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OBJECTIVE: This population-based study aimed to compare presentation, treatment allocation and survival of potentially curable esophageal cancer patients between Sweden and the Netherlands. SUMMARY OF BACKGROUND DATA: Identification of inter-country differences in treatment allocation and survival may be used for targeted esophageal cancer care improvement. METHODS: Nationwide datasets were acquired from a Swedish cohort study and the Netherlands Cancer Registry. Patients with potentially curable (cT1-T4a/Tx, cN0/+, cM0/x) esophageal adenocarcinoma or squamous cell carcinoma (SCC) diagnosed in 2011-2015 were included. Multivariable logistic regression provided odds ratios (OR) for treatment allocation, and multivariable Cox model provided hazard ratios (HR) for overall survival, all with 95% confidence intervals (CI), adjusted for age, sex, year, tumor sub-location and stage. RESULTS: Among 1980 Swedish and 7829 Dutch esophageal cancer patients, Swedish patients were older (71 vs 69 years, P

Objective To examine 5-year survival in esophageal cancer after minimally invasive esophagectomy (MIE) compared to open esophagectomy (OE). Summary background data MIE is becoming an increasingly common approach in the surgical treatment of esophageal cancer. A recent meta-analysis suggested 18% lower 5-year all-cause mortality after MIE compared to OE, but the quality of the included studies was limited. Methods Population-based cohort study including almost all patients who underwent elective esophagectomy for esophageal cancer in Sweden or Finland in 2010-2016, with follow-up until 2020. Cox regression was used to provide hazard ratios (HRs) with 95% confidence intervals (CIs) of all-cause 5-year mortality (main outcome) after MIE (hybrid or total) versus OE. Adjustments were made for age, sex, comorbidity, pathological tumor stage, histological tumor type, neoadjuvant chemo(radio)therapy, country, and annual hospital volume of esophagectomy. Results Among all 1,264 patients, 470 (37.2%) underwent MIE and 794 (62.8%) underwent OE. MIE was associated with an 18% decreased risk of all-cause 5-year mortality, compared to OE (adjusted HR 0.82, 95% CI 0.67-1.00 [P = 0.048]). The HR of all-cause 5-year mortality was seemingly lower after total MIE compared to OE (adjusted HR 0.77, 95% CI 0.60-0.98) than after hybrid MIE compared to OE (adjusted HR 0.87, 95% CI 0.68-1.11). Conclusions This bi-national study indicates that MIE is associated with a higher 5-year survival than OE in patients with esophageal cancer, and that the survival benefit is greater after total MIE than hybrid MIE.

Background: There is no consensus on how tourniquet and tranexamic acid (TXA) use in total knee arthroplasty (TKA) affect blood transfusion rates and total blood loss. We compared outcome measures and transfusion rates after TKA, with and without the use of tourniquet and TXA. Methods: A retrospective study of 477 consecutive patients undergoing primary TKA between 2008 and 2013 was performed. There were 243 in the tourniquet-assisted (TA) and 234 in the tourniquet-unassisted (TU) group. Operative times, hemoglobin levels, blood transfusion rates, complications, and length of stay were assessed. Subanalysis was performed on those patients receiving and not receiving TXA within the TU group. Results: Mean operative duration was 66.4 minutes in the TA group and 87.5 minutes in the TU group (P < .0001). Mean postoperative drop in hemoglobin was greater in TU group (3.1 g/dL vs 2.8 g/dL, P = .002). The transfusion rate was 9.5% in TA compared with 11.5% in TU patients (P = .46) with comparable mean units transfused (2.6 vs 2.2, P = .30). There was no difference in wound infection (P = .82) and total complication rates (P = .27) between groups. Those patients given TXA had a lower hemoglobin drop (2.6 g/dL vs 3.3 g/dL, P = .04) with similar transfusion (13.3% vs 11%, P = .61) and complication (P = .95) rates. Conclusions: TU TKA had a greater operative duration and postoperative drop in hemoglobin than TA TKA. However, transfusion rates were similar between groups. TXA use reduced the operative decrease in hemoglobin with no effect on complication or transfusion rates. Level of Evidence: Level III, retrospective cohort study.

Introduction: Medial Longitudinal Arch (MLA) is important for the foot, since it provides necessary shock absorption during movement. Its estimation can be done by various techniques, viz navicular height method, footprint, radiography. On the footprint various indexes have been suggested by researchers. The study aims to correlate the values of medial longitudinal arch by using standing navicular height method, Clark’s angle and chosen morphological characteristics (mid-footprint planter angle; MFPA) in medical and health science students of Sumandeep Vidyapeeth University. Materials and Methods: Non-randomized study was conducted in the department of Anatomy in SBKSMI&RC on 50 students of medical & health science at Sumandeep Vidyapeeth after prior approval. Three different methods were used for measuring MLA, navicular height method, Clark’s angle (using footprint) and MFPA (using footprint an angle formed by joining the medial most point anteriorly with the point of maximum concavity on the medial side of the foot while posteriorly due to calcaneus bone forming a triangle with this angle). Results: Middle level negative correlation (-0.531 & -0.500) between MFPA and Clark’s angle for right & left foot with statistical significance of Conclusion: The new technique (MFPA) of estimating MLA using footprint is significant and strongly correlated with other methods, thus can be considered efficient method for estimation of arch in OPD on day to day basis. Keywords: Medial longitudinal arch, Navicular height method, Footprint, Clark’s angle.

Objective To examine the hypothesis that survival in esophageal cancer increases with more removed lymph nodes during esophagectomy up to a plateau, after which it levels out or even decreases with further lymphadenectomy. Summary background data There is uncertainty regarding the ideal extent of lymphadenectomy during esophagectomy to optimize long-term survival in esophageal cancer. Methods This population-based cohort study included almost every patient who underwent esophagectomy for esophageal cancer in Sweden or Finland in 2000-2016 with follow-up through 2019. Degree of lymphadenectomy, divided into deciles, was analyzed in relation to all-cause 5-year mortality. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (95% CI) adjusted for all established prognostic factors. Results Among 2,306 patients, the 2nd (4-8 nodes), 7th (21-24 nodes) and 8th decile (25-30 nodes) of lymphadenectomy showed the lowest all-cause 5-year mortality compared to the 1st decile (HR = 0.77, 95% CI 0.61-0.97, HR = 0.76, 95% CI 0.59-0.99, and HR = 0.73, 95% CI 0.57-0.93, respectively). In stratified analyses, the survival benefit was greatest in decile 7 for patients with pathological T-stage T3/T4 (HR = 0.56, 95% CI 0.40-0.78), although it was statistically improved in all deciles except decile 10. For patients without neoadjuvant chemotherapy, survival was greatest in decile 7 (HR = 0.60, 95% CI 0.41-0.86), although survival was also statistically significantly improved in deciles 2, 6, and 8. Conclusion Survival in esophageal cancer was not improved by extensive lymphadenectomy, but resection of a moderate number (20-30) of nodes was prognostically beneficial for patients with advanced T-stages (T3/T4) and those not receiving neoadjuvant therapy.

