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Background: Cancer stem cell biomarkers SRY (sex‐determining region Y)‐box 2 (SOX2) and octamer‐binding transcription factor 4 (Oct4) account for radioresistance in cervical squamous cell cancers (CSCCs). Their clinical implications are limited and contradictory. Methods: In this prospective cohort study, we recruited patients with FIGO IB2‐IVA CSCC treated with primary chemoradiotherapy on regular follow‐up. Tissue biopsy specimens were evaluated for SOX2 and Oct4 expression by immunohistochemistry, quantified by a product of proportion and intensity scores. Results: A total of 59 patients were included. Most had a moderately differentiated (81%), keratinizing (59%) CSCC, and ≥FIGO stage IIB disease (95%). SOX2 expression (high:low 21:38 patients) and Oct4 expression (high:low 4:55 patients) had a significant interrelation (p = 0.005, odds ratio (95% CI) − 1.23 (1.004–1.520)). At a median follow‐up of 36 months, the 3‐year overall survival (OS) was 60% and 53% for low and high SOX2 expression (p = 0.856), and 54% and 100% for low and high Oct4 expression (p = 0.114). The 3‐year disease‐frese survival (DFS) was 65% and 50% in the low and high SOX2 expression (p = 0.259), and 59% and 75% for low and high Oct4 expression (p = 0.598). SOX2 expression was the only variable significantly associated with a lower OS and DFS on regression analysis. Conclusion: Our study demonstrated a trend toward improved OS and DFS with low SOX2 and high Oct4 expression in CSCC patients undergoing chemoradiotherapy. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 30-year-old woman suffering from pain and lump in the left side of the abdomen.

Worldwide, hospitals are facing problems in managing cancer patients during the ongoing COVID-19 pandemic. Given the immense cancer burden of oral cancer in India, scheduling surgeries are becoming increasingly difficult. Upfront surgeries are recommended for curative treatment of oral cancers and postponing them raises the fear of progression. Metronomic chemotherapy can be considered during the waiting period given its potential oncological benefits and ease of administration without much toxicity. [ABSTRACT FROM AUTHOR]

Current experiment was conducted during 2017-18 at Biochemistry Section, Post Harvest Research Center, Ayub Agricultural Research Institute, Faisalabad, Pakistan to evaluate the effect of seasonal variations on the recovery and chemical composition of aloe vera (Aloe barbadensis) gel. Samples of aloe vera leaves were collected four times in a year, in the months of January, April, July and October of 2017 and 2018, and analyzed for various quality parameters. Results of two years studies were compiled and average values were calculated. Results indicated that seasonal variation had no significant effect on the recovery of gel and its chemical composition. There was no significant variation recorded in quality parameters throughout the year. On an average, gel recovery was 64.6 ± 3.05, 35.4 ± 3.07%. Average value for pH of gel was 4.62 ± 0.33, total soluble solids (TSS) 1.00 ± 0.25%, vitamin C 2.86 ± 0.79 mg/100g and antioxidant potential of aloe vera was 66.50± 1.25% and dry matter ranged from 2.48 to 2.75%. Crude protein, crude fat, crude fiber, ash, Cu, Zn, Fe and Ca were determined in dried leaves and the mean value of these parameters were 14.6 ± 0.75 %., 0.45 ± 0.12 %, 0.14 ± 0.04 %, 0.15 ± 0.2 %,16.0 ± 2.73 mg/kg, 3.03 ± 0.8 mg/kg, 110.7±19.9 mg/kg and 247.1 ± 22.5 mg/kg, respectively. Nitrogen free extract (NFE) or available carbohydrate ranged from 84.48 ± 0.70 to 84.93 ± 0.82 % with an average value of 84.70 ± 0.80 %. It was concluded that seasonal variation had no significant effect on the aloe vera leaf biochemical components like TSS, crude protein, vitamin C. [ABSTRACT FROM AUTHOR]

A field experiment was conducted at Soil Bacteriology Section, Agricultural Biotechnology Research Institute, AARI, Faisalabad, Pakistan in the year 2013-14, to evaluate the potential of PGPR on wheat, facing water stress at tillering and grain filling stages. Inoculum of PGPR having CFU 106 mL-1 was applied as seed coating at sowing. Water stress was given at two sensitive stages (tillering and grain filling). Fertilizers (100-100-60 kg NPK ha-1) were applied in the form of Urea, single super phosphate and sulphate of potash to all the treatments, following RCBD results revealed that PGPR inoculation produced more grain yield (4.95 t ha-1) in treatment where water stress was given at grain filling stage compared to water stress at tillering (4.51 t ha-1). Number of tillers (582), 1000-grains weight (40.3 g) and spike length (18.4 cm) were more with PGPR where water stress was given at grain filling stage compared to where irrigation was skipped at tillering stage (499, 37.7 g and 18.3 cm). It was concluded that drought is more harmful at tillering than at grain filling stage and stress can be evaded to some extent by inoculation with PGPR. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • Synthesis of stable and porous thermally expended reduced-graphene oxide (TErGO/Ni 3 C-Ni) nanocomposite. • High performance reduction of Cr(Ⅵ) via TErGO/Ni 3 C-Ni nanocatalyst. • Fast reduction of dyes with the help of TErGO/Ni 3 C-Ni nanocatalyst. Abstract A high performance thermally expanded reduced graphene oxide (TErGO) nanocomposite decorated with Ni 3 C-Ni nanoparticles (TErGO/Ni 3 C-Ni) has been successfully synthesized by using a facile and eco-friendly approach. The morphology, textural features, surface composition and stability of TErGO/Ni 3 C-Ni nanocomposite are investigated by various physicochemical characterizations which revealed the uniform dispersion of crystalline metal nanoparticles inside TErGO matrix. The composite has been exhibited a large surface area and pore volume of 121 m2 g−1 and 0.791 cm3 g−1, respectively. The TErGO/Ni 3 C-Ni exhibited remarkable catalytic performance surpassing most metal-based catalysts with various kind of support matrices reported in recent literature. The reduction of Cr(Ⅵ) to Cr(Ⅲ) was achieved within 1 min with an excellent rate constant of 2.74 min−1 and phenomenally higher specific removal rate (SRR) of 0.29 mg Cr(VI) min−1. mg−1 of TErGO/Ni 3 C-Ni. While it also proved an excellent reducing catalyst for organic dyes via NaBH 4 with full reduction achieved within 30 s. Moreover, as prepared nanocatalyst possesses excellent stability and recyclability with easy magnetic separation. [ABSTRACT FROM AUTHOR]

