Infantile acute megakaryoblastic leukaemia with T(1:22) in a non-down syndrome child.

Megakaryoblastic leukaemia is the commonest form of leukaemia occuring in Down syndrome infants. However, it’s subtype with translocation t(1;22)(p13;q13)is uncommon comprising <1% of all cases and reported to exclusively occur in infant without Down syndrome. It has a female predominance and carries apoor prognosis. We described this rare form of leukaemia in a 9-month-old girl who presented with bruises, massive hepatosplenomegaly and multiple cervical and inguinal lymphadenopathy. The blood film showed severe anaemia with ovalostomatocytosis, thrombocytopenia and mild leucocytosis. The bone marrow aspirate showed numerous blasts showing high nuclear-cytoplasmic ratio and agranular cytoplasm with cytoplasmic blebs. Peroxidase staining was negative. The immunophenotyping of the blasts showed positive expression of CD117, CD13, CD33 and CD61 which confirmed the diagnosis of acute megakaryoblastic leukaemia. Interestingly, the cytogenetic finding of translocation t(1;22) which is most common in acute megaloblastic leukaemia in infants without Down syndrome was found in this case. She received the AML trial 15 ADE protocol chemotherapy regime and developed severe neutropenic sepsis and respiratory distress requiring ventilatory support and granulocyte colony stimulating factor (G-CSF). She recovered wellmafter the first course of chemotherapy and was discharged. Unfortunately, she was not brought in for follow-up chemotherapy and presented a few months later with relapsed AML. She was re-started on ADE protocol and currently is on oral thioguanine for maintenance therapy

Ruthenium-106 brachytherapy for thick uveal melanoma: Reappraisal of apex and base dose radiation and dose rate

Purpose: To evaluate the outcomes of ruthenium-106 (106Ru) brachytherapy in terms of radiation parameters in patients with thick uveal melanomas. Material and methods: Medical records of 51 patients with thick (thickness � 7 mm and &lt; 11 mm) uveal melanoma treated with 106Ru brachytherapy during a ten-year period were reviewed. Radiation parameters, tumor regression, best corrected visual acuity (BCVA), and treatment-related complications were assessed. Results: Fifty one eyes of 51 consecutive patients including 25 men and 26 women with a mean age of 50.5 ± 15.2 years were enrolled. Patients were followed for 36.1 ± 26.5 months (mean ± SD). Mean radiation dose to tumor apex and to sclera were 71 (± 19.2) Gy and 1269 (± 168.2) Gy. Radiation dose rates to tumor apex and to sclera were 0.37 (± 0.14) Gy/h and 6.44 (± 1.50) Gy/h. Globe preservation was achieved in 82.4. Preoperative mean tumor thickness of 8.1 (± 0.9) mm decreased to 4.5 (± 1.6) mm, 3.4 (± 1.4) mm, and 3.0 (± 1.46) mm at 12, 24, and 48 months after brachytherapy (p = 0.03). Four eyes that did not show regression after 6 months of brachytherapy were enucleated. Secondary enucleation was performed in 5 eyes because of tumor recurrence or neovascular glaucoma. Tumor recurrence was evident in 6 (11.8) patients. Mean Log MAR (magnification requirement) visual acuity declined from 0.75 (± 0.63) to 0.94 (± 0.5) (p = 0.04). Best corrected visual acuity of 20/200 or worse was recorded in 37 of the patients at the time of diagnosis and 61.7 of the patients at last exam (p = 0.04). Non-proliferative and proliferative radiation-induced retinopathy was observed in 20 and 7 eyes. Conclusions: Thick uveal melanomas are amenable to 106Ru brachytherapy with less than recommended apex radiation dose and dose rates. © 2016, Termedia Publishing House Ltd. All rights reserved

Development of an indoor air quality checklist for risk assessment of indoor air pollutants by semiquantitative score in nonindustrial workplaces

Background: To meet the current diversified health needs in workplaces, especially in nonindustrial workplaces in developing countries, an indoor air quality (IAQ) component of a participatory occupational safety and health survey should be included. Objectives: The purpose of this study was to evaluate and suggest a multidisciplinary, integrated IAQ checklist for evaluating the health risk of building occupants. This IAQ checklist proposed to support employers, workers, and assessors in understanding a wide range of important elements in the indoor air environment to promote awareness in nonindustrial workplaces. Methods: The general structure of and specific items in the IAQ checklist were discussed in a focus group meeting with IAQ assessors based upon the result of a literature review, previous industrial code of practice, and previous interviews with company employers and workers. Results: For practicality and validity, several sessions were held to elicit the opinions of company members, and, as a result, modifications were made. The newly developed IAQ checklist was finally formulated, consisting of seven core areas, nine technical areas, and 71 essential items. Each item was linked to a suitable section in the Industry Code of Practice on Indoor Air Quality published by the Department of Occupational Safety and Health. Conclusion: Combined usage of an IAQ checklist with the information from the Industry Code of Practice on Indoor Air Quality would provide easily comprehensible information and practical support. Intervention and evaluation studies using this newly developed IAQ checklist will clarify the effectiveness of a new approach in evaluating the risk of indoor air pollutants in the workplace

Corneal patch graft: A new approach for scleral necrosis secondary to plaque radiotherapy

