SAT-512 Severe Hypocalcemia Presenting as Status Epilepticus after Denosumab Use in Metastatic Prostate Cancer

Introduction: Denosumab decreases the incidence of skeletal-related events in patients with metastatic bone disease and is used routinely as part of the therapeutic strategy for various cancers. However, it is associated with a high risk of hypocalcemia with incidence of high-grade hypocalcemia (defined as total calcium < 7mg/dl) as high as 5.1% in patients with castrate-resistant prostate cancer. We present a case of severe hypocalcemia presenting with status epilepticus 32 days after administration of denosumab. Case: A 83 year old African American man presented to the emergency room with status epilepticus. Initial labs revealed a critically low calcium (Ca) of <5mg/dl (8.5-10.1) with albumin 2.2 g/dl (3.4-5.0), ionized calcium 1.09 mg/dl (4.6-5.1) and creatinine (Cr) 3.68 mg/dl (0.67-1.17). QTC was prolonged at 544ms (<400ms). He was intubated for airway protection and a continuous infusion of intravenous calcium gluconate was initiated. Three months prior, he had been diagnosed with prostate cancer with diffuse osteoblastic metastases to his ribs, cervical, thoracic, lumbar and sacral vertebrae, right humerus and bilateral iliac bones. He received a first dose of conventional chemotherapy and 120mg denosumab subcutaneously 32 days prior to hospital admission. Lab investigations then were pertinent for Ca of 9 mg/dl, Cr 1.46 mg/dl, and alkaline phosphatase 362 Units/L (25-125). A 25-hydroxy vitamin D (25-D) was not checked. Further evaluation demonstrated intact parathyroid hormone 677.2 pg/ml (18.4-80.1), alkaline phosphatase 397 Units/L, phosphorus 3.6 mg/dl (2.5-4.9) and 25-D 18 ng/ml (30-100). He was also found to have metastatic obstruction of both ureters which had resulted in acute kidney injury. He was slowly weaned off the intravenous calcium and started on calcitriol 2mcg twice daily, 4 gram elemental calcium daily via feeding tube and cholecalciferol 6000 units daily. Calcium levels remained stable at 8.0-8.5mg/dl on this regimen. Given the extensive metastatic disease, the patient’s family elected to pursue hospice care, and he passed away 9 days later. Conclusion: Patients with osteoblastic metastases and renal impairment are at particularly increased risk of hypocalcemia after denosumab, which can be potentially life-threatening. Physicians caring for patients with metastatic prostate cancer should ensure that vitamin D levels are replete and calcium levels are normal prior to administration of denosumab, monitor calcium levels closely, and counsel them about the signs and symptoms of hypocalcemia to allow prompt diagnosis and treatment

Developing improved algorithms for detection and analysis of skin cancer

University of Technology Sydney. Faculty of Engineering and Information Technology.Malignant melanoma is one of the deadliest forms of skin cancer and number of cases showed rapid increase in Europe, America, and Australia over the last few decades. Australia has one of the highest rates of skin cancer in the world, at nearly four times the rates in Canada, the US and the UK. Cancer treatment costs constitute more 7.2% of health system costs. However, a recovery rate of around 95% can be achieved if melanoma is detected at an early stage. Early diagnosis is obviously dependent upon accurate assessment by a medical practitioner. The variations of diagnosis are sufficiency large and there is a lack of detail of the test methods. This thesis investigates the methods for automated analysis of skin images to develop improved algorithms and to extend the functionality of the existing methods used in various stages of the automated diagnostic system. This in the long run can provide an alternative basis for researchers to experiment new and existing methodologies for skin cancer detection and diagnosis to help the medical practitioners. The objective is to have a detailed investigation for the requirements of automated skin cancer diagnostic systems, improve and develop relevant segmentation, feature selection and classification methods to deal with complex structures present in both dermoscopic/digital images and histopathological images. During the course of this thesis, several algorithms were developed. These algorithms were used in skin cancer diagnosis studies and some of them can also be applied in wider machine learning areas. The most important contributions of this thesis can be summarized as below: - Developing new segmentation algorithms designed specifically for skin cancer images including digital images of lesions and histopathalogical images with attention to their respective properties. The proposed algorithm uses a two-stage approach. Initially coarse segmentation of lesion area is done based on histogram analysis based orientation sensitive fuzzy C Mean clustering algorithm. The result of stage 1 is used for the initialization of a level set based algorithm developed for detecting finer differentiating details. The proposed algorithms achieved true detection rate of around 93% for external skin lesion images and around 88% for histopathological images. - Developing adaptive differential evolution based feature selection and parameter optimization algorithm. The proposed method is aimed to come up with an efficient approach to provide good accuracy for the skin cancer detection, while taking care of number of features and parameter tuning of feature selection and classification algorithm, as they all play important role in the overall analysis phase. The proposed method was also tested on 10 standard datasets for different kind of cancers and results shows improved performance for all the datasets compared to various state-of the art methods. - Proposing a parallelized knowledge based learning model which can make better use of the differentiating features along with increasing the generalization capability of the classification phase using advised support vector machine. Two classification algorithms were also developed for skin cancer data analysis, which can make use of both labelled and unlabelled data for training. First one is based on semi advised support vector machine. While the second one based on Deep Learning approach. The method of integrating the results of these two methods is also proposed. The experimental analysis showed very promising results for the appropriate diagnosis of melanoma. The classification accuracy achieved with the help of proposed algorithms was around 95% for external skin lesion classification and around 92 % for histopathalogical image analysis. Skin cancer dataset used in this thesis is obtained mainly from Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital. While for comparative analysis and benchmarking of the few algorithms some standard online cancer datasets were also used. Obtained result shows a good performance in segmentation and classification and can form the basis of more advanced computer aided diagnostic systems. While in future, the developed algorithms can also be extended for other kind of image analysis applications

