Cochlear implantation candidacy criteria have continued to evolve over the years, and cochlear implantation is possible with many inner-ear and brain anomalies with good hearing and linguistic ...outcomes. Cystic leukoencephalopathy without megalencephaly is a rare disease in children, with only 30 cases reported in the literature, but it is associated with hearing loss in only three cases. Radiological investigations can help in diagnosing this rare entity before proceeding with cochlear implantation.
A four-year-old female child born out of consanguinity with normal psychomotor development, bilateral sensorineural hearing loss and an incidental magnetic resonance imaging finding of cystic leukoencephalopathy without megalencephaly underwent successful cochlear implantation. Her post-operative period was uneventful with successful mapping of the cochlear implant.
This is the first reported case of cystic leukoencephalopathy without megalencephaly and with sensorineural hearing loss in which cochlear implantation was performed successfully. White matter and temporal lobe abnormalities should not deter paediatric cochlear implantation.
We assessed the management and outcomes of non-ST segment elevation myocardial infarction (NSTEMI) patients randomly assigned to fractional flow reserve (FFR)-guided management or angiography-guided ...standard care.
We conducted a prospective, multicentre, parallel group, 1 : 1 randomized, controlled trial in 350 NSTEMI patients with ≥1 coronary stenosis ≥30% of the lumen diameter assessed visually (threshold for FFR measurement) (NCT01764334). Enrolment took place in six UK hospitals from October 2011 to May 2013. Fractional flow reserve was disclosed to the operator in the FFR-guided group (n = 176). Fractional flow reserve was measured but not disclosed in the angiography-guided group (n = 174). Fractional flow reserve ≤0.80 was an indication for revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). The median (IQR) time from the index episode of myocardial ischaemia to angiography was 3 (2, 5) days. For the primary outcome, the proportion of patients treated initially by medical therapy was higher in the FFR-guided group than in the angiography-guided group 40 (22.7%) vs. 23 (13.2%), difference 95% (95% CI: 1.4%, 17.7%), P = 0.022. Fractional flow reserve disclosure resulted in a change in treatment between medical therapy, PCI or CABG in 38 (21.6%) patients. At 12 months, revascularization remained lower in the FFR-guided group 79.0 vs. 86.8%, difference 7.8% (-0.2%, 15.8%), P = 0.054. There were no statistically significant differences in health outcomes and quality of life between the groups.
In NSTEMI patients, angiography-guided management was associated with higher rates of coronary revascularization compared with FFR-guided management. A larger trial is necessary to assess health outcomes and cost-effectiveness.
Permanent pacemaker (PPM) requirement is a recognized complication of transcatheter aortic valve implantation. We assessed the UK incidence of permanent pacing within 30 days of CoreValve ...implantation and formulated an anatomic and electrophysiological model.
Data from 270 patients at 10 centers in the United Kingdom were examined. Twenty-five patients (8%) had preexisting PPMs; 2 patients had incomplete data. The remaining 243 were 81.3±6.7 years of age; 50.6% were male. QRS duration increased from 105±23 to 135±29 milliseconds (P<0.01). Left bundle-branch block incidence was 13% at baseline and 61% after the procedure (P<0.001). Eighty-one patients (33.3%) required a PPM within 30 days. Rates of pacing according to preexisting ECG abnormalities were as follows: right bundle-branch block, 65.2%; left bundle-branch block, 43.75%; normal QRS, 27.6%. Among patients who required PPM implantation, the median time to insertion was 4.0 days (interquartile range, 2.0 to 7.75 days). Multivariable analysis revealed that periprocedural atrioventricular block (odds ratio, 6.29; 95% confidence interval, 3.55 to 11.15), balloon predilatation (odds ratio, 2.68; 95% confidence interval, 2.00 to 3.47), use of the larger (29 mm) CoreValve prosthesis (odds ratio, 2.50; 95% confidence interval, 1.22 to 5.11), interventricular septum diameter (odds ratio, 1.18; 95% confidence interval, 1.10 to 3.06), and prolonged QRS duration (odds ratio, 3.45; 95% confidence interval, 1.61 to 7.40) were independently associated with the need for PPM.
