Assessment of indoor air concentrations of VOCs and their associated health risks in the library of Jawaharlal Nehru University, New Delhi

The present work investigated the levels of total volatile organic compounds (TVOC) and benzene, toluene, ethylbenzene, m/p-xylene, and o-xylene (BTEX) in different microenvironments in the library of Jawaharlal Nehru University in summer and winter during 2011-2012. Carcinogenic and non-carcinogenic health risks due to organic compounds were also evaluated using US Environmental Protection Agency (USEPA) conventional approaches. Real-time monitoring was done for TVOC using a data-logging photo-ionization detector. For BTEX measurements, the National Institute for Occupational Safety and Health (NIOSH) standard method which consists of active sampling of air through activated charcoal, followed by analysis with gas chromatography, was performed. Simultaneously, outdoor measurements for TVOC and BTEX were carried out. Indoor concentrations of TVOC and BTEX (except benzene) were higher as compared to the outdoor for both seasons. Toluene and m/p-xylene were the most abundant organic contaminant observed in this study. Indoor to outdoor (I/O) ratios of BTEX compounds were generally greater than unity and ranged from 0.2 to 8.7 and 0.2 to 4.3 in winter and summer, respectively. Statistical analysis and I/O ratios showed that the dominant pollution sources mainly came from indoors. The observed mean concentrations of TVOC lie within the second group of the Molhave criteria of indoor air quality, indicating a multifactorial exposure range. The estimated lifetime cancer risk (LCR) due to benzene in this study exceeded the value of 1 × 10(-6) recommended by USEPA, and the hazard quotient (HQ) of non-cancer risk came under an acceptable range.

Hair: an unusual foreign body in airways presenting with haemoptysis in an adult patient

Haemoptysis is defined as expectoration of blood originating from the lungs or tracheo-bronchial tree. It is attributed to various causes like tuberculosis, bronchiectasis, lung cancer, mycetoma, foreign bodies etc. Various types of foreign bodies have been reported in the literature. We report the case of an adult female patient who presented with an episode of haemoptysis (150 mL) in whom flexible fibreoptic bronchoscopy revealed a single long hair at the carina going to left main bronchus. Following successful removal of this hair there were no further episodes of haemoptysis and the patient manifested clinical and radiological improvement.

Vaccine for prevention of mild and moderate-to-severe influenza in children

BACKGROUND

Commonly used trivalent vaccines contain one influenza B virus lineage and may be ineffective against viruses of the other B lineage. We evaluated the efficacy of a candidate inactivated quadrivalent influenza vaccine (QIV) containing both B lineages.

METHODS

In this multinational, phase 3, observer-blinded study, we randomly assigned children 3 to 8 years of age, in a 1:1 ratio, to receive the QIV or a hepatitis A vaccine (control). The primary end point was influenza A or B confirmed by real-time polymerase chain reaction (rt-PCR). Secondary end points were rt-PCR-confirmed, moderate-to-severe influenza and rt-PCR-positive, culture-confirmed influenza. The vaccine efficacy and the effect of vaccination on daily activities and utilization of health care resources were assessed in the total vaccinated cohort (2584 children in each group) and the per-protocol cohort (2379 children in the QIV group and 2398 in the control group).

RESULTS

In the total vaccinated cohort, 62 children in the QIV group (2.40%) and 148 in the control group (5.73%) had rt-PCR-confirmed influenza, representing a QIV efficacy of 59.3% (95% confidence interval [CI], 45.2 to 69.7), with efficacy against culture-confirmed influenza of 59.1% (97.5% CI, 41.2 to 71.5). For moderate-to-severe rt-PCR-confirmed influenza, the attack rate was 0.62% (16 cases) in the QIV group and 2.36% (61 cases) in the control group, representing a QIV efficacy of 74.2% (97.5% CI, 51.5 to 86.2). In the per-protocol cohort, the QIV efficacy was 55.4% (95% CI, 39.1 to 67.3), and the efficacy against culture-confirmed influenza 55.9% (97.5% CI, 35.4 to 69.9); the efficacy among children with moderate-to-severe influenza was 73.1% (97.5% CI, 47.1 to 86.3). The QIV was associated with reduced risks of a body temperature above 39°C and lower respiratory tract illness, as compared with the control vaccine, in the per-protocol cohort (relative risk, 0.29 [95% CI, 0.16 to 0.56] and 0.20 [95% CI, 0.04 to 0.92], respectively). The QIV was immunogenic against all four strains. Serious adverse events occurred in 36 children in the QIV group (1.4%) and in 24 children in the control group (0.9%).

CONCLUSIONS

The QIV was efficacious in preventing influenza in children. (Funded by GlaxoSmithKline Biologicals; ClinicalTrials.gov number, NCT01218308.).

Immunogenicity and safety of an inactivated quadrivalent influenza vaccine candidate: a phase III randomized controlled trial in children

BACKGROUND

Mismatch between circulating influenza B viruses (Yamagata and Victoria lineages) and vaccine strains occurs frequently.

METHODS

In a randomized controlled trial, immunogenicity and safety of an inactivated quadrivalent influenza vaccine candidate (QIV) versus trivalent inactivated influenza vaccine (TIV)-Victoria(Vic) and TIV-Yamagata(Yam) in children 3-17 years of age was evaluated. In an open-label study arm, QIV only was assessed in children 6-35 months of age.

RESULTS

A total of 3094 children (932 QIV, 929 TIV-Vic, 932 TIV-Yam, and 301 QIV only) were vaccinated. QIV was noninferior to the TIVs for shared strains (A/H3N2 and A/H1N1) based on hemagglutination-inhibition (HI) antibodies 28 days after last vaccination, and superior for the unique B strains Victoria and Yamagata (geometric mean titer ratios 2.61, 3.78; seroconversion rate differences 33.96%, 44.63%). Among children in the randomized trial, adverse event rates were similar except for injection site pain (dose 1: 65.4% QIV, 54.6% TIV-Vic, 55.7% TIV-Yam).

CONCLUSION

QIV elicited superior HI responses to the added B strains compared to TIV controls, potentially improving its effectiveness against influenza B. HI responses were similar between QIV and TIV controls for the shared strains. QIV had an acceptable safety profile relative to TIVs.

CLINICAL TRIALS REGISTRATION

NCT01198756.

