A simple, sensitive and high throughput ultra performance liquid chromatography tandem mass spectrometry method has been developed for the determination of mycophenolic acid in human plasma. The method involved simple protein precipitation of MPA along with its deuterated analog as an internal standard (IS) from 50 mL of human plasma. The chromatographic analysis was done on Acquity UPLC C18 (100mm*2.1mm,1.7mm) column under isocratic conditions using acetonitrile and 10 mM ammonium formate, pH 3.00 (75:25, v/v) as the mobile phase. A triple quadrupole mass spectrometer operating in the positive ionization mode was used for quantitation. In-source conversion of mycophenolic glucuronide metabolite to the parent drug was selectively controlled by suitable optimization of cone voltage, cone gas flow and desolvation temperature. The method was validated over a wide concentration range of 15–15000 ng/mL. The mean extraction recovery for the analyte and IS was 495%. Matrix effect expressed as matrix factors ranged from 0.97 to 1.02. The method was successfully applied to support a bioequivalence study of 500 mg mycophenolate mofetil tablet in 72 healthy subjects.

Esthesioneuroblastoma (ENB) is a slow growing malignant tumour of olfactory neuro-epithelium that is locally aggressive with a tendency to recur years later.Infrequently, it can be associated with paraneoplastic syndrome. Here, we a report a pediatric case of ENB in whom syndrome of inappropriate ADH secretion (SIADH) was detected during ongoing primary treatment which reflected disease progression after initial response to chemotherapy, that was substantiated radiologically. SIADH has been reported in only a few cases of ENB.

Esthesioneuroblastoma (ENB) is a slow growing malignant tumour of olfactory neuro-epithelium that is locally aggressive with a tendency to recur years later.Infrequently, it can be associated with paraneoplastic syndrome. Here, we a report a pediatric case of ENB in whom syndrome of inappropriate ADH secretion (SIADH) was detected during ongoing primary treatment which reflected disease progression after initial response to chemotherapy, that was substantiated radiologically. SIADH has been reported in only a few cases of ENB.

Esthesioneuroblastoma (ENB) is a slow growing malignant tumour of olfactory neuro-epithelium that is locally aggressive with a tendency to recur years later.Infrequently, it can be associated with paraneoplastic syndrome. Here, we a report a pediatric case of ENB in whom syndrome of inappropriate ADH secretion (SIADH) was detected during ongoing primary treatment which reflected disease progression after initial response to chemotherapy, that was substantiated radiologically. SIADH has been reported in only a few cases of ENB.

Esthesioneuroblastoma (ENB) is a slow growing malignant tumour of olfactory neuro-epithelium that is locally aggressive with a tendency to recur years later.Infrequently, it can be associated with paraneoplastic syndrome. Here, we a report a pediatric case of ENB in whom syndrome of inappropriate ADH secretion (SIADH) was detected during ongoing primary treatment which reflected disease progression after initial response to chemotherapy, that was substantiated radiologically. SIADH has been reported in only a few cases of ENB.

BACKGROUND: Hip fractures are a significant cause of morbidity and mortality in the elderly. Fast-track multidisciplinary co-management of these patients, rapid preoperative optimization, early surgery, and expeditious rehabilitation may minimize morbidity and mortality. In this study, we evaluated outcomes of fixation of hip fractures in the elderly patients managed by Geriatric Hip Fracture Program at a military hospital in India. METHODS: A total of 114 patients above 60 years of age with hip fractures were enrolled. They were comanaged by a team of specialists and fast-tracked to surgery. Independent ambulation with support of a walker was achieved before discharge to home. Patients were followed up for 1 year. RESULTS: The average age of the 114 patients was 77 years; 24 patients were octogenarian. Eighty-four percent of injuries were due to a domestic fall. Hypertension (41%) and diabetes (22%) were the most common comorbidities. All patients were optimized before surgery. The average delay from injury to admission was 1.7 days (range, 0 to 14 days) and that from admission to surgery was 1.8 days (range, 0 to 19 days). Hence, the average time from injury to surgery was 3.5 days. The length of stay in hospital was, as per rehabilitative milestones achieved, 2 to 5 days in 40% of the patients and 6 to 15 days in 60% of the patients. At 1 year after surgery, 95 patients were independently ambulant (56 patients with support and 39 patients without support). Twenty-three percent of the patients had postoperative complications and eight patients died (7.7%) at 1-year follow-up; 11 patients were lost to follow-up. CONCLUSIONS: Elderly hip fracture has a high risk of mortality (14%–58%). Thus, expeditious surgery within 24 hours of admission has been advocated in the Western literature to minimize mortality. Mortality rate at 1 year after surgery remains at 10% to 24%. In our study, even with aggressive co-management, the average delay to hip fracture fixation was more than 3 days; however, the 1-year mortality was relatively low (7.7%). This indicates the importance of preoperative optimization and postoperative rehabilitation for independent ambulation and mortality reduction in the elderly population.
Aged ; Aged, 80 and over ; Comorbidity ; Follow-Up Studies ; Fracture Fixation ; Hip Fractures ; Hip ; Hospitals, Military ; Humans ; Hypertension ; India ; Length of Stay ; Lost to Follow-Up ; Mortality ; Postoperative Complications ; Rehabilitation ; Specialization ; Veterans ; Walkers ; Walking

