Massive Hemoptysis and Pulmonary Thromboembolism in a Patient with Pulmonary Tuberculosis: A Therapeutic Conundrum Managed with Bronchial Artery Embolization

Hemoptysis is a crucial entity taking into account its morbidity and mortality. Pulmonary tuberculosis is the leading cause for massive hemoptysis in our part of the world, which if left untreated may be life threatening. We present a case of a 37-year-old male patient with pulmonary tuberculosis with concurrent pulmonary thromboembolism presenting with massive hemoptysis, which was successfully managed with Bronchial Artery Embolization. This case represents that this measure can be a viable therapeutic choice for a patient with a severe lifethreatening hemoptysis, particularly when other treatment options are unavailable or ineffective.

Diagnostic Accuracy of Drop Hydrogen Peroxide Test as a Novel Bedside Diagnostic Test to Differentiate Transudative and Exudative Pleural Effusion Against Light's Criteria

Background Diagnostic evaluation of pleural fluid according to Light's criteria to differentiate between exudative and transudative fluid takes 1 or 2 working days. For rapid clinical management, especially in critically ill patients, a simpler bedside diagnostic test can be done which has similar diagnostic accuracy as that of Light's Criteria. Objective To determine the diagnostic accuracy of Drop Hydrogen Peroxide test to differentiate exudative and transudative pleural effusion in comparison to Light's criteria. Method A concurrent validity test was performed using a convenient sampling technique including patients presenting to the Department of Internal Medicine from January to September 2021, who had pleural effusion. Two milliliters of tapped pleural fluid of patients who underwent aseptic thoracocentesis was collected in a test tube to which one to two drops of 20% hydrogen peroxide was added. Presence of bubbles suggested an exudative type of fluid. Rest of the tapped pleural fluid was sent to the laboratory for further evaluation by Light's criteria, which was compared with the results by Drop Hydrogen Peroxide Test. Result There were 83 patients who had pleural effusion, of them a total of 43 patients had transudative pleural effusion while 40 patients had exudative pleural effusion based on Light's criteria and 37 patients had transudative pleural effusion while 46 patients had exudative pleural effusion based on drop hydrogen peroxide test. Conclusion The drop hydrogen peroxide test allows cost effective and prompt evaluation of the type of pleural effusion is exudative or transudative, thereby making it a convenient diagnostic bedside test.

Adverse childhood experiences and substance misuse in young people in India: results from the multisite cVEDA cohort

BACKGROUND

Adverse childhood experiences (ACEs) increases vulnerability to externalising disorders such as substance misuse. The study aims to determine the prevalence of ACEs and its association with substance misuse.

METHODS

Data from the Consortium on Vulnerability to Externalising Disorders and Addictions (cVEDA) in India was used (n = 9010). ACEs were evaluated using the World Health Organisation (WHO) Adverse Childhood Experiences International Questionnaire whilst substance misuse was assessed using the WHO Alcohol, Smoking and Substance Involvement Screening Test. A random-effects, two-stage individual patient data meta-analysis explained the associations between ACEs and substance misuse with adjustments for confounders such as sex and family structure.

RESULTS

1 in 2 participants reported child maltreatment ACEs and family level ACEs. Except for sexual abuse, males report more of every individual childhood adversity and are more likely to report misusing substances compared with females (87.3% vs. 12.7%). In adolescents, family level ACEs (adj OR 4.2, 95% CI 1.5-11.7) and collective level ACEs (adj OR 6.6, 95% CI 1.4-31.1) show associations with substance misuse whilst in young adults, child level ACEs such as maltreatment show similar strong associations (adj OR 2.0, 95% CI 1.1-3.5).

CONCLUSION

ACEs such as abuse and domestic violence are strongly associated with substance misuse, most commonly tobacco, in adolescent and young adult males in India. The results suggest enhancing current ACE resilience programmes and 'trauma-informed' approaches to tackling longer-term impact of ACEs in India.

FUNDING

Newton Bhabha Grant jointly funded by the Medical Research Council, UK (MR/N000390/1) and the Indian Council of Medical Research (ICMR/MRC-UK/3/M/2015-NCD-I).