Purpose: To evaluate the anatomical outcomes of corneal patch grafts in patients with progressive scleral necrosis secondary to plaque radiotherapy used for uveal malignant melanoma management. Methods: In this case series, 4 patients with progressive scleral necrosis after Ru-106 plaque radiotherapy underwent corneal patch grafts with the anterior corneal button from Descemet stripping automated endothelial keratoplasty donor tissue to strengthen the sclera and to improve appearance of the eye. Results: Ciliary body involvement was evident in all cases. All 4 patients had received radiation doses of 400 Gy or more to the tumor base. The mean time interval between plaque radiotherapy and scleral necrosis was 24.5 ± 7.5 months (range, 18-34 months). Successful results were achieved in all patients with tectonic graft. No patients experienced graft thinning, rejection, infection, or tumor recurrence in a mean follow-up of 28.5 ± 7.9 months (range, 20-39 months). Conclusions: Corneal patch graft by anterior corneal button from Descemet stripping automated endothelial keratoplasty donor tissue results in successful restoration of globe integrity and satisfactory cosmetic appearance in patients with scleral necrosis secondary to plaque radiotherapy. © 2016 Wolters Kluwer Health, Inc. All rights reserved

Ru-106 plaque radiotherapy for vasoproliferative tumors of retina: a 15-year single-center experience

Purpose: This study evaluates the outcomes of ruthenium-106 (Ru-106) plaque brachytherapy for vasoproliferative tumors (VPTs) of the ocular fundus in a single referral ocular oncology center. Methods: The clinical charts of all patients diagnosed with VPT who underwent plaque radiotherapy from 2002 to 2017 were reviewed. Clinical features, types of treatment, outcomes and complications were evaluated. Results: Of 46 patients with VPT diagnosis in our ocular oncology clinic, 25 (54.34) cases were treated with Ru-106 plaque brachytherapy. Eleven patients (44) were male, and the mean age at the time of diagnosis was 40.92 ± 13.11 years. The mean follow-up time was 47.56 ± 36.87 months. Inferotemporal quadrant was the most common site of the tumor (64.00). The mean delivered apex and scleral dose was 101.56 ± 6.51 and 412.26 ± 113.66 Gray (Gy), respectively. Initial tumor length, width and thickness were 10.26 ± 3.42, 8.05 ± 2.83 and 4.27 ± 1.10 mm, respectively. The mean tumor thickness decreased to 2.60 ± 0.63 mm, postoperatively. Complete resolution of subretinal fluid around the tumor was achieved in 81.80 of cases. Visual acuity was more than 20/400 in 64 of patients before treatment and 60 of patients at last follow-up. Conclusion: Our study showed that Ru-106 plaque radiotherapy is an effective and safe method of treatment in VPTs. © 2020, Springer Nature B.V

Bilateral responses of trapezius muscle to transcranial magnetic stimulation in normal subjects

Introduction: Motor evoked potentials (MEPs) can be elicited in trapezius and other axial musclesby ipsilateral transcranial magnetic stimulation (TMS).The purpose of this study is to compare therelative amplitudes and latencies of ipsilateral versus contralateral responses to TMS from trapeziusmuscle of normal subjects.Materials and Methods: MEPs were bilaterally recorded during complete relaxation and voluntarycontraction from upper trapezius muscle in 40 healthy right handed subjects by TMS in right and lefthemispheres. Base-to-peak amplitude and latency of MEP were measured for each muscle on bothsides.Results: At rest, a contralateral response was obtained in 45 trapezius muscles. Ipsilateralresponses were observed in 11 muscles (latency contra-lateral and ipsilateral 9.8ms and 15.5 ms,respectively, P <0.001). During contraction ipsilateral MEPs could be evoked in 37 muscles.Contralateral MEPs were obtained in 76 experiments on 40 subjects (latency contralateral andipsilateral 8.5ms and 12.6 ms, respectively, P <0.001).Conclusion: MEPs can be readily evoked by TMS over the ipsilateral motor cortex in a variety ofproximal muscles, such as trapezius. Ipsilateral MEPs have a later onset and lower amplitude thancontralateral responses. It is considered that oligosynaptic connections may be a common feature ofaxial muscles, such as trapezius. These patterns of connections are discussed in relation to thecontrasting bilateral functional roles of this muscle

Heart disease diagnosis system using fuzzy logic

Treating people with ill health is a major problem in developed and underdeveloped countries. Most of these countries allocate a considerable portion of their budgets to ensuring that their citizens are healthy. However, countries remain unable to meet the demand for ideal medical services of their citizens because of the shortage of medical expertise in various hospitals. Medical diagnosis systems have been widely applied to diagnosing the symptoms of diseases such as cancer and diabetes. However, the analysis tools and methods are insufficient for identifying hidden relationships in the symptoms of coronary heart disease (CHD). Consequently, the ratio of people who suffer from this disease is growing rapidly; 12 million deaths each year are attributed to CHD. Meanwhile, the complex interdependency on various symptoms of this ailment indicates the difficulties in diagnosing CHD at an early stage. Furthermore, the diagnosis of CHD is a complex task that requires precision and effectiveness. Doctors do not have adequate time to devote to each case and encounter difficulties in keeping abreast of the newest application developments. Many alternative methods have been suggested for medical diagnosis in the healthcare domain. However, evaluating the functionality of CHD diagnosis systems remains challenging. Therefore, this study aims to develop a system that diagnoses CHD via fuzzy logic and evaluate the functionality of the proposed diagnostic CHD system. This study contributes to the healthcare domain as the developed system can assist doctors in accurately diagnosing when CHD symptoms have an ambiguous relationship. Therefore, the developed system will decrease doctors’ workloads during consultations