Computed tomography guided fine needle aspiration cytology of thoracic lesions: 10 year experience of an interventional pulmonologist

Background: Diagnosis of thoracic lesions may be challenging, due to various factors associated with the lesion and subsequent invasive investigations. Computed tomography guided fine needle aspiration cytology (CT-guided FNAC) is a minimally invasive method for thoracic lesions considered non approachable by other modalities.Methods: Retrospective analysis of patients subjected to CT-guided FNAC during year 2004 to 2014 was done. In these patients, non-invasive and invasive methods like fibre-optic bronchoscopy/ ultrasound guided FNAC were inconclusive/ expected to be inconclusive. Records were statistically analyzed for patient related, lesion related and procedure related factors, and their effect on yield and complications.Results: 435 patients underwent CT-guided FNAC. Age ranged from 10 to 95 years, with male preponderance. Diagnostic yield was 80.2%. Neoplastic lesions (255/435 (58.6%)) were most commonly diagnosed with majority (206/255 (80.8%)) being non-small cell lung cancer (NSCLC). This was followed by non-neoplastic lesions (94/435 (21.6%)) with Tuberculosis (42/94(44.7%)) being most common in this group. In 227/435 patients, other details like side and size of the lesion, position of patient during the procedure, depth of lesion from skin surface, number of passes undertaken and complications, if any, were also available. They were separately analyzed. Mean size of lesion was 5.7575 X 5.4173cms (maximum vertical X maximum horizontal diameter). Mean depth to which needle was inserted was 5.6663cms. Mean number of passes per patient were 1.98. Right sided lesions were more commonly sampled than left. Supine positioning was most commonly employed. Overall complication rate was 4% (9/227).Conclusions: CT-guided FNAC for thoracic lesions can serve as early diagnostic tool and guide in planning effective management strategies

Indian Diabetes Risk Score (IDRS) as a strong predictor of diabetes mellitus: A cross sectional study among urban population of Jhalawar, Rajasthan

Introduction: The patients with Type 2 diabetes Mellitus may often remain asymptomatic for a longer period of time. The Indian Diabetes Risk Score (IDRS), a simple screening tool for prediction of undiagnosed diabetes. Objective: Validation of IDRS with standard test for type 2 diabetes among urban population of Jhalawar, Rajasthan. Material and Methods: A Community based Cross-sectional study was carried out in urban field practice area of Department of Community Medicine, Jhalawar Medical College, Jhalawar, Rajasthan. The study was conducted using a two-stage sampling design. A predesigned, pretested proforma and Indian Diabetes Risk Score (IDRS) sheet was used to collect data from the study participants. The IDRS is based on four parameters: age, family history of diabetes, waist circumference and physical inactivity. Data was collected using the World Health Organization stepwise approach to surveillance (STEPS). Results: Among 450 participants, 12.7% participants were in low risk, 59.1% were in moderate risk and 28.2% were in high risk of developing diabetes according to IDRS score. IDRS score of ?60 turned out to be the best cut point for identifying undiagnosed diabetes with sensitivity 92.3% and specificity 82.6%. Positive Predictive value and Negative Predictive value were 47.3% and 98.5% respectively. Conclusion: Association of IDRS was found significant with diabetes. IDRS score of ?60 turned out to be the best cut point for identifying undiagnosed diabetes. IDRS is found valid screening tool for early detection of Diabetes

Psychosocial Impact of Pandemic and State Imposed Lockdown on Caregivers of Patients Presenting with Respiratory Complaints Mimicking COVID-19: A Short-term Follow-up Study

