantly associated with increased risk of ED-TH. • Bleeding/Thrombosis is majorly responsible for early death in Acute Promyelocytic Leukemia (APL). • Factors associated with early death due to bleed/thrombosis (ED) in APL patients were analysed. • Prothrombin Time and activated partial thromboplastin time were associated with increased risk of ED. • Better predictors of ED may help improve outcomes further in patients with APL. [ABSTRACT FROM AUTHOR]

Introduction: The quality of life (QoL) analysis is likely to differ by region, ethnicity, and questionnaires in comparison with age‐matched healthy controls. Methods: The EORTC QLQ‐C30 and QLQ‐CLL17 questionnaire validated in regional languages were administered to 127 consecutive CLL and 100 age‐matched, healthy controls at a single center from 2018 to 2019. Results: All groups of CLL patients either on wait and watch (W&W) or on treatment had significantly impaired QoL in all functional domains including global health compared to controls (P <.0001). CLL patients had significantly higher symptom scores than controls in most domains (P <.0001, 0.03 for diarrhea). There was no difference in the QoL by age or gender. Lower socioeconomic status patients had higher financial difficulty (P =.02). Patients on CIT had the worst global health (OR 12.21 compared to patients on W&W) (P =.03). Patients on ibrutinib had less worries/fears about health and functioning than patients who were on CIT (P =.04). Conclusions: Quality of life is severely affected in CLL patients on W&W. Global health status and worries about future health and functioning were major concerns. Socioeconomic status but not age or gender impacted QoL. Patients on ibrutinib had better QoL than on CIT. [ABSTRACT FROM AUTHOR]

Magnetic skyrmioniums are unique spin structures that can be viewed as two skyrmions with an opposite skyrmion number providing a zero topological charge. Here, we propose a unique method to nucleate magnetic antiskyrmioniums in ferromagnetic materials with D2d symmetry. Using micromagnetic simulations, we show the stabilization of isolated antiskyrmionium from ferromagnetic as well as antiskyrmionic ground states. By invoking material specific parameters, we have established the regions of the stable antiskyrmionium phase and investigated their dynamics under current in-plane as well as perpendicular to plane geometry. Our study shows that antiskyrmioniums can be moved with a large velocity at very small current density in comparison to antiskyrmions and their anisotropic magnetization distribution provides a distinct current driven dynamics in comparison to skyrmioniums. Most importantly, we demonstrate that an antiskyrmionium can be stabilized and switched reversibly from a single antiskyrmion. We have also shown that the antiskyrmionium can be driven efficiently in an anisotropy gradient, where the velocity varies inversely with the damping constant. The present results add a distinct direction to the realization of antiskyrmionium based racetrack devices using D2d symmetry based materials. [ABSTRACT FROM AUTHOR]

The self-assembly and gelation behavior of a series of mono- and disubstituted ferrocene (Fc)-peptide conjugates as a function of ferrocene conformation and amino acid chirality are described. The results reveal that ferrocene-peptide conjugates self-assemble into organogels by controlling the conformation of the central ferrocene core, through inter- versus intramolecular hydrogen bonding in the attached peptide chain(s). The chirality controlled assembling studies showed that two monosubstituted Fc conjugates FcCO- L Fl FlA-OMe and FcCO- L Fl FdA-OMe form gels with nanofibrillar network structures, whereas the other two diastereomers FcCO- D Fl FlA-OMe and FcCO- L Fd FlA-OMe exclusively produced straight nanorods and non-interconnected small fibers, respectively. This suggests the potential tuning of gelation behavior and nanoscale morphology by altering the chirality of constituted amino acids. The current study confirms the profound effect of diastereomerism and no influence of enantiomers on gelation. Correspondingly, the diastereomeric and enantiomeric Fc[CO-FFA-OMe]2 were constructed for the study of chirality-organized structures. [ABSTRACT FROM AUTHOR]