Low availability of native soil phosphorus (P) is a major constraint limiting sustainable crop production especially in alkaline calcareous soils. Application of organic manure in this regard has gained attention of the scientific community. Yet, the potential of fermented animal manure in improving P use efficiency and subsequent crop yield has not been assessed. This pot experiment was designed to study the performance of wheat under application of non-fermented and fermented animal manure in combination with 0, 45 or 90 kg·ha−1 phosphorus in the form of diammonium phosphate (DAP). Results show that non-fermented animal manure and split dose of phosphorus fertilizer improved plant quantitative attributes including plant growth, yield and nutrient uptake parameters. However, the placement of fermented animal manure combined with the full amount of P (90 kg·ha−1) fertilizer gave the mean highest value of fertile tillers per pot (12) and their grain yield (5.2 g). Moreover, plant physiological parameters were enhanced with fermented animal manure and the recommended rate of P fertilizer compared with the control. Likewise, the biochemical properties of wheat grain such as fat, fiber, ash and protein contents were increased by 1.24, 2.26, 1.47 and 11.2%, respectively, in plants receiving fermented animal manure and P fertilizer (90 kg·ha−1). Furthermore, co-application of fermented animal manure with P (90 kg·ha−1) into soil improved phosphorus uptake from 0.72 to 1.25 g·pot−1, phosphorus usage efficiency from 0.715 to 0.856 mg·pot−1, and soil phosphorus extent from 7.58 to 16.1% over controls. It is thus inferred that this new approach resulted in release of P from fermented manure that not only reduced fixation but also enhanced the growth, yield, physiology and nutrient uptake in wheat. [ABSTRACT FROM AUTHOR]

• Erythrina suberosa is a medicinal plant known to possess antiulcer activity. • Various fractions of plant flowers are screened for antioxidant and anti-urease activities. • The most active n -hexane fraction is subjected to GC-MS analysis and molecular docking studies. • In the light of docking results, anti-urease activity is suggested due to synergistic effect of secondary metabolites in the n -hexane fraction. The plants of the Erythrina genus possess tremendous pharmacological properties and thus are utilized in traditional medicines owing to their bioactivities. In the present study, methanolic extract (EsM) of flowers of Erythrina suberosa Roxb. and its fractions (n -hexane (EsH), chloroform (EsC) and aqueous (EsW) parts) were tested for preliminary phytochemical analysis, antioxidant and urease inhibition activities. The EsM extract was found to be most active for antioxidant activity, whereas the EsH extract showed the highest anti-urease potential with an inhibition value of 62.9 % (at a concentration of 100 µg/ml), while the other extracts were least active. The EsH extract being most active against urease enzyme, was further subjected to gas chromatography-mass spectrometry (GC-MS) analysis, which revealed the tentative presence of 18 secondary metabolites of various classes. Furthermore, the in-silico studies of the major compounds as detected in EsH extract by GC-MS analysis were performed to correlate the potential interaction of compounds with the active site of the enzyme. The selected compounds were docked against the urease enzyme, and their affinities were compared. Binding affinity data and interaction patterns of all the studied phytochemicals indicated that these compounds could inhibit urease enzyme synergistically and can be further studied to prevent ulcer and related problems. It is, therefore concluded that E. suberosa flowers possess interesting antioxidant and anti-urease potential and thus could further be adopted for industrial and biopharmaceutical applications. [ABSTRACT FROM AUTHOR]

Nb-Si based alloys are considered as a potential candidates to substitute for Ni-based super alloys. However, its poor mechanical properties and high temperature oxidation resistance greatly limit its development and application. Alloying can effectively improve the mechanical properties and oxidation resistance of Nb-Si based alloy. In this work, the effects of Al, Cr, B elements addition on the mechanical properties and oxidation resistance of niobium-silicon ternary alloys are summarized. The microstructure, oxidation behavior and mechanical properties of various alloys were analyzed and compared. Moreover, the fracture and oxidation failure mechanism of the alloys are also summarized. Finally, the development trend of ternary Nb-Si based oxidation-resistant alloys in the future has been prospected. [ABSTRACT FROM AUTHOR]

A field experiment was conducted to assess the quality of carrot variety T-29 as affected by the application of potassium fertilizer. Potassium was applied @ 0, 40, 60, 80, 100 and 120 kg/ha and carrot was sown during the month of November of every year. The experiment was continued for consecutive three years i.e. 2016-17, 2017-18 and 2018-19 at research area of Biochemistry Section, Ayub Agricultural Research Institute, Pakistan. Yield data were collected and quality parameters pulp, juice, TSS, vitamin C, dry matter, total sugars and reducing sugars were determined. Results revealed that the application of K enhanced the yield and quality parameters. Root yield in various treatments ranged from 20.6 to 30.8 in 2017, 18.0 to 25.8 in 2018 and 17.5 to 27.8 t/ha in 2019, minimum in control and maximum at treatment where K was applied @ 120 kg/ha. Quality parameters like pulp, juice, mineral matter and vitamin-C did not affect significantly by the application of K while the total sugars were increased from 4.0 to 5.6, 4.7 to 5.5 and 5.5 to 6.8% (Minimum in control and maximum with 120 kg/ha K application) during the years 2016-17, 2017-18 and 2018-19, respectively. Maximum antioxidant potential i.e. 75.2, 80.13 and 78.6 was found with potassium application of 120 kg/ha during all years. Pro vitamin A contents (3782 and 3706 μg/100g) were analyzed during 2018 and 2019, respectively where 100 kg/ha potassium was applied. In short, potassium application could be effective for carrot optimum yield and quality enhancement. [ABSTRACT FROM AUTHOR]

Living organisms need essential macro and micronutrients received from their diet to sustain metabolism. Bio fortification is a significant technique to enhance trace minerals concentration in the grains, basically to improve the nutritional value of cereal and solve health issues in less privileged areas. Zinc (Zn) is widely involved in various human metabolisms and thus Zn deficiency has many harmful effects on human health and growth. In daily human food, bioavailability of zinc can be improved through an increase in zinc contents or Zn promoters (specific substances which support absorption of Zn in the body) or a decrease in anti-nutrients of Zn (that basically decrease absorption of Zn). Cereal grains contain Phytate which delays the absorption of Zn, Ca and Fe in human intestine. In specifically wheat grains, Zn concentration can be improved while phytate concentration reduced by application of Zn. By keeping in view the all stated facts a trial in the field was conducted during 2016-2018 at Soil Bacteriology Section, Ayub Agricultural Research Institute, Faisalabad, Pakistan. Isolation of zinc mobilizing bacteria was carried out in lab. Efficient isolates were selected for the experiment. This experiment was conducted to evaluate the bio fortification potential of wheat crop by exogenously applied micro nutrient (Zn) and PGPR (zinc mobilizing bacteria). Soil application with three Zn levels (2.5, 5.0, 7.5 kg ha-1 ZnSO4.7H2O) and PGPR (zinc mobilizing bacteria) were applied according to randomized complete block design (RCBD). Recommended dose of fertilizer was applied to all treatments. The results clearly indicate that biofortification of zinc with PGPR increases the yield (3456-4016 kg/ha) and also improves the plant height (104.7 - 105.7 cm) of wheat crop. By the application of zinc through soil has significant effect on nutrient availability and their amount in wheat grain, straw and hence on all growth parameters. [ABSTRACT FROM AUTHOR]

