HIGH-VELOCITY FRACTURE: CASE OF DISPLACED INTERTROCHANTERIC FRACTURE OFFEMUR WITH SPIRAL FRACTURE OF SHAFT OF RIGHT FEMUR

BACKGROUND Intertrochanteric fracture is a common orthopedic condition characterized by extracapsular fractures of the proximal femur that occur between the greater and lesser trochanter with predominance in elderly population, especially those with osteoporosis, wherein even a low energy mechanism is enough to cause the fracture. There is an observed female predominance with ratio between 2:1 and 8:1. [1,2] Commonly observed symptoms include shortened and externally rotated limb, pain and bony tenderness around the hip joint, inability to bear weight on the affected limb to name a few. Management depends upon age of patient, nature of the fracture, number of comminuted fragments and blood loss. Treatment for intertrochanteric fractures includes conservative management using Thomas splint application and immobilization after reduction of fracture. In case the fracture is displaced then there is a need for surgical reduction and internal fixation using dynamic hip screw, proximal femoral nail or gamma nails. CASE DESCRIPTION A 27-year-old male patient presented to the emergency department of JSS hospital with alleged history of road traffic accident with inability to bear weight on the right lower limb, bony tenderness and crepitus over right hip joint and over right thigh which was confirmed to be intertrochanteric fracture and spiral fracture of shaft of femur on radiographic imaging. CONCLUSION This case report presents the mechanism of injury which is high energy mechanism leading to intertrochanteric fracture in young individual and its management

SCAVENGING OF FREE RADICALS AND TOTAL PHENOLS OF METHANOL EXTRACT OF AZIMA TETRACANTHA LAM

Objective: To report the antioxidant activity, phenolic acid profile of the Azima tetracantha methanolic extract and find the correlation between the total phenolic content and their relative antioxidant activity Methods: The total antioxidant activity, hydroxyl radical and hydrogen peroxide scavenging of A. tetracantha methanol extract was evaluated by adopting various standard methods. Total phenolic content was estimated from dried methanolic extract and the phenolic acids in the extract were identified by HPLC. Results: The methanolic extract of A. tetracantha showed free radical scavenging in a concentration dependant manner. The studies showed that the extract possess high free radical scavenging property, especially against hydroxyl radicals (67.61±0.42%). The correlation analysis results showed linear relation between phenolics content of methanolic extract and antioxidant assays (R2=0.97, 0.94, 0.99 and 0.98, significance at P<.0.001). The phenolic acid profile showed the presence of both benzoic acid and cinnamic acid derivatives, well known for their antioxidant potential. Conclusion: The current observations suggested that the methanol extract of A. tetracantha exhibited multiple antioxidant activities, by scavenging free radicals. So, it can be concluded that the extract is a source of natural antioxidant, suggesting its traditional use as a rejuvenating agent

Comparison of Conventional PAP smear and Manual Liquid Based Cytology with P16 marker in screening for cervical cancer in Indian tertiary healthcare setups in Mysuru

In India, there are 20.2 per 100000 new cases of Cervical Cancer diagnosed and 11.1 per 100000 deaths annually accounting for more than one fifths of global cervical cancer deaths. [1] Thus, due to an absence of a national immunization program to cover human papillomavirus (HPV) vaccination and lack of accessible cervical cancer screening, the disease is characterized by late detection, lack of access to affordable and quality health care, and high mortality rates. [2] Papanicolaou Smear Test was a novel invention by Dr George Papanicolaou in the year 1927 which gained maximum popularity in 1950 as a screening test for Cervical Cancer. Liquid based cytological technique has been recently developed and has gained popularity because in preliminary studies the use of such techniques was associated with a reduction in incidence of inadequate cervical smears. [3, 4] Manual Liquid Based Cytology (MLBC) is a technique that enables cells to be suspended in a monolayer and thus improves detection of precursor lesions and improvement of specimen adequacy. MLBC has been reported to improve the effectiveness of cervical cancer screening in a population by increasing the detection of histologically confirmed neoplastic and preneoplastic disease while simultaneously decreasing over diagnosis of benign processes. [1] Liquid-based cytology (LBC), although claimed to provide clearer background and better preservation of nuclear and cytoplasmic details, have yet to be proven to have better sensitivity and specificity for identification of high-grade cervical intraepithelial lesions compared to the conventional smears.[5] P16 expression, which can be detected immunohistochemically, is directly related to the presence of HPV [8]. Thus, this protein can be used as a biomarker that can add significant diagnostic precision in the assessment of CIN lesions [7, 9]. Add about ancillary technique like use of immunomarker p16 on mlbc. The aim of this study is establishing that MLBC with p16 immunomarker is very effective in screening for cervical cancer as it overcomes the major setbacks like inadequate sampling, drying artefacts and obscuring blood which are seen in conventional PAP smear technique