OBJECTIVES: We evaluated and recorded post-traumatic and postoperative neurosensory deficits of the inferior alveolar nerve (IAN) in mandibular fracture in order to identify associated risk factors. MATERIALS AND METHODS: This was a prospective cohort study composed of 60 patients treated for mandibular fracture. The primary study variable was the change between the post-traumatic IAN neurosensory examination score and the score after fracture reduction. Risk factors were categorized as demographic, anatomic, fracture displacement, and treatment. Appropriate descriptive and bivariate statistics were computed. RESULTS: Sixty patients with unilateral mandibular fracture reported within 24 hours of injury were evaluated over a one-year period. A post-traumatic neurosensory deficit was observed in 52 patients (86.7%), the percentage of which was reduced to 23.3% over the follow-up period. Abnormal postoperative neurosensory scores were significantly higher in angle fracture cases (33.3%) compared to body fracture cases (11.1%). When recovered and non-recovered neurosensory scores were compared by fracture location, 88.9% of body fracture cases showed significant recovery compared to 66.7% of mandibular angle fracture cases. Cases with less than 5 mm fracture displacement showed statistically significantly higher neurosensory recovery scores (90.6%) compared to those with more than 5 mm fracture displacement (60.7%). CONCLUSION: Use of a miniplate with mono-cortical screws does not play a role in increasing IAN post-traumatic neurosensory deficit. Early management can reduce the chances of permanent neurosensory deficit. Mandibular fracture displacement of 5 mm or more and fracture location were found to be associated with an increased risk of post-traumatic IAN neurosensory score worsening.
Cohort Studies ; Follow-Up Studies ; Humans ; Mandibular Fractures* ; Mandibular Nerve* ; Prospective Studies* ; Risk Factors

Purpose: Incidental gallbladder carcinoma (IGBC) is diagnosed in post-cholecystectomy specimens for benign indications, where the role of 2-fluro-2-deoxyglucose positron emission tomography/computed tomography(FDG-PET/CT) is not clearly defined. The present study aimed to assess the benefits of staging and prognosticating with FDG-PET/CT in IGBC. Materials and Methods: A retrospective observational study from a tertiary-care center from January 2010 to July 2020 was performed. The demographic, clinical, histopathological, and treatment-related histories were collected. FDG-PET/CT-image findings were compared with survival outcomes through telephonic follow-up. The chi-square test was used for comparing frequencies. The univariate and multivariate survival estimates were analyzed using the Kaplan–Meier analysis and the Cox-proportional hazard model, respectively. Log-rank test was used to compare the Kaplan–Meier curves. Results: The study included 280 postcholecystectomy participants (mean age: 52 ± 11 years; women: 227) of whom 52.1% had open surgery(146/280). Residual disease in the gallbladder fossa (54.8% vs. 36.6%, p = 0.002) and liver infiltration (32.9% vs. 22.4%, p = 0.05) were seen more frequently in open surgery compared to laparoscopic surgery, while anterior abdominal wall deposits were more common in laparoscopy(35.1% vs. 24%,p = 0.041). FDG-PET/CT changed the management in 10% (n = 28) of patients compared to contrast-enhanced CT. The median survival was 14 months (95%CI-10.3–17.7). A higher stage of the disease on the FDG-PET/CT (loco-regional disease-HR 4.86, p = 0.006; metastatic disease-HR 7.53, p < 0.001) and the presence of liver infiltration (HR-1.92, p = 0.003) were independent predictors of poor survival outcomes. Conclusion FDG-PET/CT detects residual and metastatic disease in patients with IGBC, enabling the institution of appropriate management and acting as a tool for prognostication of survival.