Publications by authors named "Rajeev Kumar"

686 Publications

Secretory carcinoma of salivary gland origin: A recently established masquerader.

Indian J Cancer 2021 Apr-Jun;58(2):278-284

Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.

Secretory carcinoma (SC) of the salivary gland is considered to be a low-intermediate grade tumor with the potential of locally aggressive behavior. This tumor is similar both genetically (ETV6-NTRK3 fusion) and histologically to secretory carcinoma of the breast. We intent to share our experience of four cases of SC in terms of clinical behavior, pathological features, and treatment outcome. Medical records of four cases of SC were retrieved and analyzed for clinical presentation, surgical treatment, and outcome. Pathological data was reanalyzed along with immunohistochemistry. Out of the four identified SC cases, three were men. Two lesions originated from the parotid gland and two from minor salivary glands. Two of these cases exhibited features of locally aggressive pattern. SC of salivary gland origin has distinct histological and immunohistochemical features apart from the characteristic genetic translocation and fusion. Surgery with or without adjuvant radiotherapy is the treatment of choice. To establish the biological behavior of this tumor, larger case series with long-term follow-up is desirable.
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http://dx.doi.org/10.4103/ijc.IJC_274_20DOI Listing
June 2021

Neoadjuvant chemotherapy for locoregionally advanced squamous cell carcinoma of the paranasal sinuses-Is it worthwhile?

Cancer 2021 Jun 3. Epub 2021 Jun 3.

Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1002/cncr.33674DOI Listing
June 2021

Assessment of the Impact of Tardive Dyskinesia in Clinical Practice: Consensus Panel Recommendations.

Neuropsychiatr Dis Treat 2021 24;17:1589-1597. Epub 2021 May 24.

Rocky Mountain Movement Disorders Center, Englewood, CO, USA.

Purpose: Tardive dyskinesia (TD) is a hyperkinetic movement disorder in which patients experience abnormal involuntary movements that can have profound negative impacts on physical, cognitive, and psychosocial functioning. Use of measures to assess the functional impact of TD in routine clinical practice is lacking. To address this gap, an advisory panel of experts in psychiatry and movement disorder neurology was convened to develop consensus recommendations on assessment of the impact of TD on patients' functioning that can be used in clinical practice.

Methods: An advisory panel provided recommendations using an iterative process, beginning with a narrative literature review regarding current practices for assessing the impact of TD in clinical settings. A detailed summary was generated, and the advisory panel provided comments about the content and answered questions about assessing TD impact in clinical practice. The panelists' responses were discussed during a virtual meeting held on August 28, 2020. A second meeting on September 25, 2020, focused on developing and refining recommendations for assessment of the impact of TD in clinical practice. At the conclusion of the second meeting, general consensus was reached on all recommendation statements.

Results: As part of routine clinical practice, it is imperative to assess the impact of TD on the patient's life to help guide treatment decisions. Key domains for assessing the overall impact of TD include social, physical, vocational, and psychological functioning and the impact of TD on the underlying psychiatric disorder. Assessment of TD impact should be performed at every patient visit. Impact assessments should include consultation with patients, caregivers, and family members. Shared decision-making to initiate TD treatment should consider impact.

Conclusion: The impact of TD should be assessed routinely, including the key domains of social, physical, vocational, and psychological functioning and the impact of TD on the underlying psychiatric disorder.
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http://dx.doi.org/10.2147/NDT.S310605DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164384PMC
May 2021

Sinonasal polyposis complicated with extradural abscess and lateral rectus palsy.

BMJ Case Rep 2021 May 26;14(5). Epub 2021 May 26.

ENT & Head and neck surgery, All India Institute of Medical Sciences, New Delhi, India.

Sinogenic intracranial and orbital complications are infrequent complications of chronic rhinosinusitis with nasal polyposis (CRSwNP), leading to potentially fatal intracranial and orbital sequelae. The mortality and morbidity associated with these complications remain high despite the widespread use of antibiotics. We report a patient with CRSwNP presenting with acute onset extradural empyema and sixth nerve palsy in whom the diagnosis was delayed, necessitating early surgical intervention. Our case shows that delay in management and underdiagnosis of sinusitis with nasal polyposis can lead to devastating complications. A high index of suspicion, early recognition of the clinical findings and radiological evaluation with contrast-enhanced CT of paranasal sinuses, orbit and brain are essential to rule out fatal complications associated with CRSwNP. Timely endoscopic intervention and the use of antibiotics can lead to good outcomes, even in complicated cases.
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http://dx.doi.org/10.1136/bcr-2021-242667DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160177PMC
May 2021

Ensuring data integrity of healthcare information in the era of digital health.

Healthc Technol Lett 2021 Jun 16;8(3):66-77. Epub 2021 Apr 16.

Department of Information Technology Babasaheb Bhimrao Ambedkar University Lucknow Uttar Pradesh India.

Data integrity continues to be a persistent problem in the current healthcare sector. It ensures that the data is correct and has not even in any manner been improperly changed. Incorrect data might become significant health threats for patients and a big responsibility for clinicians, resulting in problems such as scam, misconduct, inadequate treatment and data theft. This sort of endangering scenario causes tremendous difficulty in handling healthcare data. This research intends to describe the threat plot of data integrity in healthcare through numerous attack statistics from around the world and Saudi Arabia and identify the criticality in Saudi Arabia in particular. A literature review by descriptive analysis, unit analysis and rating analysis to achieve the planned systematic literature review goal is outlined. The outcome of ranking analysis using a fuzzy analytical hierarchy process methodology offers a route for Saudi Arabian researchers to promote medical records or data security in Arabic healthcare. It is suggested that blockchain is the most prioritized method for regular use and adaptation across Saudi Arabia in all data integrity management techniques. To address the challenges of data integrity and future path, the authors critically examine the challenges posed by data integrity in the healthcare sector.
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http://dx.doi.org/10.1049/htl2.12008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136763PMC
June 2021

Tracheo-bronchial recurrent respiratory papillomatosis: role of powered instruments in overcoming surgical challenges.

