Latent lip print: A comparative study of developers

Identification of a person is of paramount importance in a medico-legal investigation. At present more and more people use protecting lipsticks and permanent lipsticks. With these lipsticks a latent lip print is generated by contact with a surface and, like with the latent fingerprints occur, this latent lip print can be developed. This study aims to retrieve latent lip prints from various inanimate surfaces like thermocoal plate, bone china, and glass to compare the efficacy of developers i.e., fingerprint powder, Sudan III, Vermillion, and its comparison with standard lipstick prints. Current research assesses the effectiveness of particular surfaces in the retrieval of lip print in personnel identification. This study included a total of 30 subjects. Latent lip print was developed on the different inanimate surfaces by pressing the lips against the different vehicles. After collecting samples, a camel hair brush was used to retrieve all three chemicals individually by simply tapping on all three surfaces. Application of chemicals was continued until the print became clearly visible for the study. Developed latent lip print was then compared with the visible lip print. Subsequently, a standard lipstick print was developed from the same subject. All the samples were coded and graded according to the patterns suggested in the literature. Discrete (categorical) data were summarized in number and percentage and compared by chi-square (χ2) test. Analyses were performed on SPSS software (Windows version 17.0).: The overall (i.e., total of all three surfaces) favourable outcome was found highest in Fingerprint powder (58.9%) followed by Sudan III (28.9%) and Vermilion (10.0%) the least (Vermilion < Sudan III < Fingerprint powder).Comparing the overall outcomes of three developers, χ2 test showed significantly different and higher favourable outcome in Fingerprint powder as compared to both Sudan III and Vermilion (χ2=92.09, p<0.001) The study found Fingerprint powder the best developer and Thermocol plate the best surface. The findings of this study may be beneficial for investigators.

Management of Non-Prosthetic Peri-Implant Fracture in a Case of Broken Intramedullary Locking Nail - A Rare Case Report and Review of Literature

A non-prosthetic peri-implant fracture (NPPIF) can be defined as a fracture in a bone with an existing non-prosthetic implant such as an extramedullary plate and screws or an intramedullary nail, NPPIFs are mostly reported together with peri-prosthetic fractures (PPFs) that occur around joint replacement implants, but they represent a separate clinical entity with different conceptual and practical considerations1. Our case is a 72-year male with a broken humerus intramedullary Nail in right upper limb who was managed with implant removal and bridge plating with locking plate. The favourable outcome in our case sheds a light in a grey region of non-prosthetic peri implant fractures of upper limbs where no definite management protocol is available. Our patient had very good outcome which was noted by 0/100 on dash scores and complete pain-free range of movement elbow and shoulder. Our case stands as a manifest for NPPIFs of humerus, which can be managed with similar protocol which was used in our case.

Extent, pattern, and prognostic value of MGMT promotor methylation: does it differ between glioblastoma and IDH-wildtype/TERT-mutated astrocytoma?

Introduction The cIMPACT-NOW update 6 first introduced glioblastoma diagnosis based on the combination of IDH-wildtype (IDHwt) status and TERT promotor mutation (pTERTmut). In glioblastoma as defined by histopathology according to the WHO 2016 classification, MGMT promotor status is associated with outcome. Whether this is also true in glioblastoma defined by molecular markers is yet unclear. Methods We searched the institutional database for patients with: (1) glioblastoma defined by histopathology; and (2) IDHwt astrocytoma with pTERTmut. MGMT promotor methylation was analysed using methylation-specific PCR and Sanger sequencing of CpG sites within the MGMT promotor region. Results We identified 224 patients with glioblastoma diagnosed based on histopathology, and 54 patients with IDHwt astrocytoma with pTERTmut (19 astrocytomas WHO grade II and 38 astrocytomas WHO grade III). There was no difference in the number of MGMT methylated tumors between the two cohorts as determined per PCR, and also neither the number nor the pattern of methylated CpG sites differed as determined per Sanger sequencing. Progression-free (PFS) and overall survival (OS) was similar between the two cohorts when treated with radio- or chemotherapy. In both cohorts, higher numbers of methylated CpG sites were associated with favourable outcome. Conclusions Extent and pattern of methylated CpG sites are similar in glioblastoma and IDHwt astrocytoma with pTERTmut. In both tumor entities, higher numbers of methylated CpG sites appear associated with more favourable outcome. Evaluation in larger prospective cohorts is warranted.