Background & objectives: Both innovator and generic imatinib are approved for the treatment of Chronic Myeloid Leukaemia-Chronic phase (CML-CP). Currently, there are no studies on the feasibility of treatment-free remission (TFR) with generic imatinib. This study attempted to determine the feasibility and efficacy of TFR in patients on generic Imatinib. Methods: In this single-centre prospective Generic Imatinib-Free Trial-in-CML-CP study, twenty six patients on generic imatinib for ≥3 yr and in sustained deep molecular response (BCR ABLIS ≤0.01% for more than two years) were included. After treatment discontinuation, patients were monitored with complete blood count and BCR ABLIS by real-time quantitative PCR monthly for one year and three monthly thereafter. Generic imatinib was restarted at single documented loss of major molecular response (BCR ABLIS>0.1%). Results: At a median follow up of 33 months (interquartile range 18.7-35), 42.3 per cent patients (n=11) continued to be in TFR. Estimated TFR at one year was 44 per cent. All patients restarted on generic imatinib regained major molecular response. On multivariate analysis, attainment of molecularly undetectable leukaemia (>MR5) prior to TFR was predictive of TFR [P=0.022, HR 0.284 (0.096-0.837)]. Interpretation & conclusions: The study adds to the growing literature that generic imatinib is effective and can be safely discontinued in CML-CP patients who are in deep molecular remission. [ABSTRACT FROM AUTHOR]

Organ transplantation is the primary therapy for organ failure caused by telomere biology disorder (TBD). We describe the first documented case of simultaneous liver and kidney transplantation (SLKTx) for TBD, although the diagnosis of TBD was reached only three months following SLKTx. The patient was born prematurely, displayed growth retardation, and developed chronic kidney and liver diseases. His pre-SLKTx autoimmune, metabolic, and viral assessments were negative, and persistent pancytopenia (bone marrow cellularity 70–80%) was attributed to renal disease-associated bone marrow changes. Following SLKTx, he was discharged with stable graft function on tacrolimus and prednisolone. Although mycophenolate mofetil was discontinued on the second postoperative day, his pancytopenia persisted. Despite extensive evaluations, including drug, immune, nutritional, and viral assessments, all results were negative. A bone marrow biopsy conducted three months post-transplant revealed significant hypocellularity (40-50%). Whole genome sequencing revealed a likely pathogenic variant of the TINF2 gene. The patient was subsequently treated with danazol. At the nine-month follow-up post-SLKTx, he exhibited stable graft function and improved cell counts while maintaining triple-drug immunosuppression. Given the lack of uniform diagnostic criteria for TBD, healthcare providers must be vigilant with patients presenting with multi-organ failure and persistent cytopenias. Effective pre-transplant screening for TBD can lead to timely diagnoses, better management, and improved post-transplant outcomes. [ABSTRACT FROM AUTHOR]

Symptomatic hyperviscosity is an oncologic emergency which is suspected when patients with certain hematogical malignancies present with neurological symptoms. Hyperviscosity syndrome is a rare clinical manifestation in multiple myeloma. We describe a case of a 61 year old lady who developed pulmonary infiltrates after being diagnosed with multiple myeloma. Treated as an infection with antibiotics and intravenous immunoglobulin, she had neurological symptoms which suggested the possibility of hyperviscosity syndrome. The patient received one session of plasma exchange with which her symptoms improved and chest infiltrates resolved (high output pulmonary edema). The case highlights a known but rare manifestation of multiple myeloma, which when diagnosed and treated quickly can have gratifying results. [ABSTRACT FROM AUTHOR]