Acta Otorhinolaryngol Ital 2021 Apr;41(2):146-150

Department of Otorhinolaryngology, AIIMS, New Delhi, India.

Objective: Respiratory papillomatosis involving the trachea is a challenging problem. In this paper, we present our experience in the management of 13 cases of tracheal papillomatosis and the difficulties encountered in the procedure. The surgical technique and results are discussed.

Methods: A modified transoral trans-stomal approach was employed for the removal of papillomas by using microdebrider. All patients were operated on under general anaesthesia with intermittent removal of intubation tube and apnoea. All patients required repeated surgeries. Tracheostomy removal was considered after adequate surgery and recurrence-free interval. The follow-up period was 12-24 months.

Results: The total number of surgeries per patient ranged from 3-35 (mean 10). Decannulation could be successfully achieved in 9 patients. There were no procedure-related complications.

Conclusions: Transoral trans-stomal microdebrider assisted excision of tracheal papilloma showed excellent results without procedure-related complications. It can be used as a routine procedure for tracheal papillomas. The prognosis of tracheal involvement is fair and most patients can be decannulated.
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http://dx.doi.org/10.14639/0392-100X-N0822DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142726PMC
April 2021

TIGIT and PD-1 Immune Checkpoint Pathways Are Associated With Patient Outcome and Anti-Tumor Immunity in Glioblastoma.

Front Immunol 2021 7;12:637146. Epub 2021 May 7.

Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States.

Glioblastoma (GBM) remains an aggressive brain tumor with a high rate of mortality. Immune checkpoint (IC) molecules are expressed on tumor infiltrating lymphocytes (TILs) and promote T cell exhaustion upon binding to IC ligands expressed by the tumor cells. Interfering with IC pathways with immunotherapy has promoted reactivation of anti-tumor immunity and led to success in several malignancies. However, IC inhibitors have achieved limited success in GBM patients, suggesting that other checkpoint molecules may be involved with suppressing TIL responses. Numerous IC pathways have been described, with current testing of inhibitors underway in multiple clinical trials. Identification of the most promising checkpoint pathways may be useful to guide the future trials for GBM. Here, we analyzed the The Cancer Genome Atlas (TCGA) transcriptomic database and identified PD1 and TIGIT as top putative targets for GBM immunotherapy. Additionally, dual blockade of PD1 and TIGIT improved survival and augmented CD8 TIL accumulation and functions in a murine GBM model compared with either single agent alone. Furthermore, we demonstrated that this combination immunotherapy affected granulocytic/polymorphonuclear (PMN) myeloid derived suppressor cells (MDSCs) but not monocytic (Mo) MDSCs in in our murine gliomas. Importantly, we showed that suppressive myeloid cells express PD1, PD-L1, and TIGIT-ligands in human GBM tissue, and demonstrated that antigen specific T cell proliferation that is inhibited by immunosuppressive myeloid cells can be restored by TIGIT/PD1 blockade. Our data provide new insights into mechanisms of GBM αPD1/αTIGIT immunotherapy.
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http://dx.doi.org/10.3389/fimmu.2021.637146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137816PMC
May 2021

An intelligent Hybrid Wind-PV farm as a static compensator for overall stability and control of multimachine power system.

ISA Trans 2021 May 17. Epub 2021 May 17.

Electrical and Electronics Engineering Department, Krishna Institute of Engineering and Technology, Ghaziabad, India.

The paper demonstrates the potential of a hybrid Wind-PV farm as STATCOM (Static Synchronous Compensator) for damping and control of overall chaotic oscillations in a two-area power system. Kundur's modified system associated with a hybrid Wind-PV farm is simulated in MATLAB to demonstrate the detailed performance assessment of the hybrid farm. A unique controller is deployed to regulate the AC and DC currents of the STATCOM using two PI controllers. A swarm-based hybrid metaheuristic optimizer PSO-BFOA optimally tunes and controls the PI controller parameters. The system is compensated to an optimum level of 85% and exposed to a 3-phase fault. Zero dampings are accompanied by additional disturbances of a 20% change in electric torque and the reference voltage. The disturbances are made to model the worst conditions to examine the rigorous performance of the hybrid Wind-PV​ farm in alleviating the overall chaotic oscillations. The simulation results for the performance assessment in different cases, i.e., without control, with Wind-STATCOM, with PV-STATCOM, and with the hybrid Wind-PV-STATCOM, reveal the potential of the hybrid Wind-PV Farm as STATCOM in alleviating the overall chaotic oscillations.
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http://dx.doi.org/10.1016/j.isatra.2021.05.014DOI Listing
May 2021

A Prospective Randomised Study to Assess the Analgesic Efficacy of Serratus Anterior Plane (SAP) Block for Modified Radical Mastectomy Under General Anaesthesia.

Turk J Anaesthesiol Reanim 2021 Apr 30;49(2):124-129. Epub 2020 Nov 30.

Department of Onco-Anaesthesiology and Palliative Medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.

Objective: Breast cancer is the most common malignancy among women and often requires surgery for the removal of the tumour. Uncontrolled pain after breast surgeries is a common problem. Serratus anterior plane (SAP) block is a recently designed technique to block the lateral cutaneous branches of the ventral rami of thoracic intercostal nerves and may cover the area of surgical dissection for modified radical mastectomy (MRM). The primary objective of this study was to evaluate the effect of SAP block on the time to first rescue analgesic in the post-operative period in patients undergoing MRM.

Methods: A randomised, single-blind, parallel group trial was conducted in a single teaching hospital. A total of 100 patients undergoing MRM were randomised in a 1:1 ratio into 2 groups: MRM under general anaesthesia (GA) alone (group G, n=50) or GA with SAP block (group S, n=50). Blocks were performed under ultrasound guidance at the level of the 5 rib in the midaxillary line with 0.4 mL kg of 0.375% ropivacaine.