Use of constant wavelength synchronous spectrofluorimetry for identification of polycyclic aromatic hydrocarbons in air particulate samples

We have developed a simple, rapid, inexpensive method for the identification of fluoranthene (Flan), benz(a)anthracene (BaA), benzo(a)pyrene (BaP), benzo(k)fluoranthene (BkF), pyrene (Pyr), benz(ghi)perylene (BghiP) in suspended particulate matter in an urban environment of Delhi. Suspended particulate matter samples of 24h duration were collected on glass fiber filter papers. Polycyclic aromatic hydrocarbons (PAHs) were extracted from the filter papers using dichloromethane (DCM) and hexane with ultrasonication method. Comparison of the characteristic emission of spectra of PAHs with standard spectra indicated the degree of condensation of aromatic compounds present in investigated mixtures. It was also possible to identify some individual compounds. However, this identification could be more effective with the use of the respective values of Δλ parameter for each particular component of the mixture.

The effects of meteorological parameters in ambient noise modelling studies in Delhi

The acoustic environment in urban areas has gained prominence in recent times due to rapid industrial and commercial development in metropolitan cities. Various attempts have been made to predict and model the trends in urban ambient noise levels using different statistical and dynamic models. The present study makes an attempt to examine the role of meteorological parameters affecting the ambient noise levels in Delhi. The results show significant improvement in overall noise scenario of Delhi since the introduction of compressed natural gas vehicles in public transport of Delhi. The noise level is significantly reduced by high vegetation cover as well as by low relative humidity over Delhi. The regression models developed for the present study clearly show the significant contribution of meteorological parameters in governing the ambient noise levels in Delhi.

Angiokeratoma circumscriptum of the tongue

Angiokeratoma circumscriptum is rare cutaneous disorder. It usually presents as multiple,red, blue or black asymptomatic papules on lower extremities. Oral involvement, common in systemic form, is rare in localized forms. We report a case of angiokeratoma circumscriptum of tongue, involving both dorsal and ventral aspects.

Immunogenicity and Safety of 2 Dose Levels of a Thimerosal-Free Trivalent Seasonal Influenza Vaccine in Children Aged 6-35 Months: A Randomized, Controlled Trial

BACKGROUND

Improved influenza vaccine strategies for infants and preschool children are a high priority.

METHODS

The immunological response and safety of a thimerosal-free trivalent inactivated influenza vaccine at 2 different doses (0.50 mL vs 0.25 mL) was evaluated in children aged 6-35 months. The study was randomized, observer blind, multicenter, and stratified by age (6-23 months and 24-35 months), and it accounted for prior influenza immunization status.

RESULTS

Three hundred seventy-four children were in the total vaccinated cohort (study vaccine 0.25-mL dose, n = 164; 0.50-mL dose, n = 167; comparator 0.25 mL, n = 43). Regulatory criteria for immunogenicity of influenza vaccines in adults were met for all virus strains and doses for both age strata. A modest but not statistically significant improvement in immune responses was observed with the higher dose and reactogenicity, and safety of the 2 doses was not significantly different.

CONCLUSIONS

The 0.5-mL dose of the study vaccine, when administered to children aged 6-35 months, resulted in a modest but not statistically significant improvement in immunogenicity with clinically similar safety and reactogenicity compared with the 0.25-mL dose. Further studies comparing full- and half-dose influenza vaccine in young children are needed.

CLINICAL TRIALS REGISTRATION

NCT00778895.

Size distribution and source apportionment of polycyclic aromatic hydrocarbons (PAHs) in aerosol particle samples from the atmospheric environment of Delhi, India

Ambient aerosol particles were collected using a five-stage impactor at six different sites in Delhi. The impactor segregates the TSPM into five different sizes (viz. >10.9, 10.9-5.4, 5.4-1.6, 1.6-0.7, and <0.7μm). Samples collected were chemically analyzed for all the five size ranges, for the estimation of 16 different PAHs. The particle size distribution of PAHs was observed to be unimodal in nature with the highest peak towards the smallest size aerosol particle (<0.7μm). The five size ranges were categorized into two broad categories viz. coarse (>10.9+10.9 to 5.4+5.4 to 1.6μm) and fine (1.6 to 0.7+<0.7μm). It was observed that the dominant PAHs found were pyrene, benzo(a)pyrene, benzo(ghi)perylene and benzo(b)fluoranthene for both the coarse and fine fractions. Source apportionment of polycyclic aromatic hydrocarbons (PAHs) has been carried out using principal component analysis method (PCA) in both coarse and fine size modes. The major sources identified in this study, responsible for the elevated concentration of PAHs in Delhi, are vehicular emission and coal combustion. Some contribution from biomass burning was also observed.

A supercritical fluid chromatography/tandem mass spectrometry method for the simultaneous quantification of metformin and gliclazide in human plasma

Present study reports the development and validation of a simultaneous estimation of metformin and gliclazide in human plasma using supercritical fluid chromatography followed by tandem mass spectrometry. Acetonitrile:water (80:20) mixture was used as a mobile phase along with liquid CO₂ in supercritical fluid chromatography and phenformin as an internal standard. The modified plasma samples were analyzed by electro-spray ionization method in selective reaction monitoring mode in tandem mass spectrometry. Supercritical fluid chromatographic separation was performed using nucleosil C₁₈ containing column as a stationary phase. The separated products were identified by characteristic peaks and specific fragments peaks in tandem mass spectrometry as m/z 130 to 86 for metformin, m/z 324 to 110 for gliclazide and m/z 206 to 105 for phenformin. The present method was found linear in the concentration ranges of 6.0-3550 ng/ml and 7.5-7500 ng/ml for metformin and gliclazide, respectively. Pharmacokinetic study was performed after an oral administration of dispersible tablets containing 500 mg of metformin and 80 mg of gliclazide using same techniques.