Introduction: Pandemics and subsequent lockdowns affect mental health of different subgroups of populations. In Coronavirus Disease-2019 (COVID-19), caregivers of those patients who have respiratory complaints is one such subgroup which is more vulnerable to disturbances in mental health, because of the fear that their patient’s respiratory symptoms could be because of COVID-19. Aim: To assess the psychosocial impact of COVID-19 and subsequent state imposed lockdown on the caregivers of patients presenting with respiratory complaints and also to evaluate the effect of relaxation of lockdown after following-up them over a period of time. Materials and Methods: This prospective observational study was conducted in the Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India (tertiary care institute), from April 2020 to June 2020. Baseline assessment was done using socio-demographic proforma, lockdown related questionnaire {3 domains, summed as total score (lockdown)}, COVID-19 related questionnaire {total score (COVID-19)} and General Health Questionnaire-12-Hindi version (GHQ-12). Reassessment was done twice i.e., at 11-15 days and 41-45 days after relaxation of lockdown. Quality Of Life (QOL) at first and second follow-up versus prelockdown times (score A and C) and first follow-up versus unlockdown (score B) was also noted. Analysis was conducted using Statistical Package for Social Sciences (IBM, SPSS)version 22.0. Results: Total 65 caregivers were enrolled in the study. Mean age of the participants was 40.2±11.812 years with maximum caregivers 25 (41.7%) aged between 31-40 years. Majority (83.3%) were men. Psychological distress was experienced in 50% of caregivers at baseline and 23.7% caregivers at first follow-up (p-value=0.001). Worry for COVID-19 (p-value=0.035), Domain 1 scores (p-value <0.001), Domain 2 scores (p-value=0.003), Domain 3 scores (p-value=0.001), and Total score lockdown (p-value <0.001) decreased significantly at first follow-up. Mean C score was significantly better than mean A score (p-value <0.001). Baseline psychological distress was significantly more in those with worry for COVID-19 (p-value=0.018), poorer scores of domains 1 (p-value=0.005), domains 2 (p-value <0.001), domains 3 (p-value <0.001), total score (lockdown) (p-value <0.001) and total score (COVID-19) (p-value=0.010). Follow-up psychological distress was more in those with “worry for COVID-19” (p-value <0.001), negative thoughts (p-value=0.001), poorer follow-up scores of three domains, total score (lockdown), mean A, B and C scores (p-value <0.001). Conclusion: Caregivers experienced extreme levels of psychological distress, which decreased, but persisted even after relaxation in lockdown

Atypical Neurofibroma and Osteosclerotic Metastasis

35-year-old male presented with multiple swellings in left leg, headache, weakness of limbs for 4 months, and blurring of vision for the last 15 days. On examination, he was pale, cachexic with generalized lymphadenopathy and lower motor neuron type weakness of limbs sparing right upper limb. Blood investigations showed anemia with high alkaline phosphatase. Chest radiograph revealed osteosclerotic metastatic lesion in humerus. Biopsy of leg lesion revealed atypical neurofibroma. Computed tomography (CT) of thorax revealed osteoblastic metastasis. Bone marrow aspiration showed cells with round to oval nuclei, fine granular chromatin with large central prominent nucleoli and eosinophilic cytoplasm with acini formation. Magnetic resonance imaging (MRI) of brain and spinal cord defined metastatic leptomeningeal deposits. Cerebrospinal fluid (CSF) cytology was positive for malignant cells. Gastroscopy showed an ulceroinfiltrative growth from stomach which on histopathology revealed diffuse adenocarcinoma. Palliative treatment was given with intrathecal methotrexate and systemic corticosteroid with chemotherapy. Patient's symptom improved drastically, but we lost him to followup

The relationship between spatial configuration of urban parks and neighbourhood cooling in a humid subtropical city

Context Urban parks are essential for maintaining aesthetics within cities and keeping their its energy balance by helping mitigate the Urban Heat Island (UHI) effect through controlling ambient and land surface temperature (LST). Objectives To investigate the impact of cooling in terms of distance by variously configured urban parks of a humid subtropical city, using landscape metrics and open-source data. Methods Land use (LU) was obtained through maximum likelihood classification of 3 m resolution aerial RGB-NIR imagery supported by ground control points and park boundaries collected during field survey. LST at matching resolution was obtained through downscaling of Landsat-8 LST at 30/100m resolution, calculated with the Radiative Transfer Equation (RTE). Landscape metrics for patches of parks were calculated using landscapemetrics R library and related to neighbourhood distances over built-up land use (LU). Results Urban parks with homogenous cores and less complex shape provide distinctly higher cooling of neighbouring built-up LU of circa 2.55 °C over the distance of 18 m from park boundaries. Four metrics: contiguity index (CONTIG), core area index (CAI), fractal dimension index (FRAC) and perimeter-area ratio (PARA) represent significant relationship between spatial configuration of parks and their cooling distance. No cooling capacity of parks regardless of their shape and core was observed beyond the distance of 18 m, which remained constant with small fluctuations in the range of 0.5 °C up to the distance of 600 m. Conclusions The study concludes that cooling distance of urban parks in their neighbourhood extends up to 18 m, which is shorter than suggested by other studies

Convalescent Plasma: An Evidence-Based Old Therapy to Treat Novel Coronavirus Patients

