Imaging assessment of haematopoietic and lymphoid tumours; advancing methodologies and applications

Haematological malignancies are a burden being the fifth most common cancer and the second leading cause of cancer mortality on a global scale. Their presentation is complex due to disparate patterns of biological behaviour and anatomical involvement. Accurate detection of disease and precise assessment of treatment response is critical for optimal patient management. However, the appropriate use of imaging tests requires awareness of their strengths and limitations and appreciation of the myriad biological behaviours of haematological malignancies. This thesis presents research undertaken to enhance the imaging assessment of haematological malignancies. Four key themes of concern were identified and addressed. Firstly, general reporting of haematological malignancies lacked standardisation in staging, response, and prognostication assessment across all imaging studies: computed tomography (CT), positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI). A multimodality imaging report with a multidisciplinary team meeting (MDTM) style conclusion needs to be issued at each relevant timepoint in the patient pathway. The aim was to reduce imaging ‘error’ rates by using template reports, produce comparative datasets from different centres, and improve patient outcomes. Analogous to UK developments in pathology reporting, a robust and adaptable methodology, termed ‘Specialist Integrated Haematological Malignancy Imaging Reporting’ (SIHMIR), was formulated. Secondly, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) imaging guidance varied widely. There was no detailed analysis of the strengths and weaknesses of the numerous imaging tests used, and patient data was prone to misinterpretation. No comprehensive imaging guidance was available for the distinct types of BIA-ALCL, a ‘cascade’ of investigations being performed. An assessment of the strengths and limitations of all anatomical and functional imaging investigations in BIA-ALCL was undertaken, and patient imaging pathways were developed. Thirdly, a prompt diagnosis of Richter’s transformation (RT) from chronic lymphocytic leukaemia (CLL) was needed. The selection of a biopsy target to diagnose RT was a particular challenge in clinical practice. A PET-CT driven decision-making pathway to decide whether biopsy was required and, if so, to select a representative biopsy site in the era of novel therapies was developed. Lastly, MRI, used for central nervous system lymphoma (CNSL) imaging, was unable to differentiate disease activity from benign post-biopsy and inflammatory change and did not provide prognostic information. Two imaging applications for this purpose were developed: (i) the theoretical concept and clinical use of contrast clearance analysis (CCA), with its ability to differentiate viable CNSL from benign enhancement, and (ii) 18F-choline radiotracer (FCH) cranial PET-CT for staging, response-assessment, and prognostication. This thesis advances the imaging assessment in haematopoietic and lymphoid tumours, most notably with a standardised reporting framework (SIHMIR), guidance in both BIA-ALCL and CLL RT, and two CNSL imaging applications. The disease-histology specific approach to the use of imaging tests has been endorsed by the UK National Institute of Health and Care Excellence (NICE) Guidelines and UK Medicines and Healthcare products Regulatory Agency (MHRA) Guidelines. The new methodologies and tools described, particularly the two new tools for CNSL assessment, have the capacity to change global clinical and research trial practice