Neutropenic sepsis is a life-threatening medical emergency in paediatric haematology and oncology patients. It is a complication of myelosuppressive therapy used to treat children with cancer. Improvement in supportive care in oncology has seen the mortality from febrile neutropenia (FN) fall from 40% to 1%–3% in the last 50 years,1 with the risk of FN in children being reported as low as 0.4%–1%.2 However, many children will still undergo frequent and long inpatient admissions to the hospital, due to fever and neutropenia, while remaining clinically well with no identifiable source of infection. This new guidance draws on evidence from the Predicting Infectious Complications in Children with Cancer collaboration (PICNICC+) collaboration between UK, Australian and Swiss groups to propose a risk-stratified approach to managing these patients and ultimately reducing the time spent in the hospital.3 4 Clinicians and families may find this desirable, particularly during the COVID-19 pandemic while trying to reduce hospital time and keeping patients at home where possible. ### Information about the current guideline This guideline has been written by the Children’s Cancer and Leukaemia Group using/adapting the Australian low-risk FN programme.5 Principal treatment centres and their associated paediatric oncology shared care units should consider whether they wish to adopt the protocol as written or to adapt it to fit their needs. The reader should check whether their local hospital policies support ambulatory care management of patients with suspected FN who are at low risk of sepsis. This guidance uses the validated Australia–UK–Swiss (‘AUS’) Score to risk stratify patients (see table 1) using three variables: chemotherapy intensity, total white cell count and platelets at admission. View this table: Table 1 AUS Score risk stratification There is no previous guidance in the UK …

To study the technique of intra-operative imprint cytology for intraoprative diagnosis and management in cases of Head and Neck malignant lesions and to compare its result with postoperative histopathology. Prospective study conducted over 2 yrs period at the Department of ENT of a tertiary care centre in central India. A total of 60 patients who were operated for Head and Neck malignant lesions were studies with regards to intraoperative diagnosis, marginal status and lymphnodal status and compared with postoperative histopathology. Mean age-group was 47.70 (± 13.7) years. There was male preponderance. Bucco-aveolar complex lesions constituted the majority followed by Tongue and thyroid lesions. Intraoperative cytology technique showed a sensitivity of 92.98%, 80.60% and 92.30% as regards the intraoperative diagnosis, marginal clearance and nodal metastases respectively; while the specificity was 100%, 90.09% and 83.33% respectively. At the end of the study we conclude that intra-operative cytology is a good technique for intra-operative evaluation in Head and Neck lesions, where facilities for frozen section are not available. It can be used as a simple, non-expensive and rapid alternative to frozen section. A larger and longer study can validate its routine use in surgical setups where high-end pathology setup is not available.

The treatment for pediatric acute myeloid leukemia (AML) has not changed significantly over the past 3 decades, yet outcomes have improved with cure rates increasing from 30% to over 60% of all newly diagnosed children over this period. This improvement in survival has been attributed to both treatment intensification and improved supportive care over the decades, although the precise impact of each remains unknown.We retrospectively analyzed a unique cohort of 276 patients with de novo AML diagnosed in childhood, all treated with the same chemotherapy protocol over a 25-year period from 1986 to 2012.The contemporary cohort (2000-2012), compared with the historical cohort (1986-1999) had significantly improved overall survival (75% vs. 50%; hazard ratio, 2.17; 95% confidence interval, 1.15-2.93), lower disease-related mortality (38% vs. 19%, P=0.02) and were significantly more likely to receive an allogeneic transplant after relapse (stem cell transplantation [SCT], 73% vs. 12%; P0.0001). Allogeneic transplant postrelapse was associated with a significantly improved survival across the entire cohort (overall survival 50% for allogeneic SCT vs. 12% for autologous or none, P0.0001). There was no significant difference between the contemporary and historical cohorts in treatment-related mortality (13% vs. 7%, P=0.42) or relapse rates after induction (50% in older cohort vs. 40% in recent era, P=0.25), suggesting consistency of induction treatment efficacy and toxicity across the 2 periods.This data suggests improved survival in pediatric AML in the modern era has predominantly resulted from changes in treatment after relapse, including increased use of allogeneic SCT.

Evaluate the existing literature comparing long-term survival after minimally invasive esophagectomy (MIE) and open esophagectomy (OE), and conduct a meta-analysis based on relevant studies.It is unknown whether the choice between MIE and OE influences the long-term survival in esophageal cancer.A systematic electronic search for articles was performed in Medline, Embase, Web of Science, and Cochrane Library for studies comparing long-term survival after MIE and OE. Additionally, an extensive hand-search was conducted. The I test and χ test were used to test for statistical heterogeneity. Publication bias and small-study effects were assessed using Egger test. A random-effects meta-analysis was performed for all-cause 5-year (main outcome) and 3-year mortality, and disease-specific 5-year and 3-year mortality. Meta-regression was performed for the 5-year mortality outcomes with adjustment for the covariates age, physical status, tumor stage, and neoadjuvant or adjuvant therapy. The results were presented as hazard ratios (HRs) with 95% confidence intervals (CIs).The review identified 55 relevant studies. Among all 14,592 patients, 7358 (50.4%) underwent MIE and 7234 (49.6%) underwent OE. The statistical heterogeneity was limited [I = 12%, 95% confidence interval (CI) 0%-41%, and χ = 0.26] and the funnel plot was symmetrical both according to visual and statistical testing (Egger test = 0.32). Pooled analysis revealed 18% lower 5-year all-cause mortality after MIE compared with OE (HR 0.82, 95% CI 0.76-0.88). The meta-regression indicated no confounding.The long-term survival after MIE compares well with OE and may even be better. Thus, MIE can be recommended as a standard surgical approach for esophageal cancer.

