Pre-mixed insulin has a similar efficacy to basal-bolus insulin in reducing HbA1c levels in type 2 diabetics

A clinical decision report using: Fulcher G, Roberts A, Sinha A, Proietto J. What happens when patients require intensification from basal insulin? A retrospective audit of clinical practice for the treatment of type 2 diabetes from four Australian centres. Diabetes Research and Clinical Practice, 2015;108(3):405–413. https://doi.org/10.1016/j.diabres.2015.03.004 for a patient with uncontrolled type 2 diabetes

Heterogenous Manifestations of Post Renal Transplant Lymphoma

Introduction: Post-transplant lymphoproliferative disorder (PTLD) is a serious complication occurring in 1-3% of adult renal transplant recipients (RTR). We present a case series of 16 RTR who demonstrate a variety of PTLD manifestations. Results: 63% of RTR received rATG induction and 38% Basiliximab. Maintenance immunosuppression post-transplantation was Prednisone, Tacrolimus, and Mycophenolate Mofetil. Average time from transplantation to PTLD diagnosis was 96.8 months ( Immunosuppression was discontinued in all RTR at diagnosis except Prednisone. Treatment was chemotherapy alone or in combination with radiation, resection, or salvage therapy; complications included Tumor Lysis Syndrome and infections. 56% of RTR developed renal insufficiency. 5 RTR (31%) achieved complete remission with a functioning graft. PTLD mortality rate was 63%; 9 RTR died with a functioning graft. Mortality with Basiliximab induction was 83% and 55% with rATG induction. T-cell PTLD had a 100% mortality while B-cell PTLD had a 54% mortality. EBV- PTLD had a higher mortality rate (88%) than EBV + (38%) PTLD. Patients died between Conclusion: PTLD with T-cell characterization, EBV negative status, and bone marrow and lymph node involvement demonstrated an increased mortality rate. PTLD has a myriad of manifestations and should be considered as a differential diagnosis in patients presenting with post-transplant lesions

Heterogeneous Manifestations of Posttransplant Lymphoma in Renal Transplant Recipients: A Case Series

Posttransplant lymphoproliferative disorder (PTLD) occurs in 1% to 3% of adult renal transplant recipients (RTRs). PTLD has a heterogeneous presentation and is often associated with Epstein-Barr virus (EBV) and immunosuppression. We present a descriptive case series of 16 RTRs who demonstrate a variety of PTLD manifestations. Fifty-six percent received rabbit antithymocyte globulin induction, and 37.5% received basiliximab. Maintenance immunosuppression included glucocorticoids, tacrolimus, and mycophenolate mofetil. Median time from transplantation to PTLD diagnosis was 96.5 months. PTLD involved a single site in 44% of RTRs and multiple sites in 56%. PTLD was localized to the gastrointestinal tract in 9 RTRs, in lymph nodes in 9, central nervous system in 4, bone marrow in 3, skin in 3, lungs in 2, perinephric space in 2, mediastinum in 1, and native kidney in 1. PTLD was EBV positive in 8 RTRs, monomorphic/monoclonal in 14, and of B-cell lineage in 13. Three RTRs had T-cell PTLD. Immunosuppressive agents, except glucocorticoids, were discontinued at diagnosis. Treatment was chemotherapy either alone (in 14 RTRs) or in combination with radiation. Complete remission was achieved in 62.5% of RTRs. Renal dysfunction developed in 62.5% of RTRs, and 4 received dialysis. The overall mortality rate was 62.5%, with median time of death 6.5 months after diagnosis. PTLD that was EBV negative and had T-cell involvement presented with aggressive disease and a higher mortality. Clinicians should be aware of the various PTLD manifestations. Early diagnosis and a multidisciplinary approach to treatment is crucial for improved patient outcomes

Endobronchial Tuberculosis Presenting as a Post-obstructive Pneumonia, Para-hilar Mass Lesion in Chest Radiograph and 'Tumorous' Endobronchial Lesion during Bronchoscopy: A Case Report

Abstract Tuberculosis (TB) remains a major health problem in India, and accounts for nearly 20-30% of the global TB burden. Prevalence of tuberculosis infection in India is 40%, with pulmonary tuberculosis accounts for 80% cases, and Endobronchial tuberculosis (EBTB) is present in 10-40% of patients with active pulmonary tuberculosis. EBTB has diverse clinical and radiological presentation and overall scenario is confusing. Normal chest radiograph is present in 10-20% cases in EBTB, and is the common reason for delay in diagnosis. In this case report, a 25 year male presenting as febrile respiratory illness with post-obstructive pneumonia & para-hilar mass in chest radiograph and having tumorous Endobronchial growth during bronchoscopy. We confirm finally as Endobronchial tuberculosis after histopathological evaluation. Gene Xpert is rapid and sensitive test to diagnose EBTB. He is treated with antituberculosis drugs for six months and recovered clinically and radiologically completely. Bronchoscopy is must in all the cases of high index of suspicion of EBTB

Role of pleural fluid “Cell Block” in malignant pleural effusion: Underutilized, sensitive, and superior over conventional fluid cytology; Does it will decrease need for thoracoscopy guided procedures?

