A study to evaluate asbestos fiber burden in lung and pleural malignancies

BACKGROUND

There is scarcity of data on asbestos fiber burden in lung and pleural malignancies.

AIM

To evaluate asbestos fiber burden in biopsy samples of suspected lung and pleural malignancies.

STUDY DESIGN

This was a single-centre, observational study.

STUDY PERIOD

From August 2010 to July 2010.

SETTING

Department of Pulmonary Medicine, CSMMU, UP, Lucknow, a tertiary care hospital in India.

STUDY POPULATION

Suspected cases of lung and pleural malignancy.

MATERIALS AND METHODS

Biopsy tissues taken by computed tomography (CT)-guided biopsy, bronchoscopic biopsy, and pleural biopsy by Cope's needle were analyzed for histopathology and asbestos burden by Haq et al.'s method.

RESULTS

20 patients were studied. Mean fiber burden was 9.25 × 10 4 fibers/g. Average burden in lung malignancies (11 patients) was 9.178 × 10 4 fibers/g and in pleural tissue (9 patients) was 9.332 × 10 4fibers/g. Among the different cell types, mean fiber burden in squamous cell carcinoma was 8.99 × 10 4 fibers/g, in adenocarcinoma was 9.71 × 10 4 fibers/g, and in small cell carcinoma was 7.54 × 10 4 fibers/g. Mean fiber burden in bronchoscopic endobronchial biopsy tissue was 10.69 × 10 4 fibers/g, while in CT-guided biopsy was 8.60× 10 4fibers/g.

CONCLUSION

Maximum number of fibers was found in adenocarcinoma.

Blood pressure lowering, fibrinolysis enhancing and antioxidant activities of cardamom (Elettaria cardamomum)

Elettaria cardamomum (L.) Maton. (Small cardamom) fruit powder was evaluated for its antihypertensive potential and its effect on some of the cardiovascular risk factors in individuals with stage 1 hypertension. Twenty, newly diagnosed individuals with primary hypertension of stage 1 were administered 3 g of cardamom powder in two divided doses for 12 weeks. Blood pressure was recorded initially and at 4 weeks interval for 3 months. Blood samples were also collected initially and at 4 weeks interval for estimation of lipid profile, fibrinogen and fibrinolysis. Total antioxidant status, however, was assessed initially and at the end of the study. Administration of 3 g cardamom powder significantly (p<0.001) decreased systolic, diastolic and mean blood pressure and significantly (p<0.05) increased fibrinolytic activity at the end of 12th week. Total antioxidant status was also significantly (p<0.05) increased by 90% at the end of 3 months. However, fibrinogen and lipid levels were not significantly altered. All study subjects experienced a feeling of well being without any side-effects. Thus, the present study demonstrates that small cardamom effectively reduces blood pressure, enhances fibrinolysis and improves antioxidant status, without significantly altering blood lipids and fibrinogen levels in stage 1 hypertensive individuals.

Complete radiological clearance in bilateral loculated pyopneumothorax managed conservatively

We are reporting a case of bilateral loculated pyopneumothorax in a 30-year-old male patient, who was treated conservatively with antibiotics alone, and had complete radiological clearance.

East Central South African genotype as the causative agent in reemergence of Chikungunya outbreak in India

Chikungunya fever is an important arboviral infection prevalent throughout Africa and Southeast Asia. Recently, in 2006, it has reemerged in many parts of India, affecting more than a million persons. A detail serological, virological, and molecular investigation of this unprecedented outbreak was carried out by collecting and studying 540 samples from all the affected regions of India during this epidemic. An in-depth investigation revealed the presence of anti-Chikungunya antibodies in 68% of the samples and genomic RNA in 49% of them. In addition 32 Chikungunya viruses were isolated from 45 representative polymerase chain reaction-positive samples. The nucleotide sequences of partial E1 gene of 25 representative Chikungunya viruses were deciphered. The sequence analysis indicated that all the isolates of this epidemic belonged to the new Indian Ocean island clade of East Central South (ECS) African genotype. This study conclusively proved the genotype shift from Asian to ECS African as the major factor in the reemergence of Chikungunya in an unprecedented outbreak in India after a gap of 32 years.

MRI detection of a female pelvic arteriovenous fistula after hysterectomy: treatment with superselective coil embolisation

We present a rare case of acquired pelvic arteriovenous fistula of the uterine vessels in a woman with a remote history of hysterectomy who presented with chronic pelvic and left limb pain. It was successfully treated by coil embolisation of the left uterine artery. The MRI and angiographic features are described, together with the current management and a review of literature.