Background: Epithelial ovarian cancer is the second most common gynecological cancer. Human Epididymis Protein 4 is a novel biomarker for ovarian cancer. This study aims to explore the role of HE4 in monitoring recurrence and prognostication of ovarian cancer by predicting overall survival (OS) and progression-free survival (PFS).Materials and Methods: In total, 149 patients with ovarian carcinoma were enrolled in the study. Baseline and post-treatment 3 monthly biomarker levels were recorded. For analysis, patients were divided into primary debulking surgery (PDS) and interval debulking surgery (IDS) groups. Statistical analysis was done using SPSS 24.Results: Median age of patients at diagnosis was 45 (19-75) years. Recurrence was seen in 68.5% (n = 102) patients. The sensitivity of serum HE4 in detecting recurrence was 85.3% (95%CI: 76.95%-91.5%) and specificity was 91.5% (95%CI: 89.5%-98.2%). A >80% decline in HE4 levels during treatment indicated a better PFS, which was statistically significant in both groups (P = 0.04 in PDS and P = <0.001 in IDS group). Multivariate analysis suggested that OS was influenced by optimal cytoreduction in both groups of patients and stage in the IDS group. On the contrary, PFS was influenced by stage and response in HE4 levels in both groups.Conclusion: HE4 levels have similar sensitivity but more specificity when compared with CA125 in diagnosing recurrent ovarian cancer. A >80% decline in HE4 levels during treatment predicts better PFS and can help in prognostication. [ABSTRACT FROM AUTHOR]

Food is a vital product for the survival of human beings and with passage of time quality concerns of consumers are rising. Edible films and coatings are thin layers applied on food products to protect them and improve their quality. Films/coatings are prepared from naturally occurring renewable sources (polysaccharides, proteins, lipids and composites) which we can eat without disposing them. These films are environment friendly and contain antioxidants, anti-browning agents and colorants. Various methods (spraying, brushing, electro-spraying) are used to apply a coating on food material to protect them from microbial growth, prolonging their shelf life and improving other quality aspects like sensory attributes, appearance, originality and freshness of ingredients. In addition to edible films, some special additives like glycerol, sorbitol etc. is used to improve the efficiency of edible films and coatings. Chemistry and nature of these films and coatings vary in the vast range of hydrophilic and hydrophobic boundaries to cover the whole range of food products. In recent times, herbal coatings are widely used for the coating purposes e.g. Aloe Vera, citral and eugenol essential oils. However, some challenges presented are focusing the scientific attention for viable solution. [ABSTRACT FROM AUTHOR]

Inguinal skin flap necrosis (SFN) is a significant clinical problem associated with inguinal lymph node dissection (ILND). The aetiology of SFN is multifactorial, and its manifestations vary widely. Thermal damage caused by electrocautery during the elevation of the skin flap may contribute to this problem, which has not been studied previously. This prospective, observational study included patients undergoing ILND from January 2020 to July 2022. Based on the technique of raising the inguinal skin flaps, the patients were divided into two groups (cold knife or electrocautery). The remaining part of the procedure was the same. The inguinal wound was examined and photographed to assess the SFN. A total of 42 patients were included (21 in each group). Age, gender, body mass index (BMI), alcohol or tobacco consumption, immune compromised status, and serum albumin were comparable ( p  > 0.05). The average time required to elevate flaps was 13.14 vs. 11.47 min ( p  = 0.0231), and gauze soakage was 2.05 vs. 1.52 ( p  < 0.0001) with a cold knife compared to electrocautery. The incidence of SFN and surgical site infection (SSI) was significantly lower with the use of a cold knife [4.8% vs. 33.3% ( p  = 0.045) and 0% vs. 19% ( p  = 0.0378)]. Grade 3 necrosis was observed only with electrocautery use. Compared to conventional electrocautery, the cold knife technique lowers the incidence of SFN and SSI. Further research with a larger sample size and a standardized definition is needed to validate these results., Competing Interests: Conflicts of InterestWe have no conflicts of interest to disclose., (© The Author(s), under exclusive licence to Indian Association of Surgical Oncology 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Introduction: The vulva is the external genitalia in females. Vulvar carcinoma is a rare entity, with squamous cell carcinoma as the most common histology while basal cell carcinoma, extra-mammary Paget's disease, and melanoma are still rarer subtypes. Treatment often comprises a multidisciplinary approach with surgery being the mainstay, followed by adjuvant therapy, depending upon pathological stage and other factors. Neoadjuvant treatment is considered in locally advanced cases where upfront surgery would not achieve adequate margin or organ preservation (urethra and anal canal). Due to the rarity of the disease and initial presentation at advanced stages in third-world countries, it is important to have strict treatment protocols with identifications of various prognostic factors and regular timely follow-up, which would, in turn, improve treatment outcomes. Here, we are presenting our institutional retrospective cohort spanning over eight years., Methods: This is a retrospective descriptive study done in the department of surgical oncology of a tertiary care cancer center in India from January 2016 to April 2024. A total of 21 patients with histologically proven diagnoses of vulvar cancer were included in the analysis. Stage of disease, treatment modalities used, and disease outcomes in terms of survival were tabulated. Statistical analysis was done using SPSS version 17 for Windows (SPSS Inc., Chicago, IL)., Results:  The estimated five-year overall survival was ≈71% using Kaplan-Meier analysis. On univariate analysis (testing other factors), using a log-rank test, neither stage nor nodal positivity were significant prognostic factors for overall survival. Given the small number of cases, multivariate analysis was not possible., Conclusion:  In carcinoma of the vulva, treatment should be individualized with multidisciplinary cooperation. In many series, stage, nodal positivity, and extracapsular extension are found to be significant prognostic factors, though our results did not correspond with these data probably due to a small cohort. The paucity of data, especially from India and other developing countries, necessitates the need for more studies, preferably multicentric, keeping in mind the low prevalence of disease., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. AIIMS, Patna, India issued approval Exempt. This is an observational study based on retrospective data of patients who were treated as per international guidelines. No experimental interventions were done on any patient and they were just followed up for their survival outcomes. Data were compared for oncological outcomes with the available literature, hence ethical approval was not mandated (given the retrospective observational nature of the study). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Azhar et al.)