FAST DISSOLVING SUBLINGUAL PATCH OF PHENOBARBITAL SODIUM: FORMULATION AND IN VITRO EVALUATION

Objective: To formulate and characterize. Phenobarbital sodium loaded sublingual patch using biodegradable, mucoadhesive, fast-dissolving natural polymer pullulan for immediate management of epileptic seizures. Methods: Phenobarbital sodium loaded sublingual patches were prepared by the solvent casting method and were subjected to various physicochemical evaluation parameters to find the optimized sublingual patch. The in vitro drug release study and kinetic model of the optimized formulation was also carried out. The stability study of the optimized Phenobarbital sodium loaded sublingual patch was also done. Results: From in vitro drug release study, it was found that Phenobarbital sodium loaded sublingual patch (S4) exhibited a maximum drug release of 96.24±1.27% at the end of 60 min compared to other formulations indicating a faster drug release from the formulation with release kinetics as Higuchi diffusion model. In fact, a notable release data was obtained between 0.5 to 8 min by all formulations, specifically S4 formulation (20.84±1.97% and 77.22±2.41% drug release at the end of 0.5 min and 8 min respectively) showed a better percentage release profile in comparison with other formulations. Such a trend is vital to deliver the drug at a faster rate to promote immediate effect for managing the fatal and complicated seizure. Considering the physicochemical property and in vitro drug release data, S4 formulation was regarded as an optimized one. The stability study also confirmed that S4 formulation is stable at refrigeration conditions. Conclusion: The formulated Phenobarbital sodium loaded sublingual patch is an effective drug delivery carrier which enables faster drug release to manage epileptic seizure

A Survey on Dynamic Spectrum Sharing Using Game Theory in Cognitive Radio Networks

Due to the tremendous increase in wireless data traffic, a usable radio spectrum is quickly being depleted. Current Fixed Spectrum Allocation (FSA) strategy give rise to the problem of spectrum scarcity and underutilization. Cognitive Radio (CR) is proposed as a new wireless paradigm to overcome the spectrum underutilization problem. CR is a promising technology which for future wireless communications. CRs can change its operating parameters intelligently in real time to account for dynamic changes in a wireless environment. CR enables a technique called Dynamic Spectrum Allocation (DSA) where the users are able to access unlicensed bands opportunistically. Since idle spectrum from PU is a valuable commodity, many cognitive users will be competing for it simultaneously. Therefore, there arises competition among the users. Users may be only concerned about maximizing their own benefits by behaving rationally and selfishly. Thus spectrum allocation problem falls under NP-hard complex based on its complexity to solve. Out of several solution approaches, Game theory is found to be an efficient mathematical tool since it deals with solving the conflicts among the users. This survey is aimed at providing a comprehensive overview on dynamic spectrum allocation using game theory

DISCOSOMES: A FUTURISTIC UPHEAVAL IN VESICULAR DRUG DELIVERY

The formulation system employed to convey pharmaceutical drugs compound in the body to attain the desired therapeutic effect at a predetermined rate depending on pharmacological aspects, drug profile, and physiological conditions can be referred to as a novel drug delivery system (NDDS). Due to the intricately sensitive anatomy and physiology of the eye pharmacologist find the ocular delivery system to be more involuted than other routes. Pre-corneal, static and dynamic is the 3 types of ophthalmic barriers, which along with the inflow and outflow of lacrimal fluids, nasolacrimal drainage, are some of the germane factors that affect bioavailability. Unlike conventional dosage forms, where the distribution of drugs in non-targeted body fluids and tissues transcends the quantity of required drug in targeted tissues and causes repercussions, these modified drug delivery systems surpass the ocular barriers and adverse reactions, emphasizing on less invasive, prolonged action. It also promotes sustained release formulation that subjugates the drug loss or degradation to treat many ocular diseases effectively. The current review recapitulates the fundamentals of discosomes, a type of vesicular drug delivery system that acts as a vehicle for the drug delivery of both hydrophilic and lipophilic drugs. Discosomes are giant, disc-shaped structures modified from niosomes by arresting the vesicles at the discosome phase. Due to their idiosyncratic size, it provides all due benefits compared to other ocular drug delivery systems. From the review, it can be culminated that discosomes are a potential subject of opposition and opportunities in the arena of safe and effective ocular drug delivery

Real-world outcomes in elderly ALL patients with and without allogeneic hematopoietic stem cell transplantation: a single-center evaluation over 10 years

Elderly patients (EP) of 60 years and above with acute lymphoblastic leukemia (ALL) have a dismal prognosis, but pediatric-inspired chemotherapy and allogeneic stem cell transplantation (allo HCT) are used reluctantly due to limited data and historical reports of high treatment-related mortality in EP. We analyzed 130 adult ALL patients treated at our center between 2009 and 2019, of which 26 were EP (range 60-76 years). Induction with pediatric-inspired protocols was feasible in 65.2% of EP and resulted in complete remission in 86.7% compared to 88.0% in younger patients (YP) of less than 60 years. Early death occurred in 6.7% of EP. Three-year overall survival (OS) for Ph - B-ALL was significantly worse for EP (n = 16) than YP (n = 64) with 30.0% vs 78.1% (p ≤ 0.001). Forty-nine patients received allo HCT including 8 EP, for which improved 3-year OS of 87.5% was observed, whereas EP without allo HCT died after a median of 9.5 months. In Ph + B-ALL, 3-year OS did not differ between EP (60.0%, n = 7) and YP (70.8%, n = 19). Non-relapse mortality and infection rate were low in EP (14.3% and 12.5%, respectively). Our data indicate that selected EP can be treated effectively and safely with pediatric regimens and might benefit from intensified therapy including allo HCT. Keywords: Acute lymphoblastic leukemia; Allogeneic hematopoietic stem cell transplantation; Elderly; Treatmen

