Kovai Medical Center and Hospital

Parvovirus B19 (PVB19) is a clinically important cause of refractory anemia in kidney transplant recipients (KTRs). Data from low- and middle-income settings remain scarce despite high transplant volumes. This study evaluated the clinical spectrum, management practices, and outcomes of PVB19 infection across major transplant programs in India. We conducted a retrospective multicenter cohort study across 14 tertiary transplant centers. All KTRs with PCR-confirmed PVB19 infection and complete clinical data were included. Clinical features, bone marrow findings, immunosuppressive (IS) adjustments, intravenous immunoglobulin (IVIG) use, and patient and graft outcomes were analyzed. A total of 135 KTRs were identified. Median time to infection was 11 weeks posttransplant. Anemia was universal, not frequently accompanied by leukopenia (17.7%) or thrombocytopenia (14.8%). Bone marrow examinations (n=34) demonstrated giant proerythroblasts or pure red cell aplasia. IS reduction was implemented in all patients; most commonly, complete MMF withdrawal (61.5%). IVIG was administered to 90% (median cumulative dose 100g). Overall, 97% achieved hematologic recovery, with a median response time of 20 days. Recurrence occurred in 4.4%. At a median follow-up of 18 months, graft survival was 92.6%; graft loss (n=10) was primarily due to antibody-mediated rejection, and no deaths were attributable to PVB19. PVB19 infection represents an important consideration in the differential diagnosis of early posttransplant anemia in KTRs. Timely PCR testing and pragmatic treatment strategies can achieve favorable hematologic and graft outcomes in resource-constrained settings.

Abstract Abnormal uterine bleeding (AUB) is a common gynecological symptom experienced by approximately one-third of women at some point in their lives. There are various terminologies used to describe the symptoms of AUB, which can lead to inconsistency in interpretation. To address this, the International Federation of Gynecology and Obstetrics (FIGO) Menstrual Disorders Working Group established standardized terminology and definitions for different types of AUB in 2007. AUB can have both structural and nonstructural causes, and it is possible for more than one cause to coexist in a single patient. To categorize and evaluate the causes of AUB consistently, FIGO defined a classification system in 2011 known as the AUB system 2. This system is referred to by the acronym PALM-COEIN. “PALM” stands for the structural causes: Polyp (P), Adenomyosis (A), Leiomyoma (L), and Malignancy and hyperplasia (M). “COEIN” represents the nonstructural causes: Coagulopathy (C), Ovulatory dysfunction (O), Endometrial causes (E), Iatrogenic factors (I), and causes that are Not yet classified (N). In this article, we review the standardized definitions and terminologies used to describe the symptoms of AUB and discuss the role of imaging and approach in identifying and classifying its causes.

Although the predictors of chronic subdural hematoma (SDH) recurrence after surgical evacuation are well known, there is limited evidence available on factors affecting its recurrence after middle meningeal artery (MMA) embolization. The objective of this study was to determine the factors influencing the risk of recurrence in patients with chronic SDH undergoing MMA embolization. A prospective study was performed between September 2022 and October 2024 on patients with chronic SDH who underwent MMA embolization with or without surgical evacuation. The primary outcome was clinical recurrence of SDH within 90 days after the embolization, defined as new onset or worsening of existing neurological symptoms, associated with a residual or recurrent SDH with hyperdense contents on computed tomography (CT). The association of demographic, clinical, imaging, and angiographic parameters with SDH recurrence was analyzed. For variables that showed a significant association with recurrence, relative risks were ascertained. All statistical tests were two-sided, and a p -value of less than 0.05 was considered significant. Seventy-four patients (mean age, 67.3 ± 11 [standard deviation] years; males, 66/74 [89.2%]) with 96 SDHs were included in the study. Clinical recurrence of chronic SDH was observed in 6 patients (8.1%). Membrane enhancement on pre-embolization CT was less common in hematomas that recurred than those that did not (2/8, 25% vs. 61/88, 69.3%; p = 0.018). The absence of membrane enhancement was a significant risk factor for clinical recurrence after MMA embolization (relative risk, 5.7 [95% confidence interval, 1.2-26.8], p = 0.01). Out of the 33 SDHs with no membrane enhancement, 6 recurred (18.2%). The absence of enhancement on pre-embolization CT is a risk factor for SDH recurrence after MMA embolization. The high recurrence rate in hematomas without membrane enhancement indicates that MMA embolization may not reduce the risk of recurrence in these patients.

