One-pot biogenic synthesis of C. limon/TiO2 with dual applications as an advance photocatalyst and antimicrobial agent

The present study portrays a facile, cost effective and environmental benign way for preparation of TiO₂ nanoparticles utilizing C. limon extract which possesses phytochemicals as reducing and stabilizing agents. Structural characterization by XRD reveals that C. limon/TiO₂ NPs exhibits anatase-type tetragonal crystallinity. An average crystallite-size is calculated using Debye Scherrer's method (3.79 nm), Williamson-Hall plot (3.60 nm), and Modified Debye Scherrer plot (3.68 nm) which are very much intercorrelated. The absorption peak at 274 nm (UV-Visible spectrum) corresponds to the bandgap (E_g) value of3.8 eV. The existence of different phytochemicals containing organic groups like N-H, C=O, O-H, has been elucidated from FTIR along with Ti-O bond stretching at wavenumber 780 cm^-1. Micro-structural investigations of TiO₂ NPs using FESEM and TEM display different geometrical configurations involving spherical, pentagons, hexagons, heptagons and capsule like structures. BET and BJH analysis show mesoporous characteristics of synthesized nanoparticles with specific surface-area (97.6 m² g^-1), pore-volume (0.018322 cm³ g^-1), and mean pore-diameter (∼7.5 nm) values. In adsorption studies, the influence of reaction parameters i.e., catalyst dosage and contact-time for removal of Reactive Green dye is explored along with Langmuir and Freundlich models. The highest adsorption capability is ∼219 mg g^-1 for green dye. TiO₂ displays an excellent photocatalytic efficiency of ∼96% towards the degradation of reactive green dye within 180 min and excellent reusable performance. C. limon/TiO₂ is found to have an outstanding performance with quantum yield value of 4.68 × 10^-5 molecules photon^-1 for Reactive Green dye degradation. Additionally, synthesized nanoparticles have exhibited antimicrobial activity against Gram-positive Staphylococcus aureus (S. aureus) and gram-negative Pseudomonas aeruginosa (P. aeruginosa) bacteria.

Highly customized porous TiO2-PANI nanoparticles with excellent photocatalytic efficiency for dye degradation

The present work encompasses a simple strategy to synthesize highly porous TiO₂ by incorporating PANI polymer into the sol-gel chemistry of Titanium dioxide/Titanium (IV)-iso-propoxide (TiO₂/TTIP). A series of TiO₂ samples by varying wt.% of PANI, have been synthesized. A probable growth mechanism has been presented for the formation of a porous ginger-like nanostructure of TiO₂-PANI (TP). HRTEM images reveal that the particle size range is 6-16 nm for pristine TiO₂ and 5-13 nm for TP samples. XPS analysis confirms the presence of the hydrogen bonds in-between surface hydroxyl groups (Ti-OH) of TiO₂ and the protonated nitrogen of PANI. UV-visible absorption study reveals a small shift towards longer wavelength for TP8 sample than that of pristine TiO₂ (λ_max = 314 nm) as well as reduction in E_g value from 3.02 eV to 2.89 eV. FTIR results confirm the successful interaction of PANI and TiO₂. BJH and BET analysis confirms an increase of porosity in TP8 sample with an average pore volume of 0.36 cm³ g^-1. High photocatalytic activity (98.77%) towards Methylene blue dye degradation is observed for TP8 sample having 8 wt% of PANI and it is explained through the combined effect of structural porosity of TiO₂ and synergic effect of PANI. The K_appa value at pH 11 (0.01372 min^-1) is found to be 7.84-folds higher than that of the photocatalytic reaction at pH 3 (K_appa = 0.00175 min^-1). While pristine TiO₂ exhibits the minimum removal efficiency (89.57%) with K_appa of 0.00756 min^-1. K_appa value of catalysis reaction for TP8 is found to be almost 2-fold higher than pristine TiO₂. Quantum Yield value for TP8 is found to be 3.59 × 10^-4 molecules photon^-1. This high Quantum Yield value of present photocatalytic system explicates the low energy consumption for the treatment of textile dye pollutant. Additionally, STY value (1.79 × 10^-5 molecules photon^-1 mg^-1) confirms the outstanding mineralization strength of TP8 by a unit mass for high amounts of MB dye per unit time. Thus, the present study offers an excellent photocatalyst i.e., TP8 having 8 wt% of PANI for the degradation of MB dye.

Sunlight-driven photocatalytic degradation of ciprofloxacin and organic dyes by biosynthesized rGO-ZrO2 nanocomposites

Aquatic ecology has been greatly threatened by the discharge of effluents of textile and antibiotic industries into natural waters. Herein, an efficient and easily recycled reduced graphene oxide/zirconium oxide nanocomposite has been synthesized using banana peel extract (abbreviated as rGO-ZrO₂ in this work). The X-ray diffraction (XRD), field emission scanning electronic microscopy (FESEM), high-resolution transmission electron microscopy (HRTEM), Brunauer-Emmett-Teller (BET), UV-visible diffuse reflectance spectroscopy (DRS), X-ray photoelectron spectroscopy (XPS), and Fourier transform infrared (FTIR) spectroscopy were used to analyze the synthesized material. The as-prepared rGO-ZrO₂ nanocomposite was employed as a photocatalyst for the decomposition of rhodamine blue (RhB) and crystal violet (CV) dyes, and ciprofloxacin (CIP) antibiotic by illumination with direct sunlight. The RhB and CV were degraded to maximum extent of around 86 and 90%, respectively, over the rGO-ZrO₂ nanocomposite after exposure to direct sunlight for 120 min. On the other hand, the degradation of CIP was approximately 93.1% over the rGO-ZrO₂ nanocomposite in 240 min under same experimental conditions. Further studies were performed regarding the role of parameters like pH, catalyst dose, and scavengers, in order to understand the superiority of rGO-ZrO₂ nanocomposite in degrading organic pollutants. Moreover, the intermediate products and plausible CIP degradation mechanisms were examined using liquid chromatography-mass spectrometry (LC-MS). Moreover, the catalyst was easily separated from the solution and demonstrated good stability and reusability. The RhB, CV, and CIP removal efficiency were 80%, 83%, and 88%, respectively, after five cycles.

Photocatalytic degradation of tetracycline antibiotic and organic dyes using biogenic synthesized CuO/Fe2O3 nanocomposite: pathways and mechanism insights

Tetracycline (TC) is a frequently administered antibiotic in many countries, due to its low price and excellent potency. However, certain antibiotics can be hazardous to living creatures due to their accumulation by complexation with metal ions which can contribute to teratogenicity and carcinogenicity. In this investigation, copper oxide-ferric oxide nanocomposite (CuO/Fe₂O₃ nanocomposite) was synthesized employing Psidium guajava (P. guajava) leaf extract as a reductant as well as a capping agent in an environment friendly and economical green synthesis method. The as-synthesized CuO/Fe₂O₃ nanocomposite was comprehensively characterized using various sophisticated techniques and its efficiency as a photocatalyst for degradation of tetracycline (TC) antibiotic and toxic dyes, i.e., rhodamine B (RhB) and methylene blue (MB) were investigated. The CuO/Fe₂O₃ nanocomposite exhibited exceptional efficiency for degradation of TC antibiotic (88% removal in 80 min), RhB (96% removal in 40 min), and MB (93% elimination in 40 min) with apparent rate constant of 0.048, 0.068, and 0.032 min^-1, respectively. In the degradation experiments, photocatalytic activity of CuO/Fe₂O₃ nanocomposite was studied by varying different factors such as time of contact, catalyst dose, and solution pH. The role of reactive species in antibiotics and dye degradation was validated by radical scavenging studies which indicated that^.OH radical played a critical role in photocatalytic decomposition. Furthermore, liquid chromatography-mass spectrometry (LC-MS) investigations were employed to anticipate a plausible mechanism for TC degradation.