Curcumin nanoparticles: preparation, characterization, and antimicrobial study

Curcumin is a highly potent, nontoxic, bioactive agent found in turmeric and has been known for centuries as a household remedy to many ailments. The only disadvantage that it suffers is of low aqueous solubility and poor bioavailability. The aim of the present study was to develop a method for the preparation of nanoparticles of curcumin with a view to improve its aqueous-phase solubility and examine the effect on its antimicrobial properties. Nanoparticles of curcumin (nanocurcumin) were prepared by a process based on a wet-milling technique and were found to have a narrow particle size distribution in the range of 2-40 nm. Unlike curcumin, nanocurcumin was found to be freely dispersible in water in the absence of any surfactants. The chemical structure of nanocurcumin was the same as that of curcumin, and there was no modification during nanoparticle preparation. A minimum inhibitory concentration of nanocurcumin was determined for a variety of bacterial and fungal strains and was compared to that of curcumin. It was found that the aqueous dispersion of nanocurcumin was much more effective than curcumin against Staphylococcus aureus , Bacillus subtilis , Escherichia coli , Pseudomonas aeruginosa , Penicillium notatum , and Aspergillus niger . The results demonstrated that the water solubility and antimicrobial activity of curcumin markedly improved by particle size reduction up to the nano range. For the selected microorganisms, the activity of nanocurcumin was more pronounced against Gram-positive bacteria than Gram-negative bacteria. Furthermore, its antibacterial activity was much better than antifungal activity. The mechanism of antibacterial action of curcumin nanoparticles was investigated by transmission electron micrograph (TEM) analysis, which revealed that these particles entered inside the bacterial cell by completely breaking the cell wall, leading to cell death.

Effect of functional groups on antioxidant properties of substituted selenoethers

Selenoethers attached to functional groups through propyl chain viz., bis(3-carboxypropyl)selenide (SeBA), bis(3-hydroxypropyl)selenide (SePOH) and bis(3-aminopropyl)selenide dihydrochloride (SePAm), have been examined for their ability to inhibit peroxyl radical mediated DNA damage, peroxyl radical scavenging ability and glutathione peroxidase (GPx) like activity. The DNA damage was monitored by gel electrophoresis, bimolecular rate constants for scavenging of model peroxyl radical were determined by pulse radiolysis and the GPx activity was followed by their ability to reduce hydrogen peroxide in the presence of glutathione utilizing NADPH decay and HPLC analysis. Among these compounds, SeBA showed maximum DNA protecting activity and it was also the most efficient in scavenging peroxyl radicals with the highest GPx mimicking activity. Quantum chemical calculations confirmed that SeBA with the highest energy level of HOMO (highest occupied molecular orbital) is the easiest to undergo oxidation and therefore exhibits better radical scavenging, GPx mimicking and DNA protecting activity than SePOH or SePAm.

Immunologic non-inferiority of a newly licensed inactivated trivalent influenza vaccine versus an established vaccine: a randomized study in US adults

A trivalent inactivated influenza vaccine (Fluarix (™) , GlaxoSmithKline Biologicals) was licensed under US accelerated approval regulations. We performed a randomized, observer-blind, post-approval study to demonstrate its immunological non-inferiority versus an established US-licensed vaccine (primary endpoint). Adult (including elderly) subjects received a single injection of newly-licensed vaccine (n = 923) or established vaccine (n = 922). Serum hemagglutination-inhibition titers were determined pre-vaccination and 21-28 days after vaccination. Non-inferiority was assessed by post-vaccination geometric mean titer (GMT) ratio (upper 95% confidence interval [CI] ≤ 1.5) and difference in seroconversion rate (upper 95% CI ≤ 0.1) for all three vaccine strains. Safety was monitored for 6 months. The newly-licensed vaccine was non-inferior to the established vaccine in all subjects (≥ 18 years) and in elderly subjects (≥ 65 years). Adjusted GMT ratios (established/newly-licensed) against the H1N1, H3N2 and B strains were 0.65 (95% CI: 0.58, 0.73), 0.93 (0.83, 1.04) and 1.13 (1.03, 1.25) for all subjects and 0.75 (0.67, 0.85), 0.95 (0.82, 1.09) and 1.13 (1.00, 1.27) for elderly subjects. Corresponding values for the differences in seroconversion rate (established minus newly-licensed) were -0.12 (-0.16, -0.07), -0.02 (-0.06, 0.03) and 0.01 (-0.04, 0.06) for all subjects and -0.11 (-0.16, -0.05), -0.02 (-0.07, 0.04) and 0.02 (-0.04, 0.08) for elderly subjects. The most common adverse events with both vaccines were injection site pain, fatigue and headache, and no serious adverse events or deaths were considered related; there were no clinically relevant differences between the vaccines. In conclusion, the newly-licensed vaccine was well tolerated and immunologically non-inferior to the established vaccine for all three vaccine strains in the whole population and the elderly.

In vivo radioprotection studies of 3,3'-diselenodipropionic acid, a selenocystine derivative

3,3'-Diselenodipropionic acid (DSePA), a diselenide and a derivative of selenocystine, was evaluated for in vivo radioprotective effects in Swiss albino mice, at an intraperitoneal dose of 2 mg/kg body wt, for 5 days before whole-body exposure to gamma-radiation. The radioprotective efficacy was evaluated by assessing protection of the hepatic tissue, the spleen, and the gastrointestinal (GI) tract and survival against sub- and supralethal doses of gamma-radiation. DSePA inhibited radiation-induced hepatic lipid peroxidation, protein carbonylation, loss of hepatic function, and damage to the hepatic architecture. DSePA also attenuated the depletion of endogenous antioxidants such as glutathione, glutathione peroxidase, superoxide dismutase, and catalase in the livers of irradiated mice. DSePA also restored the radiation-induced reduction in villus height, crypt cell numbers, and spleen cellularity, indicating protective effects on the GI tract and the hematopoietic system. The results from single-cell gel electrophoresis of the peripheral blood leukocytes showed that DSePA can attenuate radiation-induced DNA damage. The mRNA expression analysis of genes revealed that DSePA augmented GADD45alpha and inhibited p21 in both spleen and liver tissues. DSePA also inhibited radiation-induced apoptosis in the spleen and reversed radiation-induced alterations in the expression of the proapoptotic BAX and the antiapoptotic Bcl-2 genes. In line with these observations, DSePA improved the 30-day survival of irradiated mice by 35.3%. In conclusion, these findings clearly confirm that DSePA exhibits protective effects against whole-body gamma-radiation and the probable mechanisms of action involve the maintenance of antioxidant enzymes, prophylactic action through the attenuation of the DNA damage, and inhibition of apoptosis.