Given the convenience of using plastics, addressing the growing concerns about their hazardous health effects is imperative. Consequently, a comprehensive risk assessment is necessary to gauge the potential harm microplastics pose. With its urgent call to action, this study aimed to investigate the indoor source and abundance of microplastics in private dental units during routine professional activities. The current analyzed microplastic quantity variations based on morphological characteristics, seasonal fluctuations and polymer-types. The polymer hazard index (PHI) was calculated to evaluate the significant human health risks posed to dental professionals by inhalation of microplastics. Dust samples were collected using a clean brush and steel pan from various flat and horizontal surfaces within each dental unit. The study found that clinical dental units had fewer microplastics (587 ± 184.9 MPs/g/day) than teaching hospitals (1083.80 ± 133.7MPs/g/day), with comparatively more abundance in winter (31 %). ATR-FTIR analysis determined polyethylene terephthalate to be a more abundant polymer (39 %). This study also found an average inhalation microplastic intake risk of 20.23 MP/g/day and 5259.85 MP/g/year for clinical and 29.45 MP/g/day and 765.12 MP/g/year for teaching hospital dental units. Female dental professionals have 1.1 times more microplastic inhalation risks than male dental professionals. According to PHI findings, overall minor to medium polymer risk was determined. In conclusion, this evidence-based research underscores the urgent need for a shift towards more sustainable practices in the dental healthcare sector. Dental professionals should prioritize using non-plastic material protective equipment and a proper ventilation system to reduce exposure to these particles., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: We compared the predictive performance of the 7th and 8th editions of the AJCC staging systems in stratifying disease-related survival outcomes in patients with GBC undergoing curative intent surgery., Methods: Patients that underwent curative intent surgery for GBC at our institution (2014 and 2021) were included in the study. Various clinico-pathological data were extracted to perform Kaplan-Meier survival analysis., Results: A total of 240 patients were included in the study. Both, TNM-7, and TNM-8 staging systems can stratify patients into stages with statistically significant differences in disease-free and overall survival. Survival rates drop with stage progression. Using TNM-8, 8/240 (3.33%) patients were upstaged from Stage IIIB (TNM-7) to IVB (TNM-8) and 12/240 (5%) were down-staged from Stage IVB(TNM-7) to IIIB(TNM-8). Survival curves of the re-classified patients matched those of the corresponding TNM-8 stage. Additionally, there was statistically significant difference in their survival (p < 0.001) compared to their corresponding TNM-7 stage. There was no statistically significant difference in survival rates between stages IIA, IIB (TNM-8), and stage II (TNM-7). However, stage IIA had a slightly better survival than stage IIB., Conclusion: Though both TNM-7 and TNM-8 are useful for stratifying patients with GBC, TNM-8 has a better prognostic performance than TNM-7., (© 2024 Wiley Periodicals LLC.)

The current study planned to explore the correlation between an elevated Charlson Comorbidity Index score and post-operative complications following radical nephrectomy in patients with renal cell carcinoma. A total of 70 patients aged 30-80 years undergoing radical nephrectomy were categorised into low Charlson Comorbidity Index score <4 group A and high score >4 group B. Post-operatively, complications were noted in 21(30%) patients, with higher grades more prevalent in the group B patients (relative risk: 1.96, p=0.004). The finding underscored the importance of considering comorbidities in assessing the risk of complications following radical nephrectomy.

Antibiotic resistance, a significant public health hazard, is predicted to cause 10 million deaths worldwide by 2050. The study aimed to identify culturable bioaerosols in the indoor air of dental units in Lahore and assess their antibiotic resistance. Air samples were collected from 10 dental unit locations at different distances, with average concentrations of fungi and bacteria falling within intermediate ranges, per the Global Index of Microbial Contamination (GIMC/m3) index. The study found higher antibiotic-resistant strains in hospital dental units, particularly during winter. The most vigorous strain, S.aureus -NAJIH18, exhibited 70% resistance to ceftazidime. The research highlights the importance of quantifying microbial pollutants for evaluating their source and complexity. It suggests proactive mitigation techniques, such as focused cleaning and air filtration, to improve indoor air quality can mitigate the spread of antibiotic-resistant strains. These insights offer hope in combating the growing public health threat of antibiotic resistance.

Gallbladder cancer (GBC) is a lethal disease. Incidentally detected gallbladder cancer (IGBC) presents a unique opportunity for early management and better outcomes. We present the institutional experience of a high-volume tertiary care center in northern India. Retrospective analysis of a prospectively maintained database was performed and data of all IGBC patients between January 2014 to December 2021 was analyzed. There were 125 patients of IGBC among the 750 patients of GBC seen during the study period. Of these 125 patients, 72 (57.6%) patients were not eligible for surgery. Successful completion radical cholecystectomy (CRC) was possible in 37 (69.8%) of the 53 patients who underwent surgery. On univariate analysis, thickness of gallbladder wall 10 mm or more ( p  < 0.001, OR 19.0, 95% CI 4.58-78.76), pathological stage ( p  < 0.001, OR 5.8, 95% CI 2.45-14.98) and median delay of 16 weeks or more ( p  < 0.001, OR 17.0, 95% CI = 4.08-70.76), were associated with inoperability. However, on multivariate analysis only gallbladder wall thickness of 10 mm or more ( p  < 0.001, AOR 17.9, 95% CI 3.24-98.78) and median delay of 16 weeks or more ( p  < 0.001, AOR 32.33, 95% CI 6.05-172.66) remained significant. Median time to recurrence (TTR) and overall survival (OS) was not reached after a median follow up of 30 months in patients undergoing successful CRC. Successful outcomes of IGBC are dependent on several factors. Diligent workup of suspicious thickening before simple cholecystectomy for gallstone disease and timely referral of IGBC to tertiary care are the keystones for good outcomes., Competing Interests: Conflicts of InterestThe authors declare that they have no conflicts of interest and have not received any funding., (© The Author(s), under exclusive licence to Indian Association of Surgical Oncology 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Older patients with multimorbidity and polypharmacy have been under-represented in clinical trials. We aimed to assess the effect of different intensities of antihypertensive treatment on changes in blood pressure, major safety outcomes, and patient-reported outcomes in this population., Methods: ATEMPT was a decentralised, two-armed, parallel-group, open-label randomised controlled pilot trial conducted in the Thames Valley area, South East England. Individuals aged 65 years or older with multimorbidity (three or more chronic conditions) or polypharmacy (five or more types of medications) and a systolic blood pressure of 115-165 mm Hg were eligible for inclusion. Participants were identified through a search of national hospital discharge databases, identification of patients registered with an online pharmacy, and via targeted advertising on social media platforms. Participants were randomly assigned to receive up to two more classes versus up to two fewer classes of antihypertensive medications. Apart from routine home visits for conducting the baseline assessment, all communication, monitoring, and management of participants by the trial team was conducted remotely. The primary outcome was change in home-measured blood pressure., Findings: Between Dec 15, 2020, and Aug 31, 2022, 230 participants were randomly assigned (n=126 to more vs n=104 to fewer antihypertensive medications). The frequency of serious adverse events was similar across both groups; no cardiovascular events occurred in the more antihypertensive drugs group, compared with six in the fewer antihypertensive drugs group, of which two were fatal. Over a 13-month follow-up period, the mean systolic blood pressure in the group allocated to receive more antihypertensive medications decreased from 134·5 mm Hg (SD 10·7) at baseline to 122·1 mm Hg (10·5). By contrast, in the group allocated to receive fewer antihypertensive medications, it remained relatively unchanged, moving from 134·8 mm Hg (SD 11·2) at baseline to 132·9 mm Hg (15·3); this corresponded to a mean difference of -10·7 mm Hg (95% CI -17·5 to -4·0)., Interpretation: Remotely delivered antihypertensive treatment substantially reduced systolic blood pressure in older adults who are often less represented in trials, with no increase in the risk of serious adverse events. The results of this trial will inform a larger clinical trial focusing on assessing major cardiovascular events, safety, physical functioning, and cognitive function that is currently in the planning stages. These results also underscore the efficiency of decentralised trial designs, which might be of broader interest in other settings., Funding: National Institute for Health Research Oxford Biomedical Research Centre and the Oxford Martin School., Competing Interests: Declaration of interests KR reports grants outside the submitted work from the British Heart Foundation, Horizon Europe AI4HF consortium (R79992/CN001), Novo Nordisk Oxford Big Data Partnership, University of Oxford, and UK Research and Innovation's Global Challenge Research Fund (grant reference: ES/P011055/1). KR has previously received consulting fees from Medtronic CRDN, and honoraria or fees from BMJ Heart, PLoS Medicine, AstraZeneca MEA Region, Medscape, and WebMD Medscape UK. MN is supported by a research fellowship from the British Heart Foundation (grant number FS/IPBSRF/22/27060). JP is supported by the British Heart Foundation, outside of the submitted work. DK receives grants from the National Institute for Health and Care Research (NIHR), British Heart Foundation, EU/EFPIA Innovative Medicines Initiative, UK National Health Service, Cook & Wolstenholme Charitable Trust, European Society of Cardiology, Bayer, Amomed, and Protherics Medicines Development, all outside the submitted work. BG and MMA received patient and public involvement payments in line with NIHR guidelines for public contributors. AP-C reports consulting fees from Leantropy. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Aims: To synthesize a silver-cored nanosuspension utilizing Ziziphus spina-christi fresh-leaf extract and evaluate their antimicrobial activity against multidrug-resistant pathogenic microbes. Materials and Methods: The prepared nanosuspension was analyzed by spectro-analytical techniques and tested for antimicrobial activity and resistance to biofilm formation. The leaf extract and nanosuspension were tested separately and together as a mixture. Results: Constituent nanoparticles were average-sized (∼34 nm) and were active against both Gram-positive and Gram-negative microbes and yeast. Candida albicans showed a 24.50 ± 1.50 mm inhibition zone, followed by Escherichia coli and Staphylococcus aureus . Increased bioactivity with the highest multifold increments, 150%, for erythromycin against all tested microbes was observed. Carbenicillin and trimethoprim showed 166%- and 300%-fold increments for antimicrobial activity against Pseudomonas aeruginosa , respectively. Conclusion: The nanosuspension exhibited strong potential as an antimicrobial agent and overcame multidrug resistance.