Results: The time to request of first rescue analgesia was significantly prolonged in group S compared with group G (p=0.008). Median (interquartile range) for time to rescue analgesia in group S was 120 (60-300) min, whereas in group G, it was 60 (15-120) min. Post-operative pain scores and the number of patients requiring intra-operative additional fentanyl were significantly less in group S. No technique-related adverse events were observed.

Conclusion: SAP block improved perioperative analgesia in patients undergoing MRM.

Clinical Trial Registry Number: CTRI/2017/11/010424. (http://ctri.nic.in/Clinicaltrials/regtrial.php?modid=1&compid=19&EncHid=45912.14862).
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http://dx.doi.org/10.5152/TJAR.2020.13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8098724PMC
April 2021

CanAssist Breast Impacting Clinical Treatment Decisions in Early-Stage HR+ Breast Cancer Patients: Indian Scenario.

Indian J Surg Oncol 2021 Apr 9;12(Suppl 1):21-29. Epub 2019 Dec 9.

OncoStem Diagnostics Private Limited, 4, Raja Ram Mohan Roy Road, Aanand Towers, 2nd Floor, Bangalore, Karnataka 560027 India.

CanAssist Breast (CAB) has thus far been validated on a retrospective cohort of 1123 patients who are mostly Indians. Distant metastasis-free survival (DMFS) of more than 95% was observed with significant separation ( < 0.0001) between low-risk and high-risk groups. In this study, we demonstrate the usefulness of CAB in guiding physicians to assess risk of cancer recurrence and to make informed treatment decisions for patients. Of more than 500 patients who have undergone CAB test, detailed analysis of 455 patients who were treated based on CAB-based risk predictions by more than 140 doctors across India is presented here. Majority of patients tested had node negative, T2, and grade 2 disease. Age and luminal subtypes did not affect the performance of CAB. On comparison with Adjuvant! Online (AOL), CAB categorized twice the number of patients into low risk indicating potential of overtreatment by AOL-based risk categorization. We assessed the impact of CAB testing on treatment decisions for 254 patients and observed that 92% low-risk patients were not given chemotherapy. Overall, we observed that 88% patients were either given or not given chemotherapy based on whether they were stratified as high risk or low risk for distant recurrence respectively. Based on these results, we conclude that CAB has been accepted by physicians to make treatment planning and provides a cost-effective alternative to other similar multigene prognostic tests currently available.
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http://dx.doi.org/10.1007/s13193-019-01014-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8119549PMC
April 2021

Prospective Analysis of the Chronology of Smell and Taste Dysfunction in COVID-19 Positive ENT Doctors.

Indian J Otolaryngol Head Neck Surg 2021 Apr 23:1-6. Epub 2021 Apr 23.

Department of Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India.

Olfactory and gustatory dysfunction has been reported as an early presentation in COVID-19. We intent to analyze the chronological outline of these chemosensory disturbances in term of onset, progression and resolution in ENT doctors with COVID-19. In six symptomatic otolaryngologists who tested positive for SARS-CoV-2, detailed symptomatology of olfactory and gustatory dysfunction was collected prospectively on regular basis till a period of at least three months. Due to their awareness, sensitivity and reliability, even mild and transient relevant symptomatology could be recorded accurately. Olfactory and gustatory dysfunction was universally present in all the six otolaryngologists. The onset of the symptoms was in first week and resolved completely within 4 weeks in four of them. In two doctors the recovery of olfactory dysfunction to near normal level was delayed and prolonged over 2 and 3 months. The pattern of involvement of basic tastes like sweet, salt, sour and bitter as well as food temperature and texture etc. pointed towards involvement of the gustatory mucosa with non-uniform involvement of the papilla and taste receptors. One of the doctors also experienced reappearance of parosmia and phantosmia in the 3rd month following complete disease resolution. Due to their expertise in the field of Otolaryngology, the recruited doctors represented the precise pattern of progression and resolution of olfactory and gustatory dysfunction in COVID-19. Larger studies are needed to validate our reported universal presence of these symptoms with complete recovery rate following disease resolution.
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http://dx.doi.org/10.1007/s12070-021-02551-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063168PMC
April 2021

6 "I" for endoscopic surgical management of early glottic squamous cell carcinomas.

Oral Oncol 2021 Apr 22:105308. Epub 2021 Apr 22.

Department of Neuroanaesthesia and Critical Care, Medanta-The Medicity, Gurugram 122001, Harayana, India.

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http://dx.doi.org/10.1016/j.oraloncology.2021.105308DOI Listing
April 2021

Intraoral ultrasonography A high precision route map for achieving "clear" margins in squamous carcinomas of oral tongue!

Oral Oncol 2021 Apr 18:105299. Epub 2021 Apr 18.

Department of Otorhinolaryngology and Head-Neck Surgery, Teaching Block, All India Institute Of Medical Sciences (AIIMS), New Delhi 110029, India.

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http://dx.doi.org/10.1016/j.oraloncology.2021.105299DOI Listing
April 2021

Robotic assistance helps low-volume surgeons deliver better outcomes to their patients.

Indian J Urol 2021 Jan-Mar;37(1):1-3

Department of Urology, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/iju.IJU_216_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8033219PMC
April 2021

Do ipsilateral lateralized squamous cell carcinomas of oral tongue with a depth of invasion (DOI) greater than 10 mm warrant a bilateral neck dissection to prevent future regional recurrences on contralateral side? A continuing conundrum.

Oral Oncol 2021 Apr 7:105285. Epub 2021 Apr 7.