Despite the general recommendation to avoid Tyrosine Kinase Inhibitors (TKIs) for Chronic Myeloid Leukemia (CML) during pregnancy, unplanned pregnancies still occur, particularly among female patients residing in low- and middle-income countries (LMICs). We aimed to investigate the outcomes of pregnancy, foetal development, and disease progression among female CML patients in chronic phase (CML-CP) undergoing TKI therapy who encountered unplanned pregnancies in a tertiary care hospital in northern India. We conducted a retrospective analysis of all pregnancies in female CML-CP between January 2002 and December 2022 at our hospital. Patients were included if they had a confirmed diagnosis of CML-CP, were receiving TKI therapy during conception, and had available medical records. We analysed the data on pregnancy outcomes, foetal development, and disease progression through a review of medical records. We identified 36 pregnancies in female CML-CP patients on TKI therapy during the study period, with 33 (91.7%) being unplanned. Sixteen pregnancies (48.5%) were conceived at less than major molecular remission (MMR) status. Twelve pregnancies (36.4%) were electively terminated, 4 (12.1%) had miscarriages, and, 17 (51.5%) pregnancies resulted in childbirth. Out of the 17 childbirths, 10 were full-term deliveries, and 7 were preterm deliveries. Twin pregnancies had a high incidence (18.2%). Among the 21 pregnancies that were not electively terminated, TKI was stopped at the first pregnancy detection in 14 pregnancies, while imatinib was continued throughout 7 pregnancies. Patients who discontinued TKI had a higher but statistically non-significant incidence of adverse pregnancy outcomes compared to those who continued imatinib throughout pregnancy (64.2% vs. 28.6%, p = 0.18). Additionally, the risk of long-term disease progression among patients who discontinued TKI during pregnancy and those who continued imatinib throughout pregnancy was 21.4% and 16.7% (p = 0.9), respectively. The risk of long-term disease progression was significantly increased in those persistently at less than MMR pre- and post-gestation (p = 0.0002). Our findings suggest that continuing imatinib therapy during pregnancy, may be a reasonable option for CML patients residing in low- and middle-income countries to reduce the risk of disease progression and adverse pregnancy outcomes. Patients persistently at less than MMR levels pre- and post-gestation should be closely monitored for the risk of long-term disease progression. Further studies with larger sample sizes are needed to confirm these results. • High incidence of unplanned pregnancies noted in female chronic myeloid leukaemia patients on tyrosine kinase inhibitors. • Continuing imatinib during pregnancy may be a reasonable option for CML patients residing in low-and-middle-income countries. • Long-term disease progression is higher in patients with poorly controlled CML who discontinue therapy during pregnancy. • Patients without major molecular remission pre-and post-gestation require close monitoring for long-term disease progression. [ABSTRACT FROM AUTHOR]

Background: Infections are a significant cause of morbidity and mortality after autologous hematopoietic cell transplantation (AHCT) in multiple myeloma (MM) patients. There has been a rapid advancement and evolution in MM treatment landscape in the last decade. There is limited information on post‐AHCT infectious complications among MM patients with or without levofloxacin prophylaxis from developing countries. Materials and methods: We performed a retrospective study to explore the incidence, pattern, and clinical outcome of infections following AHCT in MM patients from 2010 to 2019 at our center. Patient‐specific, disease‐specific, and transplant‐specific details were retrieved from the case files. The characteristics of infectious complications (site, intensity, organism, treatment, and outcomes) were analyzed. All patients who underwent transplantation from 2010 to 2016 received levofloxacin antibiotic prophylaxis. Common terminology criteria for adverse events (CTCAE) criteria (v5.0) were used for the grading of infections and regimen‐related toxicity. International Myeloma Working Group updated criteria were used for the assessment of disease response before transplant and at day +100. Results: Ninety‐five consecutive patients with newly diagnosed multiple myeloma (NDMM) (n = 85), RRMM (n = 7), plasma cell leukemia (n = 2), and Polyneuropathy, Orgaomegaly, Endocrinopathy, Monoclonal gammopathy, skin abnormalities (POEMS) syndrome (n = 1) underwent AHCT during the study period. Their median age was 55 years (range 33–68); 55.8% were males. Immunoglobulin IgG kappa was the most common monoclonal protein (32.6%), International Staging System stage III disease was present in 45.3%, and 84.2% of patients achieved more than very good partial response before AHCT. The median time from diagnosis to AHCT was 10 months (range 4–144). Eighty‐nine patients (93.7%) developed fever after AHCT. Fever of unknown focus, microbiologically confirmed infections, and clinically suspected infections were found in 50.5%, 37.9%, and 5.3% of patients, respectively. Clostridiodes difficile‐associated diarrhea was observed in eight patients (8.4%). Neutrophil and platelet engraftment occurred after a median of 11 days (range 9–14) and 12 days (range 9–23), respectively. The median duration of hospital stay was 16 days (range 9–29). Only two patients (2.1%) required readmission for infections within 100 days of AHCT. Transplant‐related mortality (TRM) in the study population was 4.2% (n = 4). The levofloxacin prophylaxis group (n = 32, 33.7%) had earlier neutrophil engraftment (day +10 vs. day +11) and platelet engraftment (day +11 vs. day +12), but time to fever onset, duration of fever, hospital stay, TRM, and day +100 readmission rates were not significantly different from those of patients without levofloxacin prophylaxis. There was no significant difference in the spectrum of infections between patients with and without levofloxacin prophylaxis. The overall survival and progression‐free survival of the study population at 5 years were 72.7% and 64.8%, respectively. Conclusion: This study shows that the incidence of infections and TRM are higher in MM patients from lower‐middle income countries after AHCT than in those from developed countries. The majority of such patients lack clinical localization and microbiological proof of infection. There was no significant difference in the spectrum of infections and their outcomes in patients with and without levofloxacin prophylaxis. [ABSTRACT FROM AUTHOR]

