A study on the histopathological pattern of thyroid lesions in a tertiary care hospital

Background: Thyroid diseases are one of the most common endocrine disorders affecting the general population. They range from non-neoplastic to neoplastic lesions. The prevalence and pattern of these disorders depend on various factors including sex, age, ethnic and geographical patterns. The aim of the present study was to determine the pattern of thyroid lesions in thyroidectomy specimens received in the pathology department of MOSC Medical College Hospital, Kolenchery, Kerala, India.Methods: It was a 6 year retrospective study (January 2010 to December 2015) of all thyroidectomy specimens received in the Pathology department. All the biopsy reports were reviewed and different lesions were categorized according to age and gender distribution.Results: There were a total of 801 specimens, of which 716 were females and 85 were males. Maximum number of thyroid lesions were seen in the age group 41-50 yrs. Multinodular goiter was the most common non-neoplastic thyroid lesion (71.5%) followed by thyroiditis. There were 151 carcinomas (18.8%). Maximum numbers of carcinomas were seen in age group 31-40 (28.8%).The frequency of carcinomas among the total thyroid lesions was almost same for both males and females (18.82% and 18.85%). Papillary carcinoma was the most frequent malignancy, out of which half were of the micro papillary subtype.Conclusions: Multinodular goiter was found to be the most common thyroid lesion in this study. The percentage of malignant thyroid tumors was high compared to other studies done in Kerala. Papillary carcinoma was the most common malignant neoplasm. The micropapillary variant comprised 50% of the papillary carcinoma

Monopolar Gene Electrotransfer Enhances Plasmid DNA Delivery to Skin

A novel monopolar electroporation system and methodologies were developed for in vivo electroporation intended for potential clinical applications such as gene therapy. We hypothesized that an asymmetric anode/cathode electrode applicator geometry could produce favorable electric fields for electroporation, without the typical drawback associated with traditional needle and parallel plate geometries. Three monopolar electrode applicator prototypes were built and tested for gene delivery of reporter genes to the skin in a guinea pig model. Gene expression was evaluated in terms of kinetics over time and expression distribution within the treatment site. Different pulsing parameters, including pulse amplitude, pulse duration, and pulse number were evaluated. Monopolar gene electrotransfer significantly enhanced gene expression compared to controls over the course of 21 days. Gene expression distribution was observed throughout the full thickness of the epidermis, as well as notable expression in the deeper layers of the skin, including the dermis, and the underlying striated muscle without any damage at the treatment site, which is a substantial improvement over previously reported expression confined to the epidermis only. Expression distribution observed is consistent with the electric field distribution model, indicating that our novel electrode geometry results in targeted electroporation and gene transfer. This is important, as it may facilitate translation of many electroporation-based clinical therapies including gene therapies, IRE, and ECT

ASSESSMENT OF COMPARATIVE PATIENT SATISFACTION AND SIDE-EFFECTS ASSOCIATED WITH TAMSULOSIN VERSUS SILODOSIN THERAPY IN BENIGN PROSTATE HYPERPLASIA

Objective: The aim of our study was to assess the comparative patient satisfaction and side-effects of the currently prescribed drugs – tamsulosin and silodosin for benign prostatic hyperplasia (BPH). Methods: A prospective study was conducted in a total of 110 BPH patients from the Department of Urology for a period of 6 months. Fifty-five patients in each group received silodosin 8 mg or tamsulosin 0.4 mg once daily. Data were collected using a suitably designed pro forma and the patient satisfaction was assessed with patient’s perception of study medication (PPSM) scale. International prostate symptom score (IPSS) was used for assessing the severity of symptoms. Results: The current study found that the treatment had a significant effect on improving scores of PPSM and IPSS at which all changes were significant at p<0.01 (paired t-test). An independent t-test showed that silodosin group had a greater improvement in PPSM scores – PPSM total by 40.4%, PPSM global by 43.7%, and PPSM pain by 0.39% which was supported by corresponding decline in IPSS scores. The side effects reported for tamsulosin were headache (5.5%), dizziness (5.5%), dry mouth (3.6%), and postural hypotension (14.4%) and those reported for silodosin were myalgia (5.5%), dizziness (7.3%), diarrhea (1.8%), and postural hypotension (10.9%). Conclusion: Patient satisfaction was improved by both the alpha blockers but silodosin showed a significantly greater increase in patient satisfaction than tamsulosin. Thus, silodosin is the better drug of choice

Impact of educational intervention on medication adherence, quality of life, knowledge attitude and practice among benign prostate hyperplasia patients: a prospective study

