An Unusual Presentation of Adult Onset Still's Disease

Adult onset still's disease usually presents with high grade intermittent fever, polyarthritis, salmon pink evanescent rash and hepatosplenomegaly. Pulmonary involvement in the form of pneumonitis, as a presenting feature is very rare. We report a case of a young lady who presented with fever, cough and respiratory distress. Chest X-ray revealed patchy infiltration in left upper lung zone. She was subsequently diagnosed as Adult onset Still's disease. There was no improvement in clinical condition despite five days of antibiotics. On trans-bronchial lung biopsy (TBLB) proved she had interstitial pneumonitis and responded dramatically to steroid treatment.

Impact of a standardized nurse observation protocol including MEWS after Intensive Care Unit discharge

BACKGROUND

Analysis of in-hospital mortality after serious adverse events (SAE's) in our hospital showed the need for more frequent observation in medical and surgical wards. We hypothesized that the incidence of SAE's could be decreased by introducing a standard nurse observation protocol.

AIM

To investigate the effect of a standard nurse observation protocol implementing the Modified Early Warning Score (MEWS) and a color graphic observation chart.

METHODS

Pre- and post-intervention study by analysis of patients records for a 5-day period after Intensive Care Unit (ICU) discharge to 14 medical and surgical wards before (n=530) and after (n=509) the intervention.

RESULTS

For the total study population the mean Patient Observation Frequency Per Nursing Shift (POFPNS) during the 5-day period after ICU discharge increased from .9993 (95% C.I. .9637-1.0350) in the pre-intervention period to 1.0732 (95% C.I. 1.0362-1.1101) (p=.005) in the post-intervention period. There was an increased risk of a SAE in patients with MEWS 4 or higher in the present nursing shift (HR 8.25; 95% C.I. 2.88-23.62) and the previous nursing shift (HR 12.83;95% C.I. 4.45-36.99). There was an absolute risk reduction for SAE's within 120h after ICU discharge of 2.2% (95% C.I. -0.4-4.67%) from 5.7% to 3.5%.

CONCLUSION

The intervention had a positive impact on the observation frequency. MEWS had a predictive value for SAE's in patients after ICU discharge. The drop in SAE's was substantial but did not reach statistical significance.

Decision forests for tissue-specific segmentation of high-grade gliomas in multi-channel MR

We present a method for automatic segmentation of high-grade gliomas and their subregions from multi-channel MR images. Besides segmenting the gross tumor, we also differentiate between active cells, necrotic core, and edema. Our discriminative approach is based on decision forests using context-aware spatial features, and integrates a generative model of tissue appearance, by using the probabilities obtained by tissue-specific Gaussian mixture models as additional input for the forest. Our method classifies the individual tissue types simultaneously, which has the potential to simplify the classification task. The approach is computationally efficient and of low model complexity. The validation is performed on a labeled database of 40 multi-channel MR images, including DTI. We assess the effects of using DTI, and varying the amount of training data. Our segmentation results are highly accurate, and compare favorably to the state of the art.

The Turbid Crystal Ball: Life Plans Affected by MS

Since multiple sclerosis (MS) has its onset at a young age, it is valuable to know how it affects life plans and future perspectives of patients. Through two narratives, this aspect is discussed in this article. The first is the autobiographical journal: The Journal of a Disappointed Man by WNP Barbellion, published in 1920, and the other one is from a contemporary patient. Despite the fact that both narratives are derived from different centuries, clear similarities have been perceived in the patients life plans and future perspectives. The narratives show that the life plans of both patients were adjusted due to physical limitations. Additionally, both patients experienced sorrows for losing the ability to perform passionate hobbies during their life. Moreover, a strong sense of uncertainty was expressed in both narratives concerning their future.

Effects of intrathecal midazolam in spinal anaesthesia: a prospective randomised case control study

INTRODUCTION

Subarachnoid block with local anaesthetics and adjuvants has been extensively used for surgery. Intrathecal midazolam produces antinociception and potentiates the effect of local anaesthetics. We compared intrathecal bupivacaine with and without midazolam to assess its effect on the duration of sensory block, motor block and pain relief.

METHODS

A total of 100 patients scheduled for elective lower abdominal, lower limb and gynaecological procedures were selected to participate in this prospective, randomised, double-blind study. Patients were randomly allocated into two groups for intrathecal drug administration. Group B received 3 mL 0.5 percent bupivacaine with 0.4 mL saline, and group BM received 3 mL 0.5 percent bupivacaine and 0.4 mL (2 mg) midazolam mixture. The onset, duration of sensory/motor block, time to first rescue analgesia and side effects were noted.