Minimal change disease (MCD) following vaccination with ChAdOx1 nCoV-19 vaccine in a young Indian male: A case report

Various vaccines against coronavirus disease 2019 (COVID-19) have been developed amidst the ongoing pandemic. Few cases of glomerulonephritis after COVID-19 vaccination have been reported globally. We present a case of nephrotic syndrome due to minimal change disease (MCD) most likely associated with the ChAdOx1 nCoV-19 vaccine. A 24-year-old male presented with anasarca and frothy urine after receiving the first dose of the COVID-19 vaccine. On admission, the patient had normal serum creatinine with 24-h urinary protein excretion of 4.1 g/day and severe hypoalbuminemia. Kidney biopsy revealed nonproliferative glomerular morphology with relatively unremarkable-appearing glomeruli on light microscopy and diffuse effacement of the odocyte foot processes on electron microscopy, consistent with diagnosis of MCD. This case highlights the risk of new-onset nephrotic syndrome due to MCD after COVID-19 vaccination.

Outcome of COVID-19 in Kidney Transplant Patients from Eastern India: A Single Center Study

Introduction

COVID-19 in kidney transplant recipients (KTR) had been associated with high incidence of acute kidney injury and higher mortality. Management of these patients is still evolving.

Methods

A retrospective observational study was done that included all KTR aged ≥18 years and ≤65 years who had COVID-19 diagnosis via RTPCR test between 1 June 2020 and 30 May 2021. Severity of COVID-19 was determined as per the guidelines given by Government of India. Acute kidney injury was defined according to KDIGO guideline. Data was collected and analyzed using SPSS version 16.0 (Chicago, SPSS Inc.).

Results

Out of 34 patients, 29 were men. Median age of patients was 39.9 years and median time since transplantation was 34 months. Presenting symptoms were fever (100%), cough (79.4%), gastrointestinal symptoms (23.5%), and dysgeusia/anosmia (23.5%). COVID-19 was severe in 17.6%, moderately severe in 32.4%, and mild in 50% of patients. Time since transplantation, duration of symptoms, hospital stay and inflammatory markers like CRP, LDH, ferritin and d-dimer were significantly associated with disease severity (P < 0.05). Steroids were increased in 55%, antiproliferative agents stopped in 97%, and calcineurin inhibitors stopped in 26% of patients. 70.6% of the patients were managed in home isolation. Acute kidney injury occurred in 58.8% cases. 75% of the AKI patients recovered by 28 days after discharge.

Conclusion

Our study showed that outcome of COVID-19 in kidney transplant patients was reasonably good.

Sunlight driven photocatalytic degradation of organic pollutants using a MnV2O6/BiVO4 heterojunction: mechanistic perception and degradation pathways

In the field of photocatalysis, fabrication of a heterojunction structure with effective charge separation at the interface and charge shift to enhance the photocatalytic activity has acquired extensive consideration. In the present investigation, MnV₂O₆/BiVO₄ heterojunction samples with excellent photocatalytic performance under sunlight irradiation were conveniently synthesized by a hydrothermal technique, and characterized by UV-Vis, FTIR, XRD, FESEM, HRTEM, PL, BET and XPS techniques. The prepared samples were investigated as photocatalysts for degrading MB and RhB dyes under sunlight. Among various samples of MnV₂O₆/BiVO₄, the S-V hetero-junction sample exhibited maximum photocatalytic activity with 98% and 96% degradation of MB and RhB dyes, respectively, in 6 and 35 min. The high photocatalytic activity of MnV₂O₆/BiVO₄ may be due to the successful generation and shift of charges in the presence of visible light. The average reduction of chemical oxygen demand (COD) was found to be 75% after irradiation with direct sunlight. In the degradation process of dyes, superoxide anion radicals were the main responsive species, as revealed by trapping experiments. The degradation efficiency of MnV₂O₆/BiVO₄ heterojunction did not diminish even after four cycles. In addition, the catalytic performance of the fabricated heterojunction was also explored for reducing 4-nitrophenols (4-NP) by using NaBH₄. Absolute conversion of 4-NP to 4-aminophenol (4-AP) occurred without the production of intermediate byproducts.

CaFu MOF as an efficient adsorbent for simultaneous removal of imidacloprid pesticide and cadmium ions from wastewater

Heavy metal ions and pesticides are the noteworthy toxic substances which must be removed from contaminated water for safeguarding public health. The higher levels of these substances in natural water may adversely affect the human health, climate and the eco-framework. The adsorptive removal of hazardous constituents employing metal organic frameworks has drawn considerable attention of researchers during the last decade. From this point of view, single crystal of calcium fumarate [Ca(C₄H₄O₄)_1.5 (H₂O)(CH₃OH)₂] has been developed and analyzed by single crystal X-ray crystallography which confirmed the formation of 3-D metal organic frameworks (MOFs). The synthesized MOFs was employed for simultaneous adsorptive removal of imidacloprid, a high consumption pesticide, and highly toxic Cd (II) from aqua ecosystem. The effect of variation in experimental conditions such as solution pH, adsorbent dosage, contact time, initial concentration and temperature on adsorption was systematically evaluated. Both the imidacloprid and Cd(II) exhibited maximum adsorption at pH 6.5 and 7.8, respectively. The equilibrium empirical data was fitted into Langmuir, Freundlich and Temkin isotherms. The adsorption capacity of CaFu MOFs was observed to be 467.23 and 781.2 mg g^-1 for imidacloprid and cadmium ions, respectively. The adsorbed pollutants were desorbed from the adsorbent using dilute HCl, and the material was reused for five adsorption-desorption cycles without any appreciable loss of adsorption capacity. Therefore, the 3-D CaFu MOFs could be utilized as a novel material for adsorptive removal of imidacloprid pesticide as well as Cd (II) from wastewater.

Coronin-1 levels in patients with tuberculosis

Background & objectives:

Despite advances in diagnostics and therapeutics, tuberculosis (TB) is widely prevalent and contributes to a significant burden of illness in both developing and developed nations. The present study was aimed to assess the role of coronin in TB patients and healthy controls. Coronin is a leucocyte-specific protein that is actively recruited in mycobacterial phagolysosomes, where it inhibits lysosomal delivery of Mycobacterium by activating a calcium-dependent phosphatase-calcineurin.

Methods:

In the study, 100 newly diagnosed cases of TB (pulmonary and extra-pulmonary) and healthy controls were prospectively enrolled over one year and the levels of coronin-1a in these patients and controls were measured by quantitative PCR (qPCR).

Results:

A total of 100 TB patients and 100 healthy individuals as controls were assessed. There were 59 patients with extra-pulmonary TB (EPTB) and 41 of pulmonary TB (PTB). In 47 per cent of patients, corroborative histopathological evidence of TB was also available. Significantly higher values of coronin-1a were observed in TB patients (19.94±2.61) than in healthy controls (16.09±1.91) (P<0.001).