Quality of ground water used for irrigation in Ujjain district of Madhya Pradesh, India

The ground water samples collected from different tehsils of Ujjain district were analysed in the laboratory for electrical conductivity (EC), pH, cations (Na+, K+, Ca2+ and Mg2+) and anions (CO3(2-)), HCO3-, Cl- and SO4(2-)). The water samples were categorized as per criterion developed by Central Soil Salinity Research Institute, Karnal, Haryana, India. Out of 712 samples, 105, 144, 150, 84, 68, 111 and 50 samples belong to Ujjain, Mahidpur, Khachrod, Tarana, Barnagar, Nagda and Ghatia tehsils of the district respectively. 80% samples indicated good water quality at the district as a whole, whereas 14% were found saline (marginally saline (B1)-9%, saline (B2)-4%, high SAR saline (B3)-1%) and 6% as alkali (marginally alkali (C1)-5%, and alkali (C2)-1%) categories. In general, these waters were of Ca-Na-Mg type with the dominance of Cl followed by HCO3 and CO3 in case of good quality waters. The poor water quality belonged to categories of B1, B2, B3, C1 and C2, which were either having accumulation of salts (high EC) or high sodium adsorption ratio (SAR) and residual sodium carbonate (RSC). High significant negative correlation coefficient between pH and SO4-- was observed. The sodium (Na+) content showed significant positive correlation coefficient with EC. Similarly, HCO3- showed a significant positive correlation with RSC content. The ground water quality map of the district was generated using ERDAS-IMAGINE 8.7 Software showing different categories.

Acute pancreatitis: a lesser-known complication of aluminum phosphide poisoning

There have been no case reports on aluminum phosphide-induced pancreatitis in the literature available. In this report, we present the case of a young man who developed acute pancreatitis and probably acute myocarditis following ingestion of aluminum phosphide pellets in the absence of the usual risk factors and after exclusion of other possible causes of pancreatitis. In the absence of re-challenge, we put forth the probable causative association of pancreatitis with aluminum phosphide or phosphine gas, its active pesticidal component.

Avoidance of allergens by the patients with bronchial asthma

OBJECTIVES

Association between environmental allergens and bronchial asthma is well established. A great number of substances found in the environment can precipitate or aggravate respiratory symptoms in asthmatics. Avoiding allergens is recognized as an integral part of management. Through various educational interventions the patients can be taught various measures to avoid these allergens. The present study was undertaken to evaluate the impact of 'self care manual' an educational intervention on the avoidance of various environmental allergens.

METHODS

The total enrolled patients were 523 of which 260 were included in the study group to whom 'self care manual' was given and 263 in the control group with no access to self care manual. A fourteen items interview schedule consisting of three parts was administered. The first two subparts were in the form of checklist to know the various allergens which were inducing symptoms in the patients and weather they could avoid these triggers. The third part which was open ended was administered to know their ways of avoiding these triggers. All the patients were followed up at 2 weeks, 6 months and at 1 year.

RESULT

Mean age of the subjects in both the groups was 36.72 +/- 11.52 years and 34.33 +/- 12.86 years respectively. Both the groups were comparable on majority of the socio-demographic variables. The number of patients whose symptoms were aggravated by a particular triggering factor reduced significantly on each successive visit in the study group. Almost all the patients started avoiding their triggers in follow-ups in the study group. In control group this change was only for few triggers. More and more patients started using inhalers on exposure to dust or triggering weather conditions. They started slowing down for exercises and diverted their attentions against triggering emotional situations.

CONCLUSION

Patient education should be an essential component in the overall management of bronchial asthma. Control of asthma symptoms is better achieved with avoidance of allergens. This can be accomplished by emphasizing these facts particularly with the use of self care manuals.

Pediatric and adolescent strangulation deaths

The incidence of pediatric and adolescent deaths due to unnatural means is increasing. Fatal strangulation constitutes a significant group of violent deaths. The characteristics of pediatric and adolescent involvement has been rarely studied. In the present study, a cohort of 28 cases of pediatric and adolescent strangulation deaths was analyzed. The data for the study were collected from inquest papers, post-mortem reports and other departmental records for the period 1993-2004 (12 years). Female victims were more than male with male, female ratio of 3:4. Ligature strangulation was three times more frequent than manual strangulation. Ninety three percent were homicidal and the remaining 7% accidental. Fracture of neck structures was found in 25% of the cases and other associated injuries on different body parts were observed in more than half of the cases. Clothing and personal belongings were the most common ligature materials and in the majority of cases the exact reason for strangulation was not known at the time of postmortem.