Studies on Effect of Electrostatic Spraying in Orchards

Evaluation of an electrostatic sprayer (Make ESS, USA) was conducted on a pear orchard planted at 2.5 m row spacing and distance between plant to plant was 1.5 m. The water sensitive paper stripes were placed on each test plant at the upper and underside of the leaves at the different heights of the plant. Effect of charging on droplet density, area covered by droplets, volume of spray deposition, uniformity coefficient and droplet size were observed during the evaluation of the electrostatic sprayer and comparison was made between two different types of nozzle i.e. twin and single nozzle. It was found that droplet density on the upper and under sides of leaves by twin nozzle (Charged) was significantly (p = 0.0005) higher than twin nozzle (Uncharged) by 57.53 and 59.60% respectively. Droplet density on the upper and underside of leaves by single nozzle (Charged) was significantly (p = 0.0011) higher than single nozzle (Uncharged) by 58.15 and 54.65% respectively. The maximum droplets, i.e. 45 numbers were of size 44 microns observed for the twin nozzle (Charged). But in case of twin nozzle (Uncharged), the maximum droplets, i.e. only 13 numbers of drops were of 44 microns. Similarly maximum droplets, i.e. 32 numbers were of size 44 microns observed for the single nozzle (Charged) and in case of single nozzle (Uncharged), the maximum droplets, i.e. only 11 numbers of drops were of 44 microns. Area covered by droplets on the upper and under sides of leaves by twin nozzle (Charged) was significantly (p = 0.0017) higher than twin nozzle (Uncharged) by 50.19 and 67.86% respectively. Area covered by droplets on the upper and under sides of leaves by single nozzle (Charged) was significantly (p = 0.0007) higher than single nozzle (Uncharged) by 45.07 and 67.53% respectively. Volume of spray deposition on the upper and underside of leaves by twin nozzle was not significantly different single nozzle. Overall results showed that charging of nozzles has increased spraying efficiency significantly than the spraying done by uncharged nozzles for orchards

Efficacy and Safety of Vildagliptin and Remogliflozin as Add-on Therapy to Metformin in Patients of Type 2 Diabetes Mellitus: An open-label comparative study

Objectives: This study aimed to evaluate the safety and efficacy of remogliflozin compared to vildagliptin as an add-on drug to metformin in type 2 diabetes mellitus (T2DM) treatment. Metformin is considered a first-line drug in T2DM. However, as the disease progresses with heightened insulin resistance and declining β-cell function, the use of metformin alone is often inadequate to achieve optimum glucose levels. Methods: This prospective, randomised study was conducted at Maulana Azad Medical College and Associated Hospital in New Delhi, India, between February 2020 to January 2021. This study recruited 60 T2DM patients aged 35–70 years with glycated haemoglobin (HbA1c) >6.5% taking metformin at a daily dosage of 1,500–3,000 mg for ≥3 months. Patients were randomly assigned in a 1:1 ratio to receive either vildagliptin (50 mg) or remogliflozin (100 mg) twice daily for 90 days. The primary endpoint was a change in HbA1c levels from baseline to the end of 90 days whereas secondary endpoints were changes in lipid profile and weight. Results: The decrement in mean HbA1c levels was significantly higher in the remogliflozin group than in the vildagliptin group (−8.1% versus −2.4%; P <0.001). In addition, more significant weight loss was found in remogliflozin-treated patients (−5.2% versus −0.6%; P <0.01). Both treatments were well tolerated throughout the study. Conclusion: Compared to vildagliptin, remoglilflozin was significantly more effective in glycaemic control and weight loss in patients with T2DM and can therefore be considered as an add-on drug in T2DM not adequately controlled by metformin monotherapy. Keywords: Remogliflozin; Vildagliptin; Metformin; Type 2 Diabetes Mellitus; Efficacy; Safety; Glycaemic Control; Weight Loss; India

Gamma Ray Irradiation for Crop Protection Against Salt Stress

Legumes have tremendous dietary value for human nutrition. However, the productivity of food legumes is always compromised owing to their insufficient ability to tolerate abiotic stresses such as drought or water logging, marginal soil, low/high temperatures and salt stress. Stress induces changes at the morphological, physiological, biochemical and molecular level which are consequently manifested in terms of reduced seed yield and quality. Salt stress is one of the most important constraints to crop production particularly in the arid and semi-arid regions of the world. Low dose of ionising radiation like gamma ray is reported to induce growth and several other physiological attributes in non-legume and legume crops. Relationship between seed gamma irradiation and salinity stress response could be related to favourable maintenance of gas exchange attributes (Pn, gs and E), 14C partitioning, activity of antioxidative enzymes (SOD, CAT and POX), membrane stability index (MSI) K+ to Na+ ratio, proline and glycine betaine content. One or more mechanisms may contribute simultaneously towards salt tolerance response of crop plants. The present review critically analyses the effect of gamma ray irradiation on growth and development of legumes under salt stress and evaluates the contribution of various physiological and biochemical mechanisms towards radiation mediated alleviation of salt stress response