Interpretation & conclusions:

Coronin 1a appears to play an important role in the TB disease pathophysiology and agents developed against coronin may have a role in the treatment of TB. Further studies are required to assess if coronin-1a levels are elevated in non-tubercular infective a etiologies and whether these can be a potential drug target in patients with TB.

Highly stable AgNPs prepared via a novel green approach for catalytic and photocatalytic removal of biological and non-biological pollutants

Increases in biological and non-biological pollutants pose a significant threat to environmental systems. In an effort to develop an effective means to treat such pollutants, the use of Phaseolus vulgaris (kidney beans) as reducing and capping agents is proposed for the green synthesis of highly stable silver nanoparticles (AgNPs) with a face-centered cubic (fcc) crystalline structure (size range: 10-20 nm). The potent role of the resulting AgNPs was found as triple platforms (photocatalyst, catalyst, and antimicrobial disinfectant). AgNPs were able to photocatalytically degrade approximately 97% of reactive red-141 (RR-141) dye within 150 min of exposure (quantum efficiency of 3.68 × 10^-6 molecule.photon^-1 and a removal reaction kinetic rate of 1.13 × 10^-2 mmol g^-1 h^-1). The role of specific reactive oxygen species (ROS) in the photocatalytic process and complete mineralization of dye was also explored through scavenger and chemical oxygen demand (COD) experiments, respectively. As an catalyst, AgNPs were also capable of reducing 4-nitrophenol to 4-aminophenol within 15 min. Overall, AgNPs showed excellent stability as catalyst and photocatalyst even after five test cycles. As an antimicrobial agent, the AgNPs are effective against both gram-positive (Bacillus subtilis) and -negative bacteria (Escherichia coli), with the zones of clearance as 15 and 18 mm, respectively. Thus, the results of this study validate the triple role of AgNPs derived via green synthesis as a photocatalyst, catalyst, and antimicrobial agent for effective environmental remediation.

Our Experience with Intraoral Submandibular Gland Excision

The aim of this paper is to present our experience with intraoral approach for submandibular gland excision in terms of effectiveness and safety in patients with chronic sialadenitis. This is a prospective study carried out from November, 2016 to April, 2018 analyzing 13 patients of chronic sialadenitis. The indication of intraoral approach was either failed attempt to remove the stone endoscopically, chronic sialadenitis or benign tumor. The surgical triangle was used as the landmark for hilar area and gland was dissected close to the capsule and removed via intraoral incision and preserving the sublingual gland. We were successfully able to remove the submandibular gland via intraoral approach in 10 cases. Two patients had to undergo transcervical gland excision and one patient refused for transcervical approach. Intraoral excision of submandibular gland is a safe and viable approach to be utilized in carefully selected patients. The major advantages being avoidance of transcervical scar and of injury to marginal mandibular branch of facial nerve.

Fibrillary glomerulonephritis presenting as crescentic glomerulonephritis in a young female: a case study

Fibrillary glomerulonephritis (FGN) is a rare disorder accounting for up to 1% of all glomerulonephritis (GN). FGN usually manifests as nephrotic or subnephrotic proteinuria, hematuria, and hypertension in patients after the sixth decade. The overall prognosis of FGN is very poor. Crescentic presentation of FGN is uncommon which may be diagnosed as rapidly progressive glomerulonephritis (RPGN) unless electron microscopy and/or special stains are done. We report a case of a young female who presented as RPGN but diagnosis was revised to crescentic FGN after electron microscopy and immunohistochemical staining with DNAJB9 stain. Patient remained dialysis-dependent after treatment with steroid and cyclophosphamide for 2 months and progressed to end-stage renal disease (ESRD). Crescentic FGN usually does not respond to treatment and invariably progresses to ESRD over few months. This case emphasizes the defining role of electron microscopy and special stains in diagnosing uncommon glomerular diseases.

Heteroatom-doped graphene as sensing materials: a mini review

Graphene is one of the astounding recent advancements in current science and one of the most encouraging materials for application in cutting-edge electronic gadgets. Graphene and its derivatives like graphene oxide and reduced graphene oxide have emerged as significant nanomaterials in the area of sensors. Furthermore, doping of graphene and its derivatives with heteroatoms (B, N, P, S, I, Br, Cl and F) alters their electronic and chemical properties which are best suited for the construction of economical sensors of practical utility. This review recapitulates the developments in graphene materials as emerging electrochemical, ultrasensitive explosive, gas, glucose and biological sensors for various molecules with greater sensitivity, selectivity and a low limit of detection. Apart from the most important turn of events, the properties and incipient utilization of the ever evolving family of heteroatom-doped graphene are also discussed. This review article encompasses a wide range of heteroatom-doped graphene materials as sensors for the detection of NH₃, NO₂, H₂O₂, heavy metal ions, dopamine, bleomycinsulphate, acetaminophen, caffeic acid, chloramphenicol and trinitrotoluene. In addition, heteroatom-doped graphene materials were also explored for sensitivity and selectivity with respect to interfering analytes present in the system. Finally, the review article concludes with future perspectives for the advancement of heteroatom-doped graphene materials.

Graphene is one of the astounding recent advancements in current science and one of the most encouraging materials for application in cutting-edge electronic gadgets.

Analysis of native kidney biopsy: Data from a single center from Bihar, India

This is a retrospective study of all native kidney biopsies performed at our center between October 1, 2012 and March 31, 2015. Relevant clinical and laboratory variables were recorded. Biopsy samples were processed for light microscopy and immunofluorescence in all cases. Histological classification was adapted from the World Health Organization recommendations. The indications for kidney biopsy were nephrotic syndrome in adults in 190 cases, rapidly progressive renal failure in 43, unexplained renal failure in 25, and steroid-resistant nephrotic syndrome in children in 12. The mean age of the patients was 31.48 ± 13.46 years. Male-to-female ratio was 1.87:1. Mean serum creatinine (SCr) of the patients was 2.36 ± 2.07 mg/dL. Primary glomerulonephritis accounted for 88.89% of cases (240) while secondary glomerulonephritis accounted for 7.40% of total cases (20). Interstitial disease accounted for 1.5% and vascular disease for 2.2%. The most common lesion among primary glomerulonephritis was focal segmental glomerulosclerosis (FSGS) (31.11%) followed by diffuse proliferative glomerulonephritis (DPGN) (13.33%) and membranous glomerulonephritis (MGN) (12.59%). Among secondary glomerulonephritis, lupus nephritis was the most common (5.56%). In patients with SCr 1.4 mg/dL or less (n = 131), FSGS was the most common histology (17.26%) followed by MGN (23.66%) and minimal change disease (7.63%). Whereas, in patients with SCr more than 1.4 mg/dL (n = 139), DPGN was the most common diagnosis (23.74%) followed by FSGS (17.26%) and IgAN (12.23%). Fourteen patients (5.2%) had one or more episode of gross hematuria, three of whom required blood transfusion. The overall FSGS was the most common lesion seen. When we consider only patients with deranged renal function, DPGN was the most common histopathological lesion. The reason for disproportionate high incidence for DPGN is not clear and requires further research.

