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Introduction: [177Lu]Lu-prostate-specific membrane antigen (PSMA)-617 has emerged as a promising radiopharmaceutical for targeting PSMA in metastatic castrate-resistant prostate carcinoma (mCRPC). ...

BACKGROUND Upper gastrointestinal bleeding (UGIB) is one of the common medical emergencies throughout the world that may require hospital admission and results in high patient morbidity and mortality. The presentation of UGI bleeding depends on the amount and location of haemorrhage. Upper gastrointestinal endoscopy (UGIE) is the preferred investigative procedure for UGIB because of its accuracy, low rate of complication, and its potential for therapeutic interventions. The present study has been carried out to evaluate the different aetiological causes of UGIB in a tertiary care centre in the North Eastern part of India and compare the same with other studies done globally. METHODS This was a hospital based observational study with cross sectional design carried out in the Department of Medicine at Tripura Medical College & DR BRAM Teaching Hospital, Agartala. Total 376 patients were selected for this study for over a period of 2 years from January 2017 to December 2018. Upper GI endoscopy was performed in all patients after hemodynamic stabilisation. Rockall scoring system was used in non-variceal cases to predict the mortality in patients with upper GI bleeding. RESULTS A total of 376 patients had endoscopy for UGIB which included 260 (69.1 %) males and 116 (30.9 %) females, and the mean age was 47.9 (± 17.0) years. The most common cause of UGIB was peptic ulcer disease (duodenal ulcer and gastric ulcer) consisting of 31.38 %, followed by erosive gastritis (23.94 %), oesophageal varix (11.17 %), portal hypertensive gastropathy (10.64 %), duodenitis (8.51 %). Gastrointestinal malignancy (gastric and oesophageal cancers) was reported in 3.98 % and rare causes of UGIB were Mallory-Weiss syndrome (1.86 %), and esophagitis (1.60 %). Among them 4.26 % of the patients had normal endoscopy findings. CONCLUSIONS In the present study, peptic ulcer disease was the most common cause of upper gastrointestinal bleeding, followed by erosive gastritis. Rockall score of more than 4 was numerically associated with increased incidence of mortality. KEYWORDS Upper Gastrointestinal Bleeding (UGIB), Upper Gastrointestinal Endoscopy (UGIE

A prototype, semi-automated, indigenous solid-target assembly has been developed to produce clinical grade 111InCl3 from natCd targets. Fluka Monte Carlo code was used to estimate the optimum proton energy range for 111Cd(p,n)111In production route and suitable decay time to get high specific-activity of 111In. The radiochemical purification and separation have been optimized using column chromatography separation method. The quality of 111InCl3 has been established by radiolabeling of Pentetreotide yielding 111In-Pentetreotide, in acceptable radiochemical purity (RCP), with expected biological efficacy in in-vitro and in-vivo models. Pre-clinical translation of 111InCl3 in formulation of 111In-Pentetreotide adds support toward its use as a clinical grade radiochemical.