Background: Epilepsy is a neurological disorder characterized by anomalous brain activity, convulsions, and odd behavior. Several substituted-(naphthalen-2-yl)-3-(1H-indol-3-yl) allyl)-1,4-dihydropyridine-4-carboxylic acid derivatives (5a-j) were intended to be produced in the current research effort to reduce convulsions and seizures., Materials and Methods: The newly developed compounds were produced by the prescribed process. Numerous methods (infrared spectroscopy (IR), nuclear magnetic resonance (NMR), mass, elemental analysis, etc.) were used to characterize these substances. Several models were used to test each of these molecules for anticonvulsant activity. By using the rotarod and ethanol potentiation techniques, neurotoxicity was also evaluated. The study meticulously examined each parameter and showed absorption, distribution, metabolism, and excretion (ADME) predictions for each of the 10 congeners that were produced. In addition, studies on molecular docking employed the gamma amino butyric acid (GABA)-A target protein., Results: Anticonvulsant screening results identified compounds 5f, 5h, 5d, and 5b as the most efficacious of the series. All synthesized equivalents largely passed the neurotoxicity test. The results of molecular docking revealed significant interactions at the active site of GABA-A with LEU B: 99, TYR A: 62, Ala A: 174, and THR B: 202, and the outcomes were good and in agreement with in vivo findings., Conclusions: The study's findings showed that some substances had promising anticonvulsant properties that were comparable to those of the standard drug. The highly active novel anticonvulsant analogs may therefore represent a possible lead, and additional studies may result in a potential new drug candidate., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Pharmacy and Bioallied Sciences.)

The rock formation of late Cretaceous-Paleocene metapsammite and metagranite found across Luk Ulo Complex indicated boulders with diameter of approximately 1 m and rounded shape along Luk Ulo River, Indonesia. However, less research found on geochronology and geochemistry has been conducted in study area, and such rocks require comprehensive understanding of magmatism and tectonic environment of Central Java, Indonesia. Therefore, the main objective of this study is to address the geochemical and geochronological age histories across Central Java, Indonesia, using U-Pb zircon dating technique. Generally, most common types of rocks were observed which composed of hornblende and garnet-bearing metapsammite and metagranite. The geochemical study showed that protolith of rocks with hornblende was identified as Cordilleran granitoid (I-type), which originated from magmatic arc with basaltic differentiation. Furthermore, protolith of rocks containing garnet was categorized as Caledonian granitoid (S-type), which is caused by post-collisional orogeny. The cluster observations of magmatic zircons reveal their magmatic ages, which vary from 67.00 ± 1.2 to 69.10 ± 0.91 Ma (late Cretaceous), whereas ages of inherited zircons ranged from 100 ± 5 to 437 ± 13 Ma (early Cretaceous to Silurian). Estimated periods of partial melting were found between 100 ± 5 Ma and 118 ± 4 Ma (early Cretaceous). Comparing the zircon ages of Luk Ulo with the zircon ages from the Sundaland regions reveals that the age distribution patterns are incredibly similar; the peak ages dispersed between the Cretaceous and Triassic periods, as well as Sundaland region was the source of the materials., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

