Methylphenols Removal from Water by Low-Cost Adsorbents

A comparative study on the adsorption of methylphenols on adsorbents prepared from several industrial wastes has been carried out. The results show that extent of adsorption on carbonaceous adsorbent prepared from fertilizer industry waste has been found to be 37.3, 40.5, 65.9, and 88.5 mg/g for 2-methylphenol, 4-methylphenol, 2,4-dimethylphenol, and 2,4,6-trimethylphenol, rspectively. As compared to carbonaceous adsorbent, the other three adsorbents viz. blast furnace sludge, dust, and slag adsorb methylphenols to a much smaller extent. This has been accounted for due to the carbonaceous adsorbent having a larger porosity and consequently higher surface area. The adsorption of phenols on this carbonaceous adsorbent as a function of contact time, concentration, and temperature has been studied by the batch method. The adsorption has been found to be endothermic and data conform to the Langmuir equation. The analysis of data indicates that adsorption is a first-order process and pore diffusion-controlled. The efficiency of the carbonaceous adsorbent was assessed by comparing the results with those on a standard activated charcoal sample. It was found that the carbonaceous adsorbent is about 45% as efficient as standard activated charcoal and can therefore be employed for the removal of methylphenols from wastewaters.

Hepatorenal syndrome

Hepatorenal syndrome is a life-threatening complication occurring commonly in cirrhosis liver and rarely in acute liver failure. It can be precipitated by shock, infection, surgery, large volume paracentesis or nephrotoxic drugs. Type I hepatorenal syndrome which usually develops over acute liver failure is rapidly progressive and has poor outcome. Type II hepatorenal syndrome is usually associated with refractory ascites and is slowly progressive with relatively good prognosis. Peripheral vasodilation with intrarenal vasoconstriction is the main pathophysiologic change. Diagnostic criteria, ascertained by international ascites club, is helpful to reach at a proper diagnosis. Management includes pharmacologic therapy to induce splanchnic vasoconstriction which improve renal circulation. Dopamine, vasopressin analogs (ornipressin and terlipressin), midodrine, noradrenaline have been used mainly as a bridge to the liver transplant or in anticipation of improvement in hepatic function. The molecular adsorbent recycling system (MARS) have been recently used in patients with hepatorenal syndrome. Transjugular intrahepatic portosystemic shunt is also another modality which has been used as a bridge to liver transplant in such patients.

Hemiplegic/monoplegic presentation of cervical spine (C1-C2) tuberculosis

Tuberculosis of the craniovertebral region is very rare. Neural deficit in this region is reported in between 24% and 64% of cases, and mainly takes the form of quadriparesis. Hemiplegic and monoplegic presentation among this set of patients is rarer. Out of 32 patients treated at our institution between May 1989 and February 2001, only one had hemiplegia, while two had monoplegia. These three cases are discussed. Case 1 involved a 45-year-old woman who presented with hemiplegia following a trivial fall. Plain radiographs and computed tomographic (CT) scans of the skull appeared normal, but CT scans of C1-C2 and the craniovertebral junction revealed destruction of the dens and atlantoaxial subluxation. The patients in cases 2 and 3 had monoplegia. Plain radiographs in both cases showed an increased prevertebral soft tissue shadow in front of C1-C2. CT in case 2 and magnetic resonance imaging (MRI) in case 3 revealed destruction of the arch of C1 and the dens, with subluxation. All three patients were successfully treated with rest, skull traction, anti-tubercular drugs and suitable braces. Case 3 required stabilization. All three patients achieved complete neural recovery. Patients 1, 2 and 3 had 22, 48 and 4 months' follow-up respectively. Patient 3 was subsequently transferred to a neurosurgery ward for stabilization of the occipito-C3 vertebrae. Hemi/monoplegic presentation is extremely rare; no author in the literature is able to give reason for the rarity or the pathomechanics of the condition. We believe that if medullary cervical junctional involvement extends slightly higher (in rare circumstances), with involvement of one of the branches of the vertebral or lower basilar artery, medial medullary syndrome will occur, sparing medial lemniscus and emerging hypoglossal nerve fibres. Thus the pyramids will be involved, causing contralateral hemiparesis, and if the pyramids are selectively involved, it will cause contralateral monoparesis.

