Differing myocardial response to a single session of hemodialysis in end-stage renal disease with and without type 2 diabetes mellitus and coronary artery disease

BACKGROUND: Though hemodialysis (HD) acutely improves cardiac function, the impact of background diseases like coronary artery disease (CAD) and Type 2 diabetes (DM) in the setting of end-stage renal disease (ESRD) is not known. Tissue velocity echocardiography (TVE) offers a fast choice to follow changes in myocardial function after HD in ESRD with concomitant DM and /or CAD. METHODS: 46 subjects (17 with ESRD, Group 1; 15 with DM, Group 2; 14 with DM+CAD, Group 3) underwent standard and TVE prior to and shortly after HD. Besides standard Doppler variables, regional myocardial systolic and diastolic velocities, as well as systolic strain rate were post processed. RESULTS: Compared with pre-HD, post-HD body weight (kg) significantly decreased in all the three groups (51 ± 9 vs. 48 ± 8, 62 ± 10 vs.59 ± 10, and 61 ± 9 vs. 58 ± 9 respectively; all p < 0.01). Left ventricular end diastolic dimensions (mm) also decreased post- HD (46 ± 5 vs. 42 ± 7, 53 ± 7 vs. 50 ± 7, 51 ± 7 vs. 47 ± 8 respectively; all p < 0.01). Regional longitudinal peak systolic velocity in septum (cm/s) significantly increased post-HD in Group 1(5.7 ± 1.6 vs. 7.2 ± 2.3; p < 0.001) while remained unchanged in the other two groups. Similar trends were noted in other left ventricular walls. When the myocardial velocities (cm/s) were computed globally, the improvement was seen only in Group 1 (6.3 ± 1.5 vs. 7.9 ± 2.0; p < 0.001). Global early regional diastolic velocity (cm/s) improved in Group 1, remained unchanged in Group 2, while significantly decreased in Group 3(-5.9 ± 1.3 vs. -4.1 ± 1.8; p < 0.01). Global systolic strain rate (1/sec) increased in the first 2 Groups but remained unchanged (-0.87 ± 0.4 vs. -0.94 ± 0.3; p = ns) in Group 3. CONCLUSION: A single HD session improves LV function only in ESRD without coexistent DM and/or CAD. The present data suggest that not only dialysis-dependent changes in loading conditions but also co-existent background diseases determine the myocardial response to HD

Head and Neck Lymphomas: Tip of the Iceberg?

ABSTRACT Background: Lymphomas comprise around 5% of all head and neck neoplasms and is the second most common extra nodal non hodgkin&apos;s lymphoma (NHL). However there is sporadic data on this entity from the subcontinent and hence we undertook this study. Methodology: This retrospective observational study was conducted at a tertiary care oncology center in India on diagnosed cases of NHL between January 2007 and December 2013. All patients were diagnosed based on histopathology and immunohistochemistry. Staging work up was done in all patients. Patients were considered as primary Head and Neck lymphomas if there was head and neck as the predominant site with or without regional lymph node involvement. Results: A total of 39 patients were studied. The age at presentation ranged from 29 to 78 years. The most common site of presentation was oral cavity (26%; n=10), followed by parotid and thyroid (18% each; n=7), eye (12%, n=5), maxilla (8%; n=3), paranasal sinuses (8%; n-=3) cheek (8%, n=3), and nasal cavity (2%, n=1). 41% (n=16) cases were in stage I, 43% (n=17) in stage II, 3% (n=1) in stage III, and 13% (n=5) were in stage IV. Most common histology was DLBCL (71%; n=28), followed by plasmablastic (10%; n=4), marginal zone (8%, n=3), mantle cell (3%; n=1), follicular lymphomas (5%; n=2), and NK/T cell lymphoma (3%; n=1). Most of the patients were of low risk (67%; n=26), followed by intermediate (23%; n=9), and high risk (10%; n=4). Patients were treated with anthracycline based chemotherapy +/-radiotherapy. In this study, stage I and stage II patients had a better prognosis and overall survival, median OS 28 months and 11 months, respectively. In stage III and IV, it was 7 and 3 months, respectively. According to site, the best median overall survival was seen with parotid (27 m), paranasal sinus (26m), and oral cavity (23 m), followed by thyroid (18 m) nasal cavity (17 m), maxilla (11 m), eye (8 m), and cheek (7 m)

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Evaluation of maize genotypes for Turcicum leaf blight (Exserohilum turcicum) in Terai and inner terai of Nepal

Thirty maize genotypes in 2014-2015 at Dumarwana, Nijgadh, Keureni and Rampur and ten genotypes in 2015-2016 at Anandpur, Shitalnagar, Dumarwana, Nijgadh and Rampur were evaluated for resistance to Turcicum leaf blight (Exserohilum turcicum) under farmers field conditions. The scale used for disease severity ranged from 1-5 scale based on the proportionate leaf area affected by the disease. The combined analysis over locations in 2014-2015 showed that among the 30 genotypes 25 genotypes were resistant (1.0-2.0 scale), and 5 genotypes were moderately resistant (2.1-3.0 scale). Similarly the pooled analysis over locations in 2015-2016 showed that 7 genotypes were resistant (1.0-2.0 scale) and 3 genotypes were moderately resistant (2.1-3.0 scale). The maize genotypes namely Z376-26, Z478-3, Z433-99, Z464-5, Z478-2, Z466-1, CAH1513, RML-95/RML-96, CAH1515, CAH1521, CAH1515, CAH151, CAH153, ZH114228 , Z376-9, Z466-3, Z376-5, RML-32/RML-17, RML-86/RML-96 and 900MGold were resistant with disease severity scale of 1.5 and with higher grain yield in both the years. Thus above genotypes were identified as promising sources of resistance against E. turcicum and they can be used to develop disease resistant and high yielding varieties to enhance maize productivity in terai and inner terai of Nepal