Background Vatarakta vis-à-vis gout is a common condition in both primary care and specialist practice. Gout is a systemic disease characterized by manifestations of chronic under­lying hyperuricemia, resulting in the deposition of monosodium urate crystals in various tissues. Gout is the most common of the crystal induced arthritis due to disturbed uric acid metabolism and precipitation of urate crystals in extracellular space of joints, periarticular tissue, bones, and other organs. Aim and objective To explore the therapeutic efficacy and safety of Amrita Guggulu and Pinda Taila in the management of hyperuricemia in gout (Vatarakta) patients. Materials and methods A total of 100 cases (25–65 years) of primary gouty arthritis fulfilling the diagnostic criteria as recommended by the American College of Rheumatology were selected for the present study from outpatient department of the Central Ayurveda Research Institute for Respiratory Disorders Patiala and Regional Ayurveda Research Institute for Urinary Disorders, Jammu, India, irrespective of their sex, religion, and socioeconomic status. Only those patients who presented themselves with at least 6 of 12 criteria of American College of Rheumatology (1977) were selected for the clinical trial. Amrita Guggulu was given 1000 mg twice daily orally and Pinda Taila was applied locally 10 mL twice daily for 84 days. Results The trial therapy was assessed based on the improvement in clinical features, Visual Analog Scale (VAS) score, Patient's Global Assessment Scale score, Physician's Global Assessment Scale Score, SF-36 Health Survey Score for quality of life (QOL), and biochemical parameters. Each patient was subjected to routine blood test, serum uric acid, liver function tests, and renal function tests before treatment, after 28 days of treatment, and after 84 days of treatment. The trial combination showed statistically significant improvement in the clinical manifestations, QOL as well as reduction in marker of hyperuricemia, i.e., serum uric acid; the mean serum uric acid at the baseline was 7.76 mg/dL, which was reduced to 6.50 mg/dL after the trial period of 84 days. There was also decrease in the level of VAS score, Patient's Global Assessment Scale score, and Physician's Global Assessment Scale score. There were no impairment in liver function test and renal function test, indicating the good safety profile of trial therapy. Conclusion Hence, Amrita Guggulu and Pinda Taila drug combination is an effective and safe remedy for gouty arthritis (Vatarakta) patients. How to cite this article Singh H, Sannd R, Bhurke LW, Kumari K, Singh R, Vedi SK, Kumar A, Bharti, Rana R, Singhal R, Srikanth N, Padhi MM, Dhiman KS. An Open Label Efficacy Study of Amrita Guggulu and Pinda Taila in the Management of Hyperuricemia in Gout (Vatarakta) Patients. J Res Ayurvedic Sci 2017;1(1):25-33.

Dyskeratosis congenita (DC) is a multisystem disorder, with a disruption in telomere biology leading to very short telomeres underpinning its pathophysiology. Bone marrow failure is a key feature in DC and is the leading cause of mortality. Hematopoietic stem cell transplantation (HSCT) is the only curative option for bone marrow failure in DC; however, small case reports and series have suggested a poor outcome after HSCT. We undertook a systematic review of all reported patients with DC who underwent HSCT to better characterize outcome and to identify factors associated with improved survival. The outcome of 109 patients found in the literature was poor, with 5- and 10-year survival estimates of only 57% and 23%, respectively. Patients transplanted after 2000 had improved early survival, with 5-year survival estimates of 70%; however, longer term survival was similar (28%). Pulmonary disease, infection, and graft failure were the leading causes of death. Prognosis after development of pulmonary disease post-HSCT was poor, with only 4 of 15 patients surviving at last follow-up. Multivariate analysis identified age >20 years at HSCT, HSCT before 2000, and alternate donor source to be poor prognostic markers. Reduced-intensity conditioning was not significantly found to be associated with improved survival. This review shows the poor outcome after HSCT in patients with DC and highlights the need for future collaborative clinical trials and extended follow-up of this rare patient population to define whether changes in therapy will lead to improved survival.

ObjectivesThe public health disorder gastro-oesophageal reflux disease (GORD) is linked with several comorbidities, including oesophageal adenocarcinoma (OAC), but whether life expectancy is reduced by GORD is uncertain. This study assessed all-cause and cancer-specific mortality in GORD after controlling for confounding by heredity and other factors.DesignPopulation-based cohort study from 1998 to 2015.SettingSwedish nationwide study.ParticipantsTwins (n=40 961) born in 1958 or earlier in Sweden.ExposureGORD symptoms reported in structured computer-assisted telephone interviews.OutcomesThe primary outcome was all-cause mortality and the secondary outcome was cancer-specific mortality among twins with GORD and twins without GORD. HRs and 95% CIs were analysed using parametric survival models, both in individual twin analyses and co-twin pair analyses, with adjustment for body mass index, smoking, education and comorbidity.ResultsAmong 40 961 individual twins, 5812 (14.2%) had GORD at baseline and 8062 (19.7%) died during follow-up of up to 16 years. The risks of all-cause mortality (HR=1.00, 95% CI: 0.94–1.07) and cancer-specific mortality (HR=0.99, 95% CI: 0.89–1.10) were not increased in individual twins with GORD compared with individual twins without GORD. Similarly, there were no differences in mortality outcomes in within-pair analyses. The OAC-specific mortality rate was 0.45 (95% CI: 0.32–0.66) per 1000 person-years in individual twins with GORD and 0.22 (95% CI: 0.18–0.27) per 1000 person-years without GORD, rendering an adjusted HR of 2.01 (95% CI: 1.35–2.98).ConclusionsGORD did not increase all-cause or cancer-specific mortality when taking heredity and other confounders into account. The increased relative risk of mortality in OAC was low in absolute numbers.

Background Studies examining hospital volume for surgery for various gastrointestinal (GI) cancer types have shown conflicting results regarding the influence on long-term prognosis. The aim of this study was to examine annual hospital volume in relation to long-term survival after elective surgery for all GI cancers (esophagus, stomach, liver, pancreas, bile ducts, small bowel, colon, and rectum). Methods Population-based cohort study including all 45,908 patients who underwent elective surgery for GI cancers in Sweden in 2005–2013. Follow-up was until 2016 for disease-specific 5-year mortality (main outcome) and 2018 for all-cause 5-year mortality (secondary outcome). Hospitals were divided into quartiles for each GI cancer according to a 4-year average annual volume of the year of surgery and three years earlier. Multivariable Cox regression provided hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for relevant confounders. Results Higher hospital volume was associated with a survival benefit in the large group of patients (n = 26,688) who underwent colon cancer resection, with HR 0.89 (95% CI 0.84–0.96) for disease-specific 5-year mortality comparing the highest with the lowest quartile. Higher hospital volume improved 5-year mortality in sub-groups of patients who underwent surgery for cancer of the esophagus, pancreas, and rectum. No such improvements were found for cancer of the stomach, liver, bile ducts, or small bowel. Conclusion Long-term survival was improved at higher volume hospitals for some GI cancers (colon, esophagus, pancreas, rectum), but not for others (stomach, liver, bile ducts, small bowel).

Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis (Mtb), kills 5,000 people per day globally. Rapid development and spread of various multi drug-resistant strains of Mtb emphasize that an effective vaccine is still the most cost-effectives and efficient way of controlling and eradicating TB. Bacillus Calmette-Guerin (BCG), the only licensed TB vaccine, still remains the most widely administered human vaccine, but is inefficient in protecting from pulmonary TB in adults. The protective immunity afforded by BCG is thought to wane with time and considered to last only through adolescent years. Heterologous boosting of BCG-primed immune responses using a subunit vaccine represents a promising vaccination approach to promote strong cellular responses against Mtb. In our earlier studies, we discovered lipopeptides of ESAT-6 antigen with strong potential as a subunit vaccine candidate. Here, we have investigated that potential as a booster to BCG vaccine in both a pre-exposure preventive vaccine and a post-exposure therapeutic vaccine setting. Surprisingly, our results demonstrated that boosting BCG with subunit vaccine shortly before Mtb challenge did not improve the BCG-primed immunity, whereas the subunit vaccine boost after Mtb challenge markedly improved the quantity and quality of effector T cell responses and significantly reduced Mtb load in lungs, liver and spleen in mice. These studies suggest that ESAT-6 lipopeptide-based subunit vaccine was ineffective in overcoming the apparent immunomodulation induced by BCG vaccine in Mtb uninfected mice, but upon infection, the subunit vaccine is effective in re-educating the protective immunity against Mtb infection. These important results have significant implications in the design and investigation of effective vaccine strategies and immunotherapeutic approaches for individuals who have been pre-immunized with BCG vaccine but still get infected with Mtb.

Antipsychotic medications are associated with adverse cutaneous reactions (ACRs) in approximately 2–3% of patients. We present three cases of possible risperidone induced periorbital oedema in the absence of any other systemic or local cause responsible for the oedema. The development of periorbital oedema after the initiation of risperidone therapy, and disappearance after the discontinuation of this drug, suggests a possible causal relationship between periorbital oedema and risperidone. To our knowledge, there are very few reports of risperidone therapy and development of periorbital oedema. Risperidone is a valid and effective choice amongst antipsychotic medications, but these cases call for caution regarding ACRs at the time of prescribing.

Background Surgery proficiency gain curves must be shortened to reduce patient harm during esophagectomy learning. Objective This study aimed to test whether surgeon volume and surgeon age influenced the length of period of surgical proficiency gain. Methods This population-based cohort study included 1384 patients with esophageal cancer who underwent esophagectomy by any of the 36 highest-volume surgeons in Sweden between 1987 and 2010, with follow-up until 2016. Annual surgeon volume was dichotomized by the median values into ‘higher-volume surgeons’ (≥ 4 cases per year) and ‘lower-volume surgeons’ (

Background: Dental caries and gum disease are a major public health problem predominantly affecting children worldwide. Therefore the present study was conducted to assess oral hygiene practices, prevalence of dental caries and periodontal diseases among 12 and 15 years old high school children in public and government schools of Ambala district, Haryana and to provide data for planning and evaluation of oral health care promotion programs. Material and Methods: A cross-sectional descriptive survey of 12 and 15 years old children in government and private schools was conducted in Ambala, Haryana. A sample of 992 school children was selected by a two-stage cluster sampling method. Dental caries and periodontal health was examined using WHO standard criteria. The student’s t-test and one way ANOVA were used for statistical analysis. Results: The prevalence of dental caries was 34.3% and 46.5% at 12 and 15 years respectively. Mean DMFT in 12 years was 0.82 and in 15 years it was 1.26. More than 90% of subjects in both the age groups were using tooth brush to clean their teeth. Toothpaste was used by 96.7% (228) of subjects belonging to 12 year age group and 93% (703) of subjects who were of 15 years of age. Gingival bleeding was found in majority of subjects. Conclusions: The overall prevalence of dental caries was low but the prevalence of gingivitis was quite high. The observations indicate the need for a school oral health promotion programme to sustain the healthy practices in this growing population

Introduction: Effective feedback helps students to realize their error and confirm most appropriate response posed by them which moreover, magnifies their conceptual understanding. Implementation of the innovative feedback on formative assessment of Continuous Cumulative Evaluation System (CCES) at our institute primes the untrained minds towards better understanding of the assessed content. Aim: To determine the impact of feedback on CCES process in medical students on learning physiology. Materials and Methods: Non-randomized, purposive, survey questionnaire based study for 150 students enrolled in 2015 to 2016 for medical program of SBKSMIRC, Sumandeep Vidyapeeth University were considered. Three focus group discussions were conducted with eight students in each group after completion of session. Pre and post-test was conducted to assess learning outcome of students by feedback methodology. Data was collected, and analyzed statistically using paired t-test and correlation analysis for gender variability for perception. Results: Pre and post-test showed statistical significance (p

Background: Lichen planus pigmentosus (LPP) is a common cause of facial melanosis in the dark-skinned population. At present, information on dermoscopy and patch testing in LPP is limited. Objectives: To describe dermoscopic findings and study the role of patch testing in patients with LPP on the face. Methods: Facial lesions of 50 patients with LPP were studied dermoscopically, followed by histological evaluation. Patch and photopatch tests with the Indian Standard Series and Scandinavian series, respectively, and patient's own cosmetics were performed on all patients. Results: The most common dermoscopic finding was dots and/or globules (43/50, 86%) in different patterns: hem-like (20.9%), arcuate (18.6%), incomplete reticular (39.5%), complete reticular (7%), and not otherwise specified (14%). Other patterns were exaggerated pseudoreticular pattern, accentuation of pigmentation around follicular openings, targetoid appearance, and obliteration of the pigmentary network. There were 26 relevant patch tests in 17 (34%) patients: para-phenylenediamine (n = 5), nickel (n = 3), colophony, perfume mix and fragrance mix (n = 2 each), thiuram mix and 3,3,4,5-tetrachlorosalicylanilide (n = 1 each), and patients' own products (n = 9). The only positive photopatch test was to fentichlor. No clinical or histological finding differed significantly based on patch test results. The only dermoscopic finding to be statistically associated with a positive patch test was the non-characteristic arrangement of dots/globules (P = 0.042). Limitations: Dermoscopic features were not correlated with clinical features or disease duration. Implications of patch testing on the management of LPP cannot be commented upon as ours was a cross-sectional study. Conclusions: The present study describes the dermoscopic findings of facial lesions in LPP. Our patch test results suggest a probable role of allergens in causing LPP on the face.