Department of Otorhinolaryngology and Head-Neck Surgery, Teaching Block, All India Institute Of Medical Sciences (AIIMS), New Delhi 110029, India. Electronic address:

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http://dx.doi.org/10.1016/j.oraloncology.2021.105285DOI Listing
April 2021

Adsorptive removal of eriochrome black T (EBT) dye by using surface active low cost zinc oxide nanoparticles: A comparative overview.

Chemosphere 2021 Sep 1;278:130366. Epub 2021 Apr 1.

Department of Chemistry and Centre of Advanced Studies in Chemistry, Panjab University, Chandigarh, 160014, India. Electronic address:

The ecological toxicity imparted by non-biodegradable organic dyes has been considered as a major risk to handle in front of mankind. In this view, the low-cost zinc oxide nanoparticles (ZnO-NPs) were facially synthesized by coating the surface with surfactant (CTAB) and ionic liquid (BMTF) molecules for the effective removal of Eriochrome Black T (EBT) from aqueous media. Various advanced characterization techniques have given insight into the morphological features, crystalline structure and physio-chemical properties of as-synthesized ZnO-NPs. The systematic analysis of the adsorption isotherms and kinetics models specifies that the adsorption of EBT follow Freundlich model and pseudo-second-order kinetics. The intraparticle diffusion model displayed a linear relationship (R = 0.98, 0.97 and 0.94 for [email protected], [email protected] and bare ZnO-NPs), which shows that pore diffusion rate is affected by surface modification and effects the overall EBT adsorption process. Furthermore, after the removal of 87% and 84% of EBT dye by [email protected] and [email protected], the fabricated nanoadsorbents of ZnO were successfully regenerated and reused after the treatments up to four times. The adsorption aptitude of ZnO-NPs towards EBT dye was systematically explored in real wastewater samples and interference study of inorganic metallic salts was also performed. The toxicity estimations of the treated dye solutions were made using floral and fungal activities, to ascertain their non-toxic nature before releasing into the environment. These outcomes have supported the immense potential of ZnO-NPs towards the removal of EBT in a cost effective manner.
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http://dx.doi.org/10.1016/j.chemosphere.2021.130366DOI Listing
September 2021

Contemporary Outcomes of Open Radical Cystectomy: a 5-Year Experience from a Tertiary Care Center.

Indian J Surg Oncol 2021 Mar 8;12(1):86-93. Epub 2021 Jan 8.

Department of Urology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India.

To evaluate the perioperative outcomes of patients undergoing open radical cystectomy for carcinoma bladder in a tertiary care center. A retrospective analysis of a prospectively maintained database of all patients undergoing open radical cystectomy with a urinary diversion from July 2014 to August 2019 was done. A total of 195 patients were included. A total of 172 patients (88.2%) underwent radical cystectomy with ileal or sigmoid conduit, 6 patients underwent orthotopic neobladder, and 17 patients underwent cutaneous ureterostomy. The mean American Society of Anaesthesiology (ASA) score was 1.4. On preoperative histopathology, 125 patients had the muscle-invasive disease. The mean operative time (± SD) was 303.6 ± 53.4 min and the operative time was significantly longer for neobladder ( = 0.033). The mean blood loss (± SD) was 977.5 ± 346.5 ml. Among the complications, a total of 350 events occurred in 96 patients (49.3%). Thirty-nine patients (20%) suffered grade I complications, 12 patients (6.2%) suffered grade II complications, 26 patients (13.3%) suffered grade III complications, and 9 patients (4.6%) suffered grade IV complications. Grade III, IV, and V complications were considered major complications and 46 patients (23.5%) had major complications. Among the grade III complications, the majority included fascial dehiscence (burst abdomen), i.e., 13.3%, and uretero-ileal leak, i.e., 2.6%. The overall 30-day mortality rate was 5.2% (10/195). On multivariate analysis, the presence of diabetes mellitus ( = 0.047), operative time ( = 0.003), and low preoperative albumin ( = 0.009) were significant predictors for major preoperative complications. Diabetes mellitus, serum albumin, and operative time are significant predictors of postoperative complications. The ASA score, low preoperative hemoglobin, and blood loss are significant predictors of perioperative mortality. Though radical cystectomy has been associated with significant perioperative morbidity and mortality, the advancements in surgical techniques and intensive care tools have led to a significant decrease in morbidity and mortality in the contemporary era.
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http://dx.doi.org/10.1007/s13193-020-01226-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7960850PMC
March 2021

Oral Cancer in the Indian Subcontinent-Survival Outcomes and Risk Factors with Primary Surgery.

Laryngoscope 2021 Apr 1. Epub 2021 Apr 1.

Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India.

Objective: To assess the oncological outcome and prognostic factors for primary Oral Squamous Cell Cancer (OSCC) staged as per AJCC 8th pTNM, and treated by the contemporary standard of primary surgery and pathology directed adjuvant radiation-chemoradiation.

Methods: A single institution cohort from a tertiary care academic institution in North India. Case inclusion 2013 to 2016; n = 218, median follow-up 35 months. All patients were restaged as per the AJCC 8th pTNM classification. Analysis for Overall Survival (OS), Disease-free Survival(DFS), and factors impacting outcome (Cox proportionate model Multivariate analysis).

Results: AJCC pTNM 7th to 8th edition conversion led to upstaging in 16.5%. Stage-II demonstrated greatest stage migration and apparent improvement in OS and DFS (P < .09). Discordance was noted between the presurgical (clinico-radiologic) and postsurgical (pathological) nodal status in 40.3% (88/218; 54 pathologically upstaged;34 downstaged). Pathological downstaging was particularly significant with advanced stage Gingivo-Buccal Cancers (25/73-34.7%). Stage-I-II early cancers had 3 years. OS-86.7% and DFS-78.8%; Stage-III-IV advanced cancers had 3 years. OS-56.7% and DFS-46.6%. Multivariate analysis identified poorer OS and DFS for age < 40 years (HR-1.8; 2.0), skin involvement (HR-2.1; 2.6) and pN+ status (HR-2.4; 3.5). Bone involvement did not compromise survival in this surgically treated set of patients.

