Mitigation of lung injury after accidental exposure to radiation

There is a serious need to develop effective mitigators against accidental radiation exposures. In radiation accidents, many people may receive nonuniform whole-body or partial-body irradiation. The lung is one of the more radiosensitive organs, demonstrating pneumonitis and fibrosis that are believed to develop at least partially because of radiation-induced chronic inflammation. Here we addressed the crucial questions of how damage to the lung can be mitigated and whether the response is affected by irradiation to the rest of the body. We examined the widely used dietary supplement genistein given at two dietary levels (750 or 3750 mg/kg) to Fischer rats irradiated with 12 Gy to the lung or 8 Gy to the lung + 4 Gy to the whole body excluding the head and tail (whole torso). We found that genistein had promising mitigating effects on oxidative damage, pneumonitis and fibrosis even at late times (36 weeks) when drug treatment was initiated 1 week after irradiation and stopped at 28 weeks postirradiation. The higher dose of genistein showed no greater beneficial effect. Combined lung and whole-torso irradiation caused more lung-related severe morbidity resulting in euthanasia of the animals than lung irradiation alone.

New approaches to preventing, diagnosing, and treating neonatal sepsis

Karen Edmond and Anita Zaidi highlight new approaches that could reduce the burden of neonatal sepsis worldwide.

Measles in children younger than 9 months in Pakistan

Pakistan has one of the highest burden of measles and measles-related deaths in the world. We compared the clinical course and outcomes of measles in infants aged <9 months with those >9 month old amongst children admitted to a tertiary care hospital. Data were collected by a retrospective chart review, and compared between age <9 months (Group A) and age >9 months (Group B). Severe malnutrition (P=0.039, adjusted odds ratio=3.02), anemia (P=0.017), leukocytosis (P<0.001, adjusted odds ratio 4.1), and conjunctivitis (P=0.021) were higher in Group A children. All four deaths occurred in Group B.

Plant growth promotion by phosphate solubilizing bacteria

Most agronomic soils contain large reserves of total phosphorus [P], but the fixation and precipitation of P cause P deficiency, and in turn, restrict the growth of crops severely. Phosphorus replenishment, especially in sustainable production systems, remains a major challenge as it is mainly fertilizer-dependent. Though the use of chemical P fertilizers is obviously the best means to circumvent P deficiency in different agro-ecosystems, their use is always limited due to its spiralling cost. A greater interest has, therefore, been generated to find an alternative yet inexpensive technology that could provide sufficient P to plants while reducing the dependence on expensive chemical P fertilizers. Among the heterogeneous and naturally abundant microbes inhabiting the rhizosphere, the phosphate solubilizing microorganisms (PSM) including bacteria have provided an alternative biotechnological solution in sustainable agriculture to meet the P demands of plants. These organisms in addition to providing P to plants also facilitate plant growth by other mechanisms. Despite their different ecological niches and multiple functional properties, P-solubilizing bacteria have yet to fulfil their promise as commercial bio-inoculants. Current developments in our understanding of the functional diversity, rhizosphere colonizing ability, mode of actions and judicious application are likely to facilitate their use as reliable components in the management of sustainable agricultural systems.

Successful Treatment of Systemic and Central Nervous System Lymphomatoid Granulomatosis with Rituximab

Lymphomatoid granulomatosis (LYG) is a rare lymphoproliferative disorder with a mortality rate approaching 60% in the first year. The median survival is 14 months from the time of diagnosis. Although a variety of chemotherapeutic regimens have been utilized, there is no standard treatment. Studies have shown that in most cases the malignant cells are B-cells, which induce massive infiltration of reactive T-lymphocytes in the background. The disease is therefore considered as a T-cell rich B-cell lymphoproliferative disorder. We report a case of LYG with pulmonary, hepatic, central and peripheral nervous system involvement that was successfully treated with the anti-CD20 (B-cell) monoclonal antibody, Rituximab.

The trouble with investigating anaemia in young adults: bleeding from a giant Meckel's diverticulum without ectopic gastric mucosa

Giant Meckel's diverticulum is rare and usually presents in childhood with haemorrhage or bowel obstruction. Bleeding results from the presence of ectopic gastric mucosa causing peptic ulceration of adjacent mucosa. We discuss the case of a 21-year-old man with a giant Meckel's diverticulum who presented with rectal bleeding. A Meckel's scan was negative and histology following surgical excision ruled out the presence of ectopic gastric mucosa. There was however evidence of chronic inflammation and small bowel mucosal ulceration. We hypothesize that this arose from ischaemia and pressure necrosis because of the large size of the diverticulum and chronic distension by food debris. This case highlights the difficulties in investigating anaemia in young adults despite modern imaging techniques.