Febrile neutropenia remains a common, life-threatening complication of chemotherapy in paediatric oncology. Delays in institution of empiric antibiotics have been identified at tertiary and regional centres caring for these patients and associated with decreased survival. Our objective was to reduce the time to administration of empiric antibiotics to less than 60 min from the time of presentation to hospital. A retrospective study of the records of oncology patients presenting to the emergency department of a tertiary hospital over a 3-month period was performed and time to first antibiotic administration recorded. Potential causes of delay in commencement of antibiotics were identified and an algorithm-based approach to the management of fever in immunocompromised children developed and implemented. Follow-up evaluation data were collected at 12 and 60 months post-intervention. Causes of delay in commencement of antibiotics at regional hospitals that share care with the tertiary hospital were identified through questionnaires, interviews and focus groups, involving patients and medical and nursing staff. The impact of the introduction of the algorithm at one peripheral hospital was evaluated. The mean time to empiric antibiotics was reduced from 148 min (95 % confidence interval (CI) 81–216) at baseline to 76 min (95 % CI 50–101) at 12 months post-intervention and sustained at 65 min (95 % CI 52–77) 5 years after the intervention. At the peripheral hospital, mean time to antibiotic delivery was reduced from 221 min (95 % CI 114–328) to 65 min (95 % CI 42–87) at 12 months after the intervention. The introduction of the guideline, with teaching and support for staff and parents, resulted in an improvement in practice, meeting international guidelines and achieving sustained results at 5 years after introduction at a tertiary hospital. The guideline has been shown to be feasible and effective at a regional hospital.

Xanthoma disseminatum (XD) is a rare, benign, non-Langerhans cell histiocytosis characterized by disseminated xanthomatous lesions with a predilection for the face, flexures, and mucosae. Approximately 100 cases have been reported in the literature. We report XD in an 8-year-old boy with symmetric synovitis and arthritis involving the wrists and knees. This case is interesting in view of the association between arthritis and synovitis and XD, which to our knowledge has not been reported in the literature. This case has to be differentiated from multicentric histiocytosis, another non-Langerhans cell histiocytosis, in which joint involvement is common.

A light sensitive wide band gap radial heterojunction between TiO2 and nSiNWs sensitized by gold nanoparticles is reported. The surface plasmon of AuNPs influences the optical and photocurrent properties of the heterojunction considerably. Improvement in the band gap emission of TiO2 has been found at the expense of defect radiation. Excitation of AuNPs deposited on nSiNWs/TiO2 by light irradiation shows a wavelength-dependent photocurrent due to the increased photoactivity of the heterojunction.

Pleomorphic adenoma, a heterogeneous mixture of epithelial and myoepithelial cells, commonly found in major salivary glands, accounts for about 3% of benign head and neck tumors. Intranasal pleomorphic adenoma (INPA) is an extremely rare variant forming a mere 8% of all pleomorphic adenomas. Majority of these arise from the nasal septum (82-90%) with only about 8% showing attachment to the lateral nasal wall. Various theories explaining etiopathological basis of INPA have been proposed but none explains its predominance in females in 3rd to 6th decade of life. Hallmark of histopathological picture of pleomorphic adenoma is epithelial tissue mixed with tissues of myxoid, chondroid or mucoid origin. But INPA shows predominantly epithelial component with scanty stroma. Considering its high cellularity and anatomical site, INPA is often misdiagnosed as unilateral nasal malignancy. Early diagnosis ensures complete excision and is paramount to make patient disease free, considering its high potential of recurrence. Hereby, we are presenting a case of giant pleomorphic adenoma of nasal cavity, arising from lateral nasal wall, causing erosion of the base of skull, with the intent of drawing attention to this rare diagnosis. How to cite this article Chavan SS, Bhople KS, Vedi JN, Jain PV, Sonavani M. Giant Intranasal Pleomorphic Adenoma: A Rare Case Report. Clin Rhinol An Int J 2013;6(2):96-99.

ObjectiveGastro-oesophageal reflux is a public health concern which could have associated oesophageal complications, including adenocarcinoma, and possibly also head-and-neck and lung cancers. The aim of this study was to test the hypothesis that reflux increases all-cause and cancer-specific mortalities in an unselected cohort.DesignThe Nord-Trøndelag health study (HUNT), a Norwegian population-based cohort study, was used to identify individuals with and without reflux in 1995–1997 and 2006–2008, with follow-up until 2014. All-cause mortality and cancer-specific mortality were assessed from the Norwegian Cause of Death Registry and Cancer Registry. Multivariable Cox regression was used to calculate HRs with 95% CIs for mortality with adjustments for potential confounders.ResultsWe included 4758 participants with severe reflux symptoms and 51 381 participants without reflux symptoms, contributing 60 323 and 747 239 person-years at risk, respectively. Severe reflux was not associated with all-cause mortality, overall cancer-specific mortality or mortality in cancer of the head-and-neck or lung. However, for men with severe reflux a sixfold increase in oesophageal adenocarcinoma-specific mortality was found (HR 6.09, 95% CI 2.33 to 15.93) and the mortality rate was 0.27 per 1000 person-years. For women, the corresponding mortality was not significantly increased (HR 3.68, 95% CI 0.88 to 15.27) and the mortality rate was 0.05 per 1000 person-years.ConclusionsIndividuals with severe reflux symptoms do not seem to have increased all-cause mortality or overall cancer-specific mortality. Although the absolute risk is small, individuals with severe reflux symptoms have a clearly increased oesophageal adenocarcinoma-specific mortality.

No general consensus has yet been established for the gold standard treatment of ankle syndesmotic complex injuries. Recent literature has documented the success of ankle tightrope fixation for heterogeneous ankle fracture patterns, resulting in syndesmotic complex injuries. We present a multicentre case series assessing the clinical, radiological and functional outcomes of patients with Weber C ankle fractures treated with the Arthrex TightRope® fixation system. We performed a retrospective analysis of all adult patients with Weber C ankle fractures who were treated with the Arthrex TightRope® fixation system at four centres over a 3-year period. All patients were followed up for a mean of 14 months (range 12–26). Outcomes measures were assessed subjectively using functional scores (AOFAS and Olerud and Molander) and objectively using radiological measurements, complication rates and revision surgery rates. Thirty-six patients met our eligibility criteria. The mean age at operation was 31 years (range 18–65). There were 20 males and 16 females. No patients were lost to follow-up. The ankle tightrope maintained satisfactory reduction in the ankle mortise in 97% of cases. Of these 35 successfully treated cases, no evidence of re-displacement on follow-up radiographs of the syndesmotic complex was observed at an average of 10.8 months (range 6–12). Post-operative mean medial clear space was 3.1 mm, and mean tibio-fibular overlap was 10.1 mm. The mean American Orthopaedic Foot and Ankle Society (AOFAS) score was 88.8 (range 67–98) at a mean follow-up of 14 months (range 12–26). The overall complication rate was 6% (one failure requiring revision surgery and one medial sided skin irritation requiring removal of suture button). No infections or wound complications occurred. Tightrope fixation is a safe alternative to screw fixation for syndesmotic complex injuries in Weber C ankle fractures. We have shown that it has low complication rates and a high patient satisfaction.