The combination of stricture dilation, endoscopic needle aspiration, and biliary brushings significantly improves diagnostic yield from malignant bile duct strictures

BACKGROUND

Brush cytology, routinely performed at ERCP to assess malignant-appearing biliary strictures, is limited by relatively low sensitivity and negative predictive value. This study assessed whether the combination of stricture dilation, endoscopic needle aspiration, and biliary brushing improves diagnostic yield.

METHODS

In a prospective nonrandomized study, 46 consecutive patients were evaluated with malignant-appearing biliary strictures at ERCP. Twenty-four patients (Group A) underwent standard brush cytology alone and 22 patients (Group B) underwent stricture dilatation to 10F, endoscopic needle aspiration, and subsequent biliary brushing by using the Howell biliary system. The diagnostic yields for both techniques were compared.

RESULTS

Of the 46 patients, 34 had proven malignant strictures (14 Group A, 20 Group B). Compared with brushing alone, the combination of stricture dilatation, endoscopic needle aspiration, and subsequent biliary brushing significantly increased both the sensitivity (57% vs. 85%, p < 0.02) and specificity (80% vs. 100%, p < 0.02) of cytology with positive brushings in all patients with pancreatic or gallbladder carcinoma.

CONCLUSIONS

The combination of stricture dilation, endoscopic needle aspiration, and biliary brushing significantly improves diagnostic yield for malignant bile duct strictures and may particularly be of benefit for extrinsic strictures caused by pancreatic or gallbladder carcinoma.

Multifocal skeletal tuberculosis

Multifocal skeletal tuberculosis is an uncommonly reported entity. The article presents a series of 18 cases encountered in our institution. There clinical characteristics are analysed and compared with available international literature.

Intracameral amphotericin B: initial experience in severe keratomycosis

PURPOSE

Fungal keratitis is a significant cause of ocular morbidity in India. The most commonly implicated fungi are Aspergillus spp. Patients often present with hypopyon, which usually contains fungal elements. The treatment is difficult owing to poor intraocular penetration of most available antifungal agents. This study evaluated the results of intracameral injection of amphotericin B in natamycin resistant cases of severe keratomycosis.

METHODS

Three patients of culture proven Aspergillus flavus corneal ulcer with hypopyon not responding to topical natamycin 5%, amphotericin B 0.15%, and oral itraconazole were administered intracameral amphotericin B. The first case received 7.5 microg in 0.1 mL followed by two subsequent injections of 10 microg in 0.1 mL each, the second case received two injections of 10 microg in 0.1 mL, and the third patient received a single dose of 10 microg in 0.1 mL. Culture of the aqueous sample also grew A. flavus in all three cases.

RESULTS

All three cases responded favorably, with the ulcer and hypopyon clearing completely. There was no clinical evidence of corneal or lenticular toxicity in any patient.

CONCLUSIONS

Intracameral amphotericin B may be a useful modality in the treatment of severe keratomycosis not responding to topical natamycin. It ensures adequate drug delivery into the anterior chamber and may be especially useful to avoid surgical intervention in the acute stage of the disease.

14C-urea breath test for assessment of gastric Helicobacter pylori colonization and eradication

BACKGROUND AND OBJECTIVE

Urea breath test (UBT) is a reliable noninvasive technique for detecting gastric Helicobacter pylori colonization. 14C isotope-based test requires simple equipment and is inexpensive. We studied the utility of 14C-UBT in diagnosis of gastric H. pylori infection.

METHODS

Presence of H. pylori was studied using antral histology and culture in patients with rapid urease test (RUT)-positive peptic ulcer. 14C-UBT was performed using a 185-kBq dose. Radioactivity in 15-min breath samples was measured using a beta-scintillation counter and result expressed as % dose recovered/mmol CO2. H. pylori was considered positive when any two tests were positive. All tests were repeated one month after completion of H. pylori eradication therapy.

RESULTS

Among 41 patients (duodenal ulcer 36, gastric ulcer 5), H. pylori was detected by histology in 23 (56%) and by culture in 27 (66%). Overall, H. pylori was detected in 28 (68%) patients. Follow-up assessment was possible in 28 patients: 26 cleared the infection (all three tests negative). Mean 14C recovery values at 15 minutes associated with H. pylori-positive status were significantly higher (12.3 [SD 6.8] x 10(-3); n=30; p<0.001) than those associated with H. pylori-negative status (2.1 [0.9] x 10(-3); n=26). Using receiver-operating-characteristic analysis of 15-minute 14C recovery values, a cut-off of 6.5x10(-3) gave the best separation of H. pylori-positive and -negative cases. 14C-UBT had 93% sensitivity, 96% specificity and 95% accuracy.

