Case Report: PTHrP Related Hypercalcemia in Diffuse Large B-cell Lymphoma

INTRODUCTION Hypercalcemia is commonly associated with solid tumor malignancies, but less often with hematologic malignancies. When present in hematologic malignancies, hypercalcemia is often secondary to overproduction of Vitamin D from the tumor cells. Very few cases with parathyroid hormone related peptide (PTHrP) induced hypercalcemia in B-cell lymphomas have been reported. Here we present a 44 year old male with a history of chronic lymphoctic leukemia who presented with hypercalcemia and an elevated PTHrP, found to have a transformation to Diffuse Large B-cell Lymphoma (DLBCL)

Caesarean delivery on maternal request (CDMR): clinical and ethical dilemma

Now a days, in developing countries like India, one of the most common contributing factor for increasing caesarean section rate is CDMR (Caesarean delivery on maternal request). Incidence of CDMR reached upto 18 percent of total caesarean deliveries worldwide. The issue of CDMR is ongoing bioethical debate which highlights the struggle to balance patient autonomy with duty of obstetrician to uphold the principle of beneficence, non maleficence and justice. Our mission should be to promote safe, effective and satisfying maternity care for all women and their families through research, education, expertise and advocacy

Set up errors in Brain tumours – A retrospective study to review the current practice of PTV margins in the institution

Set up errors in Brain tumours – A retrospective study to review the current practice of PTV margins in the institution Chaturvedi D.1 , Mehta A.2 , Kumar P.3*   1 Diksha Chaturvedi, Junior Resident, Department of Radiation Oncology, Shri Ram Murti Institute of Medical Sciences, Bareilly, Uttar Pradesh, India. 2 Ankita Mehta, Senior Resident, Department of Radiation Oncology, Shri Ram Murti Institute of Medical Sciences, Bareilly, Uttar Pradesh, India. 3* Piyush Kumar, Professor and Head, Department of Radiation Oncology, Shri Ram Murti Institute of Medical Sciences, Bareilly, Uttar Pradesh, India. Corresponding Author: Dr. Piyush Kumar, Professor and Head, Department of Radiation Oncology, all authors are affiliated to Shri Ram Murti Institute of Medical Sciences, Bareilly, Uttar Pradesh, India, E-mail: [email protected]   Abstract Background Radiotherapy in brain tumors needs accuracy and reproducibility of the patient’s position. There may be set up errors which are taken care by adding planning target volume (PTV) margin. Lesser PTV margins may lead to tumor miss or greater margins may lead to unnecessary radiation of normal brain tissue. The present study is done to evaluate whether the current practice of PTV margins in our institute is optimum or not. Materials and methods Eleven patients of brain tumours who received adjuvant radiotherapy were retrospectively selected for determining the setup errors. These patients were immobilised in supine position and contrast enhanced CT of head was taken for radiotherapy planning. Delineation of gross tumor volume and clinical target volume was done with 5 mm PTV margin. The treatment was delivered by 3-Dimensional Conformal Radiotherapy or Intensity Modulated Radiotherapy Technique. The set up errors in three dimensions were determined retrospectively for all images. PTV margins were calculated using International Commission on Radiation Units And Measurements Report 62, Stroom’s and Van Herk formulae. Results The overall population set up error was 0.034,-0.048, 0.028 in X, Y, Z directions respectively. The population systematic error was calculated to be 0.107, 0.069, 0.092 and population random error was 0.221, 0.202, 0.217 in X, Y, Z directions respectively. The calculated setup margin as per the three formulas was less than 5 mm in all directions. Conclusion The present study showed that the institutional protocol of 5 mm is optimum to counter the setup errors.&nbsp

Case Report: Uncontrolled Anasarca: Capillary Leak Syndrome

INTRODUCTION Capillary leak syndrome (CLS) is a rare clinical disease that causes edema, hypoproteinemia, episodic hypotension, dyspnea, hyponatremia, and weight gain that can be life threatening1. Although the underlying pathology is currently unknown, CLS is thought to be secondary to a systemic process associated with hyperpermeability of the body\u27s microcirculation, resulting from a diffuse and severe disruption of the endothelium and causing generalized edema and often acute respiratory distress2

Misplaced intra uterine devices: a rare case of vaginal entrapment

Intra uterine devices (IUD) are the second most common accepted methods of contraception worldwide after sterilization. It is a long acting reversible contraceptive (LARC) which is now being promoted as a simpler, safer and effective method of contraception for those women who do not want a permanent method of contraception. Missing thread is the most common complaint seen within 6 weeks of insertion and may be the only presentation of misplaced IUD. Most women who spontaneously expel the IUD are unaware of the situation. We are presenting a case of misplaced IUD which was partially expelled and got embedded in the vagina which is a rare site of misplaced IUD

Schema Matching using Machine Learning

Schema Matching is a method of finding attributes that are either similar to each other linguistically or represent the same information. In this project, we take a hybrid approach at solving this problem by making use of both the provided data and the schema name to perform one to one schema matching and introduce the creation of a global dictionary to achieve one to many schema matching. We experiment with two methods of one to one matching and compare both based on their F-scores, precision, and recall. We also compare our method with the ones previously suggested and highlight differences between them.Comment: 7 pages, 2 figures, 2 table

Real-world observational study to capture practice pattern of controlled ovarian stimulation in the in vitro-fertilization and embryo transfer or intracytoplasmic sperm injection-2