In vitro radioprotection studies of organoselenium compounds: differences between mono- and diselenides

Organoselenium compounds belonging to the class of monoselenides, such as selenomethionine (SeM) and methylselenocysteine (MSeCys) and diselenides including selenocystine (SeCys) and selenopropionic acid (SePA), were examined for their comparative radioprotective effects using in vitro models. Effects of these compounds on the inhibition of gamma-radiation induced lipid peroxidation in liposomes, protein carbonylation in bovine serum albumin (BSA) and strand breaks in pBR322 plasmid DNA, assessed, respectively, by the formation of thiobarbituric acid reactive substances, formation of 2,2'-dinitrophenyl hydrazine (DNPH) carbonyl complex and horizontal gel electrophoresis, were used to compare their radioprotective ability. The IC 50 values for SeCys, SePA, SeM and MSeCys for lipid peroxidation were 27 +/- 1, 33 +/- 2, 200 +/- 8 and 163 +/- 4 microM, respectively, and the values for inhibition of protein carbonylation were >200, 300 +/- 6, 464 +/- 8 and 436 +/- 3 microM, respectively. Inhibition of DNA strand break formation was tested at 200 microM for all the compounds and SePA and SeCys exhibited a protective effect on DNA, while SeM and MSeCys did not lead to any protection. The in vitro cytotoxicity studies in normal and tumor cells revealed that MSeCys and SeM were not cytotoxic to lymphocytes and EL4 tumor cells at the concentrations employed. In contrast, SeCys was toxic, with a higher effect on tumor cells than lymphocytes. Our studies suggest that the non-toxic diselenides like SePA should be explored as protective agents against gamma-irradiation induced damage.

SEM-EDX analysis of various sizes aerosols in Delhi India

Scanning electron microscopy-energy dispersive X-ray analysis (SEM-EDX) was used to understand the differences in morphology, elemental composition and particle density of aerosols in different five size ranges to further investigate the potential sources as well as transport of pollutants from/at a much polluted and a very clean area of Delhi. Aerosol samples were obtained in five different size ranges viz. > or = 10.9, 10.9-5.4, 5.4-1.6, 1.6-0.7 and < or = 0.7 microm from a considerably very clean and a much polluted area of Delhi. It was observed that at polluted area most of the particles irrespective of size are of anthropogenic origin. At clean area, in coarse size fractions particles are of natural origin while in fine size range the presence of anthropogenic particles suggests the transport of particles from one area to the other.

Atmospheric polycyclic aromatic hydrocarbons (PAHs) in the urban air of Delhi during 2003

Atmospheric concentrations of polycyclic aromatic hydrocarbons (PAHs) in Delhi were evaluated to study particulate PAHs profiles during the different seasons of 2003. Samples of urban suspended particulate matter were collected during January 2003 to December 2003 at three locations (Okhla, Dhaulakuan and Daryaganj), using a high volume sampler provided with glass fiber filters. Samples were analyzed using the gas chromatography technique. The annual average concentrations of total PAHs were found as 1,049.3 ng/m(3) at Okhla, 1,344.37 ng/m(3) at Daryaganj, and 1,117.14 ng/m(3) at Dhaulakuan. The seasonal average concentrations were found to be maximum in winter and minimum during the monsoon season. Principal Component Analysis (PCA) of the data was also carried out and the results indicate that diesel and gasoline driven vehicles are the principal sources of PAHs at all the three sites under investigation. Other sources might come from stationary combustion sources such as cooking fuel combustion and industrial emission.

A clinically relevant major cross-reactive allergen from mesquite tree pollen

BACKGROUND

Prosopis juliflora (mesquite) is one of the major sources of pollinosis in tropical and semi-arid countries of the world. The present study was undertaken to purify and characterize a major cross-reactive allergen from this tree species.

MATERIALS AND METHODS

Mesquite pollen extract was purified using reverse-phase chromatography. Allergen characterization was done by electrophoresis, enzyme-linked immunosorbent assay (ELISA) and Western blotting. Clinical relevance of the purified protein was analyzed by in vivo (skin tests) and in vitro experiments such as ELISA, histamine release, peripheral blood mononuclear cells (PBMC) proliferation and cytokine assays. Cross-reactivity of purified protein with allergenic tree species and lima bean (food) was assessed by inhibition assays.

RESULTS

A 66-kDa protein was purified from mesquite pollen extract using octadecyl silica resin. Purified protein recognized 90% of mesquite-sensitized patients in skin test and ELISA. It induced significant histamine release in allergic patients' blood and interleukin-4 secretion in the PBMC culture supernatants. Inhibition assays suggested close allergenic relationship of this protein with Ailanthus excelsa, Cassia siamea, Salvadora persica pollen and Phaseolus lunatus (lima bean - an edible legume).

CONCLUSIONS

A 66-kDa major cross-reactive allergen was isolated from mesquite pollen using single-step purification procedure. The protein seems relevant for clinical applications in allergic disorders.

Late onset isotretinoin resistant acne conglobata in a patient with acromegaly

A 55 year-old male presented with multiple pus-discharging abscesses and sinuses and mutilating scarring on the gluteal region and back prevalent for the last ten years with exacerbations and remissions. Physical examination revealed acromegaly with frontal bossing, prognathism, a barrel chest and acral hypertrophy. Dermatological examination revealed cutis verticis gyrata, thick eyelids, a large triangular nose, a thickened lower lip, macroglossia, widely spaced teeth and widened skin pores with wet and oily skin. Hair was fine and nails were flat and wide. There were multiple inflammatory papules, tender nodules, draining sinuses, and grouped, polyporous comedones as well as multiple and extensive depressed and keloidal scars localized predominantly over the gluteal region with a few scattered lesions over the back. A computed tomography (CT) scan showed widened sella turcica. His basal fasting growth hormone (GH) levels were markedly raised (230 ng/mL; normal 1-5 ng/mL) while the prolactin levels were moderately raised (87 ng/mL; normal 2-5 ng/mL). These findings were consistent with a diagnosis of acromegaly. The patient was put on antibiotics, nonsteroidal antiinflammatory drugs and isotretinoin at a dose of 1 mg/kg/day, which was increased to 1.5 mg/kg/day. Except for an initial mildly beneficial response, the skin lesions were largely resistant to high doses of isotretinoin at the end of four months.