RESULTS

Demographic profile and duration of surgery were comparable between the two groups. The onset of sensory (4.8 versus 4.6 min) and motor block (5.9 versus 6 min) was also comparable between the groups. The duration of sensory blockade was prolonged in the midazolam group (90.8 versus 115.8 min, p-value is 0.001), while the duration of motor blockade was comparable (151.8 versus 151.3 min, p-value is 0.51). The duration of effective analgesia was significantly longer in the midazolam group compared to the control group (121.3 versus 221.1 min, p-value is 0.001). Sedation score was comparable in the two groups.

CONCLUSION

The addition of preservative-free midazolam to bupivacaine intrathecally resulted in prolonged postoperative analgesia without increasing motor block.

Neuroimaging reveals dual routes to reading in simultaneous proficient readers of two orthographies

Orthographic differences across languages impose differential weighting on distinct component processes, and consequently on different pathways during word-reading tasks. Readers of transparent orthographies such as Italian and Hindi are thought to rely on spelling-to-sound assembly and show increased activation in phonologically tuned areas along the dorsal pathway, whereas reading an opaque orthography such as English is thought to rely more on lexically mediated processing associated with increased activation of semantically tuned regions along the ventral pathway. To test if biliterate Hindi/English readers exhibit orthography-specific reading pathways, we used behavioural measures and functional neuroimaging. Reaction times and activation patterns of monolingual English and Hindi readers were compared to two groups of adult biliterates; 14 simultaneous readers who learnt to read both languages at age 5 and 10 sequential readers who learnt Hindi at 5 and English at 10. Simultaneous, but not sequential readers demonstrated relative activation differences of dorsal and ventral areas in the two languages. Similar to native counterparts, simultaneous readers preferentially activated the left inferior temporal gyrus for English and left inferior parietal lobule (L-IPL) for Hindi, whereas, sequential readers showed higher activation along the L-IPL for reading both languages. We suggest that early simultaneous exposure to reading distinct orthographies results in orthography-specific plasticity that persists through adulthood.

Obstructive sleep apnoea and anaesthesia

Obstructive sleep apnoea (OSA) correlates positively with obesity and age, both of which are becoming increasingly prevalent. Obstructive sleep apnoea occurs much more frequently in clinical practice than formerly diagnosed, and that this condition represents complex challenges for difficulty in mask ventilation, laryngoscopic intubation, accelerated arterial desaturation, postoperative monitoring and discharge status. In this review article pathophysiology, diagnosis, and perioperative management of this group of patients have been discussed in detail.

Blue rubber bleb nevus syndrome causing refractory anaemia

Blue Rubber Bleb Nevus Syndrome (BRBNS) is a rare angiomatosis characterized by distinctive cutaneous and gastrointestinal venous malformations that result in gastrointestinal haemorrhage and iron-deficiency anaemia secondary to the bleeding episodes. We hope to emphasize the possibility of recurrent melaena in BRBNS and heighten physicians' awareness about the disease to contribute to its early detection.

Bioleaching of low-grade uranium ore using Acidithiobacillus ferrooxidans

Bioleaching of uranium was carried out with Turamdih ore sample procured from Uranium Corporation of India Limited, Jaduguda. The bacterial strain that was used in the leaching experiments was isolated from the Jaduguda mine water sample. Efficiency of bioleaching was studied by varying parameters like pulp density and initial ferrous concentration as source of energy. It is observed that the efficiency of bioleaching was 49% at 10% pulp density (w/v) and initial pH 2.0. Addition of external has no effect on efficiency of bioleaching showing domination of direct leaching mechanism over indirect.

Acclimation of Anabas testudineus (Bloch) to three test temperatures influences thermal tolerance and oxygen consumption

Teleost fish have developed their own specific adaptive mechanism, both behavioral and physiological, to maintain homeostasis in response to unfavorable temperatures. Therefore, this study was aimed at assessing the critical thermal maxima (CT(Max)), critical thermal minima (CT(Min)), and oxygen consumption rate of Anabas testudineus (17.03 +/- 1.2 g) after acclimating to three preset temperatures (25, 30, and 35 degrees C) for 30 days. The CT(Max) and CT(Min) were 40.15, 41.40, 41.88 degrees C and 12.43, 13.06, 13.94 degrees C, respectively, and were significantly different (P < 0.05). The thermal tolerance polygon for the specified temperatures was 278.30 degrees C(2). The oxygen consumption rate (117.03, 125.70, 198.48 mg O(2) kg(-1) h(-1), respectively) increased significantly (P < 0.05) with increasing acclimation temperatures. The overall results indicate that the thermal tolerance and oxygen consumption of A. testudineus are dependent on acclimation.