Background Takayasu arteritis, also known as “pulseless disease,” causes proximal occlusion of the lumen of large arteries of the neck and arm, leading to impalpable pulses and “pseudohypotension.” This may misdirect the management plan for a patient in the emergency setting if the presence of vascular occlusion is not previously known. Case Report We describe a young woman who presented to the emergency department (ED) with fever. On evaluation, she had shock, which was not responsive to a fluid bolus. Bedside Rapid Diagnostic Test was positive for Plasmodium vivax , and a diagnosis of severe vivax malaria was made. She was started on intravenous artesunate and vasopressors in view of her persistent hypotension in the face of a normal central venous pressure. A thorough examination at that time revealed palpable lower limb pulses with feeble upper limb pulses. Vasopressors were tapered while monitoring lower limb blood pressure. Computed tomographic angiogram confirmed the diagnosis of Takayasu arteritis. Why Should an Emergency Physician Be Aware of This? Hypotension and shock are regularly encountered in the ED. Occlusive arterial disease involving upper limbs can mimic refractory shock, leading to potentially harmful and unnecessary interventions. Emergency physicians should be aware of this possibility. A simple routine of quickly checking all peripheral pulses would help them avoid this pitfall. [ABSTRACT FROM AUTHOR]

Background: Takayasu arteritis, also known as "pulseless disease," causes proximal occlusion of the lumen of large arteries of the neck and arm, leading to impalpable pulses and "pseudohypotension." This may misdirect the management plan for a patient in the emergency setting if the presence of vascular occlusion is not previously known.Case Report: We describe a young woman who presented to the emergency department (ED) with fever. On evaluation, she had shock, which was not responsive to a fluid bolus. Bedside Rapid Diagnostic Test was positive for Plasmodium vivax, and a diagnosis of severe vivax malaria was made. She was started on intravenous artesunate and vasopressors in view of her persistent hypotension in the face of a normal central venous pressure. A thorough examination at that time revealed palpable lower limb pulses with feeble upper limb pulses. Vasopressors were tapered while monitoring lower limb blood pressure. Computed tomographic angiogram confirmed the diagnosis of Takayasu arteritis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Hypotension and shock are regularly encountered in the ED. Occlusive arterial disease involving upper limbs can mimic refractory shock, leading to potentially harmful and unnecessary interventions. Emergency physicians should be aware of this possibility. A simple routine of quickly checking all peripheral pulses would help them avoid this pitfall. [ABSTRACT FROM AUTHOR]

Background: Immunomagnetic cell sorting (IMCS) is a preferred technique for the enrichment of plasma cells (PC) before fluorescence in situ hybridization (FISH). Here, we share our real‐world experience regarding the success rate of IMCS, its limitations, and the utility of alternate sources to obtain a successful FISH in various PC disorders. Materials and Methods: A retrospective analysis was performed in patients with a PC neoplasm, who underwent bone marrow (BM) examination, and FISH testing over 30 months. In all cases with an unsuccessful IMCS, an attempt was made to identify the cause of failure. Results: Immunomagnetic cell sorting of PCs was successful in 395/450 cases (87.8%; 77/98 cases (78.6%) with <10% PCs and 318/352 (90.3%) with ≥10% PCs in BM aspirate; P =.003). Among cases with unsuccessful IMCS (<10% PCs; n = 21 and ≥10% PCs; n = 34), an alternate source could be used successfully in 34 (62%) patients and includes air‐dried trephine biopsy imprint smears (n = 28) with aggregates or sheets of PCs, fine‐needle aspiration smears/biopsy from plasmacytoma (n = 5), and ascitic fluid (n = 1). 284/395 (71.9%) patients with successful IMCS and all 34 cases with an alternate source of PCs showed at least one cytogenetic abnormality on four‐probe FISH. Conclusion: Variations in the sample quality together with significant variation in the number of PCs between BM aspirate and the trephine biopsy imprint smears/biopsy reduce the success rate of IMCS in a real‐world scenario and necessitate utilization of patient‐specific alternate sources of PCs like a trephine biopsy imprint or cytology smears from extramedullary sources for successful FISH testing in PC neoplasms. [ABSTRACT FROM AUTHOR]