Background: NHS Library Services are utilised by NHS staff and junior trainees to locate scientific papers that provide them with the evidence base required for modern medical practice. The cost of accessing articles can be considerable particularly for junior trainees. Objectives: This survey looks at variations in cost of journal article loans and investigates access to particular orthopaedic journals across the country. Methods: A national survey of UK Health Libraries was performed. Access to and costs of journals and interlibrary loan services were assessed. Availability of five wide-reaching orthopaedic journals was investigated. Results: Seven hundred and ten libraries were identified. One hundred and ten libraries completed the questionnaire (16.7%). Of these, 96.2% reported free access to scientific journals for users. 99.1% of libraries used interlibrary loan services with 38.2% passing costs on to the user at an average of £2.99 per article. 72.7% of libraries supported orthopaedic services. Journal of Bone and Joint Surgery (British) had greatest onsite availability. Conclusions: The study demonstrates fluctuations in cost of access to interlibrary loan services and variation in access to important orthopaedic journals. It provides a reflection of current policy of charging for the acquisition of medical evidence by libraries in the UK.

Length of post-operative stay is an important factor in improving cost-effectiveness of total hip arthroplasty (THA). Short stem femoral components may reduce soft tissue and bone damage, permitting earlier mobilization and earlier safe discharge from hospital. This study compares the length of stay of patients undergoing THA using a short stem femoral component compared to an age matched group undergoing standard THA. The mean age in the standard stem group was 52.7 years and 50.4 years in the short femoral stem group (p=0.57). Total theatre time, blood loss and post-operative Oxford hip scores in the groups were not statistically different (p=0.11, p=0.91, p=0.16). Mean post-operative stay for the short stem group was shorter (3 vs 5 days, p=0.010), resulting in 10% cost saving per patient episode.

The purpose of this study is to determine whether, in low-risk febrile neutropenic paediatric populations, oral antibiotics are as effective as intravenous antibiotics in obtaining resolution of the febrile neutropenic episode. A comprehensive literature search of MEDLINE, EMBASE and CENTRAL identified prospective, randomised controlled trials comparing oral antibiotics with intravenous antibiotics in the treatment of febrile neutropenic episodes in low-risk paediatric oncology patients. Outcomes assessed were mortality, rate of treatment failure, length of the febrile neutropenic episode and adverse events. The random effects model was used to calculate risk ratios (RRs) for dichotomous data and mean difference with standard deviation for continuous data. Seven trials were included in the overall analysis, which included 934 episodes of febrile neutropenia in 676 patients aged between 9 months and 20 years. The overall treatment failure rates were not significantly different between oral and intravenous antibiotics (RR: 1.02, 95% confidence interval 0.78-1.32, P= 0.91). In carefully selected low-risk febrile neutropenic children, empiric treatment with oral antibiotics is a safe and effective alternative to intravenous antibiotics as they lower the cost of treatment as well as psychosocial burden on these children and their families.

Although age-related changes in cancellous bone structure in human are relatively well characterized, few studies have addressed changes in cortical bone. We have investigated age-related changes in iliac crest bone biopsy specimens from 54 normal subjects, 23 men and 31 women, aged 18–90 years. A significant decrease in cortical width and area was seen (P = 0.002 and

Anterior cruciate ligament (ACL) disruptions are common injuries that currently hold a fearsome reputation among athletes of all abilities and disciplines. Indeed, if the diagnosis is missed at first presentation, it is difficult to attribute ongoing instability and recurrent injury to an ACL tear. Classically, patients then often improve shortly before repeatedly reinjuring their knee. At some point, the knee may lock, necessitating an arthroscopic meniscectomy. Tragically, this then hastens the progression of joint arthrosis and the decline of the joint function. While the burden of responsibility does not lie solely with the junior doctor or the general practitioner, it is often at the first consultation that the natural history of this devastating injury is decided. The ability to recognise, institute early management and reassure patients with ACL tears about the future is an invaluable asset to the non-specialist junior doctor. Once diagnosed, the responsibility of advising and further counselling of patients with ACL injuries is best left to the orthopaedic knee specialist. Family practitioners and emergency room doctors should not feel pressured to offer advice on specialist areas such as return to sports without reconstruction or indeed the need for reconstruction. Indeed, decisions to return to sports with ACL-deficient knees have all too often led to disastrous reinjury events to the articular cartilage and/or the menisci.

Background: Allergic rhinitis and brochial asthma are interrelated diseases because of the shared respiratory epithelium and the common allergens affecting both the areas. The treatment of both these conditions is often overlapping. Although no treatment modality is perfect in treating the disease, corticosteroids are the mainstay of the treatment for both the conditions. This study was conducted to quantify strength of association between allergic rhinitis and hyperactive lower airway disorders and to study the effect of topical intranasal steroid Fluticasone on Bronchial hyperactivity in patients with allergic rhinitis.Methods: Patient with moderate to severe allergic rhinitis presenting to ENT OPD with symptoms of lower airway hyperactivity were subjected to pulmonary function tests. After all routine investigations, the patients were started on fixed dose of intranasal fluticasone furoate nasal spray for a period of 2 months and the pretreatment and post treatment FEV1 and PEFR were compared and statistically analysed for the effect. Results: Approximately 50% of patients with allergic rhinitis showed associated lower airway hyperreactivity. There was statistically significant improvement in pulmonary function test readings after 2 months therapy with intranasal fluticasone spray.Conclusions: The study showed that the treatment of inflammation in the upper airways indirectly improves the symptoms of hyperactive lower airway disorders and decreased bronchial hyperactivity.

Background:Longer term outcome data are now becoming available for short-tapered femoral stems for cementless total hip arthroplasty. The shorter stem has a metaphyseal fit, loading the bone in this area, leading to physiological bone remodelling. It is also bone preserving, as it is 35 mm shorter. It may be easier to insert through a smaller incision and potentially reduce complication rates. We present a retrospective single surgeon case series of 196 patients (>53% follow-up over 5 years). All patients had the cementless ‘Microplasty Taperloc’ (Biomet). Primary outcome measures were femoral component revision rates. Secondary outcome measures included complications, patient-reported functional outcome scores (Oxford hip) and radiographic evidence of loosening.Methods:Patients were identified using electronic software. All were routinely followed up and assessed in clinic since implant introduction in 2009. Oxford hip scores were routinely obtained. A surgeon who had not carried out the procedure independently assessed radiographs.Results:One hundred ninety-six patients were identified. The revision rate was 0.5% due to an intraoperative peri-prosthetic fracture of the femur identified on post-operative radiograph. The complication rate was 2%, attributable to: subsidence of the prosthesis (one hip), post-operative dislocation (two hips), one of which required acetabular revision. Oxford hip scores increased on average from 21 to 45 (pre- to post-operatively). There were no signs of radiographic loosening.Conclusion:The results show that using the short-tapered stem is proving so far to be a reliable and safe alternative to its longer counterpart, with low complication rates in the short term.