There are many different infections and factors that can lead to skin illnesses, but bacteria and fungi are the most frequent. The goal of this study was to develop a hexatriacontane-loaded transethosome (HTC-TES) for treating skin conditions caused by microbes. The HTC-TES was developed utilizing the rotary evaporator technique, and Box-Behnken design (BBD) was utilized to improve it. The responses chosen were particle size (nm) (Y1), polydispersity index (PDI) (Y2), and entrapment efficiency (Y3), while the independent variables chosen were lipoid (mg) (A), ethanol (%) (B), and sodium cholate (mg) (C). The optimized TES formulation with code F1, which contains lipoid (mg) (A) 90, ethanol (%) (B) 25, and sodium cholate (mg) (C) 10, was chosen. Furthermore, the generated HTC-TES was used for research on confocal laser scanning microscopy (CLSM), dermatokinetics, and in vitro HTC release. The results of the study reveal that the ideal formulation of the HTC-loaded TES had the following characteristics: 183.9 nm, 0.262 mV, -26.61 mV, and 87.79% particle size, PDI, and entrapment efficiency, respectively. An in vitro study on HTC release found that the rates of HTC release for HTC-TES and conventional HTC suspension were 74.67 ± 0.22 and 38.75 ± 0.23, respectively. The release of hexatriacontane from TES fit the Higuchi model the best, and the Korsmeyer-Peppas model indicates the release of HTC followed a non-Fickian diffusion. By having a higher negative value for cohesiveness, the produced gel formulation demonstrated its stiffness, whereas good spreadability indicated better gel application to the surface. In a dermatokinetics study, it was discovered that TES gel considerably increased HTC transport in the epidermal layers ( p < 0.05) when compared to HTC conventional formulation gel (HTC-CFG). The CLSM of rat skin treated with the rhodamine B-loaded TES formulation demonstrated a deeper penetration of 30.0 µm in comparison to the hydroalcoholic rhodamine B solution (0.15 µm). The HTC-loaded transethosome was determined to be an effective inhibitor of pathogenic bacterial growth ( S. aureus and E. coli ) at a concentration of 10 mg/mL. It was discovered that both pathogenic strains were susceptible to free HTC. According to the findings, HTC-TES gel can be employed to enhance therapeutic outcomes through antimicrobial activity.

Soil salinity, drought, and increasing temperatures are serious environmental issues that drastically reduce crop productivity worldwide. Quinoa ( Chenopodium quinoa Willd) is an important crop for food security under the changing climate. This study examined the physio-biochemical responses, plant growth, and grain yield of four quinoa genotypes (A7, Titicaca, Vikinga, and Puno) grown in pots containing normal (non-saline) or salt-affected soil exposed to drought and elevated-temperature treatments. Combinations of drought, salinity, and high-temperature stress decreased plant growth and yield more than the individual stresses. The combined drought, salinity, and heat stress treatment decreased the shoot biomass of A7, Puno, Titicaca, and Vikinga by 27, 36, 41, and 50%, respectively, compared to that of control plants. Similar trends were observed for grain yield, chlorophyll contents, and stomatal conductance. The combined application of these three stresses increased Na concentrations but decreased K concentrations in roots and shoots relative to control. Moreover, in the combined salinity, drought, and high-temperature treatment, A7, Puno, Titicaca, and Vikinga had 7.3-, 6.9-, 8-, and 12.6-fold higher hydrogen peroxide contents than control plants. All four quinoa genotypes increased antioxidant enzyme activities (CAT, SOD, and POD) to overcome oxidative stress. Despite A7 producing the highest biomass under stress, it did not translate into increased grain production. We conclude that Puno and Titicaca are more tolerant than Vikinga for cultivation in salt-affected soils prone to drought and heat stress., Competing Interests: The authors declare no conflict of interest.

Leiomyomas are the most common benign tumours of oesophageal smooth muscle origin. In this era of constantly evolving medical technology, video-assisted, robot-assisted and endoscopic approaches are the minimally invasive strategies for the excision of these lesions. Here, we report our modification of this surgery. The lesion was excised with uniportal video-assisted thoracoscopic surgery in a semi-prone position with single-lumen endobronchial intubation., Competing Interests: None

Bacterial drug resistance to antibiotics is growing globally at unprecedented levels, and strategies to overcome treatment deficiencies are continuously developing. In our approach, we utilized metal nanoparticles, silver nanoparticles (AgNPs), known for their wide spread and significant anti-bacterial actions, and the high-dose regimen of lincosamide antibiotic, lincomycin, to demonstrate the efficacy of the combined delivery concept in combating the bacterial resistance. The anti-bacterial actions of the AgNPs and the lincomycin as single entities and as part of the combined mixture of the AgNPs-lincomycin showed improved anti-bacterial biological activity in the Bacillus cereus and Proteus mirabilis microorganisms in comparison to the AgNPs and lincomycin alone. The comparison of the anti-biofilm formation tendency, minimum bactericidal concentration (MBC), and minimum inhibitory concentration (MIC) suggested additive effects of the AgNPs and lincomycin combination co-delivery. The AgNPs' MIC at 100 μg/mL and MBC at 100 μg/mL for both Bacillus cereus and Proteus mirabilis , respectively, together with the AgNPs-lincomycin mixture MIC at 100 + 12.5 μg/mL for Bacillus cereus and 50 + 12.5 μg/mL for Proteus mirabilis , confirmed the efficacy of the mixture. The growth curve test showed that the AgNPs required 90 min to kill both bacterial isolates. The freshly prepared and well-characterized AgNPs, important for the antioxidant activity levels of the AgNPs material, showed radical scavenging potential that increased with the increasing concentrations. The DPPH's best activity concentration, 100 μg/mL, which is also the best concentration exhibiting the highest anti-bacterial zone inhibition, was chosen for evaluating the combined effects of the antibiotic, lincomycin, and the AgNPs. Plausible genotoxic effects and the roles of AgNPs were observed through decreased Bla gene expressions in the Bacillus cereus and Bla CTX-M-15 gene expressions in the Proteus mirabilis .

Considerable efforts have been directed towards development of nano-structured carriers to overcome the limitations of anticancer drug, doxorubicin's, delivery to various cancer sites. The drug's severe toxicity to cardio and hepatic systems, low therapeutic outcomes, inappropriate dose-demands, metastatic and general resistance, together with non-selectivity of the drug have led to the development of superparamagnetic iron oxide nanoparticles (SPIONs)-based drug delivery modules. Nano-scale polymeric co-encapsulation of the drug, doxorubicin, with SPIONs, the SPIONs surface end-groups' cappings with small molecular entities, as well as structural modifications of the SPIONs' surface-located functional end-groups, to attach the doxorubicin, have been achieved through chemical bonding by conjugation and cross-linking of natural and synthetic polymers, attachments of SPIONs made directly to the non-polymeric entities, and attachments made through mediation of molecular-spacer as well as non-spacer mediated attachments of several types of chemical entities, together with the physico-chemical bondings of the moieties, e.g., peptides, proteins, antibodies, antigens, aptamers, glycoproteins, and enzymes, etc. to the SPIONs which are capable of targeting multiple kinds of cancerous sites, have provided stable and functional SPIONs-based nano-carriers suitable for the systemic, and in vitro deliveries, together with being suitable for other biomedical/biotechnical applications. Together with the SPIONs inherent properties, and ability to respond to magnetic resonance, fluorescence-directed, dual-module, and molecular-level tumor imaging; as well as multi-modular cancer cell targeting; magnetic-field-inducible drug-elution capacity, and the SPIONs' magnetometry-led feasibility to reach cancer action sites have made sensing, imaging, and drug and other payloads deliveries to cancerous sites for cancer treatment a viable option. Innovations in the preparation of SPIONs-based delivery modules, as biocompatible carriers; development of delivery route modalities; approaches to enhancing their drug delivery-cum-bioavailability have explicitly established the SPIONs' versatility for oncological theranostics and imaging. The current review outlines the development of various SPIONs-based nano-carriers for targeted doxorubicin delivery to different cancer sites through multiple methods, modalities, and materials, wherein high-potential nano-structured platforms have been conceptualized, developed, and tested for, both, in vivo and in vitro conditions. The current state of the knowledge in this arena have provided definite dose-control, site-specificity, stability, transport feasibility, and effective onsite drug de-loading, however, with certain limitations, and these shortcomings have opened the field for further advancements by identifying the bottlenecks, suggestive and plausible remediation, as well as more clear directions for future development.

