Adenocarcinoma of Lung Presenting as Unilateral Blindness: A Case Report

Introduction: Lung cancer is the most common cause of death among cancers. Over 55% have distant metastasis at presentation. Intraocular metastasis is a rare site of spread. It is extremely unusual for lung cancer to present primarily with features of choroidal involvement before any respiratory symptoms are manifest.Case Report: A 53 year old lady presented with protrusion of the left eye followed by sudden unilateral painless loss of vision one month later. She was diagnosed to have a left retinal detachment due to a choroidal mass in the left eye. Enucleation was done and showed a metastatic carcinoma of unknown primary. Immunohistochemistry was suggestive of adenocarcinoma with primary in the lung. She had a right mid-lobe lesion for which biopsy was attempted but failed. She also had multiple skeletal metastases and small lesions in the liver. Mutation analysis on the enucleation specimen was positive for exon 19 mutation of EGFR gene and she was started on single agent oral gefitinib 250mg daily and bisphosphonates. Reassessment done 3 months showed reduction in the size of the primary lung lesion with resolution of the liver lesions. Skeletal lesions remained the same.Conclusion: This case of choroidal metastasis presenting with retinal detachment demonstrates a very rare initial presentation of adenocarcinoma of the lung and highlights the need to look for a primary in the lung in cases of choroidal metastasis

Purple urine bag syndrome- changing hue!

Purple Urine Bag Syndrome (PUBS) is a unique disease entity characterised by purple discoloration of urine secondary to recurrent urinary tract infections with indigo and indirubin producing bacteria and is predominantly seen in constipated, chronically debilitated and catheterised women with alkaline urine. This syndrome indicates underlying recurrent urinary tract infections (UTIs) associated with higher incidence of mortality and morbidity than urinary tract infection alone without this occurrence. This article is about an elderly hypothyroid woman with PUBS and reviews the need to be aware of this entity

Algorithms for Power Aware Testing of Nanometer Digital ICs

At-speed testing of deep-submicron digital very large scale integrated (VLSI) circuits has become mandatory to catch small delay defects. Now, due to continuous shrinking of complementary metal oxide semiconductor (CMOS) transistor feature size, power density grows geometrically with technology scaling. Additionally, power dissipation inside a digital circuit during the testing phase (for test vectors under all fault models (Potluri, 2015)) is several times higher than its power dissipation during the normal functional phase of operation. Due to this, the currents that flow in the power grid during the testing phase, are much higher than what the power grid is designed for (the functional phase of operation). As a result, during at-speed testing, the supply grid experiences unacceptable supply IR-drop, ultimately leading to delay failures during at-speed testing. Since these failures are specific to testing and do not occur during functional phase of operation of the chip, these failures are usually referred to false failures, and they reduce the yield of the chip, which is undesirable. In nanometer regime, process parameter variations has become a major problem. Due to the variation in signalling delays caused by these variations, it is important to perform at-speed testing even for stuck faults, to reduce the test escapes (McCluskey and Tseng, 2000; Vorisek et al., 2004). In this context, the problem of excessive peak power dissipation causing false failures, that was addressed previously in the context of at-speed transition fault testing (Saxena et al., 2003; Devanathan et al., 2007a,b,c), also becomes prominent in the context of at-speed testing of stuck faults (Maxwell et al., 1996; McCluskey and Tseng, 2000; Vorisek et al., 2004; Prabhu and Abraham, 2012; Potluri, 2015; Potluri et al., 2015). It is well known that excessive supply IR-drop during at-speed testing can be kept under control by minimizing switching activity during testing (Saxena et al., 2003). There is a rich collection of techniques proposed in the past for reduction of peak switching activity during at-speed testing of transition/delay faults ii in both combinational and sequential circuits. As far as at-speed testing of stuck faults are concerned, while there were some techniques proposed in the past for combinational circuits (Girard et al., 1998; Dabholkar et al., 1998), there are no techniques concerning the same for sequential circuits. This thesis addresses this open problem. We propose algorithms for minimization of peak switching activity during at-speed testing of stuck faults in sequential digital circuits under the combinational state preservation scan (CSP-scan) architecture (Potluri, 2015; Potluri et al., 2015). First, we show that, under this CSP-scan architecture, when the test set is completely specified, the peak switching activity during testing can be minimized by solving the Bottleneck Traveling Salesman Problem (BTSP). This mapping of peak test switching activity minimization problem to BTSP is novel, and proposed for the first time in the literature. Usually, as circuit size increases, the percentage of don’t cares in the test set increases. As a result, test vector ordering for any arbitrary filling of don’t care bits is insufficient for producing effective reduction in switching activity during testing of large circuits. Since don’t cares dominate the test sets for larger circuits, don’t care filling plays a crucial role in reducing switching activity during testing. Taking this into consideration, we propose an algorithm, XStat, which is capable of performing test vector ordering while preserving don’t care bits in the test vectors, following which, the don’t cares are filled in an intelligent fashion for minimizing input switching activity, which effectively minimizes switching activity inside the circuit (Girard et al., 1998). Through empirical validation on benchmark circuits, we show that XStat minimizes peak switching activity significantly, during testing. Although XStat is a very powerful heuristic for minimizing peak input-switchingactivity, it will not guarantee optimality. To address this issue, we propose an algorithm that uses Dynamic Programming to calculate the lower bound for a given sequence of test vectors, and subsequently uses a greedy strategy for filling don’t cares in this sequence to achieve this lower bound, thereby guaranteeing optimality. This algorithm, which we refer to as DP-fill in this thesis, provides the globally optimal solution for minimizing peak input-switching-activity and also is the best known in the literature for minimizing peak input-switching-activity during testing. The proof of optimality of DP-fill in minimizing peak input-switching-activity is also provided in this thesis