Background: Benign prostate hyperplasia (BPH) is one of the common bothersome diseases among elderly men of age greater than 50 years. The aim of the current study was to evaluate the impact of patient counselling on quality of life (QoL), knowledge, attitude and practice (KAP) and medication adherence among patients.Methods: A Prospective study was conducted in a total of 110 BPH patients from the department of urology for a period of 6 months. 55 patients in each group received silodosin 8 mg or tamsulosin 0.4 mg once daily. Data was collected by using a suitably designed proforma, international prostate symptom score (IPSS) and BPH impact index were used for assessing QoL, morisky green levin scale for medication adherence and a suitably designed KAP questionnaire for assessing KAP. Patients were counselled regarding the disease, drugs and lifestyle modifications using patient information leaflet.Results: The current study found that both the Tamsulosin and Silodosin group had an improvement on QoL, IPSS Q 8 by 36% and 41.5% respectively and improvement on BII by 35.5% and 47.3% respectively. Medication adherence had significant improvement from first to second review by 12%. Significant improvement in knowledge by 80.1%, attitude by 72.7% and practice by 79.2% were observed.Conclusions: The provision of effective counselling was found to have a profound impact on improving patient’s quality of life, medication adherence, knowledge, attitude and practice

"Keep it simple - a lesson from COVID-19" : highlighting the utility of chest X-rays in ARDS-associated illnesses through the Zonal Scoring System

Purpose: The post-pandemic era calls for appropriate literature on chest X-ray score cut-offs, enabling swift categorization and faster radiological reporting of patients with acute respiratory distress syndrome (ARDS)-like illnesses, hence prompting healthcare equity in low-resource centres where extortionate modalities of imaging such as computed tomography (CT) are unavailable. In this study, we aim to bridge the literature gap using the versatile zonal scoring system. Material and methods: This retrospective cohort study uses data from 751 COVID-19 RT-PCR+ patients. Concordantchest radiograph (CXR) scores were reported, and inter-rater reliability was measured using kappa indices. receiver operating characteristic curves were used to establish cut-off scores for the outcomes of interest: mild or severe disease, admission to an intensive care unit (ICU), and intubation. Categorical data were expressed using means and percentages, and c2 or t-tests were used for comparison at an a level of 0.05. Unadjusted odds ratios for each outcome of interest vs. CXR score and comorbidity were then calculated using binary logistic regression. Results: CXR findings included infiltrates (46.07%), pleural effusions (7.05%), consolidation and fibrosis (4.43%), pneumothoraces (2.71%), and cardiomegaly (2.26%). Most patients had an index CXR score of 0 (54.19%). The index cut-off score of ≤ 1 (82.95, 81.68) was established for mild disease, ≥ 4 for severe disease (85.71, 83.99), ≥ 3 for ICU admission (86.90, 71.91), and ≥ 4 for intubation (87.61, 72.90). Hypertension, type 2 diabetes mellitus, hypothyroidism, history of ischaemic heart disease, and history of tuberculosis were independent risk factors for a high CXR index score, intubation, and ICU admission. Conclusions: CXR scores can be effectively used in low-resource settings for triaging patients, maintaining records, and disease prognostication

Enabling privacy-aware interoperable and quality IoT data sharing with context

Funding: This research has been supported by the European Union projects funded under Horizon 2020 research and innovation program (smashHit), grant agreement 871477 and in part by the European Union Horizon Europe project UPCAST under grant agreement number 101093216.Sharing Internet of Things (IoT) data across different sectors, such as in smart cities, becomes complex due to heterogeneity. This poses challenges related to a lack of interoperability, data quality issues and lack of context information, and a lack of data veracity(or accuracy). In addition, there are privacy concerns as IoT data may contain personally identifiable information. To address the above challenges, this paper presents a novel semantic technology-based framework that enables data sharing in a GDPR-compliant manner while ensuring that the data shared is interoperable, contains required context information, is of acceptable quality, and is accurate and trustworthy. The proposed framework also accounts for the edge/fog, an upcoming computing paradigm for the IoT to support real-time decisions. We evaluate the performance of the proposed framework with two different edge and fog-edge scenarios using resource-constrained IoT devices, such as the Raspberry Pi. In addition, we also evaluate shared data quality, interoperability and veracity. Our key finding is that the proposed framework can be employed on IoT devices with limited resources due to its low CPU and memory utilization for analytics operations and data transformation and migration operations. The low overhead of the framework supports real-time decision making. In addition, the 100% accuracy of our evaluation of the data quality and veracity based on 180 different observations demonstrates that the proposed framework can guarantee both data quality and veracityPeer reviewe

Bone Marrow Profile in Haematological Disorders with reference to Flow Cytometry and RT-PCR in Acute Leukaemia