Background: Locoregional recurrence of oral cancer causes significant morbidity. This study aims at assessing the functional outcomes of patients undergoing treatment for recurrent oral squamous cell carcinoma., Methods: This study was done in a tertiary care center in North India and includes prospective cohort of 179 recurrent oral carcinoma patients, from September 2017 to September 2018. Patients undergoing treatment of recurrent oral carcinoma were assessed for quality-of-life score at baseline before starting treatment and two months after the completion of the treatment. For the assessment, EORTC QLQH&N35 questionnaire was used., Results: Of 179 patients included, 71 (39.66%) patients underwent salvage surgery and 104 patients (58.10%) received palliative chemotherapy. One hundred and thirty patients could complete the "EORTC-QOL-H&N-35" questionnaire on required two occasions. Forty-nine patients died before completing second questionnaire. More than half (55.6%) of patients who underwent salvage surgery had improved quality of life after the procedures. They have little or no pain in oral cavity, improved swallowing, less odynophagia, improvement in neck and shoulder pain, less problems with the external appearance and socialization, and enjoyed better sexual life. In patients receiving palliative chemotherapy, the quality of life declined in majority (88.1%) of the patients., Conclusions: Although salvage surgery is the best modality of treatment for recurrent oral carcinoma, only about one-third of patients qualify for surgery and enjoy improved quality of life following surgery. On the other hand, in majority of the patients receiving palliative chemotherapy, the quality of life worsened with time and treatment., Competing Interests: Conflict of interestNone., (© The Association of Oral and Maxillofacial Surgeons of India 2021.)

Objective: Image-guided fine needle aspiration cytology with conventional smear (CS) preparation offers onsite cellular adequacy evaluation; however, it still provides false negatives due to faulty smear preparations. Liquid-based cytology (LBC) can be advantageous in these scenarios. Hence, with an aim to investigate utility of LBC in these samples, we carried out the above study with objectives to find diagnostic accuracy of LBC and agreement of LBC with CS methods in guided aspiration samples from intra-abdominal masses., Methods: A prospective observational study, of 113 patients with clinical or radiological diagnosis of intra-abdominal masses, was carried out. SurePath BD™ was used for LBC smear preparation, and the standard protocol was used for CS preparation., Results: LBC alone was diagnostic in 80.8% of the cases, and CS alone was diagnostic in 71.2% cases (agreement was 83.7%, p = 0.03). Cellular morphology was better preserved in LBC; however, interpretation was easier in CS., Conclusion: CS may be complimented with LBC sample collection method to enhance the sensitivity of intra-abdominal FNA., (© 2022 S. Karger AG, Basel.)

Introduction: Tumors of facial skin are common in upper part of central subunit of face. Defects after resection require a flap, which is pliable, thin, and has a good colour match. Among the various local flaps available paramedian forehead flap is a good option., Patients and Methods: Patients reconstructed with paramedian forehead flap during the period from January 2015 to March 2020 were included in the study. Data regarding the demographic, clinical characteristics, and treatment details was recorded, and analyzed for postoperative complications and cosmetic outcomes., Results: Paramedian forehead flap reconstruction was performed in 37 patients who were resected for tumor involving upper central subunit of face. Median age of patients was 57 years. Male to female ratio was 1.4:1. All tumors were resected with a negative margin. Nodal disease was managed by superficial parotidectomy only (4/37), superficial parotidectomy along with supra-omohyoid neck dissection (6/37) and modified neck dissection (1/37). In five patients additional buccal mucosa graft was used to reconstruct conjunctiva. Additional flaps were required in two patients in whom nasolabial and mustarde flaps were used. Partial flap loss occurred in one patient. There was no major flap loss. Surgical site infection developed in only one patient, who had partial flap loss. On subjective assessment, nearly 60% patients described their appearance as good., Conclusion: Facial reconstruction in area of dorsum of nose and medial aspect of both eyelids using paramedian forehead flaps is a simple and quick procedure., Competing Interests: No conflict of interest., (© 2020 Craniofacial Research Foundation. Published by Elsevier B.V. All rights reserved.)

The current COVID 19 pandemic has a major impact on healthcare delivery globally. Oral cancer involving anterior arch of mandible is difficult to reconstruct and ideally, requires free fibular osteomyocutaneous flap. During this time of resource constraint situation, these free flaps are not a great choice, as it increases exposure of both patient and surgical team to the deadly virus. We are describing a novel method of reconstruction after resection of oral cancer involving anterior arch of mandible. In this new technique, we have reconstructed central arch defect by hanging bipaddle pectoralis major myocutaneous flap with orbicularis oris muscle using ethylene terephthalate suture. Operative time, early postoperative complications and early cosmetic and functional outcome were assessed. We have used this novel technique in eight patients of T4a oral cancer involving anterior arch of mandible and skin over chin. Mean operative time was 180 min. One patient had minor flap loss with surgical site infection (Clavien-Dindo grade I). In all patients, we were able to discharge all patients on eighth postoperative day. Cosmetic outcome and functional outcomes were mostly satisfactory. All patients were able to oppose their lips without any oral incompetence and drooling. Tongue mobility was good. There was no incidence of 'Andy Gump deformity'. This is a feasible option for reconstructing anterior arch defect in resource- and time-limited setting of COVID 19 pandemic. This technique can also be used in comorbid conditions where it is not advisable to do very long surgery., Competing Interests: Conflict of InterestThe authors declare that they have no conflict of interest., (© Indian Association of Surgical Oncology 2020.)