Particle size distribution of aerosols and associated heavy metals in kitchen environments

Mass size distributions of total suspended particulate matter (TSPM) was measured from Sep 2002 to April 2003 in indoor kitchen environments of five locations in Jawaharlal Nehru University (JNU), New Delhi, with the help of a high volume cascade impactor. Particulate matters were separated in five different size ranges, i.e. >10.9 microm, 10.9-5.4 microm, 5.4-1.6 microm, 1.6-0.7 microm and <0.7 microm. The particle size distribution at various sites appears to follow uni-modal trend corresponding to fine particles i.e. size range <0.7 microm. The contributions of fine particles are estimated to be approximately 50% of TSPM and PM10.9, while PM10.9 comprises 80% of TSPM. Good correlations were observed between various size fractions. Regression results reveal that TSPM can adequately act as a surrogate for PM10.9 and fine particles, while PM10.9 can also act as surrogate for fine particles. The concentrations of heavy metals are found to be dominantly associated with fine particles. However, the concentration of some metals and their size distribution, to some extent is also site specific (fuel type used).

Identification of polycyclic aromatic hydrocarbons (PAHs) in suspended particulate matter by synchronous fluorescence spectroscopic technique

The synchronous fluorescence (SF) technique has been used in the identification of polycyclic aromatic hydrocarbons (PAHs) from air particulate sample in an urban environment of Delhi, Jawaharlal Nehru University. Suspended particulate matter samples of 24h duration were collected on glass fiber filter papers. PAHs were extracted from the filter papers using dichloromethane (DCM)+hexane with ultrasonication method. Qualitative measurements of the polycyclic aromatic hydrocarbons (PAHs) were carried out using the SF technique at various wavelength intervals (Deltalambda). Due to the difference in chemical structure, each PAH gives specific characteristic spectrum for each Deltalambda. Following PAHs were detected in our measurement: benz(a)anthracene (BaA), pyrene (Pyr), chrysene (Chry), fluoranthene (Flan), phenanthrene (Phen), and benz(ghi)perylene (BghiP). This is in agreement with our earlier work for determination of these PAHs using gas chromatography (GC). The seasonal variation of the PAHs was found to be maximum in winter and minimum during the monsoon.

An estimation of annoyance due to various public modes of transport in Delhi

Measurements of noise levels associated with different types of vehicles plying the roads in Delhi were made. From the data, noise level indices L(10) , L(90) and Leq were determined. In addition, spectra of noise for different vehicles at 1- octave band frequencies were also obtained. The time-averaged noise spectra reveal that the noise intensities are significantly higher in the frequency range of 0.5 kHz to 2 kHz for all types of vehicles. Perceived noise levels (PNdB) and the total noisiness measured on NOY scale indicate that rural transport vehicles (RTVs) are most annoying, followed by buses, auto-rickshaws and taxis.

Management strategies for bilateral vestibular schwannomas

BACKGROUND

Bilateral vestibular schwannomas (VS) are rare. Most patients in India present late in the course of illness with large tumors and disabling deafness. Clinical presentation and management goals are different from that of unilateral VS.

AIMS

To highlight the differences in clinical presentations and surgical results of bilateral VS compared to unilateral VS; and, to propose a management strategy for these tumors with reference to tumor size, extent of growth and the presence or absence of hearing impairment.

METHOD

This is a retrospective study of 16 patients with bilateral VS treated over 10 years in a tertiary referral hospital. Assessment of VIIth and VIIIth cranial nerve function, tumor size, volume and extent of growth was performed in all patients. The management strategy was based on Samii's classification of tumor extent. All patients were operated using a retromastoid suboccipital approach. Postoperative results were analyzed and compared with those of unilateral VS.

RESULTS

The mean age of presentation was 25.7 years. Hearing impairment was the commonest symptom. Headache with features of raised intracranial pressure were present in 10 (62.5%) patients. Giant tumors were present in seven (43.7%) patients; large tumors in eight (50%) and a medium-sized tumor in one (6.3%). Total tumor resection was achieved in 13 patients and subtotal resection in two. One patient was managed conservatively and followed up with serial CT scans. On the contralateral side, one large tumor required total excision. One medium sized tumor underwent sub-capsular excision in an attempt to preserve hearing. The facial nerve was anatomically preserved in seven (46.7%) patients and in one, the cochlear nerve was anatomically preserved. There was no peri-operative mortality.

CONCLUSIONS

Patients with bilateral schwannomas are younger, have larger lesions, poorer preoperative hearing and are more likely to lose either auditory and/or facial nerve function during attempted total resection of the tumor. Classifying the tumors into two groups by extent, that is, tumors extending to the cerebellopontine angle cistern (T1-T3a) and, tumors extending to or compressing the brainstem (T3b to T4b), allows the surgical strategy to be defined.

Immunoglobulin E (IgE)-mediated cross-reactivity between mesquite pollen proteins and lima bean, an edible legume

Immunoglobulin E (IgE)-mediated food allergy often develops as a consequence of allergic sensitization to pollen proteins. Mesquite (Prosopis juliflora) tree pollen is reported to be cross-reactive with other pollen species, but little has been reported on its cross-reactivity with plant-derived foods belonging to the same/different families. The present study investigates the in vitro cross-reactivity of mesquite pollen and lima bean (Phaseolus lunatus), an edible seed belonging to the Leguminosae family. Of 110 patients (asthma, rhinitis or both) tested intradermally, 20 showed marked positive reactions with Prosopis pollen extract. Of these, 12 patients showed elevated specific IgE to Prosopis pollen extract alone and four to both Phaseolus and pollen extract. In vitro cross-reactivity was investigated using inhibition assays [enzyme-linked immunosorbent assay (ELISA) inhibition, immunoblot inhibition], histamine release and lymphoproliferation. P. lunatus extract could inhibit IgE binding to P. juliflora in a dose-dependent manner, requiring 400 ng of protein for 50% inhibition in ELISA assay. Immunoblot and immunoblot inhibition demonstrated the presence of 20, 26, 35, 66 and 72 kDa as shared IgE binding components between the two extracts. Histamine release, peripheral blood mononuclear cells proliferation and interleukin (IL)-4 levels also suggested allergenic cross-reactivity. In conclusion, there is humoral and cellular cross-reactivity between Prosopis pollen and Phaseolus seed allergens.