Secondary Polycythaemia as an Unusual Cause of Falsely Elevated Prothrombin Time and International Normalized Ratio

Elevated Prothrombin time is common in conditions such as liver dysfunction and use of Vitamin K antagonists. Polycythaemia is among the uncommon causes of elevated prothrombin time. Elevated hematocrit greater than 55% leads to a decrease in plasma of the blood sample, thereby reducing the coagulating factors available. Hence, it is recommended to adjust the citrate (anticoagulant) concentration for collecting blood sample from patients with high Hematocrit to get correct Hematocrit value.

Culturally Sensitive Normative Data for the Color Trails Test in the Indian Population

Objective

The Color Trails Test (CTT) is a neuropsychological measure tapping into frontal and executive functioning, while at the same time minimizing the cultural and language barriers inherent in similar neurocognitive measures such as the Trail Making Test (TMT). This study generates culturally-appropriate normative data for the CTT in an adult Indian population.

Method

Six-hundred and sixty-nine cognitively healthy, community dwelling Indian individuals between ages 18 and 69 participated in the study. Eligible participants were stratified on the basis of age, gender, and educational attainment. Participant performance on the CTT and TMT were correlated to establish concurrent validity.

Results

Significant correlations were found between TMT-part A and CTT-part 1 (r = .61) and between TMT-part B and CTT-part 2 (r = .66). In addition to generating culturally-appropriate normative data, the current study found that age and educational attainment significantly impacted participant performance on CTT-Part 1 [F(4, 649) = 4.395, p = .002], whereas gender, along with age, and educational attainment significantly impacted performance on CTT-Part 2 [F(4,649) = 2.446, p = .045]. In general, younger participants with more educational attainment performed better on both parts of the CTT. Interestingly, older female participants with lower educational attainment performed better than their younger counterparts on CTT-Part 2, whereas no such findings were noted for male participants.

Conclusions

Age, gender, and educational attainment are important factors to consider when interpreting CTT completion times in the Indian population. Normative data generated from this study has important clinical implications and contributes to the growing body of culturally-appropriate normative data available for the Indian population.

A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

Heat Shock Protein Antibody Titers Are Reduced by Statin Therapy in Dyslipidemic Subjects: A Pilot Study

Antibody titers to heat shock protein (Hsp)-60 and -65 are positively related to risk of vascular disease and cardiovascular endpoints. There are few data on the factors that regulate the levels of these antibodies. It is known that the statins have antiinflammatory and immunoregulatory properties. The authors examined the effects of 2 statins, simvastatin (Zocor®) and atorvastatin (Lipitor®) on antibody titers to Hsp-60, -65, and -70 in a group of dyslipidemic patients. Twenty patients attending a lipid clinic, and previously not receiving lipid-lowering treatment, were treated with 10 mg of simvastatin (n=11) or atorvastatin (n=9) for 4 months. An additional 14 patients were recruited from the same clinic at the same hospital as a control group. The medication of these latter patients was unaltered for 4 months and the same parameters were measured as for the statin group. Antibody titers to Hsp-60, -65, and -70 were measured by enzyme-linked immunosorbent assay and lipoprotein profile and highly sensitive serum C-reactive protein (CRP) were measured by routine methods before and after treatment. Pretreatment and posttreatment data were compared by paired t or Mann-Whitney tests. Overall statin treatment was associated with a significant reduction in median antibody titers to Hsp-60 (17.2%, p=0.03), Hsp-65 (15.9%, p=0.003) and Hsp-70 (8.3%, p=0.006), but not in control patients. Both statins caused a reduction in median serum CRP concentrations (45% overall, p<0.05), but significant changes were not observed in the control patients. The effects on Hsp antibody titers were not related to changes in serum CRP concentrations (p>0.05). However, there was a significant correlation between changes in antibody titers to Hsp-60 vs Hsp-65 (p<0.01), Hsp-60 vs Hsp-70 (p<0.05), and Hsp-65 vs Hsp-70 (p<0.001). Statin treatment was associated with a reduction in antibody titers to Hsp-60, -65, and -70. This reduction is not fully explained by the antiinflammatory effects of the statins but may be due to their other immunomodulatory properties.

Comparison of ketamine, fentanyl and clonidine as an adjuvant during bupivacaine caudal anaesthesia in paediatric patients

BACKGROUND

Caudal epidural analgesia with bupivacaine is very popular in paediatric anaesthesia for providing intra- and postoperative analgesia. Several adjuvants have been used to prolong the action of bupivacaine.

OBJECTIVES

To compare the efficacy of ketamine, fentanyl and clonidine in terms of quality and duration of analgesia they produce when added with caudal bupivacaine by single shot technique in children.