One third of patients undergoing a CoreValve transcatheter aortic valve implantation procedure require a PPM within 30 days. Periprocedural atrioventricular block, balloon predilatation, use of the larger CoreValve prosthesis, increased interventricular septum diameter and prolonged QRS duration were associated with the need for PPM.
Harmful chemical leach of plastics, such as Bisphenol A (BPA) and Bisphenol B (BPB), negatively affect public health. In fact, bisphenols in general affect the soil microbiome. In adddition, the ...antibacterial action of BPA on
Escherichia coli
has been reported
.
It is unknown whether BPB affects the growth of bacteria such as
E. coli
. Therefore, we have compared the impact of BPA and BPB on
E. coli
growth and its entire genome using in silico and in vitro strategies. We found that the
E. coli
growth was inhibited by both BPA and BPB. However, BPA caused greater inhibition of
E. coli
growth than BPB. More polymorphisms were introduced into the bacterial genome by BPA in comparison with BPB. In summary, our findings showed that both bisphenols can affect the microbiota in the environment and gut. Detailed research should be conducted to understand the effects of these harmful chemicals on the biosphere, particularly on microbiome components.
Delivering a safe and effective topical vaginal contraceptive is the need of present era. We explored the potential of a metal (copper) and herbal moiety (curcumin) for this topical contraceptive ...prophylaxis. Complex of copper and curcumin (Cu–Cur) was synthesized and the concerns regarding its aqueous solubility was resolved by including it into the hydrophobic cavity of β-cyclodextrin (β-CD) as (Cu–Cur)CD inclusion complex. Dose assessment was made on the basis of in-vitro spermicidal assays and cell cytotoxicity studies. Finally the (Cu–Cur)CD loaded vaginal gel was prepared, characterized and evaluated for in-vitro spermicidal activity and preclinical toxicity studies. Spectral and morphological characterizations confirmed the synthesis of (Cu–Cur) and (Cu–Cur)CD inclusion complex. Spermicidal assays and Hela cell cytotoxic data revealed an optimized 1.5% (Cu–Cur)CD for further studies. 1.5% w/w (Cu–Cur)CD loaded carbopol 974p gel provided 100% motility even at 2-fold dilution and preclinical toxicity studies in Rats and Rabbits revealed its highly safe profile. The hypothesis of considering metal–herbal complex and its cyclodextrin complex has worked and the well planned strategy of including it in (β-CD) cavity provided a preeminent platform for vaginal delivery. In-vitro assays and preclinical toxicity analysis confirmed its potential to be used as highly safe and effective prophylaxis.
Abstract
Background:
Nimotuzumab is an anti-epidermal growth factor receptor monoclonal antibody which can be added to chemoradiotherapy (CRT) to improve efficacy for management of locally advanced ...squamous cell carcinoma of the head and neck (LASCCHN). We prospectively evaluated the efficacy and safety of nimotuzumab with CRT for LASCCHN and compared with CRT alone.
Materials and Methods:
In this prospective study, 29 LASCCHN (Stage III–IVb) patients received Nimotuzumab plus CRT or CRT alone. Treatment included six cycles of cisplatin (40–50 mg/week) or carboplatin (area under the curve-based), nimotuzumab (200 mg/week), and radiotherapy (60–70 Gy). Tumor response was evaluated as per response evaluation criteria in solid tumors criteria. MoS was estimated using the Kaplan–Meier method. Toxicity and adverse events (AE's) were assessed as per CTCAE v 4.0.
Results:
At 24 weeks after completion of treatment, the tumor response rate (complete response, partial response, stable disease) was 53.3% and 35.7% favoring nimotuzumab arm while progression of disease was 40% and 35.7% in Nimotuzumab plus CRT and CRT groups, respectively. However, the objective response rate was 57% and 30% in favor of nimotuzumab arm. At median follow-up of 45.5 months, MoS was 33 months in Nimotuzumab plus CRT and 27 months in CRT group. The 5-year survival rate was 33.3% in Nimotuzumab plus CRT versus 7.1% in CRT group. Nimotuzumab was observed to be safe with no additional AE's such as hypersensitivity, hypomagnesemia, and allergic reaction was reported.