Size distribution and source identification of total suspended particulate matter and associated heavy metals in the urban atmosphere of Delhi

A study of the atmospheric particulate size distribution of total suspended particulate matter (TSPM) and associated heavy metal concentrations has been carried out for the city of Delhi. Urban particles were collected using a five-stage impactor at six sites in three different seasons, viz. winter, summer and monsoon in the year 2001. Five samples from each site in each season were collected. Each sample (filter paper) was extracted with a mixture of nitric acid, hydrochloric acid and hydrofluoric acid. The acid solutions of the samples were analysed in five-particle fractions by atomic absorption spectrometry (AAS). The impactor stage fractionation of particles shows that a major portion of TSPM concentration is in the form of PM0.7 (i.e. <0.7microm). Similarly, the most of the metal mass viz. Mn, Cr, Cd, Pb, Ni, and Fe are also concentrated in the PM0.7 mode. The only exceptions are size distributions pertaining to Cu and Ca. Though, Cu is more in PM0.7 mode, its presence in size intervals 5.4-1.6microm and 1.6-0.7microm is also significant, whilst in case of Ca there is no definite pattern in its distribution with size of particles. The average PM10.9 (i.e. <10.9microm) concentrations are approximately 90.2%+/-4.5%, 81.4%+/-1.4% and 86.4%+/-9.6% of TSPM for winter, summer and monsoon seasons, respectively. Source apportionment reveals that there are two sources of TSPM and PM10.9, while three and four sources were observed for PM1.6 (i.e. <1.6microm) and PM0.7, respectively. Results of regression analyses show definite correlations between PM10.9 and other fine size fractions, suggesting PM10.9 may adequately act as a surrogate for both PM1.6 and PM0.7, while PM1.6 may adequately act as a surrogate for PM0.7.

Seasonal trends in coarse and fine particle sources in Delhi by the chemical mass balance receptor model

A study of the source contribution of atmospheric particulate matter and associated heavy metal concentrations using chemical mass balance model Version 8 (CMB8) in coarse and fine size mode has been carried out for the city of Delhi. Urban particles were collected using a five-stage impactor at six sites in three different seasons, viz. winter, summer and monsoon in the year 2001. Five samples from each site in each season were collected. The results obtained indicate the dominance of vehicular pollutants in fine size mode, whilst the contribution in coarse mode to some extent is site specific but largely due to vehicular pollution and, soil and crustal dust. Seasons also play an important role but in coarse size fraction only.

Characterization and source identification of polycyclic aromatic hydrocarbons (PAHs) in the urban environment of Delhi

This paper reports on polycyclic aromatic hydrocarbons (PAHs) in the atmospheric particulate matter of Jawaharlal Nehru University campus, an urbanized site of New Delhi, India. Suspended particulate matter samples of 24h duration were collected on glass-fiber filter paper for four representative days in each month during January 2002 to December 2003. PAHs were extracted from filter papers using toluene with ultrasonication method and analysed. Quantitative measurements of polycyclic aromatic hydrocarbons (PAHs) were carried out using the gas chromatography technique. The annual average concentration of total PAHs were found to be 668+/-399 and 672+/-388 ng/m3 in the years 2002 and 2003, respectively. The seasonal average concentrations were found to be maximum in winter and minimum during in the monsoon. The results of principal component analysis (PCA) indicate that diesel and gasoline driven vehicles are the principal sources of PAHs in all the seasons. In winter coal and wood combustion also significantly contribute to the PAH levels.

Chiari I malformation associated with atlanto-axial dislocation: focussing on the anterior cervico-medullary compression

BACKGROUND

Chiari I malformation with atlantoaxial dislocation may cause both posterior and anterior cervicomedullary compression. We studied the clinicoradiological features and surgical outcome in patients having Chiari I malformation with atlantoaxial dislocation.

METHOD

Thirty-nine patients with Chiari I malformation with atlanto-axial dislocation underwent preoperative and follow-up neurological status assessment. In Chiari I malformation with reducible atlanto-axial dislocation (n = 11), a direct posterior stabilization was done. In Chiari I malformation with irreducible atlanto-axial dislocation (n = 28), a single stage transoral decompression with posterior stabilization and/or posterior decompression and duraplasty were done in 18 patients. In 10 patients, only posterior decompression and/or posterior stabilization was performed. Seven among the latter patients subsequently deteriorated and required transoral decompression. Comparison of mean neurological status scores of patients with Chiari I malformation with irreducible atlanto-axial dislocation who underwent single stage transoral decompression with posterior stabilization versus the posterior procedure alone was done using T-test and proportional significance also calculated.

FINDINGS

Patients with Chiari I malformation with atlanto-axial dislocation have a high incidence of long tract signs and sphincteric disturbances with a decrease in the mean foramen magnum diameter. The mean neurological status scores of patients with Chiari I malformation with irreducible atlanto-axial dislocation who underwent single stage transoral decompression with posterior stabilization were significantly better than those patients who underwent the posterior procedure alone. The latter patients also showed significant clinical improvement following transoral decompression. In the presence of Chiari I malformation with reducible atlanto-axial dislocation, reduction and stabilization of atlanto-axial dislocation resulted in neurological improvement. The follow up neurological status scores of these patients improved after surgical intervention even in the presence of poor preoperative grades.

CONCLUSIONS

Patients with Chiari I malformation should be investigated for the presence of atlanto-axial dislocation. In case atlantoaxial dislocation coexists, priority must be given to relieving anterior cervicomedullary compression.

Isolated breast mucormycosis

Mucormycosis is unusual in surgical practice. Awareness of the classical findings leads to early detection. Excisional therapy whenever possible along with systemic antifungal treatment is the key to successful outcome. A 70 year old female, a known case of diabetes mellitus and chronic obstructive pulmonary disease, on inhalational steroids and oral hypoglycemic agents, presented to us with complaints of sudden onset pain, redness and swelling of left breast. A diagnosis of severe mastitis was made and a release incision was taken. The entire breast became gangrenous in next 24 hours and simple mastectomy had to be performed as a life saving measure. Histopathology revealed mucormycosis of breast. To the best of our knowledge this is the first reported case of mucormycosis of breast in the English literature.