A novel [109Pd] palladium labeled porphyrin for possible use in targeted radiotherapy

The preferential accumulation of porphyrins in malignant tumor cells has been adequately documented. Hence, porphyrin derivatives radiolabeled with a suitable therapeutic radionuclide could be envisaged as potential agents for targeted tumor radiotherapy. Working in this direction, we have radiolabeled a porphyrin derivative, namely, 5,10,15,20-tetrakis[3,4-bis(carboethoxymethyleneoxy)phenyl]-porphyrin, synthesized in-house, with 109Pd [E β(max)=1.12 MeV, E γ=88 keV 3.6(%), T 1/2 = 13.7 h]. The envisaged rationale towards designing of this agent is based on the assumption that 109Pd would complex with the tetrapyrrole donor array constituting the porphyrin core, thereby providing a highly stable chelated complex, and the peripheral ester groups would impart optimum lipophilicity needed for sufficiently high tumor accumulation and retention therein. 109Pd was produced with a specific activity of ∼1.85 GBq/mg and radionuclidic purity of 100% by the thermal neutron bombardment of enriched (98% in 108Pd) metallic Pd target at a flux of 3×1013 n/cm2s1 for 3 d. The porphyrin derivative was synthesized by a multi-step reaction and characterized by normal spectroscopic techniques. 109Pd complex of the synthesized porphyrin derivative was prepared with excellent radiochemical purity (>98%) and the complex was observed to be stable upto 24 h at room temperature. Biodistribution studies carried out in Swiss mice bearing fibrosarcoma tumors revealed good tumor uptake [(5.28±1.46)% injected activity (IA)/g] within 30 min post-injection (p.i.). The complex exhibited favorable tumor/blood and tumor/muscle ratios [1.69±0.23 and 5.00±1.54, respectively at 3 h p.i.], albeit with high liver uptake throughout the time of study (>20% IA).

Stenotrophomonas maltophilia endogenous endophthalmitis: clinical presentation, sensitivity spectrum and management

Stenotrophomonas maltophilia is gaining importance as a community-acquired pathogen, after becoming firmly established as a nosocomial pathogen. Here we report a case of endogenous endophthalmitis due to S. maltophilia. Antibiotic-susceptibility testing of the isolate was performed by the Kirby-Bauer disc diffusion method. The organism was resistant to aminoglycosides, imipenem, ticarcillin and cotrimoxazole and was sensitive to ceftazidime and chloramphenicol. The patient was successfully treated with a sensitivity-based intravitreal antibiotic regimen.

Biochemical and stress responses of rohu Labeo rohita and mrigal Cirrhinus mrigala in relation to acclimation temperatures

The biochemical and stress responses of two Indian major carps, rohu Labeo rohita and mrigal Cirrhinus mrigala were studied after acclimating them to four preset temperatures (26, 31, 33 and 36 degrees C) for 30 days. The blood glucose and liver glycogen levels showed an inverse trend in both the species and were significantly different in L. rohita at higher temperatures. The decrease in the liver glycogen level of C. mrigala, however, was not significant. Plasma cortisol levels increased significantly whereas the ascorbic acid content in the brain and kidney of both the species decreased significantly with increasing temperatures. Total lipid content in the liver of both the species decreased significantly with increasing acclimation temperatures. The phospholipid concentration decreased in L. rohita with increasing acclimation temperatures, and in C. mrigala the values decreased up to 33 degrees C and increased at 36 degrees C. In C. mrigala, the cholesterol level decreased up to 33 degrees C and then increased at 36 degrees C, but the absolute value was lower in comparison to L. rohita. The cholesterol levels, however, were not significantly different in L. rohita. Triglycerides and free fatty acids concentrations decreased significantly with increasing acclimation temperatures in both the species. The present study indicates species-specific metabolic responses of L. rohita and C. mrigala to thermal acclimation.