Conclusion:
Addition of Nimotuzumab to standard CRT showed improved survival rate in unresectable, LASCCHN patients without producing additional toxicity.
Introduction: Working adults in high-altitude regions (HARs) are at higher risk of developing cerebral venous thrombosis (CVT) due to multiple factors. The clinico-radiological patterns pertaining to ...the high altitude associated with CVT can be different compared to those without HAR exposure. Objective: We aimed to study the clinico-radiological patterns of CVT in adult males diagnosed with CVT while working in mountainous regions at an altitude higher than 8000 feet above sea level. Methodology: The study population consists of adult males aged >18 years who suffered symptomatic CVT while working in mountains at high altitudes. They were divided into groups according to the altitude at which they were working as high-altitude (8202-11,483 ft), very high-altitude (11,484-19,029 ft), and extremely high-altitude (above 19,030 ft) regions. Meticulous history, clinical examination, imaging with computed tomography, magnetic resonance imaging, and laboratory investigations including procoagulation profile were done. The outcome was classified according to the modified Rankin score at 3-month follow-up. Results: Among the forty patients with CVT, 100% had a headache, 65% had vomiting, and 20% suffered convulsions at presentation. Increasing altitude was associated with higher clot load, increasing extent of involvement within the venous sinuses, and a tendency to involve deep veins in isolation or conjunction with the sinuses. Twenty-three recovered without any deficit and 15 were symptomatic without disability at the 3-month follow-up. Conclusion: In patients of CVT who are exposed to high altitudes in mountains, the increasing altitude is associated with higher clot load, increasing extent of involvement within the venous sinuses, and a tendency to involve deep veins. Polycythemia, smoking, alcohol, and deficiency of protein C are the coexisting factors.
Transradial approach has become preferable to conventional femoral artery access for both diagnostic coronary angiography and percutaneous coronary intervention. A rare but recognizable complication ...of radial access is radial artery pseudoaneurysm (RAp), which represents a potentially catastrophic complication. Treatment options comprise ultrasound (USG)-guided manual compression or thrombin injection or surgical correction. In this case series, we report four cases of RAps that we encountered at a single tertiary care center from July 2015 to January 2018. We compressed the radial artery using a sphygmomanometer cuff differentially rather than a TR band proximal to the pseudoaneurysm to treat three of them. One of the patients underwent surgical repair of the pseudoaneurysm as the location of the aneurysm was not suitable for compression or thrombin injection. In our series of cases, we conclude that RAp, a rare complication of radial catheterization, was seen more commonly in elderly female patients and can be easily treated by the USG-guided differential compression, a simple and readily available method. Prevention and early diagnosis is the key to avoid serious consequences.
The increasing scenario of sexual HIV-1 transmission and unintended pregnancies demands modern approaches to concomitantly tackle these problems. Dually active strategies with "microbicidal" ...anti-human immunodeficiency virus (anti-HIV) as well as contraceptive properties constitute one such strategy. Nano-metal and metalo-herbal technology was explored to develop such an approach with minimal toxicity. Synthesis of in situ stabilised silver nanoparticles (AgNPs) of 2-24 nm and a (copper-curcumin) beta -cyclodextrin (Cu-Cur)CD inclusion complex was carried out. Cell viability and activity analysis revealed an acceptable dose of 500 mu g ml super(-1) of silver nanoparticles and 10 mg ml super(-1) of (Cu-Cur)CD respectively. AgNP dispersed (Cu-Cur)CD incorporated carbopol 974p gel was prepared and characterized for its pharmaceutical properties. AgNPs, (Cu-Cur)CD and the whole formulation was evaluated for in vitro anti-HIV, spermicidal and antifungal potential. Results revealed that HIV-1 propagation and sperm motility was completely inhibited at folds of dilution levels. In vivo mating studies proved the contraceptive potential of the formulation. A pre-clinical toxicology study assures the acceptability of our formulation as an intravaginal product. The novel nano-metalo-herbal strategy was found to possess a potential for topical contraceptive antiretroviral (ARV) microbicide action with an undeniably safe profile to be used as a vaginal product.
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