Rapid licensure of a new, inactivated influenza vaccine in the United States

BACKGROUND

The unexpected problems at 1 of 2 US licensed manufacturers of trivalent inactivated influenza virus vaccine (TIV) in 2004 highlights the urgent need for additional vaccine sources. We evaluated a split virus TIV (Fluarix, GSK), to generate data supportive of a license application in the US.

METHODS

Healthy adults ages 18-64 years at four centers were randomly assigned to receive a single IM injection of Fluarix (n = 763) or placebo (n = 193) in double-blind fashion. Subjects were monitored for safety and serum hemagglutination-inhibition (HAI) titers determined before and 21 days after vaccination.

RESULTS

Vaccine was well tolerated, with only mild to moderate myalgias and injection site pain and redness being more common in vaccine than placebo recipients. Four-fold or greater increases in serum HAI titers were seen in 60%, 62% and 78% of vaccine recipients against the H1, H3, and B components of the vaccine, respectively, and post-vaccination titers of > 1:40 achieved in 98%, 99% and 99% of subjects, exceeding the prespecified criteria for acceptability for all three antigens.

CONCLUSIONS

Fluarix has a safety and immunogenicity profile like other US-licensed inactivated influenza vaccines and should be effective when used to immunize US adults. SUMMARY LINE: The results of this study were pivotal for the rapid approval of Fluarix in the US for use in adults 18 years of age or older.

A study to characterize the influence of outdoor SPM and associated metals on indoor environment in Delhi

In order to understand the influence of outdoor SPM and its associated metals on indoor environment, a study was carried out for 24 residential, sensitive, commercial and heavy traffic sites in Delhi. In the first phase, the samplings of SPM were conducted simultaneously indoors and outdoors at a reference site during February to March 2000 and later at all other sites from February to July 2001. Atomic Absorption Spectrometry (AAS) was used to determine the heavy metal composition of SPM, analyses of Ca, Mg, Cu, Cd, Pb, Cr, Mn, Fe and Ni were done. It is observed that, depending upon the nature of the site, the outdoor SPM concentrations affect the indoor SPM concentrations in varying degrees. In case of metals such as Cu, Cr, Cd and Ni, very good correlation between the indoor and outdoor concentrations was observed irrespective of the nature of the site. The correlation between indoor and outdoor for Mg, Fe, Mn and Pb depends upon the nature of the site. No correlation was observed between indoor and outdoor Ca at any of the chosen sites.

Intracranial aneurysms in patients 18 years of age or under, are they different from aneurysms in adult population?

BACKGROUND

Intracranial aneurysms are extremely uncommon in the first two decades of life. This study was undertaken to assess the clinicoradiological features and surgical outcome of intracranial aneurysms in patients less than or equal to 18 years of age; and, to highlight the differences between these and intracranial aneurysms seen in adult patients.

METHODS AND MATERIAL

Twenty-two patients, 18 years of age or under (male:female ratio=1.75:1; mean age 14.18+/-3.8 years, age range 5 to 18 years) and 451 adult patients aged older than 18 years (male:female ratio=1:1.05; mean age 48.21+/-12.71 years, age range, 19 to 81 years) were treated for intracranial aneurysms at our center between January 1991 and July 2003. The univariate statistical analysis was used to compare differences between the two groups.

FINDINGS

The patients under 18 years constituted 4.6% of the total patient population having intracranial aneurysms. The incidence of associated medical diseases was greater in patients under 18 years than in the adults (9% versus 0.26%, p<0.05). The incidence of seizures was more than double in patients under 18 years (36% versus 17%, p<0.05). The incidence of intracerebral haematoma (ICH; 41% versus 22.5%, p>0.05), intraventricular haemorrhage (IVH; 45% versus 34%, p>0.05), and hydrocephalus (36% versus 25%, p>0.05) were higher in patients under 18 years. In adult patients, anterior communicating artery (AcoA) and in children, ICA bifurcation were the most frequent sites of aneurysm formation respectively (p<0.05). The incidence of giant aneurysms was nearly double in children (13.6% versus 6.5%, p>0.05). The incidence of clinical vasospasm was almost the same in both groups. The overall outcome was favourable in 82% of patients under 18 years and 58.8% in adults. The management mortality in patients under 18 years was 9.1%, while in the adult patients, it was 19%.

CONCLUSION

In patients under 18 years of age, there was a definite male predominance; a higher incidence of seizures; and, the ICA bifurcation formed the most frequent site of intracranial aneurysms. In adults, AcoA a was the commonest site. Rebleeding and delayed ischaemic deficits were the major causes of morbidity. Favorable outcome after surgery in young patients was better in comparison to their adult counterparts.

Forecasting daily maximum surface ozone concentrations in Brunei Darussalam--an ARIMA modeling approach

A time series approach using autoregressive integrated moving average (ARIMA) modeling has been used in this study to obtain maximum daily surface ozone (O3) concentration forecasts. The order of the fitted ARIMA model is found to be (1,0,1) for the surface O3 data collected at the airport in Brunei Darussalam during the period July 1998-March 1999. The model forecasts of one-day-ahead maximum O3 concentrations have been found to be reasonably close to the observed concentrations. The model performance has been evaluated on the basis of certain commonly used statistical measures. The overall model performance is found to be quite satisfactory as indicated by the values of Fractional Bias, Normalized Mean Square Error, and Mean Absolute Percentage Error as 0.025, 0.02, and 13.14% respectively.

C3-4 level cervical spondylotic myelopathy

Cervical spondylotic myelopathy (CSM) is uncommon at the C3-4 level. Fourteen patients with C3-4 CSM were treated over a period of 3 years. The radiological factors contributing to CSM at the C3-4 level were studied. These factors included the assessment of static and dynamic canal diameters, retrolisthesis, posterior osteophytes and degenerative spinal segmental fusion on plain X-rays; and, the antero-posterior cord compression ratio (APCR) on magnetic resonance imaging (MRI). The clinical status of the patients was assessed by the modified Japanese orthopedic association scale (mJOAS). The mean difference between the static and dynamic canal diameters was statistically significant at C3-4 (p < 0.01). The APCR obtained at different levels showed a significant compression at the C3-4 level in comparison to the lower level. There was a correlation between the APCR and the preop mJOAS, r=0.6 (p< 0.05). The mean mJOAS improved from 9.35 to 14.35 at follo-up. The recovery rate calculated using the modified Hirabayashi rate was 66.9%. Degenerative changes at lower cervical segments predispose to increased mobility and spondylotic changes at the C3-4 level. The patients in this study were young as compared to those reported in the international literature.