Potential of Some Fungal and Bacterial Species in Bioremediation of Heavy Metals

Microorganisms including fungi and bacteria have been reported to extract heavy metals from wastewater through bioaccumulation and biosorption. An attempt was, therefore, made to isolate bacteria and fungi from sites contaminated with heavy metals for higher tolerance and removal from wastewater. Bacterial and fungal isolates were obtained from the samples collected from Karnal, Ambala and Yamunanagar districts of Haryana using enrichment culture technique. Bacterial and fungal isolates with tolerant up to 100 ppm concentration of heavy metals (Pb, Cd, Cr) were tested for their removal from liquid media containing 50 ppm concentration of Pb, Cd and Cr each. Five fungi (Penicillium chrysogenum, Aspegillus nidulans, Aspergillus flavus, Rhizopus arrhizus, Trichoderma viride) were also included in this study. Fungi Aspergillus nidulans, Rhizopus arrhizus and Trichoderma viride showed maximum uptake capacity of 25.67 mg/g for Pb, 13.15 mg/g for Cd and 2.55 mg/g of Cr, respectively. The maximum uptake capacity of tolerant bacterial isolates - BPb12 and BPb16, BCd5 and BCr14 were observed to be ~ 45 mg/g for Pb, 2.12 mg/g for Cd and 3.29 mg/g for Cr, respectively. This indicated the potential of these identified fungi and bacteria as biosorbent for removal of high concentration metals from wastewater and industrial effluents

COMPARATIVE STUDY OF THE EFFECT OF SUPEROXIDE SOLUTION VERSUS CHLORHEXIDINE GLUCONATE SOLUTION IN SURGICAL WOUND DRESSING

Objective: The objective of the study is to compare the effect of superoxide solution (SOD) and chlorhexidine gluconate on wound healing. Methods: Hundred patients with different types of wounds were recruited in this study and randomized to two groups: Group A- SOD group and Group B- Chlorhexidine group. Observations were made regarding type of wounds, reduction of edema, culture of wounds, improvement, cure rates, and hospital stay. Results: Although there were no significant difference in the reduction of edema and swelling of wound in both groups, the cure rates were statistically better with SOD (p=0.001) and hospital stay was also less with the use of SOD (p=0.006). Conclusion: SOD treated case showed less morbidity, with more improvement, and more cure rate compared to chlorhexidine solution with statistically significant p-value. However, further research into the use of SOD and the cytotoxic nature of chlorhexidine in the treatment of various wounds is required

Household symptomatic contact screening of sputum smear positive tuberculosis patients at the DOTS clinic of SGT hospital, Gurugram

Background:  Contact screening was conducted under ICMR (REFERENCE ID: 2019-07811) programme in villages near SGT hospital, Gurugram.  Objective:  To evaluate risk factors, extent of spread of tuberculosis among household contacts of tuberculosis cases and to create awareness. Methods and Material: Address of TB cases were taken from RNTCP register at DOTS clinic, SGT medical college. Then all household contacts of positive cases were screened, counselled and advised to approach ASHA Workers if such symptoms appear. Data was analysed using appropriate statistical methods. Results:21 Index cases along with 94 household contacts were screened. 61.90% families still use chullahs for cooking. 76.1% families have overcrowding. 3) 61.90% families had inadequate ventilation 4) 19.05%families were aware about the spread of this disease. 5)Only 23.80% families practised adequate sanitation methods and precautions6) 42.8% Index cases had a history of smoking. 7) 44.4% 4 continue to smoke with infection. The association of adequate sanitation with presence of awareness was found to be statistically significant. (p-value<0.05). Other factors were not significantly associated with level of awareness regarding prevention of tuberculosis spread among study participants. Conclusions: Contact screening is an effective tool and it gives the real-time picture of TB in India