Research ethics committees in a tight spot: Approving consent strategies for child research that are prima facie illegal but are ethical in terms of national guidelines

It is an internationally accepted principle that ethics norms should be applied and enforced in research with humans through ethics review by research ethics committees (RECs). This places RECs at the very heart of the system for protecting participants and enforcing their rights. In the South African ethical-legal framework for child research, there are divergent approaches to consent. That is, section 71 of the National Health Act (No. 61 of 2003) (NHA) requires mandatory parental consent for child research, and limits the authority for proxy consent to parents and legal guardians. However, national ethics guidelines authorised by section 72 of the NHA and issued by the National Health Research Ethics Council (NHREC) acting in terms of its mandate (National Department of Health, 2015) allow a more nuanced approach - i.e. self-consent by older adolescents, provided certain conditions are met, and consent by a range of parental substitutes where there are no available parents or legal guardians. We have argued elsewhere that the consent approach in section 71 is inappropriately restrictive and are of the view that the consent approach endorsed in national ethics guidelines is more defensible. An REC that elects to approve a consent strategy allowable in ethics guidelines is effectively electing to not follow section 71, which raises the question of what the consequences might be for that REC. This article examines the legal liability of RECs through three 'threads' of accountability: the NHREC, the institutions hosting RECs, and the courts. We conclude that: (i) if an REC approves a child protocol with consent strategies allowable in terms of national ethics guidelinesbut not in terms of section 71, it is unlikely that the NHREC would discipline the REC in the face of a complaint - provided the REC acted within national ethics guidelines issued by the NHREC in terms of the latter's section 72 mandate to set national norms and standards; (ii) if an REC approves a consent approach allowed for in ethics guidance, it is also unlikely that the host institution would discipline the REC in the face of a complaint - especially if the institution is aware of the REC's explicit decision to follow national ethics guidelines that are authorised by section 72 of the NHA; and (iii) an REC could only be sued by a participant in terms of the law of delict (and be liable for damages) if several demanding components are proven, such as that the harm suffered by the participant resulted directly from the REC's actions in approving a particular consent strategy for that research. Furthermore, the court may well look to national ethics guidelines in making determinations about whether an REC's conduct was wrongful for the purposes of liability in civil law. RECs are protected from being collectively liable by insurance taken out by their host institutions. We make a series of recommendations to address this issue.

Sialendoscopic Approach in Management of Juvenile Recurrent Parotitis

To assess the role of sialendoscopy as a diagnostic and therapeutic modality in juvenile recurrent parotitis. Juvenile recurrent parotitis (JRP) is the second most frequent salivary gland disease in childhood and is characterized by recurrent non suppurative and non obstructive parotid inflammation. These attacks influence the quality of life and can even lead to gland destruction, and there are no definitive treatment to avoid them. Sialendoscopic dilatation is emerging as the new treatment modality in this aspect.

STUDY DESIGN

 retrospective study.

STUDY SETTING

Department of Otorhinolaryngology in tertiary care hospital. 17 cases of juvenile recurrent parotitis (i.e. children of age group 3-11 years presenting with complaints of recurrent parotid region swelling and pain, sometimes associated with fever) were included in the study during October 2012-September 2015. All cases underwent sialendoscopy under general anaesthesia. Diagnostic (classifying the ductal lesion) and interventional sialendoscopic procedure (dilatation with instillation of steroid) were carried out in single sitting. Follow up was done for a minimum of 6 months (range 6-36 months). 17 patients with mean age of 5.6 years and gender distribution of 47:53 (boys:girls) underwent sialendoscopy for JRP. 8 patients presented with unilateral parotitis and 9 with bilateral. The mean number of attacks in previous 1 year were 9.2. Average time for procedure was 20 min. All cases had ductal stenosis and ductal mucosa was pale in 15 cases on endoscopy. 1 patient underwent repeat endoscopy after 2 years. 50% had complete resolution of symptoms and 6 patients had one mild (swelling not associated with fever which subsided on its own) attack after treatment. Follow up period ranged from 6 months to 3 years. No complications were observed. Sialendoscopy has emerged as a viable option for assessment and treatment of JRP. Dilatation of the parotid duct and steroid instillation has significantly reduced the morbidity of this condition.

Demographics, Clinical Characteristics, Management, and Outcomes of Acute Heart Failure Patients: Observations from the Oman Acute Heart Failure Registry

OBJECTIVES

We sought to describe the demographics, clinical characteristics, management and outcomes of patients in Oman with acute heart failure (AHF) as part of the Gulf aCute heArt failuRe rEgistry (CARE) project.

METHODS

Data were analyzed from 988 consecutive patients admitted with AHF to 12 hospitals in Oman between 14 February and 14 November 2012.

RESULTS

The mean age of our patients was 63±12 years. Over half (57%) were male and 95% were Omani citizens. Fifty-seven percent of patients presented with acute decompensated chronic heart failure (ADCHF) while 43% had new-onset AHF. The primary comorbid conditions were hypertension (72%), coronary artery disease (55%), and diabetes mellitus (53%). Ischemic heart disease (IHD), hypertensive heart disease, and idiopathic cardiomyopathy were the most common etiologies of AHF in Oman. The median left ventricular ejection fraction of the cohort was 36% (27-45%) with 56% of the patients having heart failure with reduced ejection fraction (< 40%). Atrial fibrillation was seen in 15% of patients. Acute coronary syndrome (ACS) and non-compliance with medications were the most common precipitating factors. At discharge, angiotensin converting enzyme inhibitors and beta-blockers were prescribed adequately, but aldosterone antagonists were under prescribed. Within 12-months follow-up, one in two patients were rehospitalized for AHF. In-hospital mortality was 7.1%, which doubled to 15.7% at three months and reached 26.4% at one-year post discharge.

CONCLUSIONS

Oman CARE was the first prospective multicenter registry of AHF in Oman and showed that heart failure (HF) patients present at a younger age with recurrent ADCHF and HF with reduced ejection fraction. IHD was the most common etiology of HF with a low prevalence of AHF, but a high prevalence of acute coronary syndrome and non-compliance with medications precipitating HF. A quarter of patients died at one-year follow-up even though at discharge medical therapy was nearly optimal. Our study indicates an urgent need for prevention, early diagnosis, and treatment of AHF in Oman.

Socio-economic & household risk factors of malaria in tribal areas of Madhya Pradesh, central India

Background & objectives:

Malaria is a major public health problem in many States of the country, particularly, in Madhya Pradesh where both Plasmodium vivax and P. falciparum are endemic. Although many studies have been conducted to investigate risk factors for malaria, but only a few have examined household and socio-economic risk factors. The present study was, therefore, undertaken to explore the relationship of different socio-demographic, socio-economic and behavioural risk factors with malaria prevalence in tribal areas of Madhya Pradesh, India.

Methods:

This study was undertaken in all 62 villages of Bargi Primary Health Centre from May 2005 to June 2008. These villages comprised 7117 households with an average family size of five members. Fortnightly fever surveys were conducted in all villages to assess prevalence of malaria infection in the community. The distinct univariate and multivariate logistic regression models were fitted on the data set.

Results:

The important socio-demographic risk factors like age of household head, social group, occupation and family size; socio-economic factors like type of walls of house, place of drinking water source, irrigated land, cash crop; and behavioural variables like place of sleeping, use of bed nets, etc. were found significantly associated with malaria in univariate analyses. In multivariate analyses only social groups, family size, type of walls of house, and place of sleeping had strong significant association with prevalence of malaria.