India has one of the highest incidences of oral squamous cell carcinoma (OSCC), with 75,000-80,000 new cases a year. The outcome in early oral cancer is better, but a significant proportion (12-14%) of these patients still relapses and dies due to locoregional or distant recurrences. Several clinicopathological and molecular factors have been used to prognosticate and predict outcomes in these patients of OSCC. The present study aims to validate Brandwein Gensler (BG) risk predictive model in surgically treated OSCC patients in a tertiary care centre in North India. All oral cavity cancer patients, treated in the Department of Surgical Oncology, King George's Medical University, between 2013 and 2017, were reviewed. Patients with histologically diagnosed OSCC, aged > 18 years undergoing primary surgical resection were included in the study. The final histopathological evaluation was done by a dedicated pathologist to categorize patients according to BG model risk categories. This model comprises of three factors, lymphocytic host response, perineural invasion and worst pattern of invasion, scored by the method described by Brandwein Gensler et al. The sum of these scores is used to define low, moderate and high risk categories. The study, conducted during 2013-2017, included 149 patients. Median age was 45 years (range 25-75 years). Tobacco use was noted in 143 patients. Buccal mucosa was the most common site (51%). Surgical margins were clear (> 5 mm) in 97.9% cases. Postoperative radiotherapy was given in 47.7% patients. Locoregional recurrences (LRR) (primary site and neck) were documented in 17 of the 149 patients (11.4%). There was no synchronous or metachronous distant metastasis noted in any of the study patients. Six patients had disease specific mortality. Among the 17 patients with LRR, majority (11) belonged to the high risk category of the BG risk model. Adjuvant radiotherapy had been administered in 10 of these 11 recurrent patients belonging to the high risk category. The Brandwein Gensler risk model is predictive of locoregional recurrences (p = 0.02) for OSCC undergoing primary surgery. It can be used to devise strategies to prevent recurrences or identification of recurrences at an earlier point for salvage. The benefit of further escalation of adjuvant therapy in the high risk category needs further studies, as 90% patients in this group recurred despite complete adjuvant treatment.

Background: Differentiating malignancy from benign diseases is the key to successful management of adnexal masses. Risk of malignancy algorithm (ROMA) has been used for this purpose. We have prospectively studied the diagnostic value of ROMA in patients presented with adnexal masses., Methods: We prospective calculated ROMA values prior to surgery for adnexal masses. The risk calculated was then correlated with the histological findings, and results were analyzed according to menopausal status. ROMA cutoff value was determined using ROC curve, and sensitivity, specificity and predictive values were calculated. Statistics were performed on SPSS software (version 20.0)., Results: There were 94 patients with adnexal masses included in the study, 65 (69.1%) had epithelial ovarian cancer and 29 (30.9%) were diagnosed benign on histopathology. In both pre- and postmenopausal patients, ROMA values were significantly higher in patients with malignancy compared to those with benign disease ( p  < 0.05). ROMA score was of a significant diagnostic value in both premenopausal (AUC = 0.914, Z  = 10.81, p  < 0.001) and postmenopausal patients (AUC = 0.975, Z  = 21.51, p  < 0.001). In premenopausal females, ROMA > 13.3% was able to discriminate malignant from benign patients with 97.06% sensitivity and 85.00% specificity. The positive and negative predictive values were 91.7% and 94.4%. Similarly, in postmenopausal females, ROMA value of > 76% achieved 87.10% sensitivity and 100.00% specificity in discriminating malignant from benign patients with 100% positive and 69.2% negative predictive value. The overall accuracy of ROMA in pre- and postmenopausal patients was 87.0% and 85%, respectively., Conclusions: ROMA is a useful and accurate test for differentiating epithelial ovarian cancer from benign ovarian masses. Further studies are needed to compare performance of ROMA with the Risk of Malignancy Index (RMI), CA 125 and HE4. Such comparative studies will be helpful to the clinician in deciding the best diagnostic tool for women with adnexal masses., Competing Interests: Conflict of interestThe authors declare that there is no conflict of interest in the present study., (© Federation of Obstetric & Gynecological Societies of India 2019.)

Pay-load deliveries across the skin barrier to the systemic circulation have been one of the most challenging delivery options. Necessitated requirements of the skin and facilitated skin layer cross-over delivery attempts have resulted in development of different non-invasive, non-oral methods, devices and systems which have been standardized, concurrently used and are in continuous upgrade and improvements. Iontophoresis, electroporation, sonophoresis, magnetophoresis, dermal patches, nanocarriers, needled and needle-less shots, and injectors are among some of the methods of transdermal delivery. The current review covers the current state of the art, merits and shortcomings of the systems, devices and transdermal delivery patches, including drugs' and other payloads' passage facilitation techniques, permeation and absorption feasibility studies, as well as physicochemical properties affecting the delivery through different transdermal modes along with examples of drugs, vaccines, genes and other payloads.

Introduction: Abundant blood supply of tongue permits various flap designs and makes it a good choice for reconstructing defects following resection of oral cancer., Aim: We aim to evaluate the reliability of tongue flap for small- and medium-size defects after resection of oral cancer in terms of viability, complications, and functional outcome., Methods: In this retrospective analysis, patients reconstructed with lateral tongue flaps after resection of oral cavity carcinoma from May 2011 to December 2017 were included., Results: Forty-two patients underwent tongue flap reconstruction during the study period. Median size of defect was 3.5 cm. Out of 42 patients, 27 had carcinoma of buccal mucosa and 8 had carcinoma of lower alveolus. Mandibular resection was performed in 30 patients. Neck was addressed in all 42 patients. Supraomohyoid neck dissection was done in 12 patients, while others had comprehensive neck dissection. Average time to harvest flap was 25 min. There was no flap loss in the postoperative period. Three patients each developed flap tip necrosis and minor orocutaneous fistula that were managed conservatively. Subjective functional outcome was good to satisfactory in most patients (88%)., Conclusion: Lateral tongue flap is a simple reliable flap for reconstruction of small- and medium-sized defects following resection of oral cavity cancers in terms of low morbidity and satisfactory functional outcomes. It obviates the need of distant tissue transfer., Competing Interests: Conflict of interestThe authors declare that they have conflict of interest.

Objective: To determine the frequency of granulomatous inflammation on histopathological findings amongst cancer patients and correlating them with tuberculosis., Methods: The retrospective review was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised medical records of cancer patients with a histopathological finding of granulomatous inflammation between January 2010 and December 2015. Data was reviewed, including clinical history, availability of acid fast bacilli stain on tissue and mycobacterium tuberculosis culture results. Data related to treatment, duration and outcomes was also reviewed and was analysed using SPSS 19., Results: Out of 28690 cancer patients during the study period, 17345(60.4%) had undergone biopsy for different reasons, and of those, 78 (0.45%) had granulomatous inflammation and formed the study sample. Among them, 40(51.3%) patients had caseous granulomatous inflammation while 38 (48.7%) had non-caseous granulomas. Acid fast bacillus tissue stain was performed on 77(98.7%) patients, of whom only 9 (11.5%) specimens showed acid fast bacilli. Mycobacterium tuberculosis culture was performed on 53(68%) specimens and among them 13(16.7%) grew mycobacterium tuberculosis. Anti-tuberculosis treatment was offered to 38 (48.7%) patients, including those with positive AFB stain and MTB culture results. Of them, 32(41%) patients completed the treatment while 4(5.1%) defaulted and 2(2.6%) died. Symptomatic and radiological improvement was observed in 16(20.5%) patients., Conclusions: Granulomatous inflammation was infrequently encountered in cancer patients. Mycobacterium tuberculosis cultures assisted in definitive decision-making but granulomatous inflammation could not be anticipated when the specimens were initially processed except when visible caseation was encountered. Processing specimens for mycobacterium tuberculosis cultures when caseation was encountered may be a reasonable strategy to adopt.