Electrolyte imbalances in patients admitted with chemotherapy-induced febrile neutropenia: Patterns and impact on outcomes, a single-centre study from Pakistan

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Background: Febrile neutropenia (FN) and myelosupression remain a challenging oncologic medical emergency and dose limiting toxicity of chemotherapy. Various factors have been studied to be associated and affect outcome of patients admitted with FN. Electrolyte abnormalities have commonly been observed, but the real incidence and impact has been only scarcely studied. This study was conducted with the aim to observe the trends of electrolyte abnormalities seen synchronously in patients admitted with chemotherapy induced febrile neutropenia and their possible influence on the outcomes. Methods: This was a prospective, observational study. A total of 215 patients admitted with FN between January 2007 and August 2008 were included. Analysis of data was made using SPSS version16.0. Toxicity profile was graded according to CTC version 3.0. Results: Febrile neutropenia was seen to be almost equally distributed among patients with solid or hematological malignancies. Males and females were seen to be affected almost equally as well. A total of 83.5% patients demonstrated some degree of electrolyte abnormalities. Hypokalemia, of any grade, was seen in 48% of patients, 51.4% having grade I, 33.3% grade III and 15.2% had grade IV hypokalemia. Hyponatremia of all grades was seen in 67.9% patients, 60.3% had Grade I, 33.3% grade III and 0.7% patients had grade IV hyponatremia. Hypomagnesaemia was seen in 54.3% patient, 94.7% having grade I decline. About 12% of patients with electrolyte deficit also had a co-existing Vomiting or diarrhea or both. Average length of stay was 5.7 days in patients having coexisting electrolyte abnormalities, compared to 4.2 days in those who had not. Out of 90 patients who requires special care unit 75 had electrolyte abnormalities, of 15 patients who expired 13 had electrolyte abnormalities. Conclusions: This analysis, which is perhaps first of its kind, suggests that electrolyte abnormalities are frequently observed in patients presenting with FN, independent of co existing vomiting or diarrhea. They can have a negative affect on the outcome such patients. Therefore the incidence and impact of electrolytes abnormalities on FN outcomes should be elaboratively studied further.

No significant financial relationships to disclose.

Co-inoculation of nitrogen-fixing and phosphate-solubilizing bacteria to promote growth, yield and nutrient uptake in chickpea

A total of 32 bacterial isolates includingMesorhizobium(N=10),Azotobacter(N=12) and phosphate-solubilizing bacteria (N=10) were isolated and tested for siderophore, HCN, ammonia, indole acetic acid production and phosphate solubilizationin vitro. The bacterial cultures were positive for siderophore, HCN and ammonia. Among the isolates,M. ciceriRC3 andA. chrococcumA4 displayed 35 and 14 μg ml−1of IAA, respectively, whereasBacillusproduced 19 (BacillusPSB1) and 17 μg ml−1(BacillusPSB10) of IAA in Luria Bertani broth. The diameter of the P solubilization zone varied between 4 (BacillusPSB1) and 5 mm (BacillusPSB10) and a considerable amount of tricalcium phosphate (7 and 8 μg ml−1byBacillusPSB1 andBacillusPSB10, respectively) was released in liquid medium, with a concomitant drop in pH. The effects of N2-fixing and PS bacteria on the growth, chlorophyll content, seed yield, grain protein and N uptake of chickpea plants in field trials varied considerably between the treatments. Nodule number and biomass were significantly greater at 90 days after sowing (DAS), decreasing by 145 DAS. Seed yield increased by 250% due to inoculation withM. ciceriRC3 +A. chroococcumA4 +BacillusPSB10, relative to the control treatment. Grain protein content ranged from 180 (BacillusPSB1) to 309 ng g−1(M. ciceriRC3 +A. chroococcumA4 +BacillusPSB10) in inoculated chickpea. The N contents in roots and shoots differed considerably among the treatments.

Impact of heavy metal toxicity on plant growth, symbiosis, seed yield and nitrogen and metal uptake in chickpea

Experiments were conducted to investigate the phytotoxic effects of heavy metals on chickpea, grown in unsterilised soils. Cadmium at 23 mg/kg soil, when used alone or in combination with other metals, was found to be the most toxic and significantly (P ≤ 0.05) reduced the plant growth, nodulation, chlorophyll content, and root and shoot N contents. Cadmium (23 mg/kg soil) and lead (390 mg/kg soil) reduced the number of nodules by 69.2 and 13.7%, respectively. Cadmium at 5.75 and 11.5 mg/kg soil decreased the seed yield by 14 and 19%, respectively, compared with the control. In contrast, lead at 97.5 and 195 mg/kg soil increased the seed yield by 12.3 and 8.8%, respectively, above the control. Generally, the chlorophyll content decreased with increasing rates of each metal. The root and shoot N content decreased by 33.3 and 30.7% at 23 mg/kg of cadmium, whereas lead at 390 mg/kg soil increased the root and shoot N content by 10 and 3%, respectively, above the control. The grain protein decreased gradually with increasing rates of each metal. An average maximum reduction (27%) in grain protein was observed with mixtures of 23 mg cadmium + 135 mg chromium + 580.2 mg nickel per kg soil. Flowering in chickpea plants was delayed following metal application. The degree of toxicity of heavy metals on the measured parameters decreased in the following order: cadmium, zinc, nickel, copper, chromium, then lead. Accumulation of heavy metals was higher in the roots relative to the shoots of chickpea and was significantly correlated with the concentration of the metals added to the soil.

Post-caesarean incisional hernia or scar endometrioma?

Scar endometrioma is an uncommon condition following caesarean section. It presents as a lump on the caesarean scar and can often be painful. Endometrioma is referred to the general surgeon as an incisional hernia. We present six such patients referred to the general surgical department by either the general practitioner or the gynaecologist. Scar endometrioma is believed to arise due to implantation of endometrial tissue during caesarean section. Cyclical pain, as in endometriosis, is characteristic but uncommon. Local wide excision remains the treatment of choice.