Haploidentical transplant with posttransplant cyclophosphamide vs matched related and unrelated donor transplant in acute myeloid leukemia and myelodysplastic neoplasm

Hematopoietic cell transplantation from haploidentical donors (haploHCT) has facilitated treatment of AML and MDS by increasing donor availability and became more feasible since the introduction of post-transplant cyclophosphamide (ptCY). In our single-center retrospective analysis including 213 patients with AML or MDS, we compare the outcome of haploHCT (n = 40) with ptCY with HCT from HLA-identical MRD (n = 105) and MUD (n = 68). At 2 years after transplantation, overall survival (OS) after haploHCT was not significantly different (0.59; 95% confidence interval 0.44-0.79) compared to MRD (0.77; 0.67-0.88) and MUD transplantation (0.72; 0.64-0.82, p = 0.51). While progression-free survival (PFS) was also not significantly different (haploHCT: 0.60; 0.46-0.78, MRD: 0.55; 0.44-0.69, MUD: 0.64; 0.55-0.74, p = 0.64), non-relapse mortality (NRM) was significantly higher after haploHCT (0.18; 0.08-0.33) vs. MRD (0.029; 0.005-0.09) and MUD (0.06; 0.02-0.12, p < 0.05). Higher NRM was mainly caused by a higher rate of fatal infections, while deaths related to GvHD or other non-relapse reasons were rare in all groups. As most fatal infections occurred early and were bacterial related, one potential risk factor among many was identified in the significantly longer time to neutrophil engraftment after haploHCT with a median of 16 days (interquartile range; 14.8-20.0) vs. 12 days (10.0-13.0) for MRD and 11 days (10.0-13.0) for MUD (p = 0.01)

Allogeneic hematopoietic stem cell transplantation in Hodgkin lymphoma in Switzerland, 20 years of experience: 2001–2020

Despite the high cure rate with initial therapy, approximately 10% of Hodgkin lymphoma (HL) patients are refractory to initial treatment, and up to 30% of patients will relapse after achieving initial complete remission. Despite promising initial results of treatment by immune checkpoint inhibitors, most patients will eventually progress. We analyzed 62 adult patients with relapsed or refractory HL (rrHL) treated by allogeneic hematopoietic stem cell transplantation (allo-HSCT) in one of three University Hospitals of Switzerland (Zurich, Basel, and Geneva) between May 2001 and January 2020. The primary endpoint was overall survival (OS). Secondary endpoints were relapse-free survival (RFS), non-relapse mortality (NRM), and relapse incidence, which were assessed in univariate analysis. The median follow-up was 61 months (interquartile range 59–139). The 2- and 5-year OS was 54% (standard error (SE) ±12) and 50.2% (SE ±13.3), respectively, and the 2- and 5-year RFS was 40.7% (SE ±16.3) and 34.4% (SE ±19.0), respectively. NRM was 23.1% (SE ±2.2) and 27.4% (SE ±2.5) at 2 and 5 years, respectively. The cumulative incidence of relapse was 36.1% (SE ±5.6) at 2 years and 38.2% (SE ±6.6) at 5 years. Our analysis of allo-HSCT outcomes in the context of rrHL shows encouraging OS and RFS rates, with the mortality rate reaching plateau at 50% at 2 years after allo-HSCT. This confirms that allo-HSCT still remains as a potentially curative option for half of patients with rrHL

Aspirin Inhibits Colon Cancer Cell and Tumor Growth and Downregulates Specificity Protein (Sp) Transcription Factors

Acetylsalicylic acid (aspirin) is highly effective for treating colon cancer patients postdiagnosis; however, the mechanisms of action of aspirin in colon cancer are not well defined. Aspirin and its major metabolite sodium salicylate induced apoptosis and decreased colon cancer cell growth and the sodium salt of aspirin also inhibited tumor growth in an athymic nude mouse xenograft model. Colon cancer cell growth inhibition was accompanied by downregulation of Sp1, Sp3 and Sp4 proteins and decreased expression of Sp-regulated gene products including bcl-2, survivin, VEGF, VEGFR1, cyclin D1, c-MET and p65 (NFκB). Moreover, we also showed by RNA interference that β-catenin, an important target of aspirin in some studies, is an Sp-regulated gene. Aspirin induced nuclear caspase-dependent cleavage of Sp1, Sp3 and Sp4 proteins and this response was related to sequestration of zinc ions since addition of zinc sulfate blocked aspirin-mediated apoptosis and repression of Sp proteins. The results demonstrate an important underlying mechanism of action of aspirin as an anticancer agent and, based on the rapid metabolism of aspirin to salicylate in humans and the high salicylate/aspirin ratios in serum, it is likely that the anticancer activity of aspirin is also due to the salicylate metabolite