Conclusion: Age < 45 is newly identified as significantly compromising DFS and OS in Oral Cancer. Established factors of skin involvement and pN+ are confirmed as impacting DFS-OS. An apparent improvement in survival in Stage II Cancers is noted as consequent to adoption of AJCC 8th edition staging.

Level Of Evidence: II (OCEBM 2011-Inception Cohort Study for Prognosis) Laryngoscope, 2021.
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http://dx.doi.org/10.1002/lary.29537DOI Listing
April 2021

THF co-solvent pretreatment prevents lignin redeposition from interfering with enzymes yielding prolonged cellulase activity.

Biotechnol Biofuels 2021 Mar 9;14(1):63. Epub 2021 Mar 9.

Department of Chemical and Environmental Engineering, Bourns College of Engineering, University of California, Riverside, 900 University Ave, Riverside, CA, 92521, USA.

Background: Conventional aqueous dilute sulfuric acid (DSA) pretreatment of lignocellulosic biomass facilitates hemicellulose solubilization and can improve subsequent enzymatic digestibility of cellulose to fermentable glucose. However, much of the lignin after DSA pretreatment either remains intact within the cell wall or readily redeposits back onto the biomass surface. This redeposited lignin has been shown to reduce enzyme activity and contribute to rapid enzyme deactivation, thus, necessitating significantly higher enzyme loadings than deemed economical for biofuel production from biomass.

Results: In this study, we demonstrate how detrimental lignin redeposition on biomass surface after pretreatment can be prevented by employing Co-solvent Enhanced Lignocellulosic Fractionation (CELF) pretreatment that uses THF-water co-solvents with dilute sulfuric acid to solubilize lignin and overcome limitations of DSA pretreatment. We first find that enzymatic hydrolysis of CELF-pretreated switchgrass can sustain a high enzyme activity over incubation periods as long as 5 weeks with enzyme doses as low as 2 mg protein/g glucan to achieve 90% yield to glucose. A modified Ninhydrin-based protein assay revealed that the free-enzyme concentration in the hydrolysate liquor, related to enzyme activity, remained unchanged over long hydrolysis times. DSA-pretreated switchgrass, by contrast, had a 40% drop in free enzymes in solution during incubation, providing evidence of enzyme deactivation. Furthermore, measurements of enzyme adsorption per gram of lignin suggested that CELF prevented lignin redeposition onto the biomass surface, and the little lignin left in the solids was mostly integral to the original lignin-carbohydrate complex (LCC). Scanning electron micrographs and NMR characterization of lignin supported this observation.

Conclusions: Enzymatic hydrolysis of solids from CELF pretreatment of switchgrass at low enzyme loadings was sustained for considerably longer times and reached higher conversions than for DSA solids. Analysis of solids following pretreatment and enzymatic hydrolysis showed that prolonged cellulase activity could be attributed to the limited lignin redeposition on the biomass surface making more enzymes available for hydrolysis of more accessible glucan.
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http://dx.doi.org/10.1186/s13068-021-01904-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944909PMC
March 2021

Multi-biological combined system: A mechanistic approach for removal of multiple heavy metals.

Chemosphere 2021 Aug 20;276:130018. Epub 2021 Feb 20.

Department of Chemistry, Faculty of Science and Arts and Promising Centre for Sensors and Electronic Devices (PCSED), Najran University, Najran, 11001, Saudi Arabia. Electronic address:

In this work, interactions of diverse fungal species by the manipulation of cell concentrations has been utilized as the driving feature for the removal of hazardous multi-metals from the aqueous solutions. This study is focused on the exploitation of internal structures of microbes as a repository of lead (Pb(II)) and nickel (Ni(II)). For the concerned purpose 24 heavy metal resistant fungi are isolated from different industrial waste sites to form different microbial combinations as a single unit 'consortia' for achieving highest possible removal rates. Polymerase chain reaction and DNA sequencing are involved for the biochemical characterization and phylogenetic analysis of the screened isolates. The identification and screening studies reveal isolated strains as two Pb resistant fungi viz. KSF-Pb15 (Aspergillus terreus) and SEF-Pb (Talaromyces islandicus) which have shown metal removal up to 93% and two Ni(II) tolerant fungal isolates namely, MEF-Ni-11 (Neurospora crassa) and Ni-1 (Aspergillus flavus) with removal efficiency of more than 91%. Relationship has been validated between the biosorption capacity and efficiency of the novel consortium under the influence of variable pH, time duration, initial concentration of Pb(II) and Ni(II), and inoculum size which has led to the foundation of effective and economical parameters for its exploitation in practical fields. The fungal consortia when applied on various industrial effluents has exhibited more than 95% of removal for both Pb(II) and Ni(II) simultaneously. The detailed mechanistic insight has shown the involvement of physical, chemical and ionic forces for the removal of heavy metals. So the designed novel multi-biological combined system acted as a repository for Pb(II) and Ni(II) ions with a greater potential which can be guided by the mechanistic methodology for the retrieval and remediation of multiple heavy metals from the real waste water samples.
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http://dx.doi.org/10.1016/j.chemosphere.2021.130018DOI Listing
August 2021

Identifying the risk factors for the prevention of hypertensive disorders in pregnancy in a tertiary care hospital: A cross-sectional study.

J Family Med Prim Care 2020 Dec 31;9(12):6121-6124. Epub 2020 Dec 31.

Officer in Charge, Station Health Organisation, Ministry of Defence, Armed Forces Medical Sciences, Roorkee, Uttarakhand, India.

Introduction: Hypertensive disorders in pregnancy accounts for maternal morbidity and mortality globally.

Aim And Objectives: We conducted this study to know the demographic profile and risk factors pertaining to lifestyle and behavioral aspects for hypertension among the pregnant women.