Interpretation & conclusions:

The study shows that in tribal areas where people are living in poor quality of houses with no proper use of preventive measures, malaria is firmly established. We conclude that community based interventions which bring improvement in standard of living, access to healthcare facilities and health awareness, will have a significant impact on malaria prevention in these areas.

Neurofibroma of the Cheek and Nasal Dorsum: A Case Report and a Mini Review

Neurofibroma is a benign neoplasm derived from peripheral nerves. Most of these are associated with neurofibromatosis but may also occur as solitary lesions. When found in the neck, they are often located in the soft tissues. They are slow-growing masses, often asymptomatic and have been found most commonly in the oral cavity. We report a case of neurofibroma involving two separate and unusual sites of face, which are subcutaneous tissues of the cheek and dorsum of nose, and present a brief review of literature.

How to cite this article

Gupta N, Kaur R, Rai A, Wadhwa N, Singh PP. Neurofibroma of the Cheek and Nasal Dorsum: A Case Report and a Mini Review. Int J Otorhinolaryngol Clin 2016;8(2):62-64.

Status of oxidative stress and antioxidant levels in smokers with breast cancer from western Nepal

BACKGROUND

Research indicates that oxidative stress induced by smoking plays a role in breast cancer. In view of these reports, we aimed to study th relationship between smoking and oxidative stress in breast cancer patients from the western region of Nepal.

MATERIALS AND METHODS

The study included a control group of 42 females (non-smoking healthy women) and a test group sudivided into Group I consisting of 46 female breast cancer patients who were smokers and Group II consisting of 42 non-smoking breast cancer patients. Detailed history of the patients was collected with the help of pre-test proforma. Plasma levels of malondialdehyde (MDA), total antioxidant activity (TAA) which represents total dietary antioxidants, vitamin C and α- tocopherol were estimated by standard methods. Statistical analysis was done using SPSS version 16.

RESULTS

The plasma MDA, TAA, vitamin C and α- tocopherol were 1±1.4nmol/ml, 918±207μmol/L, 1±0.24mg/dL and 0.94±0.31mg/dL in controls, 5±1.2nmol/ml, 458±166 μmol/L, 0.64±0.32mg/dL and 0.5±0.3mg/dL in Group-I and 2.56±1.2nmol/ml, 663±178 μmol/L, 0.78±0.2mg/dL and 0.77±0.2mg/dL in Group- II, respectively. Vitamin C, α- tocopherol and TAA (p=0.001) were significantly reduced whereas MDA (p=0.001) was significantly raised in Group-I when compared to controls and Group-II.

CONCLUSIONS

We observed a significant rise in oxidative stress and low levels of antioxidants in breast cancer patients with smoking habit. It is well known that free radicals facilitate the progression of breast cancer, possibly increasing the risk of progression to the next stage.

A systematic review to assess cost effectiveness of enhanced recovery after surgery programmes in colorectal surgery

AIM

Enhanced recovery after surgery (ERAS) programmes have been shown to reduce length of stay and peri-operative morbidity. However, there are comparatively few data on their cost effectiveness. The object of this systematic review was to appraise the current literature to determine the cost effectiveness of ERAS and to characterize how cost is reported and evaluated.

METHOD

An electronic database search identified studies comparing ERAS with standard peri-operative care in colorectal surgery where an evaluation of cost effectiveness was a primary or secondary outcome. Cost data were converted to euros to enable a more standardized comparison of the studies. There were no limits on study design.

RESULTS

Seven articles were included in the analysis. The reporting and evaluation of cost data were inconsistent. Reported cost for ERAS ranged from €1989 to €12,805 per patient. Although not all statistically significant, all studies demonstrated cost reductions with ERAS compared with non-ERAS although they were highly variable, ranging from €153 to €6537 per patient.

CONCLUSION

Although the review has shown ERAS to be cost effective, there are some important inconsistencies and deficiencies regarding the reporting of data. Authors should therefore be encouraged to report cost data to supplement the literature detailing clinical efficacy.

Quantification of clonal circulating plasma cells in newly diagnosed multiple myeloma: implications for redefining high-risk myeloma

The presence of clonal circulating plasma cells (cPCs) is a marker of high-risk disease in all stages of monoclonal gammopathies. However, the prognostic utility of quantitating cPCs using multiparametric flow cytometry in multiple myeloma (MM) patients with current treatments is unknown. There were 157 consecutive patients with newly diagnosed MM seen at the Mayo Clinic, Rochester from 2009 to 2011 that had their peripheral blood evaluated for cPCs by multiparameter flow cytometry. Survival analysis was performed by the Kaplan-Meier method and differences assessed using the log-rank test. Using a receiver operating characteristics (ROC) analysis, ⩾400 cPCs were considered as the optimal cutoff for defining high-risk disease. The presence of ⩾400 cPCs was associated with higher plasma cell (PC) proliferation and adverse cytogenetics. The median time-to-next-treatment and overall survival (OS) in patients with ⩾400 cPCs (N=37, 24%) was 14 months and 32 months compared with 26 months and not reached for the rest (P<0.001). In a multivariable model, the presence of ⩾400 cPCs and older age adversely affected OS. Flow cytometry to quantify cPCs is a valuable test for risk stratifying newly diagnosed MM patients in the era of novel agents. Future studies are needed to determine its role in developing a risk-adapted treatment approach.

Association between preoperative glucocorticoids and long-term survival and cancer recurrence after colectomy: follow-up analysis of a previous randomized controlled trial

BACKGROUND

The effect of anaesthetic drugs on long-term oncological outcomes after cancer surgery is an area of current interest. Dexamethasone is widely used in anaesthetic practice; however, its effect on long-term survival and cancer outcomes is not known. This study presents the results of a 5-yr follow-up of patients receiving dexamethasone before elective colectomy as part of a previous randomized clinical trial.

METHODS

Sixty patients who underwent elective open colonic resection for any indication between June 2006 and March 2008 were randomized to receive either 8 mg i.v. dexamethasone or placebo before surgery. A 5-yr follow-up analysis was conducted to evaluate overall survival, disease-free survival and recurrence specifically for patients undergoing resection for Stage I-III colon cancer. Kaplan-Meier analysis was performed and log-rank test was used to evaluate difference in survival between groups.

RESULTS

Forty-three of the 60 subjects had Stage I-III colon cancer and were included in the follow-up analysis. Twenty received preoperative dexamethasone and 23 received placebo. There were no significant differences between groups in baseline or disease characteristics. No differences were found between groups for overall or disease-free survival. In the dexamethasone group, there was a significantly higher rate of distant recurrence (6 compared with 1, P=0.04).

CONCLUSIONS

Preoperative dexamethasone was associated with a higher rate of distant recurrence in patients undergoing colectomy for colon cancer. Given the small sample size, this finding should be interpreted with caution, but warrants further investigation in a prospective study.

Systematic review and meta-analysis of oesophageal Doppler-guided fluid management in colorectal surgery

BACKGROUND

Oesophageal Doppler monitor (ODM)-guided fluid therapy has been recommended for routine use in patients undergoing colorectal surgery. However, recent trials have suggested either equivalent or inferior results for patients randomized to ODM-guided fluid management, especially when compared with fluid restriction or within the context of optimized perioperative care. Hence, an updated systematic review and meta-analysis was conducted.

METHODS

A systematic review and meta-analysis was conducted of all randomized trials exploring ODM-guided fluid management in major colorectal surgery with the endpoints total complications and length of hospital stay (LOS). Subset analyses were planned a priori specifically to investigate the role of the ODM in the context of fluid restriction or optimized perioperative care.