Ultralow thermal conductivity draws great attention in a variety of fields of applications such as thermoelectrics and thermal barrier coatings. Herein, the crystal structure and transport properties of Cu4TiSe4 are reported. Cu4TiSe4 is a unique example of a non‐toxic and low‐cost material that exhibits a lattice ultra‐low thermal conductivity of 0.19 Wm−1 K−1 at room temperature. The main contribution to the unusually low thermal conductivity is connected with the atomic lattice and its dynamics. This ultralow value of lattice thermal conductivity (kL) can be attributed to the presence of the localized modes of Cu, which partially hybridize with the Se atoms, which in turn leads to avoidance of crossing of acoustic phonon modes that reach the zone boundary with a reduced frequency. Like a phonon glass electron crystal, Cu4TiSe4 could also open a route to efficient thermoelectric materials, even, with chalcogenides of relatively high electrical resistivity and a large band gap, provided that their structures offer a sublattice with lightly bound cations. [ABSTRACT FROM AUTHOR]

Ultralow thermal conductivity draws great attention in a variety of fields of applications such as thermoelectrics and thermal barrier coatings. Herein, the crystal structure and transport properties of Cu4TiSe4 are reported. Cu4TiSe4 is a unique example of a non‐toxic and low‐cost material that exhibits a lattice ultra‐low thermal conductivity of 0.19 Wm−1 K−1 at room temperature. The main contribution to the unusually low thermal conductivity is connected with the atomic lattice and its dynamics. This ultralow value of lattice thermal conductivity (kL) can be attributed to the presence of the localized modes of Cu, which partially hybridize with the Se atoms, which in turn leads to avoidance of crossing of acoustic phonon modes that reach the zone boundary with a reduced frequency. Like a phonon glass electron crystal, Cu4TiSe4 could also open a route to efficient thermoelectric materials, even, with chalcogenides of relatively high electrical resistivity and a large band gap, provided that their structures offer a sublattice with lightly bound cations. [ABSTRACT FROM AUTHOR]

Cardiac involvement in T-cell lymphoma is not uncommon. Pericardial effusion is the most common manifestation of cardiac involvement with restrictive cardiomyopathy (RCM) due to tumor infiltration being extremely rare. The presence of paroxysmal nocturnal dyspnea and orthopnea in a patient presenting with pericardial effusion could be related to tamponade or underlying myocardial disease. Hence, reevaluation after pericardiocentesis is warranted. We describe a 14-year-old boy with advanced T-cell lymphoma presenting with cardiac tamponade. Repeat echocardiography after pericardiocentesis revealed mediastinal mass infiltrating cardiac chambers and great vessels along with features of RCM secondary to tumor infiltration. [ABSTRACT FROM AUTHOR]