Methodology: It was a hospital-based cross-sectional study. During the routine antenatal checkups, those antenatal cases found hypertensive, were included in the study after taking written consent. A semi-structured questionnaire was prepared and pretested before conducting the actual study. Statistical analysis was done by SPSS (version 17) software. Participants' sociodemographic characteristics were described using descriptive statistics. Results are presented using graphs, tables, mean, percentages, standard deviation, frequency, and significance.

Results: We observed that most of the study subjects 110 (48.9%) were educated up to secondary level followed by primary level 47 (20.9%) while 25 (11.1%) of the subjects were illiterate. We also found that 113 (50.2%) of the study subjects consumed additional salt in their diet and 57 (25.3%) of the study subjects had a history of intake of visible fat. Among 225 study subjects, 174 (77.3%) did not consume tobacco in any form. Among the 225 study subjects, 142 (60.9%) did not have a family history of hypertension. It was observed that 121 (53.77%) subjects had normal BMI while 16 (7.11%) subjects were underweight while 51 (22.6%) subjects were pre-obese. A total of 32 (14.22%) subjects were obese class 1 followed by 5 (2.22%) subjects who were obese class 2. It was observed that among 225 study subjects, 155 (68.9%) subjects had mild hypertension while 70 (31.1%) subjects had severe hypertension.

Discussion: The scarcity of data regarding hypertension in pregnancy in low and middle income countries despite this, a comparatively high prevalence of hypertension in pregnancy was observed due to behavioral risk factors, which is mostly preventable at the primary care level.

Recommendations: It is possible to prevent PIH by eliminating behavioral risk factors through education and counseling to the pregnant ladies, at the primary care level by family physicians or primary care physicians which will reduce maternal mortality to a great extent.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_1328_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7928098PMC
December 2020

Quality evaluation of near-isogenic line of the wheat variety HD2733 carrying the genomic region.

3 Biotech 2021 Mar 18;11(3):130. Epub 2021 Feb 18.

Division of Genetics, ICAR-Indian Agricultural Research Institute, New Delhi, 110012 India.

A near-isogenic line (NIL) of the Indian wheat variety HD2733, carrying an introgressed genomic region was used for studying the effect of this introgression on quality traits. Data on the grain yield and 21 quality traits were recorded in this NIL and its recurrent parent (RP), both of which were grown in a randomized block design for two consecutive years. The statistical analysis revealed that grain yield was on par between the NIL and the RP. The NIL and its RP were both hard grained but the NIL showed a grain hardness index reduced by 9.7%. However, quality traits such as grain weight, protein content, sedimentation value, gluten traits, and solvent retention capacity were significantly higher in the NIL. The NIL also showed an increase in dough stability a lower degree of softening and a higher farinograph quality number. These results indicated that the NIL could be utilized for hard grain, high protein and strong gluten-based products. An overall improvement in the quality of the NIL over its recurrent parent and without any yield penalty suggests that the genomic region could be gainfully utilized in wheat breeding for improving the industrial quality of wheat without jeopardising grain yield. The authors suggest that the improved quality of the NIL may be due to the genomic segment carried along with the genes.

Supplementary Information: The online version contains supplementary material available at 10.1007/s13205-021-02679-x.
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http://dx.doi.org/10.1007/s13205-021-02679-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7892657PMC
March 2021

An urgent need for early oral feeding following head and neck reconstruction with oral defects.

Oral Oncol 2021 Feb 18:105226. Epub 2021 Feb 18.

Department of Otorhinolaryngology and Head-Neck Surgery, Teaching Block, All India Institute of Medical Sciences, New Delhi 110029, India.

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http://dx.doi.org/10.1016/j.oraloncology.2021.105226DOI Listing
February 2021

Comparison of pectoralis plane blocks with ketamine-dexmedetomidine adjuncts and opioid-based general anaesthesia in patients undergoing modified radical mastectomy.

Indian J Anaesth 2020 Dec 12;64(12):1038-1046. Epub 2020 Dec 12.

Department of Breast Oncosurgery Unit, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India.

Background And Aims: Regional anaesthesia attenuates surgical stress-response, provides superior analgesia, reduces recovery time with early mobilisation and is opioid-sparing [addresses post-operative nausea vomiting (PONV), constipation, immunosuppression and cancer-progression concerns with opioids]. Hence, we studied pectoralis (PECS) blocks for modified radical mastectomy (MRM).

Methods: A prospective, interventional, double-blind, randomised, parallel-arm, active-controlled study comparing two anaesthetic techniques for post-operative pain relief in70 adult American Society of Anesthesiologists grade I/II carcinoma breast patients undergoing MRM was conducted. Patients were randomised to Group-O (opioids, sevoflurane) and Group-P (PECS-block, pre-incisional intravenous (IV) ketamine (0.5 mg/kg), pre-incisional IVdexmedetomidine (1 μg/kg over 10 min, then 0.6 μg/kg/h). Data were subjected to statistical analysis using the Statistical Package for Social Sciences, version-23 and independent sample -test/Welch test for equality of means and expressed as dotted box-whisker plots. Nominal categorical intergroup data was compared using Chi-squared test/Fisher's exact test. P<0.05 was considered statistically significant. Clinical significance was calculated.

Results: Higher Visual Analogue Scale (VAS)-scores were recorded in Group-O versus Group-P, immediately post-extubation [mean (SD) 3.6 ± 1.5 and 0.76 ± 0.6] and at 1h (3.1 ± 1.2 and1.4 ± 0.5), 2h (2.5 ± 0.9 and 1.2 ± 0.6) and 4h (2.2 ± 0.5 and 1.7 ± 0.9) respectively. At 8h and 24h post-surgery VAS was comparable. Cumulative-VAS was lower in Group-P. Intraoperative haemodynamics were comparable. Incidence of PONV and constipation was higher in Group-O where each patient received average 27.46 mg morphine-equivalents of opioids. Time to discharge from surgical intensive care unit was 2h shorter in Group-P.

