Clinical Outcome of Breast Conservation Surgery in Early Breast Cancer Patients: A Prospective Interventional Study

Introduction: Breast conservation surgery (BCS) has gained acceptance among the surgeons for the management of young patients with early breast cancer. Aim: To study the outcomes of breast conservation surgery in early breast cancer patients at a tertiary care centre in Marathwada region of Maharashtra, India. Materials and Methods: This prospective interventional study included 40 patients in the age group of 20-65 years with stage I or stage II breast cancer was carried out in Government Medical College and Hospital, Aurangabad, India. Once staging workup was done, all patients were evaluated for suitability of BCS. Surgical treatment consisted of wide local excision and axillary dissection with gross tumour surgical margin of 2 cm. Surgical morbidity like prolonged seroma formation, surgical site infection, haematoma, lymphoedema was assessed postoperatively. Pathological assessment included primary tumour size, histological type, margin status. Radiotherapy was given to all patients. Chemotherapy was used where indicated with the appropriate regimen. All patients were followed up at three months, six months and 12 months. Cosmetic outcome was assessed by Harris four point Likert Scale. Descriptive statistics was used and results were expressed in terms of frequency and percentages. Results: In this study; 28 (70%) patients had no postoperative wound complications. About 4 (10%) had surgical site infection, and 8 (20%) had prolonged seroma formation. Out of 40 patients, 37 (92.5%) patients postoperatively had all the margins free from the disease on histopathology, 2 (5%) had single margin positive which required revision surgery, and 1 (2.5%) had all the margins positive; hence Modified Radical Mastectomy (MRM) was performed. The cosmetic outcome was good to excellent in 34 (85%) cases. Conclusion: Breast conserving surgery had a good cosmetic outcome. Most patients had disease free margin

STROKE OUTCOMES IN NON-DIABETIC, DENOVO DIABETIC AND DIABETIC INDIAN PATIENTS MEASURED BY MODIFIED RANKIN SCALE: AN OBSERVATIONAL STUDY

Objective: Hyperglycemia is a known risk factor which adversely impacts the outcomes in stroke patients compared to patients with normal blood glucose levels. Patients suffering from an acute stroke who are previously nonhyperglycemic may show elevated blood glucose levels. The present study was designed to measure the outcomes in denovo diabetic and diabetic stroke patients compared to nondiabetics.Methods: A prospective observational study over a period of 6 mo, in which 103 patients were divided into three cohorts based on their blood glucose levels (nondiabetic, denovo diabetic and diabetics). The modified Rankin scale (mRS) score was calculated at in-hospital admission and discharge in these three cohorts. The initial and final scores were correlated and mean differences with respect to outcomes between all the three cohorts was calculated.Results: The mean mRS at the time of hospital admission in diabetics and nondiabetics was 3.6±0.81 and 3.3±0.78 which decreased to 2.8±0.95 and 2.9±0.83 respectively at the time of discharge. The mean mRS score in denovo diabetic stroke patients during in-hospital admission was 4±0.81 which was calculated as 3.7±0.85 at the time of discharge. The mean difference in mRS score in diabetics vs non-diabetics was found to be 0.73±0.8 (p =<0.001). The mean difference in mRS score of denovo diabetics vs non-diabetics and denovo diabetics vs diabetics was 0.30±0.63 and 0.38±0.61 respectively (p = 0.1).Conclusion: Results of these observational study in Indian patients, highlights the need for controlling hyperglycemia in stroke patients to improve outcomes and to prevent mortality arising out of acute stroke attacks

An analysis of relationship between quality of life indices and clinical improvement following intervention in patients with intermittent claudication due to femoropopliteal disease