CONCLUSION

14C-UBT appears to be a reliable noninvasive test for diagnosis of H. pylori infection.

Study of events leading cellular senescence to human mammary epithelial cancer cells in vitro

Role of various growth regulatory factors in inducing senescence in cultured HMEC cells have been investigated in ten cases of breast cancer. The histological grade of tumour cells is found to play significant role in controlling the proliferation and phenotypic charateristics of cultured HMEC cells during primary culture and also number of subsequent passages resulting in complete cellular senescence in them. Effects of conditioned media (CM) collected from primary and senescent cultures of these HMEC cells had also been studied on proliferation of their own HMEC cells used as target cells, to evaluate the role of various autocrine growth factors produced by them. Significant increase in proliferation of target cells was noticed on their exposure to CM from senescent cultures, while cessation of their proliferation was found on their exposure to CM from senscent cultures, suggesting that HMEC cells produce growth promoting factors during primary culture and growth inhibitory factors on subsequent passages, responsible for inducing features of cellular senescence in them. The role of epidermal growth factors (EGF) and transforming growth factors (TGF) alpha and beta as autocrine factors in inducing senescence of cultured HMEC cells were also investigated. Deletion of EGF from growth media initially caused decreased proliferation to target HMEC cells, followed by improvement in their proliferation. Supplementation of growth media by TGF-alpha induced significant increase in proliferation of target cells. Addition of epidermal growth factors receptor (EGFR) antibody to cells exposed to media devoid of EGF and media supplemented with TGF-alpha showed marked suppression of proliferation of target cells. The morphologic and phenotypic characteristics of target HMEC cells exposed to TGF-alpha were also found similar to those HMEC cells grown during primary culture, suggesting autocrine production of EGF and TGF-alpha by cultured HMEC cells during primary culture. Supplementation of TGF-beta to growth media induced marked suppression of proliferation to target cells along with morphologic and phenotypic features of terminal differntiation or senescence. Exposure of senescent cells to media supplemented with EGF and TGF-alpha could not induce their proliferation. This suggest that HMEC cells on subsequent passages undergo some genetic and phenotypic alterations resulting in production of growth inhibitory factor like TGF-beta which induces cessation of their proliferation alone with features of senescence.

Transdermal delivery of naloxone: effect of water, propylene glycol, ethanol and their binary combinations on permeation through rat skin

The effect of the solvent systems water, ethanol (EtOH), propylene glycol (PG) and their binary combinations was studied on the ex vivo permeation profile of the opioid receptor antagonist, naloxone, through rat skin. Fourier transform-infrared (FT-IR) spectroscopic studies were done to investigate the effect of enhancers on the biophysical properties of the stratum corneum (SC), in order to understand the mechanism of permeation enhancement of naloxone by the solvent systems used. The flux of naloxone was found to increase with increasing concentrations of EtOH, upto 66% in water, and PG upto 50% in water. The maximum flux of 32.85 microg cm(-2) h(-1) was found with 33% PG in EtOH. The FT-IR spectra of SC treated with EtOH showed peak broadening at 2920 cm(-1) at all concentrations of EtOH studied indicating that EtOH increases the translational freedom (mobility) of lipid acyl chains. Theoretical blood levels well above the therapeutic concentration of naloxone can be achieved with the solvent system comprising 33% PG in EtOH and hence, provides flexibility in choice of patch size depending on the addiction status of the patient to be treated.

First care givers of mentally ill patients: a multicenter study

Pathways to psychiatric care were evaluated among three hundred and eighty four first-contact psychiatric patients from five socio-culturally different regions of India by a modified version of World Health Organization encounter form for 'pathways in psychiatric care'. Concerning first caregivers, out of 384 respondents 34.1% had chosen the psychiatrists, 29.4% the general practitioners and 26% had chosen faith healers and exorcists. Choice for the first caregiver was not influenced by gender differences, literacy status and family type. Mostly the subjects hailing from rural areas and those presenting with somatic symptoms chose psychiatrist as their first caregivers.

