Factors Influencing the Improvement of Activities of Daily Living during Inpatient Rehabilitation in Newly Diagnosed Patients with Glioblastoma Multiforme

Glioblastoma multiforme (GBM) is the most common and aggressive brain tumor. To identify the factors influencing the improvement of the activities of daily living (ADL) in newly diagnosed patients with GBM, we investigated the characteristics and variable factors and overall survival. A total of 105 patients with GBM were retrospectively analyzed and categorized into the following three groups according to the quartile of change of their Barthel index score from admission to discharge: deterioration (n = 25), no remarkable change (n = 55), and good recovery (n = 25). A statistical difference was observed in the pre-operative, intra-operative, post-operative, and rehabilitation-related factors between the deterioration and good recovery groups. Multiple regression analysis identified the following significant factors that may influence the improvement of ADL after surgery: the improvement of motor paralysis after surgery, mild fatigue during radio and chemotherapy, and length up to early walking training onset. The median overall survival was significantly different between the deterioration (10.6 months) and good recovery groups (18.9 months, p = 0.025). Our findings identified several factors that may be associated with post-operative functional improvement in patients with GBM. The inpatient rehabilitation during radio and chemotherapy may be encouraged without severe adverse events and can promote functional outcomes, which may contribute to the overall survival of newly diagnosed patients with GBM.

Recognising and managing eating disorders in the emergency department

Compared with other mental health conditions or psychiatric presentations, such as self-harm, which may be seen in emergency departments, eating disorders can seem relatively rare. However, they have the highest mortality across the spectrum of mental health, with high rates of medical complications and risk, ranging from hypoglycaemia and electrolyte disturbances to cardiac abnormalities. People with eating disorders may not disclose their diagnosis when they see healthcare professionals. This can be due to denial of the condition itself, a wish to avoid treatment for a condition which may be valued, or because of the stigma attached to mental health. As a result their diagnosis can be easily missed by healthcare professionals and thus the prevalence is underappreciated. This article presents eating disorders to emergency and acute medicine practitioners from a new perspective using the combined emergency, psychiatric, nutrition and psychology lens. It focuses on the most serious acute pathology which can develop from the more common presentations; highlights indicators of hidden disease; discusses screening; suggests key acute management considerations and explores the challenge of mental capacity in a group of high-risk patients who, with the right treatment, can make a good recovery.

Method Development and Validation for Pyrogallol Content Quantification by HPLC in Trimetazidine Dihydrochloride

Trimetazidine dihydrochloride (TD) is an anti-ischemic drug that is used to effectively treat angina pectoris symptoms. During the manufacture of TD from gallic acid a process related impurity, pyrogallol, is produced. Up to the present time, no appropriate method has been proposed for the detection and analysis of pyrogallol in the TD at the level of threshold of toxicological concern. Therefore, in this investigation, a reliable and reproducible HPLC method was developed for the detection and analysis of pyrogallol in the TD. The method was validated in full compliance with the recommendations of the International Harmonization Council. Regression analysis indicated a correlation coefficient value of 0.9990 for pyrogallol between 6.3 ppm and 31.5 ppm. The LOD was 1.89 ppm and LOQ was 6.3 ppm for pyrogallol. Good recovery (accuracy) was observed in the range of 98.34% to 118.54 % with an RSD value (precision) of 0.150%. Pyrogallol analysis in batches TD material has demonstrated the good performance of the method. The process is therefore useful in the identification and evaluation of pyrogallol content in drug substance of TD.

A case of Bochdalek hernia with anomalous hepatic lobe heterotopia-case report

Background Bochdalek hernia is the most common type of congenital diaphragmatic hernia (CDH) resulting from postero-lateral diaphragmatic defect. Hepatic heterotopia is very rarely associated with CDH, and hepatic herniation favors the worst prognosis. Case presentation We present a case of a neonate diagnosed with right Bochdalek hernia (BH) with anomalous hepatic lobe heterotopia. Intra operatively, mal-rotated loops were also found to be herniating in the right hemithorax. The mal-rotated loops were reduced back into abdomen after performing Ladd’s procedure and diaphragmatic defect was repaired over the anomalous liver lobe. Baby was discharged on 7th postoperative day and follow-ups showed good recovery. Conclusion This case report discusses the presentation, classification, and significance of this association. Our case report is noteworthy as Bochdalek hernia is very rarely associated with anomalous hepatic lobe.

[OPy][BF4] Selective Extraction for Trace Hg2+ Detection by Electrochemistry: Enrichment, Release and Sensing

Trace mercury ion (Hg2+) detection is important for environmental monitoring and water safety. In this work, we study the electrochemical strategy to detect trace Hg2+ based on the preconcentration of temperature-controlled N-octylpyridinium tetrafluoroborate ([OPy][BF4]) dispersive liquid–liquid microextraction. The [OPy][BF4] selectively extracted Hg2+ from aqueous solution by the adsorption of unsaturated N in [OPy][BF4], which increased the concentration of Hg2+ and decreased that of other interference ions. It was noted that the adsorption of [OPy][BF4] to Hg2+ was weakened by aqueous solution. Hence, after extraction, precipitated [OPy][BF4] was diluted by a buffer solution comprising a mixture of water and acetonitrile to release Hg2+ and the single was detected by electrochemistry. Water is proposed to release Hg2+ adsorbed by [OPy][BF4], and the acetonitrile serves as a co-solvent in buffer solution. Sensitivity and anti-inference ability of sensors were improved using the proposed method and Hg2+ releasing procedure. The detection limit (S/N = 3) of the sensor is 0.0315 μg/L with a linear range from 0.1 to 1 μg/L. And the sensor exhibits good recovery with an range from 106 % to 118%, which has great potential for trace Hg2+ determination.