Objectives: To establish the relationship between quality of life (QOL) index scores and clinical indicators of lower limb ischemia. Methods: One hundred seventy-eight patients (108 men, median age 70 years) with femoropopliteal lesions suitable for angioplasty were recruited. Assessments were performed prior to and at 1, 3, 6, and 12 months following intervention (angioplasty and/or supervised exercise program). Clinical indicators of lower limb ischemia (treadmill walking distances, ankle pressures), generic (SF36, EuroQol), and disease-specific (Kings College VascuQol) quality of life questionnaires were analyzed. Correlation analysis was performed for index scores (SF-6D, EQ-5D, VascuQol) and individual domain scores using nonparametric tests. Results: All clinical indicators of lower limb ischemia and quality of life index scores showed a statistically significant improvement as result of intervention (Friedman test, P < .001). Both generic QOL index scores (SF-6D, EQ-5D) showed moderate but statistically significant correlation (Spearman’s rank correlation, P < .001) with treadmill walking distances (SF-6D r � 0.533, EQ-5D r�0.500) and weak but significant correlation to resting and postexercise ankle-brachial pressure index (SF-6D r�0.253, EuroQol r � 0.214). Disease-specific index scores (VascuQol) showed similar moderate correlation to treadmill walking distances (r � 0.584, P < .001) and weak but statistically significant correlation with resting and postexercise ABPI (r � 0.377, P < .001). All index scores showed strong and statistically significant (P<.001) correlation with patient-reported walking distance (SF-6D r� 0.604, EQ-5D r � 0.511, VascuQol r � 0.769). All domains of SF36 showed similar correlation with clinical indicators except general health. The strongest correlation was seen with treadmill walking distances in the domains of physical function (r�0.538) and bodily pain (r � 0.524). Conclusion: All generic and disease-specific QOL scores show statistically significant improvement with angioplasty and/or supervised exercise in patients with claudication due to femoropopliteal atherosclerosis. However, the degree of improvement seen in clinical indicators of lower limb ischemia is not reflected in these scores. These findings support the use of composite outcome measures with mandatory, independent assessment of QOL as an independent outcome measure in intervention studies in these patients

Inhibition of miRNA-34a Promotes M2 Macrophage Polarization and Improves LPS-Induced Lung Injury by Targeting Klf4

Acute respiratory distress syndrome (ARDS) is an outcome of an accelerated immune response that starts initially as a defensive measure, however, due to non-canonical signaling, it later proves to be fatal not only to the affected tissue but to the whole organ system. microRNAs are known for playing a decisive role in regulating the expression of genes involved in diverse functions such as lung development, repair, and inflammation. In-silico analyses of clinical data and microRNA databases predicted a probable interaction between miRNA-34a (miR-34a), mitogen-activated protein kinase 1 (ERK), and kruppel like factor 4 (Klf4). Parallel to in silico results, here, we show that intra-tracheal instillation of lipopolysaccharides (LPS) to mice enhanced miR-34a expression in lung macrophages. Inhibition of miR-34a significantly improved lung histology, whereas over-expression of miR-34a worsened the lung injury phenotype. miR-34a over-expression in macrophages were also demonstrated to favour pro-inflammatory M1 phenotype and inhibition of M2 polarization. In a quest to confirm this likely interaction, expression profiles of Klf4 as the putative target were analyzed in different macrophage polarizing conditions. Klf4 expression was found to be prominent in the miR-34a inhibitor-treated group but down-regulated in the miR-34a mimic treated group. Immuno-histopathological analyses of lung tissue from the mice treated with miR-34a inhibitor also showed reduced inflammatory M1 markers as well as enhanced cell proliferation. The present study indicates that miR-34a intensified LPS-induced lung injury and inflammation by regulating Klf4 and macrophage polarization, which may serve as a potential therapeutic target for acute lung injury/ARDS

Effects of an aerobic training program on liver functions in male athletes: a randomized controlled trial

Abstract The optimal functioning of the liver is essential for athletic performance. It is necessary to maintain the liver’s enzymes at an optimal level so that liver cells can be protected from inflammation or damage. This study investigated the effects of a 12-week aerobic exercise program on the liver function of adult athletes. A pretest–posttest experimental design was used. A total of thirty healthy male athletes (football players) aged 21 to 24 years were recruited for this study and randomly and equally divided into the experimental group (EG) and control group (CG). The CG did not participate in any special activities. The EG performed an aerobic training program consisting of several exercises for 12 weeks. Evaluation of all participants in both groups was carried out before and after the intervention by measuring the blood levels of Alkaline phosphate, AST/SGOT, ALT/SGPT, Bilirubin Total/indirect/direct, Albumin, Globulin, and Total protein using the standard methods by collecting blood samples. There was a significant decrease (p  0.05) between both groups post-treatment. The 12 weeks of aerobic training used in the study can potentially improve the liver function of adult athletes

Decision Support System for Predicting Survivability of Hepatitis Patients

Viral hepatitis is a major public health concern on a global scale. It predominantly affects the world's least developed countries. The most endemic regions are resource constrained, with a low human development index. Chronic hepatitis can lead to cirrhosis, liver failure, cancer and eventually death. Early diagnosis and treatment of hepatitis infection can help to reduce disease burden and transmission to those at risk of infection or reinfection. Screening is critical for meeting the WHO's 2030 targets. Consequently, automated systems for the reliable prediction of hepatitis illness. When applied to the prediction of hepatitis using imbalanced datasets from testing, machine learning (ML) classifiers and known methodologies for encoding categorical data have demonstrated a wide range of unexpected results. Early research also made use of an artificial neural network to identify features without first gaining a thorough understanding of the sequence data