Recent studies in iron-depleted women have challenged the current approach of treating iron-deficiency anemia (IDA) with oral iron in divided daily doses. Alternate day dosing leads to more fractional absorption of iron. In this randomized controlled trial, we looked at the efficacy and safety of alternate-day (AD) versus twice-daily (BD) oral iron in all severity of IDA. Total of 62 patients were randomized, 31 patients in BD arm received 60 mg elemental iron twice daily while 31 patients in AD arm received 120 mg iron on alternate days. The primary endpoint of 2 g/dl rise in hemoglobin was met in significantly more patients in the BD arm at 3 weeks (32.3% vs. 6.5%, p < 0.0001) and 6 weeks (58% vs. 35.5%, p = 0.001). There was a significant rise in the median hemoglobin at 3 (1.6 vs. 1.1, p = 0.02) and 6 weeks (2.9 vs. 2.0 g/dl, p = 0.03) in the BD arm. However, the median hemoglobin rise in the AD arm at 6 weeks was not significantly different than the BD arm at 3 weeks. Alternate-day dosing for 6 weeks and twice-daily dosing for 3 weeks resulted in the provision of the same total amount of iron. There were more reports of nausea in the BD arm (p = 0.03). In conclusion, the choice of twice-daily or alternate-day oral iron therapy should depend on the severity of anemia, the rapidity of response desired, and patient preference to either regimen due to adverse events. Trial Registration: CTRI reg. no. CTRI/2018/07/015106 http://ctri.nic.in/Clinicaltrials/login.php. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study is to compare the model for end-stage liver disease (MELD) with clinical prognostic indicators (CPI) specifically the change in these parameters after 48 h of admission in predicting the mortality in patients with acute liver failure (ALF) due to acute viral hepatitis. Materials and Methods: An open label, investigator-initiated prospective study was conducted that included 41 patients with acute viral hepatitis with ALF. The cases were followed prospectively till death or discharge. The MELD and CPI were calculated at admission and 48 h of admission. Results: Patients having no change or worsening in CPI score, i.e., delta CPI more negative had a higher mortality over the next 48 h compared to patients having an improvement in their respective CPI score. Delta CPI predicted adverse outcome better than the presence of any three CPI on admission (P = 0.019). Patients having no change or a worsening in MELD score, i.e., delta MELD more negative, had a higher mortality in the next 48 h compared to the patients having improvement in their respective MELD score. However, MELD >33 on admission was superior to delta MELD in predicting the adverse outcome (P = 0.019). Conclusion: Among the patients with ALF due to viral hepatitis, delta CPI was found to be superior to delta MELD in predicting the adverse outcome in patients with viral ALF (P < 0.0001). [ABSTRACT FROM AUTHOR]

Temporomandibular joint dislocation refers to the dislodgement of mandibular condyle from the glenoid fossa. Anterior and anteromedial dislocations of the mandibular condyle are frequently reported in the literature, but superolateral dislocation is a rare presentation. This report outlines a case of superolateral dislocation of an intact mandibular condyle that occurred in conjunction with an ipsilateral mandibular parasymphysis fracture. A review of the clinical features of superolateral dislocation of the mandibular condyle and the possible techniques of its reduction ranging from the most conservative means to extensive surgical interventions is presented. [ABSTRACT FROM AUTHOR]

Background: One of the common reason for which patients seek dental treatment is toothache. Root canal therapy and tooth extraction are amongst the most commonly administered treatments for pain relief. Hence; we planned the present study to evaluate the incidence of apical periodontitis and endodontic therapy quality in a known population. Materials & methods: The present study included assessment of incidence of apical periodontitis and quality of root canal therapy in a known population. A total of 100 participants were included in the present study. De Moor et al criteria were used for the evaluation of endodontic therapy and peri- apical status. All the results were compiled and analysed by SPSS software. Chi- square test and student t test were used for the assessment of level of significance. Results: 5 percent of the root canal treated cases showed presence of apical periodontitis whereas in 56 percent of the cases, no apical periodontitis was detected. 70 percent of the cases of teeth treated with root canal therapy with less than 2 mm from radiographic apex showed presence of apical periodontitis. Conclusion: Prevalence of apical periodontitis is dependent up on the technical quality of root canal therapy. [ABSTRACT FROM AUTHOR]

Acquired haemophilia A (AHA) is a rare disorder with mostly idiopathic aetiology that leads to factor VIII (FVIII) deficiency due to coagulation inhibitors formation. Treatment protocol includes immunosuppression and Factor VIII bypassing agents including activated Prothrombin Complex Concentrates (PCC). Nevertheless, the role of plasma exchange is not clear in the treatment of AHA. We report a case of 73 year old male who presented with haematuria, prolonged activated partial thromboplastin time (APTT) and a very high titres of Factor VIII inhibitors of 98 Bethesda units (BU) and was diagnosed with acquired haemophilia A. He failed to respond to multiple immunosuppressive therapies including rituximab. Therefore, therapeutic plasma exchange (TPE) therapy was planned due to persistence of haematuria despite immunosuppressive therapies. After five cycles of plasma exchange, APTT became normal, haematuria subsided and Factor VIII inhibitors became negative. Patient was discharged without any bleeding and in a stable condition. In this index case, plasma exchange played a very crucial role, resulting in recovery of the patient. These results advocate that therapeutic plasma exchange is an effective therapy for acquired haemophilia A. [ABSTRACT FROM AUTHOR]