Cytological Pattern of Salivary Gland Lesions

&nbsp;To study the cytological pattern of salivary glands swellings on fine needle aspiration cytology (FNAC). Methods: Patients who underwent fine needle aspiration cytology (FNAC) for their salivary gland swellings, were included. Data was analyzed from various angles including site, diagnostic categories, diagnostic entities, age and gender. Results: Parotid gland (74.3%) was the most frequently affected site, followed by submandibular gland (23.6%). The cases were divided into four main reporting groups i.e. unsatisfactory, inconclusive/ lesion of undetermined significance, non neoplastic and neoplastic constituting 0.7%, 3.6%, 22.9% and 72.9% of all the lesions respectively. Non neoplastic lesions included non specific sialadenitis, cystic lesions without any evidence of neoplasia and sialadenosis comprising 43.8%, 37.5% and 18.8% of these lesions respectively. Neoplastic lesions were divided into three categories namely benign, malignant and indeterminate. Benign tumors constituted 79 (56.4%), malignant neoplasms consisted of 8 (5.7%) and indeterminate category contained 15 (10.7%) of all cases. Mean age was 43 years and MF ratio was 1:1.7. Pleomorphic adenoma was the most frequent diagnosis among all cases, in all neoplasms as well as in benign neoplasms. Conclusion: Parotid was the commonest site of involvement. Pleomorphic adenoma and mucoepidermoid carcinoma were the most common lesions in benign and malignant neoplastic categories respectively

Impacts of Land Cover and Climate Change on Water Resources in Suasco River Watershed

Hydrological balance and biogeochemical processes in watershed are significantly influenced by changes in land use land cover (LULC) and climate change. Those changes can influence interception, evapotranspiration (ET), infiltration, soil moisture, water balance and biogeochemical cycling of carbon, nitrogen and other elements at regional to global scales. The impacts of these hydrological disturbances are generally reflected in form of increasing runoff rate and volume, more intense and frequent floods, decreasing groundwater recharge and base flow, elevated levels of sediments and increase in concentration of nutrients in both streams and shallow groundwater. Water quality of Sudbury, Assabet and Concord (SuAsCo) watershed in Massachusetts is also compromised because of influx of runoff, sediments and nutrients. There is a crucial need to evaluate the synergistic effects of LULC change and climate change on the water quality and water quantity in a watershed system. A watershed simulation model is used to simulate hydrologic processes and water quality changes in sediment loads, total nitrogen (TN), and total phosphorus (TP). The model is calibrated and validated with field-measured data. Climatic scenarios are represented by downscaled regional projections from Global Climate Model (GCM) models and regional built out scenarios of LULC are used to assess the impacts of projected LULC and climate change on water quality and water quantity. Simultaneous changes in LULC and climate significantly affect the water resources in the SuAsCo River watershed. Change in climate increased ET (4.7 %) because of high temperature, but independent change in land cover reduced ET (6.5%) because of less available vegetation. Combined change in land cover and climate reduced ET (2.1%) overall, which indicates that land cover change has significant impact on ET. Change in climate increased total run off (6%) and this increase is more significant as compared to 2.7 % increase in total runoff caused by land cover change. Change in land cover increased surface runoff more significantly (69.2%) than 7.9 % increase caused by climate change. Combined change in land cover and climate further increased the average storm peak volume (12.8 percent) because of high precipitation and impervious area in future. There is a potential for reducing runoff, sediments and nutrients loads by using conservation policies and adaptation strategies. This research provides valuable information about the dynamics of watershed system, as well as the complex processes that impair water resources