Summary The Standardbred trotter must pull a considerable load when racing and, consequently, draught loading is a common method of training in the Standardbred and the effects of loading and fatigue due to loading on the locomotor pattern was the purpose of this investigation. Four mature healthy Standardbred horses trotted with and without a horizontal-pulling loading of 34 kg until the horses were no longer willing to keep pace with the treadmill despite encouragement. Heart rate was monitored every min using a bipolar electrocardiogram. The kinematics for 5 consecutive strides were filmed. Horses exercised on the treadmill for 7–10 mins. The mean heart rate was 206 beats/min at the end of the exercise. Due to draught loading, the horses reduced significantly the time of the stance phase in both the fore- and hindlimb. Three of the 4 horses reduced their stride lengths as the result of increased loading. The general movement pattern of the horses remained similar. More dramatic changes in the movement pattern were observed because of fatigue. The limbs of the horse were significantly more compressed as the result of greater joint excursion during the stance phase. Furthermore, the length of stride was significantly increased as the result of fatigue. The results show that both loading and fatigue change the locomotor pattern of the Standardbred trotter. Although the horizontal loading was. considerable, the horse maintained similar joint movement with increases in stride frequency. During fatigue the horse seems to be unable to maintain stride frequency, probably due to a compromised power capacity of the muscles. The increase in joint excursion due to fatigue may have an important influence on certain types of injury to the locomotor system of the racehorse.

The present investigation deals with the evaluation of antifilarial efficacy of liposome entrapped antiwolbachial antibiotics doxycycline and rifampicin (5 doses at 10 mg/kg, subcutaneously for 15 days) alone and/or in combination with standard filaricide diethylcarbamazine (DEC) against human lymphatic filariid Brugia malayi in rodent host Mastomys coucha. The delivery system maintained the sustained release of antibiotics up to 48 h and significantly (P0.05) augmented the antifilarial potential of these antibiotics over their free administration. A combination of DEC with each entrapped antibiotics significantly (P0.05) improved microfilaricidal efficacy, while marginal enhancement was noticed in adulticidal activity. Combination of both antibiotics formulation with DEC demonstrated marginal increase in macrofilaricidal efficacy; however, it was highest ( approximately 75%).

Introduction We have reported that after an acute stroke, intravenous zoledronate prevented bone loss in the hemiplegic hip. Participants from the trial also volunteered for trans-iliac bone biopsy, to assess the early effects of stroke and zoledronate on iliac bone remodelling. Methods Patients with acute stroke were randomly assigned to a single intravenous dose of zoledronate 4 mg or placebo within 5 weeks of stroke. Biopsies from 14 patients (3 female, 11 male, mean age 71 ± 11) were suitable for analysis. These were taken at mean 10 weeks (± 2) post-stroke, and included 5 patients who had received zoledronate. Histomorphometry was performed on undecalcified sections using light and fluorescence microscopy. Static and dynamic indices of remodelling were compared to a local reference range from healthy controls. Osteoclasts and their precursors were identified on frozen sections using tartrate resistant acid phosphatase (TRAP) staining. Dual-energy x-ray absorptiometry (DXA) of the proximal femora was performed at baseline and 6 months later. Results The eroded surface in cancellous bone (ES/BS) was significantly higher in stroke patients than controls (5.7% vs. ref 1.6%, p

Introduction: Health field per se requires mental, physical and psychological steadiness and wellbeing. In modern times decline in psychological and physical health has been observed in student after admission in health education program. Factors like perfectionism, self-esteem, personal and professional consequence have affected their academic score directly or indirectly. Life Orientation Test-Revised (LOT-R) instrument measures optimism in relation to self-esteem of individual. A better score will show more confidence level of the student. Aim: To find an association of LOT-R with the academic score of health professional students and assess gender variation. Materials and Methods: A total of 350 students enrolled for academic year 2015-16 in health professional program of medicine, dental and physiotherapy institutes of Sumandeep Vidyapeeth University were considered. Non-randomized and purposive study was done by providing LOT-R questionnaire to students. Average academic score of Anatomy and Physiology course was used for analysis excluding the biochemistry due to non-availability of tangible data at the time of study. Data was collected, analysed statistically using independent t-test, ANOVA with post-hoc and correlation analysis. Result: Statistical significant for one-way ANOVA was assessed for academic score between the group of health professional students. While no statistical correlation of significance was observed for LOT-R score with that of academic score. As per gender distribution there was no statistical significant observation for LOT-R score within the groups. Conclusion: The present study highlighted the need of student’s counseling for their approach towards health education; as their career. Psychological self-reliance and optimism improves the academic score. A study needs to be compared with the socioeconomic status of the student to have a better understanding of the LOT-R.

OBJECTIVEComputerized decision support systems (CDSSs) can provide indication-specific antimicrobial recommendations and approvals as part of hospital antimicrobial stewardship (AMS) programs. The aim of this study was to assess the performance of a CDSS for surveillance of invasive fungal infections (IFIs) in an inpatient hematology/oncology cohort.METHODSBetween November 1, 2012, and October 31, 2013, pediatric hematology/oncology inpatients diagnosed with an IFI were identified through an audit of the CDSS and confirmed by medical record review. The results were compared to hospital diagnostic-related group (DRG) coding for IFI throughout the same period.RESULTSA total of 83 patients were prescribed systemic antifungals according to the CDSS for the 12-month period. The CDSS correctly identified 19 patients with IFI on medical record review, compared with 10 patients identified by DRG coding, of whom 9 were confirmed to have IFI on medical record review.CONCLUSIONSCDSS was superior to diagnostic coding in detecting IFI in an inpatient pediatric hematology/oncology cohort. The functionality of CDSS lends itself to inpatient infectious diseases surveillance but depends on prescriber adherence.Infect. Control Hosp. Epidemiol. 2015;36(11):1313–1317

The opioid neuropeptide haemorphin-7 was measured, by immunoreactivity, in Standardbred horses during low-speed (7 m/s) and high-speed (10 m/s) endurance exercises, lasting 49-58 and 12-16 min respectively. In parallel, heart rate, muscle temperature and plasma lactate concentrations were measured. The profile of the low-speed exercise showed significantly increased heart rate after 10 min [154 beats per minute (bpm)]. After the exercise, muscle temperature (42.1 degrees C) and plasma lactate (4.8 mmol/l) were significantly increased. The profile of the high-speed exercise was comparatively characterized by a higher increase of heart rate after 5 min (194 bpm) and higher increases of muscle temperature (43.2 degrees C) and lactate levels (15.8 mmol/l) after the exercise. The horses were probably exhausted by glycogen depletion in the low-speed exercise and by muscle pH decrease in the high-speed exercise. Haemorphin-7 increased significantly during the high-speed exercise (274.8 fmol/ml) but not during low speed (108.3 fmol/ml), coincident with the results of lactate. These results suggest that plasma haemorphin-7 is measurable in the horse by immunoreactivity, and that intense exercise stimulates release of this opioid. Such endogenous opioids are most likely involved in regulatory functions associated with pain, physical effort, inflammation, and blood pressure variation in horses, as have been established in other species.