Conclusion: Pre-emptive PECS-blocks supplemented with low-dose ketamine and dexmedetomidine comprise a practical and useful alternative technique to the standard opioid-based general anaesthetic technique for MRM.
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http://dx.doi.org/10.4103/ija.IJA_8_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852431PMC
December 2020

Mounier-Kuhn syndrome.

BMJ Case Rep 2021 Jan 28;14(1). Epub 2021 Jan 28.

Otorhinolaryngology & Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1136/bcr-2020-239876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7845718PMC
January 2021

Recurrent Morel-Lavallée lesion obliterated with povidone iodine, a case report.

Int J Surg Case Rep 2021 Feb 20;79:343-349. Epub 2021 Jan 20.

Department of Surgery, The Aga Khan Hospital, P. O. Box 2289, Barack Obama Drive, Dar es Salaam, Tanzania. Electronic address:

Introduction And Importance: A Morel-Lavallee lesion is a closed degloving injury due to traumatic separation of the hypodermis from underlying fascia. Accumulation of hemolymphatic fluid that occurs is a potential habitat for bacteria. Management options include percutaneous aspiration, open debridement, or a non-surgical approach, each with recurrence risk. In the event of recurrence, sclerotherapy is used. In this case report, after reviewing povidone iodine's efficacy in treating seromas, we used it as a sclerosant for recurrent Morel-Lavallee lesion as the more established options were unavailable in our setting.

Case Presentation: A 49-year-old with no known comorbid presented following a motor traffic accident, with left lateral thigh swelling. He was stable systematically, with a tense, tender left lateral thigh swelling and intact neurovascular assessment distally. X-ray and computed tomography ruled out skeletal and vascular injuries. Magnetic resonance imaging revealed a 580 ml type 1 Morell-Lavallee lesion. Open surgical debridement was done to drain and debride the lesion. He developed two recurrences that necessitated percutaneous aspiration. Doxycycline and talc sclerosants were considered; however, due to their unavailability, povidone iodine was used. It is now five months post-intervention without increased pain, recurrence, or wound complications.

Clinical Discussion: Recurrence is hypothesized to be due to the persistence of fluid loculations, unobliterated dead space, and pseudocyst formation. Sclerotherapy stimulates inflammation that results in fibrosis of the cavity walls causing its obliteration. Doxycycline, the most studied sclerosant in Morel-Lavallée lesion has an efficacy of 95.7%.

Conclusion: The current report is the first successful use of povidone iodine for sclerotherapy of recurring Morel-Lavallée lesions. Based on povidone iodine experiences as a sclerosant, it is associated with increased analgesic requirements. We cautiously propose its use as an alternative in settings where talc powder and doxycycline powder are unavailable.
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http://dx.doi.org/10.1016/j.ijscr.2021.01.067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7841207PMC
February 2021

Changes in socio-economic inequality in nutritional status among children in EAG states, India.

Public Health Nutr 2021 Apr 27;24(6):1304-1317. Epub 2021 Jan 27.

Department of Population Policies and Programmes, International Institute for Population Sciences, Mumbai400088, India.

Objective: The primary purpose of this study is to examine changes in socio-economic inequality in nutritional status (stunting and underweight) among children in Empowered Action Group (EAG) states.

Design: The study is based on the most recent two wave's cross-sectional data from the National Family Health Survey (NFHS) conducted in 2005-2006 (NFHS-3) and 2015-2016 (NFHS-4). The study used height-for-age (stunting) and weight-for-age (underweight) of children as anthropometric indicators.

Setting: EAG states including Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttarakhand and Uttar Pradesh in India.

Participants: The study includes a total of 11 858 (NFHS-3) and 92 630 (NFHS-4) children under 5 years of age.

Result: The socio-economic inequality in stunting remained unchanged in all EAG states. At the same time, the inequality in underweight decreased during 2005-2016. On decomposing, the factors contributing to socio-economic inequality revealed that household wealth index, mother's education and mother's nutritional status were the largest contributors to stunting (47 %, 24 % and 8 %) and underweight (51 %, 21 % and 16 %), respectively, in 2015-2016.

Conclusion: The study concluded the socio-economic inequality in underweight among children under 5 years of age increased over the years in EAG states in India. Altogether, household wealth index, mother's education and mother's nutritional status contributed to nearly 80 % to inequality in stunting and 90 % to inequality in underweight in 2015-2016. Hence, efforts should be made to minimise the socio-economic inequality in the nutritional status of children, particularly in EAG states in India.
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http://dx.doi.org/10.1017/S1368980021000343DOI Listing
April 2021

GAPDH and PUM1: Optimal Housekeeping Genes for Quantitative Polymerase Chain Reaction-Based Analysis of Cancer Stem Cells and Epithelial-Mesenchymal Transition Gene Expression in Rectal Tumors.

Cureus 2020 Dec 10;12(12):e12020. Epub 2020 Dec 10.

Biotechnology, Mizoram University, Aizawl, IND.