RESULTS

Six high-quality trials comprising a total of 691 patients were included in the final analysis. ODM-guided fluid therapy did not influence the incidence of complications (odds ratio 0·74, 95 per cent confidence interval (c.i.) 0·50 to 1·11; P = 0·15), with moderate heterogeneity in the results (I(2)  = 33 per cent; P = 0·19). There was no difference in mean LOS between patients receiving ODM-guided fluid therapy and controls: mean difference -0·88 (95 per cent c.i. -2·89 to 1·13) days (P = 0·39). There was no difference in complications or LOS when ODM-guided fluid therapy was compared with fluid restriction or used within an otherwise optimized perioperative environment.

CONCLUSION

ODM-guided fluid therapy did not influence LOS or complications in patients undergoing colorectal surgery. Results favouring the ODM were seen only in early studies, whereas newer trials did not show any benefit from such monitoring.

Low free to total PSA ratio is not a good discriminator of chronic prostatitis and prostate cancer: An Indian experience

Aims: To find out the utility of free to total PSA ratio in discriminating chronic prostatitis and prostate cancer. Setting and design: The patients visited urology clinics at Batra Hospital and Medical Research Center, New Delhi. Background: The use of serum free to total PSA as a diagnostic tool for prostate cancer has led to early detection of prostate cancer; however, the effect of inflammation on f/t PSA ratio restricts its use in early detection of cancer. Materials and Methods: The study was conducted in age related 101 patients which include 27 carcinoma patients (group I), 34 BPH patients (group II) and 40 chronic prostatitis patients (group III). Serum total PSA (tPSA) and free PSA (fPSA) were analyzed on Elecsys 2010. These were compared with histological reports of biopsy specimen. Other biochemistry tests were done on Randox Imola. P Value was calculated using one way ANOVA with posthoc Bonferroni analysis. Results: Serum total PSA levels were comparable in group I and III and were higher than group II (P < 0.049). Serum fPSA in group I was not significantly different from group II and III, However, group II has higher levels than group III (P < 0.035). Difference was significant for f/t PSA ratio in group I and II (P < 0.00) and group II and III (P < 0.000).Group I and III were with comparable levels (P < 0.807). Conclusions: f/t PSA ratio is not a good discriminator for malignancy and chronic prostatitis. This limitation of f/t PSA ratio must be taken into consideration while interpreting the results clinically.

Evaluation of oxidative stress and antioxidant activity in pre and post hemodialysis in chronic renal failure patients from Western region of Nepal

Objective: To evaluate the oxidative stress and antioxidant activity in pre and post hemodialysis in chronic renal failure patients using a diacetate cellulose membrane. Background: Chronic Renal Failure is a gradual, progressive and irreversible loss of normal functioning of kidneys. This is associated with increased formation of reactive oxygen species and increased oxidative stress. No studies have been undertaken in this area in Nepal. Method: The study groups were devided into chronic renal failure patients undergoing hemodialysis (n=52) and healthy controls (n=52). Diacetate cellulose was used as dialyzer membrane for chronic renal failure patients. Blood samples were collected in EDTAbottles and plasma was used for the estimation of oxidative stress marker, total antioxidant activity, vitamin C, ?-tocopherol, urea and creatinine. Results: There was significant reduction in the levels of vitamin C,? -tocopherol and total antioxidant activity in post dialysis patients compared to predialysis and control groups (p<0.001). Plasma urea and creatinine levels were high in predialysis patients compared to controls and was significantly reduced after dialysis. Significantly elevated malondialdehyde levels were found in chronic renal failure patients before and after dialysis when compared with controls. Conclusion: The results of our study indicate that there are reduced levels antioxidants in chronic renal patients in pre and post dialysis condition and also more loss of antioxidants after dialysis. All these condition leads to increased oxidative stress in these patients. DOI: http://dx.doi.org/10.3329/bjms.v13i1.14741 Bangladesh Journal of Medical Science Vol. 13 No. 01 January2014: 40-44

Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery

BACKGROUND

Several recent studies have investigated the role of C-reactive protein (CRP) as an early marker of anastomotic leakage following colorectal surgery. The aim of this systematic review and meta-analysis was to evaluate the predictive value of CRP in this setting.

METHODS

A systematic literature search was performed using MEDLINE, Embase and PubMed to identify studies evaluating the diagnostic accuracy of postoperative CRP for anastomotic leakage following colorectal surgery. A meta-analysis was carried out using a random-effects model and pooled predictive parameters were determined along with a CRP cut-off value at each postoperative day (POD).

RESULTS

Seven studies, with a total of 2483 patients, were included. The pooled prevalence of leakage was 9·6 per cent and the median day on which leakage was diagnosed ranged from POD 6 to 9. The serum CRP level on POD 3, 4 and 5 had comparable diagnostic accuracy for the development of an anastomotic leak with a pooled area under the curve of 0·81 (95 per cent confidence interval 0·75 to 0·86), 0·80 (0·74 to 0·86) and 0·80 (0·73 to 0·87) respectively. The derived CRP cut-off values were 172 mg/l on POD 3, 124 mg/l on POD 4 and 144 mg/l on POD 5; these corresponded to a negative predictive value of 97 per cent and a negative likelihood ratio of 0·26-0·33. All three time points had a low positive predictive value for leakage, ranging between 21 and 23 per cent.

CONCLUSION

CRP is a useful negative predictive test for the development of anastomotic leakage following colorectal surgery.

Relationship between initial clinical presentation and the molecular cytogenetic classification of myeloma

Multiple myeloma (MM) consists of several distinct cytogenetic subtypes, and we hypothesized that each subtype may have a unique mode of initial presentation and end-organ damage. We studied 484 patients with newly diagnosed MM to determine the relationship between specific myeloma-defining event (MDE) and the cytogenetic subtype. Patients were divided into four non-overlapping groups based on the MDE at diagnosis: isolated renal failure, isolated anemia, isolated lytic bone disease or a combination (mixed). MM with translocations without trisomies accounted for 30% of all patients, but accounted for 50% of patients with renal failure. Specifically, the t(14;16) translocation accounted for only 5% of all MM patients, but was present in 13.5% of patients with renal failure as MDE. Among patients with t(14;16), 25% presented with renal failure only as MDE. Patients with isolated renal failure as MDE had significantly poorer survival compared with all other groups, whereas patients with bone disease as MDE had the best outcome (P<0.001). Our findings support the hypothesis that in addition to prognostic differences, there is significant heterogeneity in clinical presentation associated with the cytogenetic subtype, suggesting that MM encompasses a group of cytogenetically and phenotypically distinct disorders rather than a single entity.

First report of detection and molecular confirmation of Plasmodium ovale from severe malaria cases in central India

OBJECTIVE

We report for the first-time detection of Plasmodium ovale in central India.

METHODS

From 2010, all hospitalised suspected malaria cases at the malaria clinic of the Regional Medical Research Centre for Tribals in Bastar district, central India, were screened. Plasmodium species were identified by microscopy and species-specific nested PCR of 18s rRNA.