Simultaneous Determination of Vitamins D3 (Calcitriol, Cholecalciferol) and K2 (Menaquinone-4 and Menaquinone-7) in Dietary Supplements by UHPLC

The content and composition of dietary supplements is of great interest due to their increasing consumption and variety of available brand offered in the market. Accurate determination of vitamins is important for the improvement of dietary supplement quality and nutrition assessments. In this regard, the simultaneous determination of vitamin D3 (calcitriol—CT and cholecalciferol—CHL) and K2 (menaquinone-4—MK-4 and menaquinone-7—MK-7) in dietary supplements was developed by using ultra-high-pressure liquid chromatography (UHPLC). The overall runtime per sample was above 35 min, with the retention times of 2.40, 6.59, 7.06, and 32.6 min for vitamin D3 (CT and CHL) and vitamin K2 (MK-4 and MK-7), respectively. The limits of detection and limits of quantification for the target nutritional compounds ranged between 0.04–0.05 µg/mL, respectively. The validation results indicated that the method had reasonable linearity (R2 ≥ 0.9990), good recovery (>82%), satisfactory intra-day precision (≤1.9%) and inter-day precision (≤3.5%), and high selectivity and specificity. The validated UHPLC method was demonstrated to be precise, accurate, and robust for the simultaneous determination of vitamins D3 (CT and CHL) and K2 (MK-4 and MK-7) in dietary supplements.

COVID-19 with essential thrombocythemia treated with apixaban for antithrombotic prophylaxis

A 40-year-old man was admitted to our hospital for COVID-19. He had been treated for essential thrombocythemia (ET). He was diagnosed severe illness of COVID-19, oxygen therapy and dexamethasone were administered. There was a possibility of thromboembolic events in this case, apixaban for prophylaxis was added. With these treatments, the patient has made a good recovery, and he was discharged on hospital day 11. There is no standard strategy for prophylaxis of thrombosis in patients with ET, and apixaban could be a clinical benefit for these patients.

A Prospective Clinical Study on Chronic Subdural Hematoma with Special Reference to Its Surgical Management at a Tertiary Care Hospital in North-East India

BACKGROUND Chronic subdural hematoma (CSDH) is one of the commonest disease that affects elderly people. Presentation mimics many other diseases of elderly. Timely diagnosis and prompt surgical intervention is the key to favourable outcome. This study was done to obtain baseline data on its various modes of presentation and management in a tertiary care hospital in north east India. METHODS This prospective observational study was conducted at Assam Medical College and Hospital, Dibrugarh, Assam from June 2016 to end of May 2017. All radiologically confirmed patients with CSDH were included fulfilling the inclusion and exclusion criteria. All patients underwent surgical intervention as per indication. All patients were evaluated in regard of presenting clinical features, radiological findings, treatment received, peri-operative complications, outcome and other clinical variables during hospital stay and follow up. RESULTS A total of 52 patients were included in the study. Male and female ratio was 3: 1 and 73.08 % patients were aged more than 50 years. Headache was the most common symptom followed by altered sensorium, limb weakness, intermittent vomiting, convulsions and others. History of recent trauma was found in 67.31 % and chronic alcoholism in 28.85 % of patients. Most of the patient (63.46 %) had Glasgow coma scale (GCS) score 13 - 15. Pure CSDHs were found in 19.23 % and mixed density CSDHs in 80.77 % of patients. Burr hole was done in 48 patients (92.30 %) and craniotomy in 7 (13.46 %). Electrolyte imbalance was observed in 17.31 % of patients followed by seizures, pulmonary complications and others. Four patient had moderate disability at the time of discharge and at the end of one month all discharged patient had good recovery. CONCLUSIONS Chronic subdural hematoma is one the common benign disease of old age which requires high level of suspicion for diagnosis and early radiological investigation. Timely surgical intervention carries minimal risk of complications with good recovery for most of the patients. Burr hole is the preferred surgical procedure for CSDHs with craniotomy reserved for some selected cases. KEYWORDS Chronic Subdural Hematoma, Surgical Management, Burr Hole, Craniotomy

Gold Nanoparticles-Amplified Indirect Competitive Enzyme-Linked Immunosorbent Assay of BDE-121 Using a Monoclonal Antibody

In this study, we developed a monoclonal antibody against 2,3’,4,5’,6-pentabromodiphenylether (BDE-121) using a synthesized hapten, and established an indirect competitive enzyme-linked immunosorbent assay (IC-ELISA), using gold nanoparticles, to amplify the signal. The monoclonal antibody showed high specificity, with a half inhibitory concentration (IC50) value of 2.78 ng/mL, towards BDE-121. The developed IC-ELISA exhibited high sensitivity and stability as well as good recovery. The intra-assay deviation is below 6.8% and the inter-assay deviations range from 6.5% to 8.7%. The assay of the actual samples was found to be consistent with those of gas chromatography/mass spectrometry (GC/MS).