Tillage and planting density affect the performance of maize hybrids in Chitwan, Nepal

To find out whether the different tillage methods at different planting densities affect the performance of maize hybrids, an experiment was carried out at National Maize Research Program, Rampur during spring season of 2013 and 2014. The experiment was laid out in strip plot design with three replications having 12 treatments. The vertical factor was tillage with conservation tillage (No Tillage + residue=NT) and conventional tillage (CT) and the horizontal factor were genotypes (Rampur Hybrid-2 and RML-32/RML-17) and in split planting geometries (75cm × 25cm =53333 plants/ha, 70cm × 25cm=57142 plant/ha and 60cm ×25cm= 66666 plants/ha). In both the years, the highest number of cobs (73,177 and 67638/ha) was recorded at planting density of 66666/ha. NT had the highest no of kernel rows/cob (14.01) as against 12.12 in CT in 2014. The highest number of kernels (27.3 and 29.29) per row was recorded in NT during 2013 and 2014 respectively. Similarly, in 2014, the highest number of kernels were found in RML-32/RMl-17 (29.17/row) and planting density of 53333/ha (28.46/row). In 2013, RML-32/RML-17 produced the highest test weight of 363.94g over the Rampur hybrid-2 with 362.17g. Significantly the highest grain yield of 9240.00 kg/ha in 2013 and 7459.80 kg/ha in 2014 at planting geometry of 65cm ×25cm were recorded. No effects was found by tillage methods for grain yields of maize in 2013, but was found in 2014 (7012.18 kg in NT compared to 6037.59 kg/ha in CT). NT and wider spaced crop matured earlier in both the years; however Rampur hybrid-2 matured earlier to RML-32/RML-17 in 2013. In 2014, harvest index of 47.85 % was recorded in planting geometry of 66666/ha, the highest benefit cost ratio of 1.36 was worked out in NT and 1.46 at the density of 66666/ha. The highest value of 2.46% of soil organic matter was recorded in NT as compared to 2.43% in CT

Status and prospects of maize research in Nepal

Food and nutritional securities are the major threats coupled with declining factor productivity and climate change effects in Nepal. Maize being the principal food crops of the majority of the hill people and source of animal feed for ever growing livestock industries in Terai of Nepal. Despite the many efforts made to increase the maize productivity in the country, the results are not much encouraging. Many of the maize based technologies developed and recommended for the farmers to date are not fully adopted. Therefore, problem is either on technology development or on dissemination or on both. Considering the above facts, some of the innovative and modern approaches of plant breeding and crop management technologies to increase the maize yield need to be developed and disseminated. There is a need for location-specific maize production technologies, especially for lowland winter maize, marginal upland maize production system, and resource poor farmers. Research efforts can be targeted to address both yield potential and on-farm yields by reducing the impacts of abiotic and biotic constraints. Therefore, in order to streamline the future direction of maize research in Nepal, an attempt has been made in this article to highlight the present status and future prospects with few key pathways

Chronic Myeloid Leukemia with Variant Chromosomal Translocations: Results of Treatment with Imatinib Mesylate

Objective: To evaluate the efficacy of imatinib in chronic myeloid leukemia patients with variant translocations. Methods: Forty eight chronic myeloid leukemia patients carrying variant translocations and treated with imatinib at our institute were considered for the study. Survival and response rates were evaluated. Results: The median follow up was 48 months(m). Forty three (89.58%) patients achieved complete hematologic response. Thirty one (64.58%) patients achieved complete cytogenetic response and 19(39.58%) achieved major molecular response anytime during their follow up period. Only 18.75% of the patients achieved complete cytogenetic response and major molecular response within the stipulated time frames.The estimated overall survival at 48 m median follow up was 81.2%.The progression free survival was also 81.2% and the event free survival was 79.1%.There was no significant survival difference between low vs intermediate and high risk sokal group. Conclusion: We report suboptimal responses to imatinib in chronic myeloid leukemia with variant translocations. Further studies with imatinib and the newer more active drugs dasatinib and nilotinib are justified

Performance evaluation of quality protein maize genotypes across various maize production agro ecologies of Nepal

To identify superior quality protein maize genotypes for grain yield under different agro climatic conditions of terai and hill districts in Nepal, the coordinated varietal trials (CVT) were conducted at Dailekh, Doti, Salyan, Lumle and Pakhribas in 2013 and Salyan, Pakhribas and Kabre in 2014 during summer season and coordinated farmer’s field trials (CFFT) at Surkhet and Dailekh in 2013 and Salyan, Pakhribas and Khumaltar in 2014 during summer season. The experiment was carried out using randomized complete block design with three replications for CVT and CFFT. Across the locations and years the superior genotypes found under CVT were S01SIYQ, S01SIWQ-2 and Poshilo Makai-1 where as S99TLYQ-HG-AB, S99TLYQ-B and Poshilo Makai-1 were found superior genotypes under CFFT. The superior genotypes derived from CFFT will be promoted further for similar environments across the country