RESULTS

Of 256 enrolled cases of confirmed P. falciparum malaria by microscopy, P. ovale infection was detected in three cases (1.2%) by PCR and sequencing. Of these three cases, one had cerebral malaria and another had severe malaria anaemia. In both of these cases, P. ovale infection was mixed with P. falciparum, while in third case the infection was mixed with both P. falciparum and P. vivax. Phylogenetic analysis revealed that these isolates showed closed homology with West African genotypes.

CONCLUSION

All three hospitalised patients were originally residents of remote inaccessible forest villages and never moved out of their residence. This finding also has implications in malaria control and elimination as P. ovale causes relapses. This study highlights the need of molecular diagnosis of malaria species for appropriate treatment and control.

Assessment of knowledge of harmful effects and exposure to recreational music in college students of delhi: a cross sectional exploratory study

Exposure to loud sounds results in a mild to profound degree of temporary or permanent hearing loss. Though occupational noise exposure remains the most commonly identified cause of noise-induced hearing loss, potentially hazardous noise can be encountered during recreational activities. Unfortunately not much attention is being given to the increasing trend of prolonged exposure to noisy environment, in the younger generation of Indians. The purpose of our study was to know the knowledge of college students about the harmful effects of loud music, prevailing practices with regard to exposure to recreational music and the subjective effects that this exposure is causing if any. Cross Sectional survey of College Students (n = 940), from randomly selected colleges of Delhi University. Majority of students listened to music using music-enabled phones; earphones were preferred and 56.6 % participants listened to music on a loud volume. Effects experienced due to loud sound were headache (58 %), inability to concentrate (48 %), and ringing sensation in the ear (41.8 %). Only 2.7 % respondents used ear protection device in loud volume settings. Twenty-three percent respondents complained of transient decreased hearing and other effects after exposure to loud music. 83.8 % knew that loud sound has harmful effect on hearing but still only 2.7 % used protection device. The survey indicates that we need to generate more such epidemiological data and follow up studies on the high risk group; so as to be able to convincingly sensitize the Indian young generation to take care of their hearing and the policy makers to have more information and education campaigns for this preventable cause of deafness.

Statins are associated with reduced risk of gastric cancer: a systematic review and meta-analysis

BACKGROUND

Several observational studies have shown that statins may modify the risk of gastric cancer (GC). We carried out a systematic review and meta-analysis of studies evaluating the effect of statins on GC risk.

PATIENTS AND METHODS

We conducted a systematic search of multiple databases up to December 2012. Studies that evaluated exposure to statins, reported GC outcomes and odds ratio (OR) or provided data for their estimation were included in the meta-analysis. Pooled OR estimates with 95% confidence intervals (CIs) were calculated using the random-effects model.

RESULTS

Eleven studies (eight observational, three post-hoc analyses of 26 clinical trials) reporting 5581 cases of GC were included. Meta-analysis showed a significant 32% reduction in GC risk with statin use (adjusted OR, 0.68; 95% CI, 0.51-0.91). After exclusion of one study which was contributing to considerable heterogeneity, a significant 16% reduction in GC risk was a more conservative, consistent estimate (adjusted OR, 0.84; 95% CI, 0.78-0.90). This chemopreventive association was present in both Asian (adjusted OR, 0.68; 95% CI, 0.53-0.87) and Western population (adjusted OR, 0.86; 95% CI, 0.79-0.93).

CONCLUSIONS

Meta-analysis of studies supports a protective association between statin use and GC risk, in both Asian and Western population, in a dose-dependent manner.

Randomized clinical trial of enhanced recovery versus standard care after laparoscopic sleeve gastrectomy

BACKGROUND

Optimized perioperative care within an enhanced recovery after surgery (ERAS) protocol is designed to reduce morbidity after surgery, resulting in a shorter hospital stay. The present study evaluated this approach in the context of sleeve gastrectomy for patients with morbid obesity.

METHODS

Patients were allocated to perioperative care according to a bariatric ERAS protocol or a control group that received standard care. These groups were also compared with a historical group of patients who underwent laparoscopic sleeve gastrectomy at the same institution between 2006 and 2010, selected using matched propensity scores. The primary outcome was median length of hospital stay. Secondary outcomes included readmission rates, postoperative morbidity, postoperative fatigue and mean cost per patient.

RESULTS

Of 116 patients included in the analysis, 78 were allocated to the ERAS (40) or control (38) group and there were 38 in the historical group. There were no differences in baseline characteristics between groups. Median hospital stay was significantly shorter in the ERAS group (1 day) than in the control (2 days; P < 0·001) and historical (3 days; P < 0·001) groups. It was also shorter in the control group than in the historical group (P = 0·010). There was no difference in readmission rates, postoperative complications or postoperative fatigue. The mean cost per patient was significantly higher in the historical group than in the ERAS (P = 0·010) and control (P = 0·018) groups.

CONCLUSION

The ERAS protocol in the setting of bariatric surgery shortened hospital stay and was cost-effective. There was no increase in perioperative morbidity.

REGISTRATION NUMBER

NCT01303809 (http://www.clinicaltrials.gov).

Aneurysmal bone cyst at the base of the skull

Aneurysmal bone cysts have been described as pseudocysts in view of their lack of an epithelial lining. These cysts are uncommon, but when they do occur they typically involve the long bones of the extremities, the membranous bones of the thorax and pelvis, and the vertebrae. Skull involvement is uncommon. We present the case of a 14-year-old girl who presented with nasal obstruction and a swelling of the right cheek. Contrast-enhanced computed tomography detected a heterogeneous cystic mass involving the sphenoid and ethmoid bones. The mass was excised via a lateral rhinotomy approach, and it was identified as an aneurysmal bone cyst on histologic examination. The patient experienced a recurrence in the right sphenoid sinus within 3 months, and the lesion was removed via transnasal endoscopy.

Randomized clinical trial of goal-directed fluid therapy within an enhanced recovery protocol for elective colectomy

BACKGROUND

Goal-directed fluid therapy (GDFT) has been compared with liberal fluid administration in non-optimized perioperative settings. It is not known whether GDFT is of value within an enhanced recovery protocol incorporating fluid restriction. This study evaluated GDFT under these circumstances in patients undergoing elective colectomy.

METHODS

Patients undergoing elective laparoscopic or open colectomy within an established enhanced recovery protocol (including fluid restriction) were randomized to GDFT or no GDFT. Bowel preparation was permitted for left colonic operations at the surgeon's discretion. Exclusion criteria included rectal tumours and stoma formation. The primary outcome was a patient-reported surgical recovery score (SRS). Secondary endpoints included clinical outcomes and physiological measures of recovery.

RESULTS

Eighty-five patients were randomized, and there were 37 patients in each group for analysis. Nine patients in the GDFT and four in the fluid restriction group received oral bowel preparation for either anterior resection (12) or subtotal colectomy (1). Patients in the GDFT group received more colloid during surgery (mean 591 versus 297 ml; P = 0·012) and had superior cardiac indices (mean corrected flow time 374 versus 355 ms; P = 0·018). However, no differences were observed between the GDFT and fluid restriction groups with regard to surgical recovery (mean SRS after 7 days 47 versus 46 respectively; P = 0·853), other secondary outcomes (mean aldosterone/renin ratio 9 versus 8; P = 0·898), total postoperative fluid (median 3750 versus 2400 ml; P = 0·604), length of hospital stay (median 6 versus 5 days; P = 0·570) or number of patients with complications (26 versus 27; P = 1·000).

CONCLUSION

GDFT did not provide clinical benefit in patients undergoing elective colectomy within a protocol incorporating fluid restriction.