Introduction: Evaluation of non neoplastic and neoplastic haematological disorders require bone marrow examination which is an important diagnostic tool. This includes Bone Marrow Aspiration (BMA) and Bone Marrow Biopsy (BMB). Subtyping of Acute Leukaemia (AL) requires flow cytometry immunophenotyping and Real Time Polymerase Chain Reaction (RT-PCR), which helps in identifying cell antigens and genetic abnormalities, respectively. This is helpful to guide specific treatment for patients. Aim: To evaluate the clinical profile, cytological and histological pattern of various haematological disorders using bone marrow examination and to determine immunophenotypes using ancillary techniques in patients with AL. Materials and Methods: This was a cross-sectional observational study conducted in Department of Pathology, Sree Mookambika Institute of Medical Sciences, Kulasekharam, Tamil Nadu, India. Data was collected for a period of two years from May 2020 to April 2022. A total of 62 cases were included. Clinical details and bone marrow examination findings were noted for all BMA and BMB cases that satisfied the inclusion criteria and flow cytometry along with RT-PCR diagnosis was done for suspected AL cases. Analysis was done using Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Among the 62 cases studied, age of patients ranged from 32 to 81 years. Majority of them were in the 5th to 6th decade. Females 32 (51.6%) were more commonly affected. Pancytopenia 15 (24.2%) was the most common clinical presentation. Total 49 (79%) were diagnosed with BMA and 61 (98.4%) were diagnosed with BMB. Megaloblastic anaemia 16 (25.8%) and acute myeloid leukaemias 6 (9.6%) were the most common cause of benign haematological disorder and haematological malignancy respectively. The RT-PCR test for Break point Cluster-Abelson Tyrosine Kinase (BCR-ABL) and Promyelocytic Leukaemia-Retinoic Acid Receptor Alpha (PML- RARA) fusion gene analysis showed association in patients with Acute Lymphoblastic Leukaemia (ALL) and Acute Myeloid Leukaemia (AML) respectively. Conclusion: Biopsy, being gold standard, provides details about the pattern, extent of tumour, metastatic deposit and granulomatous pathology, but BMA also proved better for study of the cell. Flow cytometry and RT-PCR were effective tools that enable the identification of immunophenotype in AL as well as to assess treatment progress and predict prognosis

Methylation Analyses Reveal Promoter Hypermethylation as a Rare Cause of “Second Hit” in Germline BRCA1-Associated Pancreatic Ductal Adenocarcinoma

Background and objectivePancreatic ductal adenocarcinoma (PDAC) is characterized by the occurrence of pathogenic variants in BRCA1/2 in 5-6% of patients. Biallelic loss of BRCA1/2 enriches for response to platinum agents and poly (ADP-ribose) polymerase 1 inhibitors. There is a dearth of evidence on the mechanism of inactivation of the wild-type BRCA1 allele in PDAC tumors with a germline BRCA1 (gBRCA1) pathogenic or likely pathogenic variant (P/LPV). Herein, we examine promotor hypermethylation as a "second hit" mechanism in patients with gBRCA1-PDAC.MethodsWe evaluated patients with PDAC who underwent Memorial Sloan Kettering-Integrated Mutation Profiling of Actionable Cancer Targets (MSK-IMPACT) somatic and germline testing from an institutional database. DNA isolated from tumor tissue and matched normal peripheral blood were sequenced by MSK-IMPACT. In patients with gBRCA1-PDAC, we examined the somatic BRCA1 mutation status and promotor methylation status of the tumor BRCA1 allele via a methylation array analysis. In patients with sufficient remaining DNA, a second methylation analysis by pyrosequencing was performed.ResultsOf 1012 patients with PDAC, 19 (1.9%) were identified to harbor a gBRCA1 P/LPV. Fifteen patients underwent a methylation array and the mean percentage of BRCA1 promotor methylation was 3.62%. In seven patients in whom sufficient DNA was available, subsequent pyrosequencing confirmed an unmethylated BRCA1 promotor. Loss of heterozygosity was detected in 12 of 19 (63%, 95% confidence interval 38-84) patients, demonstrating loss of heterozygosity is the major molecular mechanism of BRCA1 inactivation in PDAC. Two (10.5%) cases had a somatic BRCA1 mutation.ConclusionsIn patients with gBRCA1-P/LPV-PDAC, loss of heterozygosity is the main inactivating mechanism of the wild-type BRCA1 allele in the tumor, and methylation of the BRCA1 promoter is a distinctly uncommon occurrence

GA101 (obinutuzumab) monocLonal Antibody as Consolidation Therapy In CLL (GALACTIC) trial: study protocol for a phase II/III randomised controlled trial

Background: Chronic lymphocytic leukaemia (CLL) is the most common adult leukaemia. Achieving minimal residual disease (MRD) negativity in CLL is an independent predictor of survival even with a variety of different treatment approaches and regardless of the line of therapy. Methods/design: GA101 (obinutuzumab) monocLonal Antibody as Consolidation Therapy In CLL (GALACTIC) is a seamless phase II/III, multi-centre, randomised, controlled, open, parallel-group trial for patients with CLL who have recently responded to chemotherapy. Participants will be randomised to receive either obinutuzumab (GA-101) consolidation or no treatment (as is standard). The phase II trial will assess safety and short-term efficacy in order to advise on continuation to a phase III trial. The primary objective for phase III is to assess the effect of consolidation therapy on progression-free survival (PFS). One hundred eighty-eight participants are planned to be recruited from forty research centres in the United Kingdom. Discussion: There is evidence that achieving MRD eradication with alemtuzumab consolidation is associated with improvements in survival and time to progression. This trial will assess whether obinutuzumab is safe in a consolidation setting and effective at eradicating MRD and improving PFS. Trial registration: ISRCTN, 64035629. Registered on 12 January 2015. EudraCT, 2014-000880-42. Registered on 12 November 2014