Cubitus varus: problem and solution

A lateral closing wedge osteotomy was performed in 39 children with cubitus varus deformity resulting from a supracondylar fracture. All had a deformity of 15 degrees or more, with 5 having more than 30 degrees of varus. The osteotomy was fixed by three different methods. In 8 cases the osteotomy was fixed with 2 parallel Kirschner wies (group K). A modified French technique (group TBW) was used in 25 cases and held with a figure-of-8 wire loop tightened over the screw heads. In the last 6 cases the osteotomy was fixed with an external fixator (group EF). The only poor result (i.e. loss of carrying angle of more than 10 degrees and loss of flexion and extension of 20 degrees or more) was in group K due to pin tract infection and loosening of the K-wires. In the TBW group 5 patients lost some degree of correction, and none became infected. In the EF group no patient suffered pin tract infection or loss of correction. Based on our experience and results, we feel that the best age at which to correct cubitus varus deformity was 6-11 years and that the external fixator is a safe, effective and reliable method to fix the osteotomy. We propose this method of fixation as a good alternative method to the modified French technique, especially in cases of severe cubitus varus deformity, where removal of a large wedge can produce a big step at the osteotomy site, increasing the possibility of disengagement of the stainless steel wire from the screw head. In addition, minor postoperative modifications of correction, if required, can also be performed. It also avoids a second operation for implant removal.

Isolated dislocation of the second metacarpal at both ends

A dislocation of the second metacarpal at both ends is reported herein for the first time. Six weeks after injuring her right hand in a fall while climbing stairs, a 34-year-old woman visited our clinic with pain, swelling, and deformity of her hand. The radiographs showed a volar dislocation of the head and a dorsal dislocation of the base of the second metacarpal. The probable mechanism of injury was the hyperextension at the metacarpophalangeal joint; this force dislocated the metacarpal head toward the volar plate. Force then further continued along the second metacarpal shaft in the hyperflexed wrist, thus dislocating the base dorsally. We performed an open reduction and K-wire fixation of the second metacarpophalangeal joint and an arthrodesis of the second carpometacarpal joint. At the six-month follow-up, the patient had restricted flexion (0 to 50 degrees) at the second metacarpophalangeal joint, but full range of motion at the interphalangeal joints. The grip strength on the right side was 70% of that measured in the uninvolved hand. Key Words: Dislocation, Second metacarpal.

Viral hepatitis during pregnancy

OBJECTIVE

A great degree of controversy prevails over the existing reports on the severity and outcome of acute viral hepatitis (AVH) during pregnancy. The present study describes the outcome of AVH associated with pregnancy. A correlation was also assessed for gestation period, viral etiology and outcome of AVH.

METHOD

The serum samples of 273 females with viral hepatitis (age group 18--23 years) were included in the study. Among them, 127 females were pregnant and 146 were non-pregnant cases (as a control group). The sera were screened for seromarkers of the hepatitis A virus (HAV) through to the hepatitis E virus (HEV) by the latest available generation ELISA kits. Among the 127 pregnant females, 83 were AVH cases, while 44 were fulminant hepatic failure (FHF) cases. Among the 146 non-pregnant females, 129 were AVH and 17 were FHF cases.

RESULT

Among the AVH pregnant females, 73 (57.5%) had HEV infection. Fifty-eight percent of the HEV infected pregnant females were associated with FHF. Among non-pregnant females HEV was documented in 67 (46%) cases. HBV infection was observed in 19% and 18% of the pregnant and non-pregnant females, respectively. Twenty percent of the pregnant and 33% of the non-pregnant females remained non-reactive for seromarkers of HAV-HEV. The mortality rate was highest (56%) among HEV infected FHF cases during third trimester of pregnancy. The chi(2) test was applied to check the statistical significance for the differences over the prevalence in various groups.

CONCLUSION

In the present study, HEV was found to be the chief etiological agent, associated with higher morbidity and mortality. However, the incidence of HEV in pregnant females was not significantly different from non-pregnant females. The prevalence of HAV, HCV and HDV were very low in the study. An increased incidence of FHF was noted among HEV infected pregnant females, while infection with an agent other than A-E was commonly associated with FHF among non-pregnant females.