METHODS

Eighty children, age one to ten years, undergoing sub-umbilical surgery, were prospectively randomized to one of four groups: caudal analgesia with 0.75 ml/ kg of 0.25% bupivacaine in normal saline (Group B) or caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine with 1 μg/kg of clonidine in normal saline (Group BC) or caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine with ketamine 0.5mg/kg (Group BK) or caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine with fentanyl 1 mcg/kg (Group BF). Post-operative pain was assessed for 24 hours using the FLACC scale.

RESULTS

The mean duration of analgesia was significantly longer in Group BC (629.06 ± 286.32 min) than other three groups P < 0.05. The pain score assessed using FLACC scale was compared between the four groups, and children in Group BC had lower pain scores, which was statistically significant. The requirement of rescue medicine was lesser in Group BC. Clonidine in a dose of 1 μg/kg added to 0.25% bupivacaine for caudal analgesia, during sub-umbilical surgeries, prolongs the duration of analgesia of bupivacaine, without any side effects in compare to fentanyl or ketamine.

CONCLUSION

We conclude that clonidine in a dose of 1 μg/kg, added to 0.25% bupivacaine for caudal analgesia and administered as a 0.75 ml/kg mixture in children, for subumbilical surgery, significantly prolongs the duration of post-operative analgesia when compared to 0.75 ml/kg of 0.25% bupivacaine in normal saline than 0.75 ml/kg of 0.25% bupivacaine with ketamine 0.5 mg/kg or 0.75 ml/kg of 0.25% bupivacaine with fentanyl 1 mcg/kg or 0.75 ml/kg of 0.25% bupivacaine alone, without any side effects.

A comparative study on the effectiveness of chlorine dioxide gas, ozone gas and e-beam irradiation treatments for inactivation of pathogens inoculated onto tomato, cantaloupe and lettuce seeds

The increase in reported food-borne outbreaks linked with consumption of raw fruits and vegetables has motivated new research focusing on prevention of pre-harvest produce contamination. This study evaluates and compares the effectiveness of three non-thermal technologies, chlorine dioxide gas, ozone gas and e-beam irradiation, for inactivation of Salmonella enterica and Escherichia coli O157:H7 on pre-inoculated tomato, lettuce and cantaloupe seeds, and also their corresponding effect on seeds germination percentage after treatments. Samples were treated with 10mg/l ClO(2) gas for 3 min at 75% relative humidity, with 4.3mg/l ozone gas for 5 min and with a dose of 7 kGy electron beam for 1 min. Initial load of pathogenic bacteria on seeds was ~6 log CFU/g. Results demonstrate that all treatments significantly reduce the initial load of pathogenic bacteria on seeds (p<0.05). In particular, after ozone gas treatments 4 log CFU/g reduction was always observed, despite the seeds and/or microorganisms treated. ClO(2) and e-beam treatments were noticeably more effective against Salmonella on contaminated tomato seeds, where 5.3 and 4.4 log CFU/g reduction were respectively observed. Germination percentage was not affected, except for cantaloupe seeds, where the ratio was significantly lowered after ClO(2) treatments. Overall, the results obtained show the great applicability of these non-thermal inactivation techniques to control and reduce pathogenic bacteria contamination of seeds.

Rupture of left horn of bicornuate uterus at twenty weeks of gestation

Rupture uterus in nulliparous patients is generally associated with mullerian anomalies. A case of 23 years primigravida with 19 weeks gestation presenting with features of rupture is reported here. Ultrasound helped in the diagnosis of left horn of bicornuate uterus. After exploration, right ruptured horn was excised. The incidence, diagnosis and management of such cases is discussed.

Photoaffinity labeling of plasma membrane receptors for cytochalasins in Ehrlich tumor cells

Treatment of purified Ehrlich ascites cell plasma membranes either with [3H]cytochalasin B or [3H]19-O-acetylchaetoglobosin A under photolytic conditions produced several radioactive polypeptides which were characterized by SDS-PAGE analyses. The major proteins so photolabeled were in the 60,000-80,000 Da range, with less labeling found in polypeptides smaller than 43,000 and greater than 90,000 Da. Immunofluorescent staining failed to identify the major photolabeled component as actin. It is concluded, in keeping with prior investigations using other cell types, that the predominant proteins photolabeled by cytochalasins are affiliated with the glucose-transport system.