XMCD studies of thin Co films on BaTiO3_3

Different layer thicknesses of Cobalt ranging from 2.6 {\AA} (1.5 ML) up to 55 {\AA} (30.5 ML) deposited on ferroelectric BaTiO$_3$ have been studied regarding their magnetic behavior. The layers have been characterized using XMCD spectroscopy at remanent magnetization. After careful data analysis the magnetic moments of the Cobalt could be determined using the sum rule formalism. There is a sudden and abrupt onset in magnetism starting at thicknesses of 9 {\AA} (5 ML) of Cobalt for measurements at 120 K and of 10 {\AA} (5.5 ML) if measured at room temperature. Initial island growth and subsequent coalescence of Co on BaTiO$_3$ is suggested to explain the sudden onset. In that context, no magnetically dead layers are observed.Comment: 9 pages, 5 figures, submitted to J. Phys. Condens. Matte

DP-fill: a dynamic programming approach to X-filling for minimizing peak test power in scan tests

At-speed testing is crucial to catch small delay defects that occur during the manufacture of high performance digital chips. Launch-Off-Capture (LOC) and Launch-Off-Shift (LOS) are two prevalently used schemes for this purpose. LOS scheme achieves higher fault coverage while consuming lesser test time over LOC scheme, but dissipates higher power during the capture phase of the at-speed test. Excessive IR-drop during capture phase on the power grid causes false delay failures leading to significant yield reduction that is unwarranted. As reported in literature, an intelligent filling of don't care bits (X-filling) in test cubes has yielded significant power reduction. Given that the tests output by automatic test pattern generation (ATPG) tools for big circuits have large number of don't care bits, the X-filling technique is very effective for them. Assuming that the design for testability (DFT) scheme preserves the state of the combinational logic between capture phases of successive patterns, this paper maps the problem of optimal X-filling for peak power minimization during LOS scheme to a variant of interval coloring problem and proposes a dynamic programming (DP) algorithm for the same along with a theoretical proof for its optimality. To the best of our knowledge, this is the first ever reported X-filling algorithm that is optimal. The proposed algorithm when experimented on ITC99 benchmarks produced peak power savings of up to 34% over the best known low power X-filling algorithm for LOS testing. Interestingly, it is observed that the power savings increase with the size of the circuit

Ten years survival results of randomized study comparing weekly vs. triweekly cisplatin with concurrent radiation in locally advanced carcinoma cervix

Background: The current standard of treatment for locally advanced cervical cancer is concurrent chemo-radiation with improved overall survival (OS) by 6% with manageable toxicities. The cisplatin 40 mg/m2 given weekly is the widely practiced regimen for 4–6 cycles concurrently with irradiation. Materials and methods: Two hundred and twelve patients with histologically proven squamous cell carcinoma of cervix with stages IIB to IIIB were enrolled between 2007–2011. External beam radiation dose of 45 Gy in 25 fractions was delivered over 5 weeks. Brachytherapy was delivered by manual afterloading cesium-137 (Cs137) low dose brachytherapy (LDR) using modified Fletcher suit intracavitary applicators to a total dose of 30 Gy to Point A or interstitial template to dose of 21 Gy/3 fractions with remote afterloading iridium-192 (Ir192) high dose brachytherapy (HDR). Patients were randomized to arm A receiving 40 mg/m2 of concurrent cisplatin weekly and arm B receiving 100 mg/m2 of concurrent cisplatin triweekly. Results: One hundred and nine patients were randomized to weekly cisplatin and one hundred and three patients to triweekly cisplatin at the end of recruitment. At ten years, the OS was higher in the weekly arm (79.8%) compared to triweekly arm (70.9%). Disease free survival (DFS) was almost equal (76.1% and 73.8%) in the weekly and three-weekly arms. There is definite significance in overall DFS with patients receiving the cumulative cisplatin doses of more than 250 mg (p = 0.028). The patients with more than 45 years of age had better overall survival (OS) (79%) with statistical significance 31 (p = 0.020). Conclusion: Both cisplatin based triweekly and weekly concurrent chemotherapy are equally effective in terms of OS and DFS

Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with endometrial cancer

Endometrial cancer; Guidelines; TreatmentCàncer d'endometri; Pautes; TractamentCáncer de endometrio; Pautas; TratamientoThe most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with endometrial cancer was published in 2022. It was therefore decided, by both the ESMO and the Indian Society of Medical and Paediatric Oncology (ISMPO), to convene a virtual meeting in July 2022 to adapt the ESMO 2022 guidelines to take into account the variations in the management of endometrial cancer in Asia. These guidelines represent the consensus opinion of a panel of Asian experts representing the oncological societies of China (CSCO), India (ISMPO), Indonesia (ISHMO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), the Philippines (PSMO), Singapore (SSO), Taiwan (TOS) and Thailand (TSCO). Voting was based on scientific evidence and was conducted independently of the current treatment practices and treatment access constraints in the different Asian countries, which were discussed when appropriate. The aim of this guideline manuscript is to provide guidance for the optimisation and harmonisation of the management of patients with endometrial cancer across the different regions of Asia, drawing on the evidence provided by Western and Asian trials whilst respecting the variations in clinical presentation, diagnostic practices including molecular profiling and disparities in access to therapeutic options, including drug approvals and reimbursement strategies.All costs relating to this consensus conference were covered by the ESMO and the ISMPO from central dedicated funds. There was no external funding of the event or the manuscript production

Imatinib resistance mutation analysis: experience from a tertiary oncology center

Purpose: BCR-ABL kinase domain (KD) mutations account for 50-90% of the imatinib resistance observed in patients of CML-chronic phase. In CML-CP patients receiving imatinib first-line, mutation analysis is recommended in case of failure or suboptimal response using European LeukemiaNet (ELN) criteria. The present study was carried out at a tertiary oncology centre in south India to assess which mutations accounted for resistance to imatinib among patients of chronic phase CML being treated with imatinib.Methods: This was a retrospective observational study. We analyzed patients who were tested for imatinib resistance mutation in view of suboptimal responses while on imatinib or imatinib failure. Direct sequencing of the BCR-ABL transcript by the Sanger method was used for IRMA testing.Results: Out of 120 tested for IRMA, 36 (30%) had detectable mutations. We observed a higher frequency of mutations at amino acids T315, F359 and M351T.Conclusions: Among the patients who were tested for imatinib resistance mutation in view of suboptimal responses while on imatinib or imatinib failure, 30% had IRMA +ve mutations. The high incidence of imatinib resistance in present study may be attributed to the fact that our patients were given higher dose of imatinib (600 mg), if they failed to achieve CCyR at 12 months or CHR at 3 months as they could not afford second generation TKIs.</p

Imatinib resistance mutation analysis: experience from a tertiary oncology center

Purpose: BCR-ABL kinase domain (KD) mutations account for 50-90% of the imatinib resistance observed in patients of CML-chronic phase. In CML-CP patients receiving imatinib first-line, mutation analysis is recommended in case of failure or suboptimal response using European LeukemiaNet (ELN) criteria. The present study was carried out at a tertiary oncology centre in south India to assess which mutations accounted for resistance to imatinib among patients of chronic phase CML being treated with imatinib.Methods: This was a retrospective observational study. We analyzed patients who were tested for imatinib resistance mutation in view of suboptimal responses while on imatinib or imatinib failure. Direct sequencing of the BCR-ABL transcript by the Sanger method was used for IRMA testing.Results: Out of 120 tested for IRMA, 36 (30%) had detectable mutations. We observed a higher frequency of mutations at amino acids T315, F359 and M351T.Conclusions: Among the patients who were tested for imatinib resistance mutation in view of suboptimal responses while on imatinib or imatinib failure, 30% had IRMA +ve mutations. The high incidence of imatinib resistance in present study may be attributed to the fact that our patients were given higher dose of imatinib (600 mg), if they failed to achieve CCyR at 12 months or CHR at 3 months as they could not afford second generation TKIs