An Overview into the Activities of Women Extension Wing in Agricultural Development of District Muzaffarabad-AJ&K

Women Extension wing is a sole department which provides a platform for the women extension workers to interact directly with the female farmers. The present study was conducted in 2011 to overview the activities of women extension wing in district Muzaffarabad-AJ &amp; K. For this study all the female extension staff was interviewed, including 16 Lady Extension Assistants and 4 Lady Extension Officers. Multistage sampling was used to select the required sample, 67 female farmers were randomly selected from the three selected villages. A pre-tested questionnaire and interview schedule was used for data collection. Female extension staff was satisfied from the extension department activities; they faced problems of communication and lack of cooperation. On the other hand, it was found that majority (46%) of female farmers was illiterate but had several year experiences which were helpful to them in applying the knowledge given by the extension workers practically. It was observed that 100% female farmers knew female extension staff both by name and face, and also satisfied from their activities. Majority (96%) were owner-cultivators as they grow vegetables and crops on their lands. About 58% of the female respondents had &gt;5000 rupees monthly increase in income because of their participation in agricultural activities. They faced problems; lack of education, awareness and financial problems while participating in agricultural development. It is concluded that majority of the female extension staff and female farmers were satisfied from activities of women extension wing. Also, women extension wing is carrying out activities which are beneficial to female farmers. By using Chi-square test it is cleared that there is a non-significant association between the farming experience and the satisfaction from extension wing activities. It was recommended that female extension workers should be in regular contact with the female farmer, and number of trainings for both the farmers and staff should be increased by the Extension department. Also, audio-visual aids should be used for educating farmers. Keywords; Women; Extension wing; Agricultural Developmen

Environmental Costs for Highway Alignment Evaluation

The regulatory measures have set standard to be met for evaluating environmental cost of a proposed highway. However, these measures do not consider the health effects of increased concentrations of pollutants. This thesis seeks to develop a methodology for estimating the environmental cost of a new highway with a specified alignment. The proposed methodology for estimating the environmental health costs of a highway quantifies the social cost of the emission impacts. An example of a proposed highway parallel to an existing highway is considered in a rural area. The environmental costs consider emissions at the source, dispersion of particles, and population exposure. The total emissions of nitrogen dioxide are estimated using the vehicle-specific approach and the transport of these emissions is estimated with a Gaussian model for pollutant dispersion. The chronic respiratory diseases, asthma, and cardiovascular cases resulting from the dispersion of pollutant are estimated using the concentration exposure relationship. The results are analyzed for factors that influence the effects of emissions, i.e. vehicle volume, vehicle mix, wind direction, wind speed, meteorological conditions, gradient and population density

Effect of Processing Conditions on the Quality of Wheat Protein

Wheat protein determines the biochemical and rheological properties of most wheat products. The final product depends critically upon the balance between different ratios of proteins that interact with each other through various processing methodologies. Protein is the most substantial component of our intake. As we belongs to Asia, wheat is enriched source of protein for us. Excessive amount of protein is found in wheat grain as compared to wheat flour. Wheat grains is transformed into variety of food products by enduring various food processing techniques. Nutritional quality is been correlatively effected by milling. Cell wall lysing in this process inflate the nutrients whereas it result in polysaccharide by stripping off wheat nutritional layers. Solubility of wheat protein rises through mixing which is further essential in dough kneading. Structural and functional properties of proteins is affected upon heating. Proteins became denature through heating and shearing during extrusion

Transfusion Related transmission of infections among blood donors of South Punjab

Objective: To investigate the frequency of blood transmissible infections in the region of South Punjab. Study design: Descriptive cross-sectional Place and duration: Study was carried out from February 2019 to February 2021 over a period of 2 years at—removed for blind review--. Methodology: All voluntary and replacement donors who arrived at the hospital between the included time period were considered for the analysis. Total two blood samples were taken from each blood donor. For blood grouping and malarial parasite screening, Ethylene diamine tetra acetic acid (EDTA) sample was collected. Clotted sample was used for screening of Anti-HCV, HBsAg, HIV and syphilis and analyzed by ELISA. Results: Our study showed cumulative frequency of 0.8 %, 0.5% and 1% for hepatitis B, syphilis and C virus respectively, and only one case of HIV and malarial parasite observed during screening for blood transfusion among blood donors. Conclusion: Increasing transmission prevalence of hepatitis as well as syphilis in our region. Keywords: blood transfusion, infection, HBsAG, HCV