Paediatric giant cell myocarditis: a case report

A previously healthy 15-year-old teenage boy was admitted for fever and heart failure. Myocarditis was suspected, and endomyocardial biopsy revealed giant cell myocarditis. Immunosuppressive treatment was initiated, with excellent response. A plausible link to previous leptospirosis was identified. At 18-month follow-up, left ventricular function is normal. Only one other reported case of paediatric giant cell myocarditis had such a favourable outcome.

The Safety Profile of General and Local Anaesthetic Agents: Data Collected during 20 Years of Spontaneous Reporting Activities in the Campania Region (Southern Italy)

Background: General and local anaesthetics are widely used during surgery. These drugs have peculiar safety profiles, being commonly associated with mild and reversible local adverse drug reactions (ADRs), but also with more severe and systemic ADRs, including respiratory and cardiovascular depression and anaphylaxis. Methods and Objectives: We carried out a descriptive analysis of Individual Case Safety Reports (ICSRs) sent to the Campania Regional Centre of Pharmacovigilance (Southern Italy) from 2001 to 2021 that reported general or local anaesthetics as suspected drugs, with the aim of describing their overall characteristics, focussing on the ADRs’ seriousness and distribution by System Organ Class (SOC) and Preferred Term (PT). Results: A total of 110 ICSRs documenting general or local anaesthetics were sent to the Italian pharmacovigilance database during 20 years of spontaneous reporting activities in the Campania region. ADRs mainly occurred in patients with a median age of 48 years and in a slightly higher percentage of men. ADRs were more commonly classified as not serious and had a favourable outcome. In terms of ADRs’ distribution by SOC and PT, both general and local anaesthetics were associated with general and cutaneous disorders, with common ADRs that included lack of efficacy, rash, and erythema. In addition, general anaesthetics were associated with the occurrence of respiratory ADRs, while local anaesthetics were associated with the occurrence of nervous ADRs. Conclusion: Even though a limited number of ICSRs documenting anaesthetics-induced ADRs were retrieved from the Italian spontaneous reporting database in the Campania region, we believe that the continuous monitoring of these drugs is highly recommended, especially among the frail population.

Clinical case of COVID-19 in a patient treated with alemtuzumab

The need to review the guidelines for the management of patients with multiple sclerosis using multiple sclerosis disease modifying drugs has become acute enough since the beginning of 2020 following the outbreak of the COVID-19 pandemic caused by a novel coronavirus SARS-CoV-2. Immunosuppressive drugs were also specifically addressed, as it is during administration of these drugs that the more severe course of COVID-19 disease was expected. Both the Russian and foreign teams published results of their research works. This article presents a retrospective analysis of the incidence rates of COVID-19 in patients with multiple sclerosis after selective immunosuppressive therapy with alemtuzumab and a clinical case when a patient was infected with coronavirus in the first days following the last infusion of the therapy course without clinical manifestations of the infectious disease. The author discusses the mechanisms underlying such a favourable outcome due to the CD52 lymphocyte depletion leading to the reduction of risks of developing hyperimmune reactions that underlie severe complications of COVID-19, and analyses previously published works of our foreign colleagues on the same theme. The review of the accumulated works and personal experience suggest that it is the CD52 lymphocyte depletion that makes it possible to avoid the cytokine storm and, as a result, the more severe course of COVID-19. Amidst the COVID-19 pandemic, during the prescription of multiple sclerosis disease modifying drugs, it should be borne in mind that patients should have access to all types of modern therapy and that the benefits should outweigh the sum of possible risks.

201 Clinical presentation profiles and natural history of cardiac amyloidosis: long-term monocentric analysis (1990–2020)

Aims Cardiac Amyloidosis (CA) is considered a rare condition comprising different entities. Epidemiological data are limited and the natural history of disease is largely unknown. Understanding the clinical profiles at presentation, the impact of novel diagnostic strategies and the prognostic predictors at baseline will improve patients’ clinical management. We aimed to examine the epidemiology and natural history of CA in the last 30 years at a tertiary referral centre for amyloidosis. Methods and results Data of patients included in the prospective ‘Cardiac Amyloidosis Registry’ of Trieste from January 1990 to December 2020 were extracted from an electronical database and analysed. The diagnosis of CA was made in presence of (a) amyloid deposition found at endomyocardial biopsy (EMB), or (b) high grade cardiac uptake at bisphosphonate scintigraphy in absence of monoclonal components. Cardiological data of patients included (i) clinical examination, (ii) electrocardiogram (ECG), (iii) echocardiography and (iv) medications. The primary outcome measure was all-cause mortality. The secondary outcome measure was cardiac death. Of the 143 patients with CA included in this analysis, 77 (54%) were diagnosed before 2016 (historical cohort) and 66 (46%) ≥2016 (contemporary cohort). Light chain (AL) amyloidosis and transthyretin (ATTR) amyloidosis accounted for 49% and 38%, respectively, of all CA patients. CA of unknown aetiology accounted for 13% of cases. CA was diagnosed by EMB in 98 (69%) patients and by cardiac scintigraphy with bone tracers in 45 (31%) patients. Patients in the contemporary cohort (67% ATTR-CA) were diagnosed more frequently by non-invasive approach compared to those in the historical cohort. At a median global Follow-up of 36 months, a more favourable outcome was found in a) patients from the contemporary cohort compared to those from the historical cohort (P < 0.001), b) ATTR- compared to AL-CA (at 18 months of Follow-up 42 (85%) ATTR patients and 32 (60%) AAL patients were alive, P = 0.013), and, (c) patients diagnosed non-invasively by scintigraphy rather than by histology (at 18 months of Follow-up 36 (80%) of patients diagnosed by cardiac scintigraphy and 57 (60%) of those diagnosed by histology were alive, P = 0.001). Of note, while no difference in outcome was found among AL- and ATTR-CA in the historical cohort, ATTR-CA patients had lower all-cause mortality and cardiac death than AL-CA patients in the contemporary cohort. Overall, death for end stage HF was more prevalent in patients with AL- than ATTR-CA (58% vs. 25%, P = 0.002). At univariable analysis, ACE-i and beta blockers (BBs) therapy were associated with a more favorable outcome [HR: 0.38, (0.26–0.60, P < 0.001) and HR: 0.53 (0.33–0.85, P = 0.008), respectively], while experiencing a previous syncope and having low QRS voltages at surface ECG portended a worse overall survival [HR: 2.42 (1.3–4.5, P = 0.006) and HR: 1.94 (1.3–3.0, P = 0.002), respectively]. At multivariate analysis, treatment with ACE-i, BBs, and syncope had independent prognostic value [HR 0.41 (0.23–0.71, P = 0.002); HR 0.50 (0.31–0.82, P = 0.007), and HR: 2.1 (1.0–4.1, P = 0.040); respectively]. Conclusions The epidemiology and natural history of CA has been changing. Over years, ATTR-CA had the most favourable outcome. NYHA functional class, syncope, BBs and ACE-i therapy were useful parameters for prognostic stratification. Further research is needed to investigate if they could be integrated in multiparametric scores for more accurate outcome prediction.

A PROSPECTIVE STUDY TO EVALUATE THE FUNCTIONAL OUTCOME OF NON- INSTRUMENTED LUMBAR DECOMPRERSSION IN ADULT DEGENERATIVE LUMBAR CANAL STENOSIS [LCS] AND DETERMINE PREDICTIVE FACTORS OF FAVOURABLE OUTCOME

AIM AND OBJECTIVES: A prospective study to evaluate the functional outcome of non- instrumented lumbar decompression in adult degenerative lumbar canal stenosis [LCS] and determine predictive factors of favourable outcome. Study details: Patients attending Orthopedic OPD at BARC Hospital, Mumbai, who were operated for adult degerative LCS from June 2017 to May 2019. CONCLUSION: The VAS and Beaujon score were stasistically significant when compared to preoperative and 3 months post operatively

Communication between cells: exosomes as a delivery system in prostate cancer

Despite the considerable efforts in screening and diagnostic protocols, prostate cancer still represents the second leading cause of cancer-related death in men. Many patients with localized disease and low risk of recurrence have a favourable outcome. In a substantial proportion of patients, however, the disease progresses and becomes aggressive. The mechanisms that promote prostate cancer progression remain still debated. Many findings point to the role of cross-communication between prostate tumor cells and their surrounding microenvironment during the disease progression. Such a connection fosters survival, proliferation, angiogenesis, metastatic spreading and drug-resistance of prostate cancer. Recent years have seen a profound interest in understanding the way by which prostate cancer cells communicate with the surrounding cells in the microenvironment. In this regard, direct cell-to-cell contacts and soluble factors have been identified. Increasing evidence indicates that PC cells communicate with the surrounding cells through the release of extracellular vesicles, mainly the exosomes. By directly acting in stromal or prostate cancer epithelial cells, exosomes represent a critical intercellular communication system. By querying the public database (https://pubmed.ncbi.nlm.nih.gov) for the past 10 years, we have found more than four hundred papers. Among them, we have extrapolated the most relevant about the role of exosomes in prostate cancer malignancy and progression. Emerging data concerning the use of these vesicles in diagnostic management and therapeutic guidance of PC patients are also presented. Graphical Abstract