Background: Malignant pleural effusion missed routinely because of less diagnostic yield of conventional fluid cytology. Materials and Methods: Prospective multicentric study conducted during January 2014 to June 2016 in Venkatesh chest hospital, and Pulmonary Medicine, MIMSR medical college Latur, to find diagnostic yield of conventional pleural fluid cytology and pleural fluid “cell block” in malignant pleural effusion and compare yield of pleural fluid cell block with conventional cytology technique. The study included 200 cases of unexplained, exudative pleural effusion with Adenosine deaminase (ADA) ≤30/IU/l and pleural fluid cytology is either positive for malignant cell with or without cell type differentiation, or cytology suspicious for malignant cell. All cases were subjected to cell block preparation. Statistical analysis was done by using Chi-test. Observation and Analysis: In study of 200 cases, mean age of group was 68 ± 9.5 years and adenocarcinoma was predominant malignancy in 72% cases, mesothelioma in 10% cases, squamous cell carcinoma in 7% cases and 9% cases were having primary tumor outside the thoracic cavity. In study cases, pleural fluid cytology was positive in 42% cases (84/200), and pleural fluid cell block was positive in 96% cases (192/200) in detecting malignant pleural effusion (P < 0.0001). Remaining six and two cases were diagnosed by using image-guided and thoracoscopy-guided pleural biopsies, respectively. Immunohistochemistry (IHC) was done in all pleural fluid cell block preparation for calretinin, cytokeratin, and epidermal growth factor receptor. Conclusion: Pleural fluid cell block is sensitive, superior, cost-effective, and specific diagnostic method over conventional pleural fluid cytology. “Cell block” specimens are enough for primary diagnosis and IHC analysis necessary for cell typing. It will decrease the need for more invasive and costlier diagnostic methods like thoracoscopy and image-guided pleural biopsies. We recommend cell block for every exudative pleural fluid samples with ADA <30 IU/l

<span style="font-size:10.0pt;font-family: "Times New Roman";mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Mangal;mso-ansi-language:EN-US;mso-fareast-language:EN-US;mso-bidi-language: HI" lang="EN-US">Luminescence of Cu⁺ in Na₂SO₄</span>

235-240Cu+ doped Na2SO4 was synthesized and Cu+ emission has been studied. The changes in luminescence of Cu+ with the phase of Na2SO4 are shown. The luminescence from phase III is observed at 357 nm while the phase V shows emission around 396 nm. Thus shift of almost 40 nm is observed. The excitations are also different and observed at 254 nm for phase III and 270 nm for phase V. Phase I, which is hexagonal shows emission at 456 nm with the excitation at 245 nm

Video-Assisted thoracoscopic surgery for pediatric empyema by two-port technique: A single-center experience with 167 consecutive cases

Background/Purpose: The aim of our study is to determine efficacy, safety, and feasibility of video-assisted thoracoscopic surgery (VATS) in childhood empyema with a technique of only two ports and open instruments at a tertiary care center in India. Methods: This is a retrospective study of patients below 18 years, with empyema presenting to the Department of Pediatric Surgery of a Tertiary Care Referral Hospital in India, over a period of 9 years who underwent VATS decortication. Only two ports with open surgical instruments were used. The patients were assessed on the basis of mean duration of preoperative symptoms, duration of surgery, average blood loss, postoperative pain relief, complications, and need for redo surgery. Results: A total of 97 patients underwent primary VATS decortications without inserting an intercostal drainage (ICD) tube and 70 patients as a secondary procedure after ICD tube was inserted. Mean duration of symptoms was 11 days. The average blood loss during surgery was estimated to be 170 cc. The mean duration of surgery was 90 min. The most common postoperative complication was air leak seen in 19.16% of patients. Minor leaks usually settled by 24 h. In eight patients, a negative suction had to be applied to the ICD tube for persistent air leak. The average length of postoperative stay was 4 days. Two patients required a repeat open decortication procedure due to nonresolution of symptoms and poor lung expansion after VATS. Patients had minimal pain and excellent cosmetic outcome after VATS. Conclusion: Two-port VATS decortication procedure is as feasible and effective as three-port procedure for decortication with better cosmetic result and pain relief

Prerenal Transplant Education and Evaluation Positively Impacts Outcomes

Introduction: An outstanding question in kidney transplantation is how to prepare candidates and their social supports for optimal posttransplant outcomes. Project Aims: This program evaluation assessed whether a pretransplant quality improvement clinic improved clinical outcomes in the year posttransplant compared to recipients receiving standard of care. Design: The Countdown to Transplant Clinic was implemented with kidney transplant candidates expected to receive a transplant within the next few months. The clinic included an enhanced education session on posttransplant lifestyle management, confirmation of support (≥2 adults), and evaluations by transplant social work, psychology, and nephrology. Results: Seventy-five patients participated in the clinic and underwent a transplant. A retrospective chart review of posttransplant laboratory values, rehospitalizations (within 3-months posttransplant), biopsy-confirmed graft failure, and mortality (within 1-year posttransplant) were collected from both groups. Univariate and multivariate propensity score-weighted linear or logistic regression models were used to evaluate the association between clinic participation and outcomes. In models adjusting for relevant covariates, participation in The Countdown to Transplant Clinic (vs standard care) was associated with a lower coefficient of variation of serum tacrolimus (all values collected 3-12 months posttransplant), 30-day posttransplant white blood cell counts (but not 90-day), 90-day posttransplant potassium, and 30 and 31 to 90 days rehospitalizations. Clinic participation did not predict serum glucose levels at 30- or 90-days posttransplant. Due to low rates of rejection and mortality, meaningful comparisons were not possible. Conclusion: Participation in a pretransplant, multicomponent clinic may improve certain outcomes of interest posttransplantation. Pilot testing for feasibility for randomized controlled trials is a necessary next step