Investigations of the actions of estrogen on the skeleton have mainly focused on cancellous bone and there are no reported histomorphometric studies of the effects of oestrogen on cortical bone in humans. The aim of this study was to investigate the effects of both conventional hormone replacement therapy (HRT) and high-dose oestradiol on cortical bone in postmenopausal women. Transiliac biopsies were obtained from nine postmenopausal women aged 54–71 yr before and after 2 yr (mean, 23.5 months) of conventional HRT and in seven postmenopausal women aged 52–67 yr after long-term, high-dose oestradiol implant therapy (at least 14 yr). Indices of bone turnover, remodeling, and cortical structure were assessed by image analysis. Cortical width was highest in the women treated with high-dose oestrogen therapy (2.29 ± 0.78 mm; mean ± SD) and lowest in untreated women (1.36 ± 0.60 mm; P = 0.014). The proportion of canals with an eroded surface was significantly lower in the high-dose oestrogen group than in women before or after conventional HRT (3.03 ± 3.7% vs. 11.1 ± 7.1% and 10.5 ± 8.6%; P = 0.017 and 0.05, respectively). Bone formation rate (μm 2 /μm/day) in untreated women was significantly higher than in the high-dose oestrogen group (0.121 ± 0.072 vs. 0.066 ± 0.045, respectively; P = 0.05), values in women treated with conventional HRT being intermediate. Our results provide the first histomorphometric evidence in postmenopausal women of dose-dependent oestrogen-induced suppression of bone turnover in iliac crest cortical bone. There was also a trend toward higher wall width with increasing dose of oestrogen, consistent with the previously reported anabolic effect in cancellous bone.

This study reports the results of quantitative analysis of iliac bone histology in adults with cystic fibrosis (CF) and low bone mineral density (BMD). Twenty patients with CF had bone biopsies taken after double tetracycline labeling. Histomorphometric measurements were made by image analysis, and data were compared with those of healthy control subjects. Cancellous bone area was lower in the patients with CF (p = 0.003), and there was a trend towards a decrease in cancellous bone connectivity. Bone formation rate at tissue level was significantly lower in patients with CF (p = 0.0002). Wall width, representing the amount of bone formed within individual remodeling units, was decreased (p < 0.0001), as was mineralizing perimeter and mineral apposition rate. Analysis of resorption cavities revealed lower cavity area, reconstructed surface lengths, and cavity depths (p < 0.003) in patients with CF, whereas eroded surface area was higher (p = 0.0004). Our results demonstrate low cancellous bone volume in adult patients with CF with low BMD, the main cause of which appears to be low bone formation at tissue and cellular level. Osteomalacia was diagnosed in one patient. This condition should be excluded as a cause of low bone mineral density in patients with CF and vitamin D insufficiency corrected.

This article highlights some of the problems pertaining to the relationship between globalization and labour in Thailand, Malaysia, the Philippines, and Indonesia. The experience of workers and organized labour during the Asian Crisis is used to gauge the position of workers and their organizations in relation to the state and other social forces in this ‘era’ of globalization. Thus, much attention is paid to the domestic power structures which organized labour confronts. It is contended that the position of organized labour in all four Southeast Asian countries considered had been uniformly less than strong prior to the crisis, and this greatly influenced the degree to which labour organizations had the capacity to affect state policy during the debacle of 1997–98. However, the relative position of organized labour in each country was not exactly the same and, it is argued, the capacity of labour to respond to the crisis was an indicator of its standing in relation to the wider constellation of state and society forces. The analysis is informed by the theoretical position that policy-making is not a matter of arriving objectively and neutrally at ‘rational’ decisions, but involves contests between competing interests, and is therefore affected by the nature of the distribution and use of power in society.

The present study was conducted to elucidate the protective role of Withania somnifera against bromobenzene induced nephrotoxicity and mitochondrial dysfunction in rats.In this study, Wistar albino rats of either sex were divided into six groups consisting of six animals each. The first one was control, those in group II received bromobenzene (10 mmol/kg, intragastric intubation) once, but group III and IV animals received W. somnifera (250 and 500 mg/kg, orally), respectively for 8 days followed by bromobenzene once on the 8th day and silymarin (100 mg/kg, orally) was given for 8 days to group V animals and then bromobenzene on the last day. Group VI animals received only W. somnifera (500 mg/kg) for 8 days.The levels of renal lipid peroxidation, lysosomal enzymes and glycoprotein were increased significantly (p0.05) in the bromobenzene alone treated rats and antioxidant status and mitochondrial enzymes were found to be decreased, when compared to the control group. The levels of kidney functional markers (urea, uric acid and creatinine) were also found to be abnormal in serum of bromobenzene alone treated rats. On the other hand, administration of W. somnifera (250 and 500 mg/kg) along with bromobenzene offered a significant dose-dependent protection to the biochemical alterations as observed in the bromobenzene alone treated rats, which was also evidenced by histopathology.Thus, the oral administration of W. somnifera significantly protected against the bromobenzene induced nephrotoxicity and renal mitochondrial dysfunction in rats.

Despite increasing cure rates for pediatric leukemia, relapsed disease still carries a poor prognosis with significant morbidity and mortality. Novel targeted therapies are currently being investigated in an attempt to reduce adverse events and improve survival outcomes. Antibody therapies represent a form of targeted therapy that offers a new treatment paradigm. Monoclonal antibodies are active in pediatric acute lymphoblastic leukemia (ALL) and are currently in Phase III trials. Antibody-drug conjugates (ADCs) are the next generation of antibodies where a highly potent cytotoxic agent is bound to an antibody by a linker, resulting in selective targeting of leukemia cells. ADCs are currently being tested in clinical trials for pediatric acute myeloid leukemia (AML) and ALL. Bispecific T cell engager (BiTE) antibodies are a construct whereby each antibody contains two binding sites, with one designed to engage the patient’s own immune system and the other to target malignant cells. BiTE antibodies show great promise as a novel and effective therapy for childhood leukemia. This review will outline recent developments in targeted agents for pediatric leukemia including monoclonal antibodies, ADCs and BiTE antibodies.