Background The overwhelming majority of published articles have taken colon and rectal cancer as a single group, i.e., colorectal cancer, when normalizing gene expression data with housekeeping genes (HKG) in quantitative polymerase chain reaction (qPCR) experiments though there are published reports that suggest the differential expression pattern of genes between the colon and rectal cancer groups and hence the current experiment was attempted to find out the optimal set of housekeeping genes from the list of common HKG for rectal tumor gene expression analysis. Methods The expression of five potential housekeeping genes GAPDH, RPNI, PUM1, B2M, and PMM1 was analyzed through qPCR and Bestkeeper software (http://www.wzw.tum.de/gene-quantification/bestkeeper.html) in 20 stage II-IV rectal cancer samples to check for uniformity in their expression pattern. Cancer stem cell (CSC) marker ALDH1 and epithelial-mesenchymal transition marker (EMT) markers E cadherin, vimentin, Twist, and SNAI2 expression were evaluated in conjunction with the two optimal reference genes in 10 rectal cancers as part of validation. Results The standard deviation of the cycle threshold value of GAPDH was found the lowest at 0.65 followed by RPN1 at 0.88, PUM1 at 0.94, PMM1 at 0.94, and B2M at 1.21 when analyzed with BestKeeper software. Using GAPDH and PUM1 as the reference gene for the validation phase, rectal cancer patients with stage III/IV showed a 4.79-fold change (P=0.006) in ALDH1 expression, and an 11.76-fold change in Twist expression (P=0.003) with respect to stage II rectal tumor when normalized with GAPDH and PUM1. Conclusion GAPDH and PUM1 can be used as an optimal set of housekeeping genes for gene expression-related experiments in rectal tumors. ALDH1 and Twist were found significantly overexpressed in stage III/IV rectal tumors in comparison to stage II rectal cancer. Genes associated with cancer stem cells and EMT markers could be optimally analyzed by normalizing them with GAPDH and PUM1 as housekeeping genes.
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http://dx.doi.org/10.7759/cureus.12020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797410PMC
December 2020

Cadmium induced oxystress alters Nrf2-Keap1 signaling and triggers apoptosis in piscine head kidney macrophages.

Aquat Toxicol 2021 Feb 31;231:105739. Epub 2020 Dec 31.

Department of Biotechnology, Assam University, Silchar, Assam, 788011, India. Electronic address:

Cadmium (Cd) with no known functional role in any life-form has myriad of harmful effects. The present study was designed to elucidate the mechanism of Cd-induced oxystress generation and its impact on antioxidant and apoptosis signaling pathways in head kidney macrophage (HKM) of Channa punctatus Bloch. Fish were sampled and acclimatized with one group treated with cadmium chloride (CdCl) (1.96 mg/L) and another as untreated control group, both kept under observation for 7 days. Exposure to Cd caused ultrastructural changes along with reduced head kidney somatic index (HKSI). Significantly increased levels of reactive oxygen species (ROS), respiratory burst activity, lipid peroxidation, DNA fragmentation and superoxide dismutase were found in the HKM from the treated group as compared to control. In contrast, antioxidant enzymes like catalase and reduced glutathione activity decreased in the Cd exposed group. The suppressed antioxidant activity was further confirmed and corroborated from the altered expression of Kelch-like ECH-associated protein 1 (Keap1) and nuclear factor erythroid 2-related factor 2 (Nrf2) genes, the major player of antioxidant pathway. Cd induced alteration in Nrf2-Keap1 signaling pathway was also validated by the diminished levels of Nrf2 dependent expression of protein like heme oxygenase-1 (HO-1). The flow cytometry analysis supported the event of apoptosis in Cd exposed group as compared to control, which was further confirmed by the upregulated expression of caspase-3, caspase-8, caspase-9, TNF-α and p53 genes from the real-time gene expression study. In addition, altered protein level of cytochrome C validates the incidence of apoptosis. Altogether, our results demonstrate that exposure to Cd caused oxidative stress in HKM of Channa punctatus Bloch. by compromising the antioxidant enzyme activities via the down regulation of expression of genes related to antioxidant signaling pathway besides encouraging apoptosis via both mitochondrial and death receptor pathway.
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http://dx.doi.org/10.1016/j.aquatox.2020.105739DOI Listing
February 2021

Assessment of myocardial sympathetic innervation with 18F-FDOPA-PET/CT in patients with autonomic dysfunction: feasibility study in IPD patients.

J Nucl Cardiol 2021 Jan 10. Epub 2021 Jan 10.

Department of Neurology, AIIMS, New Delhi, India.

Background: Dysfunction and denervation of myocardial nor-adrenergic sympathetic neurons has been documented in IPD patients with dysautonomia. The aim of this study was to evaluate the feasibility of single tracer imaging of myocardial sympathetic and cerebral striatal involvement in these patients.

Methods: Twenty-two controls (mean-age 59.09 ± 12.39 years, 15 men) with no clinical autonomic-dysfunction and normal striatal-uptake in 18F-FDOPA-PET/CT; and 28 patients (mean-age 58.18 ± 8.25 years, 18 men) with autonomic-dysfunction (in Autonomic Function Tests) and striatal dopaminergic-dysfunction were enrolled. Both cardiac-PET/CT (40 minutes post IV-injection of 185-259MBq 18F-FDOPA) and Brain-PET/CT (60 minutes post-IV) were acquired in same session. ROIs were drawn over the entire left ventricular myocardium, individual walls and mediastinum for quantification. Patients and controls were followed-up for 26.93 ± 5.43 months and 37.91 ± 8.63 months, respectively.

Results: Striatal and myocardial-parameters were significantly lower in patients compared to controls; with Myocardium/mediastinal ratio (MwMR) yielding the area-under-the-curve of .941 (P < .001). MwMR correlated negatively with the drop in systolic blood pressure (SBP) during AFTs {Pearson-coefficient (-).565, P = .002}. Mean MwMR in patients with abnormal-AFTs was significantly lower than patients with borderline-AFTs (1.39 ± .12 vs 1.55 ± .10; P = .002). 9/20 patients with abnormal-AFTs showed functional worsening during follow-up, compared to 2/8 with borderline-AFTs.

Conclusion: Single tracer, single session imaging of striatal and cardiac sympathetic dysfunction in patients with advanced IPD is feasible with use of 18F-FDOPA. Significantly reduced 18F-FDOPA uptake is seen in the myocardium of the IPD patients with sympathetic dysfunction.
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http://dx.doi.org/10.1007/s12350-020-02474-wDOI Listing
January 2021