Evaluation of foot bimalleolar angle in the management of congenital talipes equinovarus

The study was undertaken to establish the normal foot bimalleolar (FBM) angle in Indian infants and to correlate it with the severity of deformity and results of treatment in congenital talipes equinovarus (CTEV). Foot tracings with the level of both the malleoli of 182 feet (91 normal Indian infants) were taken. The anteromedial angle between the long axis of foot and the bimalleolar plane was taken as the FBM angle. The FBM angle in normal infants was calculated as 82.5 degrees. Eighty-four CTEV (51 patients) were clinically classified as grade I (five feet; FBM angle, 73.2 degrees), grade II (21 feet; FBM angle, 66.6 degrees), and grade III (58 feet; FBM angle, 54.7 degrees), depending on whether the foot could be passively corrected (grade I) or had a fixed equinus and/or varus of <20 degrees (grade II) or >20 degrees (grade III). Thirty-one feet (22 patients) were followed up prospectively after conservative (17 feet: grade I, three feet; grade II, three feet; grade III, 11 feet) and surgical release (all grade III, 14 feet). All feet with grade I and grade II deformity and 44% (11 feet) with grade III deformity were amenable to gentle graduated manipulations and cast application, whereas 56% (14 feet) with grade III deformity underwent soft tissue release. After nonsurgical treatment, the mean FBM angle was 82.3 degrees. Of the feet that underwent surgery, those with excellent (11 feet) and good correction (3 feet) had a mean FBM angle of 79.9 degrees and 74.3 degrees, respectively. There were no feet with fair or poor results. The clinical severity of foot deformity and results of treatment correlated well with the FBM angle. Foot tracing with the FBM angle is a simple, objective, and reproducible clinical criterion to classify the severity of foot deformity and evaluate the results of treatment.

Image classification for content-based indexing

Grouping images into (semantically) meaningful categories using low-level visual features is a challenging and important problem in content-based image retrieval. Using binary Bayesian classifiers, we attempt to capture high-level concepts from low-level image features under the constraint that the test image does belong to one of the classes. Specifically, we consider the hierarchical classification of vacation images; at the highest level, images are classified as indoor or outdoor; outdoor images are further classified as city or landscape; finally, a subset of landscape images is classified into sunset, forest, and mountain classes. We demonstrate that a small vector quantizer (whose optimal size is selected using a modified MDL criterion) can be used to model the class-conditional densities of the features, required by the Bayesian methodology. The classifiers have been designed and evaluated on a database of 6931 vacation photographs. Our system achieved a classification accuracy of 90.5% for indoor/outdoor, 95.3% for city/landscape, 96.6% for sunset/forest and mountain, and 96% for forest/mountain classification problems. We further develop a learning method to incrementally train the classifiers as additional data become available. We also show preliminary results for feature reduction using clustering techniques. Our goal is to combine multiple two-class classifiers into a single hierarchical classifier.

De novo stenting of descending thoracic aorta in Takayasu arteritis: intermediate-term follow-up results

We report our intermediate-term follow-up results of de novo stenting of descending thoracic aorta in Takayasu arteritis. Six patients (5 males and 1 female) underwent aortoplasty and stenting (8 Wallstents were deployed in 6 patients). Aortoplasty was performed with conventional balloons in 5 patients and with an Inoue balloon in 1 patient. The mean diameter of the aorta increased from 5.36 +/- 0.62 mm to 13.91 +/- 1.8 mm after stenting while the peak systolic gradient was totally abolished in all cases. These results were significantly better than aortoplasty alone (p < 0.0001). Lower limb claudication improved in all patients. Hypertension was cured in 3 patients and improved in 3 patients. All patients were asymptomatic over 6Eth 30 months (mean, 22.8 +/- 4.0 months) follow-up. All patients underwent angiographic follow-up after 6 months. They continued to have an absence of gradient with excellent flow across the stents. A minimal intimal reaction was observed at the stent margins. On follow-up angiogram at 6 months, one of the patients was noted to have developed a small asymptomatic pseudoaneurysm at the lower margin of the stent, which gradually increased in size over the next year and was treated by percutaneous endovascular deployment of a Wallstent graft. Our series demonstrates the safety and efficacy of stent deployment in stenotic lesions of the aorta in Takayasu arteritis and proves that the results are superior to plain balloon aortoplasty alone. This is also the only study that demonstrates intermediate-term success by angiographic follow-up at 6 months.