A 46 years of rt handed Hindu grocer male with history of nasal polyp, allergic rhinitis for 12 years and off and on cough was admitted at Tripura Medical College & Dr. B.R.A.M. teaching hospital with chief complaints of tingling and numbness of extremities for 45 days and weakness of the lower limbs for 30 days. Forty five days before hospitalization he developed decreased sensation over both feet which progressed up to both legs below knee level over few days and was associated with burning, tingling, pins and needle sensation. Simultaneously he developed weakness of the lower limb, unable to maintain slippers, difficulties in standing up from squatting and required assistance of family member to walk. From the day of admission he developed decreased sensation over left hand then right hand with similar upward progression. He developed weakness of upper limbs in holding cup & raising hand arm above head. There was no history suggestive of involvement of any cranial nerves. There was no history of convulsion, loss of consciousness, headache, neck pain, radiculopathy, stiffness, itching, joint aches, swellings. In his past he was treated with montelukast, inhaled bronchodilators, and intranasal corticosteroids of and on for 08 years. He was on self-medication with Montelukast for last 10 years. There was No history of diabetes, hypertension, and tuberculosis. He had no history of any high-risk behaviour, no addiction. His bowel & bladder habit was normal. He has four family members all are healthy. He is allergic to dust and had off and on malaise, feverishness with intermittent non pruritic rash over legs. He is alert, co-operative, well oriented with time, place & person. Having BMI (21.08). His vitals were stable. Central nervous system examination shows he is conscious, GCS scale 15/15, MMSE- 30/30. Appearance, behaviour, speech, language is normal. No evidence of hallucination, delusion. All twelve pairs of cranial nerves examination were found to be normal. Muscle bulk symmetrical on either side. No evidence of atrophy, wasting, fasciculation, tremors, no involuntary movement. Tone decreased in all group of muscles in both upper & lower limbs. Power around shoulder, elbow are 4+/5 and power around the hip joint, knee joint, ankle joint respectively are 4/5, 4/5, 3/5. Small muscles of hand & foot are both weak. Superficial reflexes are normal. Planter reflex is bilateral flexor. Deep tendon reflexes in upper limb triceps, biceps & supinator are 1+/4, 1+/4 & 0 bilaterally. In lower limb knee reflexes are bilaterally reduced to 1/4. Ankle reflexes were absent bilaterally. No evidence of presence of any primitive reflexes. There was evidence of loss of pain, touch, temperature up to knee & wrist. Vibration & join position was lost up to knee & wrist. There was no evidence of cerebellar involvement. Gait was stepping gait. Romberg’s sign was positive. Cranium & spine were normal and there were no signs of meningeal irritation. In respiratory system examination nasal polyp was seen in left side & there was paranasal sinus tenderness over left maxillary sinus. All quadrant of lung were equally resonant. In auscultation vesicular prolonged expiration was heard in all quadrants of lung. Bilateral polyphonic wheeze heard. Cardio vascular system and gastro intestinal were essentially normal.

Letrozole (LET), an aromatase inhibitor widely used as a first-line drug for the estrogen-dependent breast cancer treatment in postmenopausal women. In this study, an attempt has been made to develop LET topical drug delivery which would be a more efficient system to treat elevated blood levels of estrogen found in breast cancer patients. The technique involves, encapsulation of the LET in phospholipids using spray dryer. The LET spray-dried powder (LT-SDP) powder was tested by Fourier transform infrared, X-RD, and differential scanning calorimetry. These studies confirm the entrapment efficiency (EE) of the system. The LT-SDP in the form dispersion was further evaluated. The confocal laser scanning microscopy (CLSM) showed spherical vesicles, the particle size, polydispersity index, and the EE was found to be 284.0 nm, 0.247, and 59.08%, respectively. LT-SDP dispersion was added into a cream base with peppermint and olive oil as natural penetration enhancers. Optimized formulation showed superior skin targeting in in vitro and in vivo studies. Cell proliferation assay and flow cytometry was carried out using human cancer cell line of breast MDA-MB-231 which showed superior anti-proliferative action and enhanced apoptosis activity of LT-SDP cream (43.9%) in comparison. The CLSM micrograph, skin irritation, and histopathology studies showed the penetration ability and inertness of the LT-SDP cream, respectively. In vivo bioavailability studies showed an almost four-fold increase in the plasma concentration (11.3 versus 4.2) while the mean residence time (81.11 versus 64.42 h) and half-life (51.01 versus 39.36 h) were reasonably higher than plain LET cream.

Rheumatological manifestations (RM) are very common in human immunodeficiency virus (HIV)-infected patients. The aim of this study was to determine the clinical spectrum of musculoskeletal involvement and relationship with the Centers for Disease Control and Prevention (CDC) stage and CD4+ cells and other factors. A cross-sectional study was conducted involving 75 patients of over 18 years of either sex with confirmed HIV status attending a tertiary care hospital in north India in one calendar year. Baseline demographic details, relevant history including duration of combination antiretroviral therapy (cART), RM, joints involved, CD4 cell count, and biochemical parameters were evaluated. Of 75 patients, 54 were male and 21 were female (mean age 33.15 ± 5.00 years, range 21–48 years). Most common RM was arthralgia (26.67%), followed by myalgia (18.67%), and arthritis (13.33%). Keratoderma blennorrhagicum (1.33%), tendo-achilles tendinitis (2.67%), and plantar fasciitis (2.67%) were other manifestations. Spondyloarthritis (SpA) was seen in 8% patients (undifferentiated SpA 4%, reactive arthritis 2.67%, psoriatic arthritis 1.67%). HIV-associated arthritis was seen in 2.67% while septic arthritis, rheumatoid arthritis, vasculitis, and diffuse infiltrative lymphocytic syndrome were seen in one patient (1.33%) each. The mean duration of disease in patients with RM was significantly less than patients without RM (p