Chiari I malformation related syringomyelia: radionuclide cisternography as a predictor of outcome

BACKGROUND

This prospective study, conducted in patients with Chiari I malformation (C I) related syringomyelia who underwent posterior decompression and duroplasty, utilizes radionuclide cisternography in order to study the cerebrospinal fluid (CSF) dynamics at the foramen magnum and to predict the clinical outcome following surgery.

METHODS

17 consecutive patients of C I with syringomyelia (but without hydrocephalus or fixed atlanto-axial dislocation), underwent a detailed neurological examination and were assigned a clinical disability score based on the modified Klekamp and Samii score. A radionuclide cisternography (using Tc99m-DTPA) was performed via the lumbar route and the ascent of the tracer was followed utilizing a gamma camera immediately after injection and then sequentially after 1, 2, 4, 6 and 24 hours. After posterior decompression and duroplasty, the modified Klekamp and Samii score was repeated at follow-up visits (range: 3 months to one year) along with radionuclide cisternography at 3 months, and MR imaging at 6 months.

FINDINGS

Three patterns of tracer flow were observed: a). rapid flow (n=7); b). supratentorial subarachnoid delay (n=7); and, c). foramen magnum block (n=3). The patients having foramen magnum block had the poorest clinical scores on admission. At follow up, there was an improvement in the clinical scores so that the mean scores in all three categories reached nearly the same level. Following posterior decompression, the radionuclide cisternography performed in 10 patients showed a rapid flow of the tracer without any obstruction. The syrinx resolved in 4 of the 11 patients in whom an MRI was done.

INTERPRETATION

The patients with C I with syringomyelia may often have a free flow of tracer across the FM. Posterior decompression and duroplasty provides maximum clinical relief in patients with a demonstrable foramen magnum block on radionuclide cisternography while those with a normal flow have less relief. The symptomatology related to brain-stem compression immediately responds to the surgical procedure but the syrinx-induced signs and symptoms of spinal cord dysfunction persist.

Comparative study of oral and topical ketoconazole therapy in pityriasis versicolor

INTRODUCTION

Both topical and systemic ketoconazole are reported to be effective against pityriasis versicolor.

MATERIAL AND METHODS

Forty patients suffering from pityriasis versicolor were treated either with oral ketoconazole 200 mg per day or 2% ketoconazole cream topically once daily for 2 weeks.

RESULTS

On global assessment, after 2 weeks of start of therapy, 18 (90%) out of 20 patients treated with oral ketoconazole were cured while 2 patients had considerable residual disease. In the ketoconazole cream group, 16 (80%) out of 20 patients were cured and 4 patients had considerable residual disease.

CONCLUSION

No significant difference was observed in the response rates in the two groups. Relapse occurred in two patients of the systemic ketoconazole group and six patients of the topical ketoconazole group during the follow-up period of three months.

Comparative study of ketoconazole versus selenium sulphide shampoo in pityriasis versicolor

Forty patients suffering from pityriasis versicolor were treated with either 2% ketoconazole shampoo (20 patients) or 2.5% selenium sulphide shampoo (20 patients), once a week for three weeks. On global assessment after one month of start of therapy, 19 (95%) out of 20 patients treated with ketoconazole shampoo were cured while one case had mild residual disease. In selenium sulphide shampoo group, 17 (85%) out of 20 patients were cured, one had mild residual disease and two had considerable residual disease. No significant difference was observed in the response rates in the two groups. Relapse occurred in one patient of ketoconazole group and two patients of selenium sulphide group during the follow-up period of three months.

Palmo-plantar lichen sclerosus et atrophicus

A case of lichen sclerosus et atrophicus (LSA) in a male patient who presented with multiple hypopigmented to depigmented macules, polygonal in shape, distributed in a bilaterally, symmetrical manner over the hands, feet and flexor aspect of wrists is being reported. Histopathology confirmed the diagnosis of LSA.

Management of congenital atlanto-axial dislocation: some lessons learnt

Congenital atlantoaxial dislocation (AAD) has a high incidence in India. In these patients, even a minor trauma may precipitate severe morbidity. The management of mobile AAD consists of posterior stabilization. In fixed AAD, the offending compressive element is present anterior to the cervicomedullary junction, which should be generously removed by the transoral approach. In many of these patients, the assimilated posterior arch of atlas or the incurving posterior margin of the foramen magnum or associated Chiari I malformation also adds to the compromise of the canal diameter at the foramen magnum. Thus, in cases of fixed AAD, the hour glass appearance of the spinal canal at the craniovertebral junction should be converted into a funnel shaped appearance which is close to normal. Since these procedures require a generous removal of the osteoligamentous structures, posterior fusion should be done in all cases after decompressive surgery. In this review, the observations that emerged during the management of congenital AAD are presented with a special focus on the assessment scales modified to the Indian settings, hypermobile AAD, rotary C1-2 dislocation, and AAD associated with Chiari I malformation and syringomyelia.

Patch testing in discoid eczema

Fifty patients of both sexes with clinically suspected discoid eczema were patch tested with the Indian Standard Patch Test Battery approved by the Contact and Occupational Dermatosis Forum of India (CODFI). Most of these patients were young adults between 20 and 39 years old, with a mean age of 36 years. The mean duration of symptoms was 21/2 years. The occupational profiles of the patients included farmers (24%), housewives (18%), students (14%), housewives engaged in farming (12%), shopkeepers (10%), and laborers (8%). The miscellaneous group, including technicians, drivers, cable operators, office workers, and computer operators, accounted for the remaining 14%. The common clinical patterns of presentation of discoid eczema included hands and feet (44%), hands and forearms' (30%), legs and feet (12%) and trunk and limbs (12%). Patch test analysis of these patients revealed that, out of the 50 subjects tested, 28 (56%) reacted to one or more allergens. Potassium dichromate was the most common allergen (20%), followed by nickel (16%), cobalt chloride, and fragrance (12% each) in decreasing order of frequency. Hence, it may be concluded that patch testing should be considered for all patients with severe or persistent discoid eczema because allergic contact dermatitis may be relatively common in such patients and the avoidance of offending allergens may be of substantial benefit to the patients.