Sodium stibogluconate-sensitive visceral leishmaniasis in the non-endemic hilly region of Uttarakhand, India

Although visceral leishmaniasis (VL) is endemic in various parts of India, mainly Bihar, West Bengal and Orissa, and neighbouring countries such as Nepal and Bangladesh, it is rarely reported from the hilly areas of India. We report on nine male VL cases from the non-endemic Garhwal region of Uttarakhand who were treated successfully with sodium stibogluconate. We conclude that sodium stibogluconate-sensitive VL is emerging in this region and that urgent and effective vector control measures may be warranted to prevent the disease from becoming a major health problem and to ensure that resistance to sodium stibogluconate does not emerge.

Stretch-induced MAP kinase activation in cardiac myocytes: differential regulation through beta1-integrin and focal adhesion kinase

Mitogen-activated protein (MAP) kinases have been implicated in hemodynamic load induced heart failure. Both angiotensin II (Ang II) and mechanical stretch activate MAP kinases in cardiac myocytes. In this study, we used a neonatal rat ventricular myocyte (NRVM) model to determine the role of focal-adhesion kinase (FAK) in beta1 integrin mediated MAP kinase activation in response to mechanical stretch in presence and absence of Ang II receptor blockade (ATB). NRVM plated on deformable membranes coated with collagen IV were exposed to 20% equiaxial static-stretch. beta1 integrin signaling was blocked by adenovirus-mediated expression of a dominant-negative form of beta1D integrin (tac-beta1D). FAK signaling was disrupted by infecting NRVM with adenovirus expressing FAK-related non-kinase (FRNK). Western blot analysis was used to assess the phosphorylation of MAP kinases. In the presence and absence of ATB, mechanical stretch caused maximal phosphorylation of ERK, p38 and JNK at 5 min, which was significantly attenuated in NRVM expressing tac-beta1D. In the presence of ATB, FRNK overexpression significantly increased basal phosphorylation of ERK (40.2+/-8.6% P<0.05), p38 (39.5+/-11.7%, P<0.05), JNK (86+/-29.4%, P<0.05) and stretch-induced p38 (48.1+/-8.7%, P<0.05) and JNK (85.0+/-19.4%, P<0.05) phosphorylation. However, in the absence of ATB, FRNK overexpression significantly reduced basal and stretch-induced phosphorylation of only ERK. Examination of FAK activation revealed that beta1 integrin was required for stretch-induced phosphorylation of FAK at Y397 and Y925, but not Y861. In summary, mechanical stretch-activated ERK1/2, p38 and JNK through FAK independent and dependent mechanisms. Beta1 integrin was required for FAK independent activation of all three MAP kinases, whereas cross-talk between beta1 integrin and Ang II receptors mediated FAK dependent regulation of ERK1/2.

Occupational physical demands and same-level falls resulting in fracture in female workers: an analysis of workers' compensation claims

OBJECTIVES

To examine the association between occupational physical demands and risk of same-level falls resulting in fracture in female workers' compensation claimants.

METHODS

From workers' compensation claims for same-level falls, 7286 female workers from three age groups (18-49, 50-59 and 60-79 years) were randomly selected. Levels of occupational physical activity, standing and sitting were assigned using occupational codes. Fracture occurrence was determined using the International Classification of Diseases codes. Risks of same-level falls resulting in fracture were compared by quartiles of physical activity, standing and sitting.

RESULTS

In the 18-49-year age group, physical activity, standing and sitting at work were not significantly associated with risk of same-level falls resulting in fracture (p value trend: 0.07, 0.18 and 0.10, respectively). In the 50-59 and 60-79-year age groups, increasing duration of standing and decreasing duration of sitting were associated with decreasing risk of same-level falls resulting in fracture (p value trend: standing<0.001, 0.01; sitting<0.001, 0.02). In the 50-59-year age group, the relative risks of same-level falls resulting in fracture were 0.53, 0.41 and 0.82 for the second, third and highest quartiles of physical activity, respectively, as compared with workers in the lowest quartile (95% confidence interval 0.35 to 0.80, 0.23 to 0.72, 0.56 to 1.21, respectively). In the 60-79-year age group, there was a similar, but not significant, U-shaped association between occupational physical activity and risk of same-level falls resulting in fracture.

CONCLUSION

Moderate occupational physical demands may be associated with a decreased risk of same-level fall resulting in fracture in female workers' compensation claimants>or=50 years of age.