We herein report an unusual case of a 55-y-old woman with papillary carcinoma of the thyroid, who presented with multiple recurrences, with its subsequent evolution to tall cell variant and thyroglobulin-elevated negative iodine scintigraphy (TENIS) syndrome. During the course of the disease the lesions became non-iodine-concentrating with an increased proportion of tall cells and evidence of local and distant metastasis. Molecular analysis of the tissue specimen demonstrated BRAFV600E and I582 M mutations along with upregulation of tumor markers in metastatic tissue. The presence of BRAFV600E mutation and other markers warrants further investigation in future studies to define their precise implications for determining the aggressiveness and development into tall cell variant and TENIS.

Acute exacerbations are significant and frequent events in the natural history of chronic obstructive pulmonary disease. Majority of these exacerbations are of infectious aetiology, bacteria being responsible for 30-50% of these cases. With not many studies of similar type being conducted in the Indian context, this study was undertaken with the purpose of determining the bacteriology of acute exacerbations of chronic obstructive pulmonary disease in hospitalized patients with advanced disease and their antibiotic susceptibility pattern to formulate a cost effective algorithm for antibiotic usage while at the same time reducing the chances of emergence of drug resistance. Sputum sample from a total of 338 patients were send for Gram’s stain and culture sensitivity testing using an array of the commonly used antibiotics. Pathogenic bacteria were isolated from 203 (60.1%) samples. Gram negative bacteria were isolated from 79.8 percent (162/203) cases while the rest were Gram positive. Klebsiella species were the commonest (49.2%; 100/203) Gram negative isolates from the sputum samples. Among the gram negative organisms, Carbapenem had the highest sensitivity (90.2%) followed by Amikacin, Ciprofloxacin and Piperacillin-Tazobactam. Linezolid was found to be 100 percent sensitive amongst the Gram positive organisms while both Amoxicillin Clavulanate and Azithromycin showed a rather low sensitivity profile overall. 5.0 percent of the Klebsiella infections were multi drug resistant. It was thereby concluded that either Amikacin, Ciprofloxacin or Piperacillin-Tazobactam for be considered for Gram negative organisms and Linezolid be considered for Gram positive organisms as first line antibiotics in empirical therapy while Carbapenems may be kept as reserve drugs should the first line drugs fail.

NOAA-AVHRR bi-monthly NDVI data of 8×8 km for the period of 1982–2006 were used to analyze the trend of crop phenology matrices over Indian region. Time series principal component analysis of NDVI was performed to produce six calibration zones for fitting equations of temporal NDVI profile. Savitzky-Golay filter with different seasonality parameters, adaptation strengths and window sizes for different calibration zones were use to smoothen the NDVI profile. Three crop phenology matrices i.e. start of the growing season (SGS), Seasonal NDVI amplitude (AMP), Seasonally Integrated NDVI (SiNDVI) were extracted using TIMESAT software. Direction and magnitude of trends of these crop phenology matrices were analyzed at pixel level using Mann-Kendall test. Further the trends was assessed at meteorological subdivisional level using "Field significance test". Significant advancement of SGS was observed over Punjab, Haryana, Marathwada, Vidarbha and Madhya Maharashtra where as delay was found over Rayalaseema, Coastal Andhra Pradesh, Bihar, Gangetic West Bengal and Sub-Himalayan West Bengal. North, West and central India covering Punjab, Haryana, West & East Uttar Pradesh, West & East Rajasthan, West & East Madhya Pradesh, Sourastra & Kutch, Rayalaseema, Marathwada, Vidarbha, Bihar and Sub-Himalayan West Bengal showed significant greening trend of kharif season. Most of the southern and eastern part of India covering Tamilnadu, South Interior Karnataka, Coastal Andhra Pradesh, Madhya Maharashtra, Gujarat region, Chhattisgarh, Jharkhand and Gangetic West Bengal showed significant browning trend during kharif season.