Background: The objective of the study was to evaluate the practice patterns of controlled ovarian stimulation (COS) in patients who underwent in vitro-fertilization and embryo transfer (IVF-ET) or intracytoplasmic sperm injection (ICSI).Methods: In REAL-COS (REAL-world observational study to capture practice pattern of COS in IVF-ET/ ICSI cycle) study, data was collected by 138 clinicians across India between April 2021 and March 2022 in a retrospective manner.Results: Data of 1651 subfertility female patients were evaluated. The mean (SD) age was 31.8 (3.9) years and majority (77.8%) of the patients were aged <35 years. Obese patients constituted 28.1% of the total population. The majority (79.5%) of the patients had primary subfertility and the polycystic ovarian syndrome (PCOS) was the most (27.8%) common cause of subfertility. Nearly equal percent of patients were treated with frozen or fresh embryo transfer. Most (~96%) of the patients received GnRH antagonist protocol wherein cetrorelix acetate was the most common drug (98.7%) while ~4% patients received GnRH agonist protocol wherein luprorelin was the most common one (83%). The most commonly used gonadotropin was recombinant follicle stimulating hormone alone therapy (rFSH, 49.2%). Majority (51.8%) of the patients were initiated at 225 IU dose of gonadotropin for COS. For ovulation trigger, human chorionic gonadotropin (hCG) was used in majority (59%) of the cases. Treatment with rFSH alone therapy resulted in max mean no. of oocytes and mean metaphase-II oocytes as compared with other treatments.Conclusions: This real-world observational study reports primary subfertility as the major reason for IVF-ET/ICSI in the study population. The GnRH antagonist protocol was followed by most of the clinicians participating in this study. rFSH was the most commonly used gonadotropin. rFSH alone therapy yielded the greatest number of oocytes and metaphase II oocytes versus other treatments

Dosimetric comparison of radiotherapy treatment plans done by IMRT and VMAT technique in head and neck cancer patients

Background: The increasing patient load in radiotherapy centres demands selection of the technique that provides plans with optimal dosimetry in terms of target volume coverage, organs at risk (OAR) sparing and a lesser treatment time. This study was designed to compare the two widely practised conformal techniques, IMRT and VMAT in head and neck cancer patients in terms of planning target volume (PTV) coverage, OAR sparing and treatment delivery parameters. Materials and methods: For ten postoperative head and neck cancer patients who had been treated by IMRT technique virtual VMAT plans were generated for study purposes. The dose prescribed to PTV was 60 Gy in 30 fractions. The dose-volume parameters of PTV and OARs and the treatment delivery parameters were compared amongst both the techniques. Statistical significance was calculated using paired ‘t’ test. Results: Both the plans were comparable in terms of dosimetry. The only significant difference being better conformity in the IMRT plans. The dose to OARs was also comparable in both the techniques except for a significant reduction in the point dose to brainstem with the IMRT technique. Given the treatment delivery parameters, there was a significant reduction in the treatment delivery time and monitor units with the VMAT technique compared to the IMRT technique. Conclusion: VMAT technique gave comparable plans to that of the IMRT technique in terms of dosimetry but reduced the treatment time. It seems feasible in radiotherapy centres with increased patient load

Inactivation of Hippo and cJun-N-terminal Kinase (JNK) signaling mitigate FUS mediated neurodegeneration in-vivo

Amyotrophic Lateral Sclerosis (ALS), a late-onset neurodegenerative disorder characterized by the loss of motor neurons in the central nervous system, has no known cure to-date. Disease causing mutations in human Fused in Sarcoma (FUS) leads to aggressive and juvenile onset of ALS. FUS is a well-conserved protein across different species, which plays a crucial role in regulating different aspects of RNA metabolism. Targeted misexpression of FUS in Drosophila model recapitulates several interesting phenotypes relevant to ALS including cytoplasmic mislocalization, defects at the neuromuscular junction and motor dysfunction. We screened for the genetic modifiers of human FUS-mediated neurodegenerative phenotype using molecularly defined deficiencies. We identified hippo (hpo), a component of the evolutionarily conserved Hippo growth regulatory pathway, as a genetic modifier of FUS mediated neurodegeneration. Gain-of-function of hpotriggers cell death whereas its loss-of-function promotes cell proliferation. Downregulation of the Hippo signaling pathway, using mutants of Hippo signaling, exhibit rescue of FUS-mediated neurodegeneration in the Drosophila eye, as evident from reduction in the number of TUNEL positive nuclei as well as rescue of axonal targeting from the retina to the brain. The Hippo pathway activates c-Jun amino-terminal (NH2) Kinase (JNK) mediated cell death. We found that downregulation of JNK signaling is sufficient to rescue FUS-mediated neurodegeneration in the Drosophila eye. Our study elucidates that Hippo signaling and JNK signaling are activated in response to FUS accumulation to induce neurodegeneration. These studies will shed light on the genetic mechanism involved in neurodegeneration observed in ALS and other associated disorders

Prosthetic Rehabilitation of a Patient with Xerostomia Following Radiotherapy: A Case Report

Xerostomia, characterized by a subjective feeling of dryness in the mouth has profound consequences on oral health including dental caries, oral discomfort, and a diminished overall quality of life. The absence or alteration of saliva can have profound consequences, manifesting as dental caries, oral discomfort, and a diminished overall quality of life. The present case report details a case of a reservoir denture, showcasing successful outcomes in the innovative management of xerostomia. By describing an alternative technique for denture fabrication, the present case report focuses on the construction of a mandibular reservoir dentur