<title>Abstract</title> Delayed diagnosis and metastasis remain major challenges in breast cancer. While the gut microbiome's influence on tumour progression is established, the presence and role of intratumoural microbial metabolites in breast cancer and their association with metastasis remain unexplored. Paired tumour and adjacent tissues were collected from 50 breast cancer patients at baseline. Patients were followed for five years; 10 who developed distant metastasis were classified as pre-metastatic, and 10 who remained disease-free formed the non-metastatic group. Untargeted LC–MS/MS-based metabolomics was performed to profile host and microbial metabolites. Multivariate analysis and pathway enrichment were used to identify discriminatory signatures. Elevated levels of carnitine, indole, tryptophan-derived metabolites, ceramides and polyamines were observed in tumour tissues on comparison with adjacent tissues. Interestingly, these metabolites were downregulated in tumour tissues of patients who progressed for metastasis (pre-metastatic) with increase in N-methylhistamine and taurolithocholic acid sulfate, suggesting metabolic reprogramming during metastatic priming. Baseline host–microbial metabolic disruptions in breast tumours are linked to future metastasis, with metabolites like indoles, bile acids, and polyamines showing promise as early biomarkers and therapeutic targets in precision oncology.

Our study aimed to compare the outcome after middle meningeal artery (MMA) embolization with polyvinyl alcohol (PVA) particles and tris-acryl gelatin microspheres (TAGMs) in patients with chronic subdural hematoma (SDH). A retrospective and prospective observational study was performed on patients with chronic SDH who underwent MMA embolization, with or without surgical evacuation, using PVA particles (250-355 µm) or TAGMs (100-300 µm) between November 2020 and June 2024. The primary efficacy outcome was the absence of recurrence, defined as new onset or worsening of existing neurological symptoms, associated with a residual or recurrent SDH with hyperdense contents on computed tomography (CT) within 90 days. Procedure-related adverse events were noted. Ninety-six patients were included in the study (mean age, 67±11.7 (standard deviation (SD)) years; males, 86/96 (89.6%)). MMA embolization was done as an adjunct to surgery in 88/96 patients (91.7%) and as the primary treatment in 8/96 patients (8.3%). PVA particles were used in 46 patients, and TAGMs in 50 patients. The clinical recurrence rate was similar in the PVA group (3/46, 6.5%) and the TAGM group (3/50, 6%) (P>0.99). The incidence of post-procedure headache was significantly higher in the TAGM group (24/50, 48%) than in the PVA group (2/46, 4.4%) (P<0.001). The recurrence rate of chronic SDH is low after MMA embolization, irrespective of the type of particulate agent used for the embolization. The distal penetration of TAGMs does not provide an added advantage over PVA particles.

Derivatives of 2-(4-chlorophenyl)-3-substituted quinazolin-4(3H) one were designed, synthesized and characterized by spectral studies. The compounds were also investigated for their antiviral and cytotoxicity against a panel of human pathogenic viruses in four cell cultures including Hel, HeLa, Vero and MDCK cell cultures. The results indicated that new 3-(2-hydroxybenzylideneamino)-2-(4-chlorophenyl)-quinazoline-4(3H)-one (C25) was found to inhibit the replication of herpes simplex virus-1 (KOS), herpes simplex virus-2 (G), vaccinia virus and herpes simplex virus-1 TK- KOS ACVr with a selectivity index of 125, 125, 250 and 125 (is there any unit ) respectively. It was also observed that majority of the synthesized compounds showed weak or found to be inactive against Influenza AH1N1 subtype, Influenza A H3N2 subtype, Influenza B. The method described in this article allows for rapid synthesis of many compounds with potential antiviral activity.

Understanding breast cancer at a molecular level is essential for developing effective treatments due to its significant impact on women's mortality rates globally. Targeted medicines focus on specific proteins crucial to breast cancer progression, offering a promising treatment avenue. These proteins, often overexpressed or mutated in cancer cells, are vital for cell proliferation, division, and survival. Targeted drugs aim to inhibit these proteins, halting disease progression and sparing non-cancerous cells, which reduces side effects and improves patient quality of life. Key proteins in breast cancer treatment include HER2 (human epidermal growth factor receptor 2), ER (estrogen receptor), and PR (progesterone receptor). Drugs like Trastuzumab target HER2 to impede tumor growth in HER2-positive cancers, while hormone therapies targeting ER and PR improve outcomes for hormone receptor-positive cancers. Examining proteins such as EGFR, HER2/Neu, and ER reveals their roles in cancer pathways, with pathways like PI3K/Akt/mTOR (phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin) and MAPK (mitogen-activated protein kinase) being crucial targets for therapies, potentially revolutionizing breast cancer treatment.