Extramedullary hematopoiesis (EMH) is a well-recognized process in which the body attempts to maintain erythrogenesis in response to an alteration in the normal production of red blood cells. It is observed in hemoglobinopathies, myeloproliferative disorders, neoplasm’s involving the bone marrow and other conditions. Commonly observed areas of EMH include the paraspinal regions of the thorax, liver and spleen, but it has been reported in other locations, including the adrenal gland, bowel, dura mater and breast. Our patient presented with E beta-thalassemia along with hypogonadism who was later diagnosed of having EMH by imaging studies.

INTRODUCTION Ruptured sinuses of valsalva aneurysm (RSVA) are a rare entity with varied clinical presentation, one of the rare complications is chronic heart failure. 1 Here we describe two cases of RSVA of right coronary sinus ruptured into right ventricle presented with features of right heart failure. CASE 1 35-year-old male with low-effort dyspnoea, nocturnal paroxysmal dyspnoea, orthopnoea, continuous murmur in left 3rd ICS, hepatomegaly and edema of the lower extremities. CASE 2 30-year-old female with dyspnoea on exertion NYHA class II-III, nocturnal paroxysmal dyspnoea, orthopnoea, diastolic murmur, congestive hepatic insufficiency, peripheral oedema diagnosed by trans thoracic Echocardiography.

B-Raf (BRAF) is the strongest activator in the downstream of MAP kinase signaling. The somatic point mutation of BRAF gene (V600E) is the most common and specific event in papillary thyroid carcinoma (PTC). However, its prevalence is variable among different studies and its association with clinico-pathological features is controversial. This study tests the prevalence of BRAF (V600E) mutation in thyroid cancer patients in Indian subcontinental population. We analyzed 140 thyroid tumor specimens for BRAF gene mutation at codon 600 using mutant-allele-specific amplification, single-strand conformation polymorphism, Mutector assay, and DNA sequencing of the PCR-amplified exon 15. BRAF mutation at codon 600 was detected in 46 of 86 PTC patients (53.4%) from Indian subcontinental cohort. Frequency of mutation varied across the subtypes of PTCs. BRAF (V600E) mutation was more common in the conventional PTC (38 out of 62; 61%) than in the follicular variant of PTC (2 out of 17; 11.7%). None of the 8 follicular thyroid adenomas, 14 follicular thyroid carcinomas, 16 medullary thyroid carcinomas, and 16 benign hyperplasia patients showed any exon 15 mutation. We found significant correlation between BRAF mutation status and extra-thyroidal invasion, lymph node metastasis, and tumor stage. However no correlation was observed with gender, age, and tumor size of the patients. Thus our findings suggest that BRAF (V600E) is a prevalent genetic alteration in adult sporadic PTCs in Indian cohort and it may be responsible for the progression of classic variant of PTC to metastatic and poorly differentiated subtype and likely to have significant impact on its diagnostic and prognostic management.

The neurological manifestations of hypothyroidism are very unusual to see as initial symptoms and they usually occur late in the course of disease. Hoffmann syndrome is a rare form of hypothyroid myopathy in adults characterized by presence of muscle weakness, stiffness and pseudohypertrophy. We present a case of 27 years old male presenting with features of proximal muscle weakness of both upper and lower limbs with hypertrophy of calf muscles. His TSH and CPK were markedly raised and EMG showed myopathic disorder. We report this case because of its rarity.

In the present work, we designed and synthesized a novel mono-guanidine heterolipid (MGH) and confirmed its structure by NMR and ESI-MS. The MGH was used as cationic lipid in developing etoposide loaded cationic self-microemulsifying drug delivery system (ECS) intended to be delivered by intratumoral route. The ECS exhibited size