Treatment of advanced hepatocellular carcinoma (HCC) has reached a plateau after the approval of sorafenib in 2007. Several molecularly targeted therapies have failed to show significant improvement in survival outcomes compared with sorafenib, due to flaws in the design of clinical trials or failure to understand and correct for the competing co-morbidity of liver dysfunction. Lenvatinib is a multitargeted tyrosine kinase inhibitor with potent antiangiogenic effects, and has recently been approved for differentiated thyroid cancer. Lenvatinib has shown highly promising response data in Phase I/II clinical trials in HCC, although with some concerns regarding its toxicity profile. The pivotal Phase III REFLECT trial comparing lenvatinib to sorafenib has been completed, and the results of this trial will determine whether lenvatinib represents a breakthrough in the current crisis affecting HCC drug development.
Background: The early diagnosis of neonatal sepsis, a significant cause of neonatal morbidity and mortality still remains a challenge. Red-cell Distribution Width (RDW) vary significantly in conditions associated with inflammation and infection like sepsis. The study aims to find the normal range of RDW in healthy newborns and investigate the role of RDW in the early diagnosis of neonatal sepsis.Methods: This is a prospective observational study, 50 normal and 50 sepsis neonates were considered for the study. The neonatal sepsis group consisted of neonates with (i) Positive sepsis screen with/without clinical features of neonatal sepsis and/or (ii) Blood, urine or CSF culture positive or signs of pneumonia on chest x-ray. The mean RDW and the relationship between RDW and neonatal sepsis were analysed using appropriate statistical methods in SPSS-25 software.Results: Mean RDW (%) was significantly higher in sepsis neonates (18.59±1.28) than in normal newborns (16.21±1.35). RDW had statistical significance with CRP (C-Reactive Protein) in the sepsis group. RDW had significant relationship with the diagnosis of neonatal sepsis with a p value of 0.000. An RDW cut-off level of 17.25% had 86% sensitivity, 87% specificity, and 93.5% accuracy in diagnosing neonatal sepsis.Conclusions: RDW helps as a diagnostic test in the early diagnosis of neonatal sepsis.
Staphylococcus aureus is a significant nosocomial pathogen and the development of resistance to methicillin poses a major threat to its control. This study was conducted over a three month period in a Burns Unit of a tertiary care hospital to determine the prevalance of methicillin- resistant S. aureus (MRSA) colonisation in health care workers. All health care workers were screened using swabs from the hairline, nostril, axilla, and hands. Seventeen of 34 health care workers screened were MRSA-positive; 16 people tested positive for the methicillin-sensitive strain of S. aureus, 7 of whom were also MRSA-positive at a different site. In total, over two thirds of all health care workers were colonised by S. aureus. Pus samples from patients admitted in the same unit over the three month study period were analysed and showed that 21% of patients were infected or colonised with MRSA. Although a direct causal relationship is not established by these data, it is reasonable to assume that transmission from colonised health care workers is responsible, at least in part, for the extent of infection/colonisation among patients. These findings identify the need for a well defined policy for screening health care workers and controlling the rates of colonisation with potentially dangerous pathogens given the risk of transmission to susceptible patients.
A 5-year-old female child presented with easy fatiguability, fever and chest pain of 2 months' duration, prior to which she was asymptomatic. This rare way of presentation of the child made us document the data. The child was immunised for age. She was active, alert and had attained developmental milestones for her age. On systemic examination, shape of the chest appeared normal with no precordial bulging. On palpation, Apex beat was palpable at left 5 th intercostal space at the midclavicular line. There was no evidence of parasternal heave and thrill on examination. First and second heart sounds were heard in all the four cardiac areas and were of normal intensity. Ejection systolic murmur was heard in the 2 nd left intercostal space. Echocardiography revealed dilated, well-circumscribed, homogeneous mass attached to the right ventricular outflow tract causing mild obstruction. Cardiac fibroma, also known as Fibrous hamartoma is a rare primary tumour encountered in infants and children without gender predilection. Fibromas are solitary tumours that are derived from fibroblasts and connective tissue with a matrix containing collagen, located mainly in the ventricular septum. [1] Macroscopically, they present as rounded, white fibrous masses whorled on cut surface. The margin may be either circumscribed or infiltrative. Histologically, fibromas are composed of bland appearing spindle shaped cells arranged in loose intersecting fascicles, which may extend into the surrounding myocardium. A 5-year-old child was referred to the tertiary care hospital, presented with chest pain of 2 months' duration. Echocardiography revealed dilated, homogeneous, well-circumscribed mass attached to the right ventricle with mild right ventricular outflow obstruction. Diagnosis of cardiac fibroma requires a high index of suspicion and correlation with physical and echocardiographic findings. Following surgical excision and histopathological confirmation, the prognosis was excellent.
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