Novel Coronavirus (nCoV-2019) is a highly infectious viral outbreak that has so far infected more than 110 million people worldwide. Fast viral transmission and high infection rates have severely affected the entire population, especially the old aged and comorbid individuals leaving significantly less time to find some effective treatment strategy. In these challenging times, convalescent plasma (CP) therapy came as a ray of hope to save humankind. It is a form of passive immunization that has been used to treat various infectious diseases since 1890, including the 1918 Spanish flu, 2002/03 SARS-CoV, 2009 H1N1, 2012 MERS-CoV, and 2014 Ebola outbreak. The transfusion includes administration of CP containing a high value of neutralizing antibodies against the virus in hospitalized patients. This chapter summarizes the potential outcome of CP therapy in the treatment of nCoV-2019 patients

Analysis and prediction of cancerlectins using evolutionary and domain information

<p>Abstract</p> <p>Background</p> <p>Predicting the function of a protein is one of the major challenges in the post-genomic era where a large number of protein sequences of unknown function are accumulating rapidly. Lectins are the proteins that specifically recognize and bind to carbohydrate moieties present on either proteins or lipids. Cancerlectins are those lectins that play various important roles in tumor cell differentiation and metastasis. Although the two types of proteins are linked, still there is no computational method available that can distinguish cancerlectins from the large pool of non-cancerlectins. Hence, it is imperative to develop a method that can distinguish between cancer and non-cancerlectins.</p> <p>Results</p> <p>All the models developed in this study are based on a non-redundant dataset containing 178 cancerlectins and 226 non-cancerlectins in which no two sequences have more than 50% sequence similarity. We have applied the similarity search based technique, i.e. BLAST, and achieved a maximum accuracy of 43.25%. The amino acids compositional analysis have shown that certain residues (e.g. Leucine, Proline) were preferred in cancerlectins whereas some other (e.g. Asparatic acid, Asparagine) were preferred in non-cancerlectins. It has been found that the PROSITE domain "Crystalline beta gamma" was abundant in cancerlectins whereas domains like "SUEL-type lectin domain" were found mainly in non-cancerlectins. An SVM-based model has been developed to differentiate between the cancer and non-cancerlectins which achieved a maximum Matthew's correlation coefficient (MCC) value of 0.32 with an accuracy of 64.84%, using amino acid compositions. We have developed a model based on dipeptide compositions which achieved an MCC value of 0.30 with an accuracy of 64.84%. Thereafter, we have developed models based on split compositions (2 and 4 parts) and achieved an MCC value of 0.31, 0.32 with accuracies of 65.10% and 66.09%, respectively. An SVM model based on Position Specific Scoring Matrix (PSSM), generated by PSI-BLAST, was developed and achieved an MCC value of 0.36 with an accuracy of 68.34%. Finally, we have integrated the PROSITE domain information with PSSM and developed an SVM model that has achieved an MCC value of 0.38 with 69.09% accuracy.</p> <p>Conclusion</p> <p>BLAST has been found inefficient to distinguish between cancer and non-cancerlectins. We analyzed the protein sequences of cancer and non-cancerlectins and identified interesting patterns. We have been able to identify PROSITE domains that are preferred in cancer and non-cancerlectins and thus provided interesting insights into the two types of proteins. The method developed in this study will be useful for researchers studying cancerlectins, lectins and cancer biology. The web-server based on the above study, is available at <url>http://www.imtech.res.in/raghava/cancer_pred/</url></p

Chromatin dynamics during interphase and cell division:similarities and differences between model and crop plants

Genetic information in the cell nucleus controls organismal development, responses to the environment and finally ensures own transmission to the next generations. To achieve so many different tasks, the genetic information is associated with structural and regulatory proteins, which orchestrate nuclear functions in time and space. Furthermore, plant life strategies require chromatin plasticity to allow a rapid adaptation to abiotic and biotic stresses. Here, we summarize current knowledge on the organisation of plant chromatin and dynamics of chromosomes during interphase and mitotic and meiotic cell divisions for model and crop plants differing as to the genome size, ploidy and amount of genomic resources available. The existing data indicate that chromatin changes accompany most (if not all) cellular processes and that there are both shared and unique themes in the chromatin structure and global chromosome dynamics among species. Ongoing efforts to understand the molecular mechanisms involved in chromatin organisation and remodeling have, together with the latest genome editing tools, potential to unlock crop genomes for innovative breeding strategies and improvements of various traits

Heterogeneous catalysis for sustainable biodiesel production via esterification and transesterification

Concern over the economics of accessing fossil fuel reserves, and widespread acceptance of the anthropogenic origin of rising CO2 emissions and associated climate change from combusting such carbon sources, is driving academic and commercial research into new routes to sustainable fuels to meet the demands of a rapidly rising global population. Here we discuss catalytic esterification and transesterification solutions to the clean synthesis of biodiesel, the most readily implemented and low cost, alternative source of transportation fuels to meet future societal demands

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH