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Objective: Intravesical bacillus Calmette-Guéin (BCG) is an established treatment in superficial bladder cancer, however its local and systemic toxicity continues to be a cause for concern. This trial was conducted using three different doses of BCG to determine whether lowering the dose of BCG could reduce toxicity without compromising its efficacy. Materials and Methods: From July 2002 to June 2006, 152 patients with superficial bladder cancer entered the trial. The patients were randomized to receive three different doses of BCG: 40, 80 and 120 mg respectively. There were no significant differences in clinical and pathological characteristics among the three groups. 24 patients could not be followed till the end of the study due to poor compliance. At completion of the study, 40 patients could be evaluated in group A (40 mg), 48 in group B (80 mg) and 40 in group C (120 mg). Results: Following treatment, patients were evaluated for a mean follow-up of 36 (range 18 to 52) months. No significant difference in recurrence rate (20 vs. 25 vs. 20% respectively; P >0.05) was observed among the groups and no progression of the disease was seen. Significant differences were observed among groups A, B and C in local toxicity (30 vs. 41.7 vs. 70% respectively; P <0.01). Systemic toxicity was more common in group C as compared to groups B and A ( P <0.01). Conclusion: Reduction in the dose of intravesical BCG can reduce the toxicity associated with the treatment without affecting the effificacy of therapy. [ABSTRACT FROM AUTHOR]

Cyanobacterium Nostoc commune is a filamentous terrestrial prokaryotic organism widely distributed, which suggest its high adaptive potential to environmental or abiotic stress. Physiological parameters and proteomic analysis were performed in two accession of N. commune with the aim to elucidate the differences of physiological trails between distant geotypes, namely Antarctic (AN) and central European (CE). The result obtained clearly showed that the AN geotype demonstrates elevated levels of total phenols, flavonoids, carotenoids, and phycobiliproteins, indicative of its adaptation to environmental stress as referred by comparison to CE sample. Additionally, we employed LC-MS analysis to investigate the proteomes of N. commune from AN and CE geotypes. In total, 1147 proteins were identified, among which 646 proteins expressed significant (up-regulation) changes in both accessions. In the AN geotype, 83 exclusive proteins were identified compared to 25 in the CE geotype. Functional classification of the significant proteins showed a large fraction involved in photosynthesis, amino acid metabolism, carbohydrate metabolism and protein biosynthesis. Further analysis revealed some defense-related proteins such as, superoxide dismutase (SOD) and glutathione reductase, which are rather explicitly expressed in the AN N. commune . The last two proteins suggest a more stressful condition in AN N. commune . In summary, our findings highlight biochemical processes that safeguard the AN geotype of N. commune from extreme environmental challenges, not recorded in CE accession, probably due to less stressful environment in Europe. This study brings the first ever proteomic analysis of N. commune , emphasizing the need for additional investigations into the climate adaptation of this species with rather plastic genome.

Purpose: To analyze the outcomes of eyes treated for retinopathy of prematurity in posterior Zone I., Methods: In a part retrospective (9 years) and part prospective (1 year) interventional study, we analyzed eyes treated for retinopathy of prematurity in posterior Zone I with a minimum follow-up for 6 months., Results: This study included 109 eyes of 56 infants; mean gestational age and birth weights were 29.3 (±2.1) weeks and 1112.5 (±381.9) g, respectively. The treatment included intravitreal anti-vascular endothelial growth factor as the initial treatment modality in 101 eyes (92.6%), either alone (27 eyes) or combined with laser or vitreous surgery (73 eyes). Laser was the initial treatment modality in eight eyes, either alone (n = 3) or in combination with surgery (n = 5). With anti-vascular endothelial growth factor alone, 30.68% (n = 27) eyes responded favorably, and the remaining 69.32% (n = 59) eyes needed retreatment (laser in the majority). At the final follow-up, 89.9% (out of 109) of eyes did well anatomically. Good outcome was significantly linked to no detachment at presentation ( P < 0.0001) and the presence of well-defined central vascular trunks ( P = 0.001)., Conclusion: Treating the eyes before retinal detachment with bevacizumab followed by laser (and surgery, if needed) results in a favorable outcome in babies with posterior Zone I retinopathy of prematurity.

Purpose: To evaluate the feasibility and outcome of a real-time retinopathy of prematurity (ROP) telescreening strategy using videoconferencing in a community setting in India., Method: In a prospective study, trained allied ophthalmic personnel obtained the fundus images in the presence of the parents and local childcare providers. Analysis of images and parental counseling were done in real time by an ROP specialist located at a tertiary center using videoconferencing software. A subset of babies was also examined using bedside indirect ophthalmoscopy by an ROP care-trained ophthalmologist. The data were analyzed using descriptive statistics, sensitivity, specificity, positive and negative predictive values, and correlation coefficient., Results: Over 9 months, we examined 576 babies (1152 eyes) in six rural districts of India. The parents accepted the model as they recognized that a remotely located specialist was evaluating all images in real time. The strategy saved the travel time for ROP specialists by 477 h (47.7 working days) and for parents (47,406 h or 1975.25 days), along with the associated travel cost. In a subgroup analysis (100 babies, 200 eyes), the technology had a high sensitivity (97.2%) and negative predictivity value (92.7%). It showed substantial agreement (k = 0.708) with the bedside indirect ophthalmoscopy by ROP specialists with respect to the detection of treatment warranting ROP. Also, the strategy helped train the participants., Conclusion: Real-time ROP telescreening using videoconferencing is sensitive enough to detect treatment warranting ROPs and saves skilled workforce and time. The real-time audiovisual connection allows optimal supervision of imaging, provides excellent training opportunities, and connects ophthalmologists directly with the parents., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Free radicals play a critical role in the chemical processes that occur in all cells. Pharmaceutical companies manufacture a variety of synthetically prepared antioxidants, but it is known that many of these can be carcinogenic. As a result, efforts are being made to find natural antioxidants that do not have these side effects. Lichens may be suitable candidates because they contain secondary metabolites with proven antioxidant properties. This could be explained by the presence of compounds with phenolic groups in lichens. The radical scavenging reaction is a chemical reaction governed by stoichiometry, and our aim is to determine the efficacy of these reactions. The aim of this study is to compare metabolite activity based on the same amount of substance involved in radical scavenging, calculated in micromoles rather than weight concentration. This provides an accurate way of comparing radical scavenging activity. We tested superoxide anion scavenging activity and free radical scavenging activity of isolated lichen secondary metabolites and their mixtures in different ratios. The following compounds were isolated and tested for antioxidant activity: gyrophoric acid ( Umbilicaria hirsuta ), evernic acid ( Evernia prunastri ), physodic acid, 3-hydroxyphysodic acid, physodalic acid and atranorin ( Hypogymnia physodes ), and usnic acid (as a synthetic compound). Of all the tested compounds, 3-hydroxyphysodic acid, as well as mixtures containing this metabolite, showed the strongest scavenging activity. The results also demonstrated that calculation by amount of substance leads to a new consideration of antioxidant activity.

Objectives: To find the prevalence of depression among elderly population of urban slum of Cuttack and to study its association with sociodemographic factors, comorbidities, and various life events and also to explore the mental health needs of the study subjects as perceived by them., Methods: It was a cross-sectional study carried out in the urban slum, Jobra of Cuttack city in Odisha. Simple random sampling was done using random number table to select the study subjects. Predesigned pretested questionnaire including Geriatric Depression Scale, Lawton's Instrumental Activities of Daily Living, and Katz Index of Independence in Activities of Daily living and questions on important life events including their perceptions regarding existing mental health services were used for data collection. Data were analyzed using SPSS, and binary logistic analysis was done to find the independent determinants of severe depression among elderly., Results: Out of 354 study subjects, 249 (70.3%) were males. Depression in severe and mild form was present among 44.9% and 36.2%, respectively. Independent risk factors of severe depression by multiple logistic regression analysis were low socioeconomic class, female gender, diabetes mellitus, hypertension, death in family members, conflicts in family, and chronic illness in family members., Conclusion: The prevalence of depression among the elderly in the urban slum was close to 80% with 45% being at risk of severe depression. Females from low socioeconomic class with comorbidities and having life stressors need to be screened regularly in the community level, and facility for counseling should be provided to them., (© 2019 John Wiley & Sons, Ltd.)

Background: Obstructive sleep apnea (OSA) is a progressive sleep disordered breathing condition characterized by repeated episodes of upper airway collapse during sleep. Despite being the most common sleep apnea, it often remains undiagnosed and untreated, especially in rural communities. There is a paucity of literature estimating the prevalence of the disease and associated risk factors from the rural population of Odisha., Methods: It is a cross-sectional study that was conducted in a rural community of Odisha, India to find out the prevalence of people living with the risk of OSA. Multi-staged sampling was done. Participants were evaluated using the Berlin questionnaire (BQ) after obtaining informed consent. Data were analyzed using SPSS with the significance level set at 95%. Univariate and multivariate analysis was done to evaluate the risk factors associated with the condition., Results: Out of 200 community dwellers surveyed using the BQ, 25% had a high likelihood of OSA. Among these high risk subjects, snoring was reported by 70%, excessive daytime sleepiness by 50%. Out of those who were at risk of OSA, 28% were smokers and 48% reported alcohol use. The associated risk factors were age >35 years (OR = 4.5, 95% CI = 1.4-13.8, p < 0.05), BMI ≥ 25 kg/m 2 (aOR = 3.5, 95% CI = 1.2- 10.5, p < 0.05), alcoholism (aOR = 4.5, 95% CI = 1.8-11.1, p = 0.001), and hypertension (aOR = 11.5, 95% CI = 4.7-28, p < 0.001). The prevalence was not affected by the type of diet (vegetarian vs non-vegetarian), use of tobacco or tea consumption., Conclusion: OSA is highly prevalent in the rural community of Odisha. Independent risk factors associated with such subjects were obesity, regular alcohol consumption, and hypertension. Further prevalence studies are recommended., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Many adjuvants have been used with local anesthetics to reduce the time of onset and prolong the duration of analgesia in brachial plexus blocks. However, few studies are there using verapamil as an adjuvant with levobupivacaine., Aims: This study aims to study the effects of verapamil as adjuvant to levobupivacaine in supraclavicular block for upper extremity surgery., Methods: In this double-blinded clinical trial, 60 American Society of Anesthesiologist Class I and II patients posted to undergo upper extremity surgery were divided into 2 different groups randomly. In Group A, the patients received 30 ml levobupivacaine 0.5% plus 2 ml normal saline and Group B patients received 30 ml levobupivacaine 0.5% plus 5 mg verapamil diluted to 2 ml normal saline for supraclavicular block. Time of request for rescue analgesia, onset and duration of sensory motor blocks and changes in hemodynamic parameters were studied and analyzed. P < 0.001 was considered statistically significant., Results: Time for a request for rescue analgesia was 425.80 ± 90.46 min in Group B and 366.13 ± 70.42 min in Group A which was clinically significant. The mean of sensory and motor block onset time in Group B was less than in Group A, the difference between the two groups being statistically significant ( P < 0.001). In Group A, mean duration of sensory block was 316.13 ± 91.08 min and in Group B was 375.83 ± 114.48 min, which was statistically significant ( P < 0.001)., Conclusion: The addition of verapamil as an adjuvant to levobupivacaine in brachial plexus blockade delayed the requirement of rescue analgesia with decreased onset time and prolonged duration of sensory and motor block characteristics., Competing Interests: There are no conflicts of interest.

Malignant peripheral nerve sheath tumor (MPNST) of the adrenal gland is extremely rare. Most of them occur in association with neurofibromatosis, ganglioneuroma or as part of a composite tumor such as pheochromocytoma. Only seven cases of MPNST of the adrenal gland have been reported in the literature till date. Discriminating this entity from other soft tissue sarcomas and gastrointestinal stromal tumor of the adrenal gland has important diagnostic and therapeutic implications. Moreover, the tumor size and pattern of expression for certain immunohistochemical markers may serve as independent predictors of aggressiveness. Herein we present a 24-years-old male with features of Von Recklinghausen's disease who presented with large left adrenal gland malignant peripheral nerve sheath tumor.

Japanese Encephalitis (JE) is an acute viral zoonotic infection of the central nervous system. A confirmed case of JE was reported in the MVH, Pooth Khurd, following which the epidemiological investigation was carried out in the study area. Clinical/Syndromic surveillance started in the hospital. The local practitioners and anganwadi workers were contacted and requested to report similar cases in their areas. Serosurveillance to delineate high risk population, animal and vector survey done by taking transect walks through the colony to look for presence of amplifying hosts like pigs, ducks etc. Out of 2328 persons surveyed, 404 persons were found to have/had fever in the preceding one month. Current fever cases were 166, out of which 9 fitted into the criteria of AES. Large water body with vegetations was present within the colony. Piggeries and ducks were found in the colony. In the hospital 9 AES cases were screened. In total only 18 (9 from field, 9 from hospital) cases subjected to testing and found to be negative for IgM specific for JE. In total only 18 (9 from field, 9 from hospital) cases subjected to testing and found to be negative for IgM specific for JE. Most probably the above case of nine year child is the first case of JE indigenous to Delhi. The environmental conditions were conducive for the transmission of the viral agent. Further research is hence recommended to find the missing links and to prevent outbreaks in Delhi.