REGISTRATION NUMBER

NCT00911391 (http://www.clinicaltrials.gov).

Antrochoanal polyp - Validating its origin and management by endonasal endoscopic sinus surgery (eess)

AIM AND OBJECTIVES

20 fresh cases of Antrochoanal Polyps were subjected to EESS for studying the site of origin and to validate its efficacy.

STUDY DESIGN

This was a prospective study in which the cases were subjected to surgery and were followed; up for evaluation of results.

METHODS

The surgery performed was an endoscopic endonasal sinus surgery preceded and followed by transcanne sinuscopy. Results/Findigs: The age at the time of presentation ranged from 7-35 years. Male to female ratio was 1:1:5. Occurrence Antrochoanal Polyp was 1.5 times more common on the left side. The mean duration of symptoms was 3 years. The main presenting symptom was unilateral nasal obstruction in 100% of cases. Allergic symtomps.were noticed in 10%. Vasmotor symptom were present in 15% of the patients. Antroscopy revealed the antral part.to be cytic in 100% of the cases. The site of origin of the polyp could be ascertained in only 12 out of 20 cases; in 7 of them it acrose from the infrolateral wall of maxillary sinus, in 2 from the infromedial wall und in 2 it appeared to arise from the supromedial wall while in 1 from margin of the ostium. Post-surgery intra-natral remnants were found in 3 out of 20 cases i.e. in 15% of them. In two cases it was removed through maxillary ostia but in one case removed through transcanine route.

CONCLUSIONS

Endoscopic Sinus Surgery is the best modality of treating Antrochoanal Polyps. We report a success rate of 95% in our series.

Antioxidant status and peroxidative stress in mother and newborn -A pilot study

Serum antioxidant status and peroxidative stress was estimated in 30 pregnant women, their newborn infants and 25 non-pregnant women. Serum Ascorbic acid, α-tocopherol, retinol & β-carotene levels were found to be significantly reduced and peroxidative stress was significantly higher in mothers as compared to matched non-pregnant women. Newborn had significantly higher levels of ascorbic acid as compared to their mother but had significantly lower levels of lipid soluble vitamins. The peroxidative stress in newborn was found to be significantly less as compared to their mothers. A positive correlation of ascorbic acid and α-tocopherol levels between mother and newborn reflects that their status in mother does influence the newborn status.

Dermal vasculature in psoriasis and psoriasiform dermatitis: a morphometric study

Background:

Vascular proliferation in the papillary dermis is considered to be an important and probably an early feature of psoriasis. Few morphometric studies have attempted to analyze the vascular changes. However, no study was found in the available literature comparing vascular changes between psoriasis and psoriasiform dermatitis.

Materials and Methods:

Skin biopsies from 25 cases each of psoriasis and psoriasiform lesions were immunohistochemically stained for CD34 (endothelial marker). Microvessel density (MVD), microvessel length density and ratio of microvessel area to papillary dermal area were calculated using image analysis software.

Results:

Skin biopsies from psoriasis showed higher staining for CD34 on light microscopy. Using morphometric techniques, microvessel length density was significantly higher in psoriasis compared to psoriasiform lesions (P value <0.05). MVD was also higher in psoriasis, though the difference was not significant. The ratio of microvessel area to dermal area was almost similar in both the groups.

Conclusion:

Our results indicate that vascular tortuousity and dilatation is significant only in psoriatic lesions. These results may assist in automated diagnosis of skin biopsies.

Development of an eco-friendly method to convert life expired composite propellant into liquid fertilizer

Large quantity of composite propellants is produced as waste due to life expiry of missiles/rejection of propellant lots during manufacturing. The environmental protection agency does not allow the hazardous materials for open burning/open detonation. Therefore, a systematic study has been carried out to develop a method for the disposal of composite propellant into liquid fertilizer without affecting the environment. In this study, propellant compositions were digested in dilute nitric acid followed by neutralization with 5M KOH solution to get precipitated out aluminium as aluminium hydroxide and finally the obtained liquid was treated with orthophosphoric acid for further neutralization. The liquid fertilizer, thus, obtained was characterized for nitrate and phosphate content using ion chromatography while ICP-AES was used for the estimation of potassium, aluminium and other noxious metallic elements such as Pb, Cd, As, Cr, Cu, Ni and Zn. The analyses data indicate that liquid fertilizer is free from aluminium and noxious metallic elements while ratio of nitrogen, phosphorous and potassium are close to the Indian NPK value.

High resolution computed tomography in stapedial otosclerosis

The value of high-resolution CT scanning in diagnosing stapedial otosclerosis and in influencing surgical planning was studied. 40 cases, consisting of patients of both genders, above the age of 14 years, with a clinical diagnosis of otosclerosis underwent HRCT of the temporal bones. Images were acquired in axial plane, with a bone algorithm, keeping slice thickness at 0.5 mm and intervals of 0.5 mm. Reconstruction of the volume data set was done to obtain overlapping slices in various planes, so as to obtain the best possible images of the footplate of stapes. The thickness of the footplate was measured and the site of lesion was noted in these images. On exploratory tympanotomy, the footplate was assessed and graded according to a visual scale. HRCT was able to diagnose stapedial otosclerosis in 85% ears. It was able to identify the presence of a thickened footplate correctly with a sensitivity of 85.3% (P value 0.16). It was able to correctly localize the site of otosclerotic focus in 85% cases (P value <0.01). Thus, an estimate of the thickness of the footplate likely to be encountered and thus the amount of drilling likely to be required to create a fenestra; and the likely site of maximum thickness could be made pre-operatively. This study also established the value of multislice CT on the acquisition of such data. This method obviates the requirement of difficult patient positioning, reduces scanning time; while greatly improving the sensitivity of the scanning.

Interventional sialendoscopy for parotid ductal calculi: our preliminary experience

With this article we present our initial experience with interventional sialendoscopy of the parotid duct for the parotid calculi. We carried out a prospective study of patients of parotid calculi in a tertiary referral centre. Diagnostic and interventional sialendoscopy was performed in five cases of parotid calculi. The outcome was classified on the basis of clearance of the lumen of the duct and resolution of symptoms. Diagnostic sialendoscopy was able to diagnose the calculus in all cases. Interventional sialendoscopy was done under general anesthesia in all cases and calculus was successfully removed. The average size of sialolith was 8.2 mm. No complications occurred in any of the cases. Check sialendoscopy was done in all cases after a minimum follow up of 6 months, which showed the duct lumen to be free of stone with no stricture of the duct. Sialendoscopy is an optimal technique for removal of intraductal parotid calculi and avoids removal of the gland. In our series there was no associated morbidity and complication.

Carcinoid tumor of the kidney: An unusual renal tumor

Carcinoid tumors are low-grade malignant tumors that arise from neuroendocrine cells. Primary renal carcinoid is extremely rare. We present a case of 57-year-old male with primary renal carcinoid tumor. Presently, the patient is on regular follow up and is doing well.

Isolated laryngeal lymphangioma: a rarity

Lymphangiomas are uncommon congenital lesions of the lymphatic system, most often located in the head and neck. Most of these lesions manifest in children less than 2 years of age. Involvement of the larynx in isolation is rare and only a few cases have been reported so far. We report the case of a thirteen-year-old girl who presented with a swelling in the supraglottis. Excision of the mass was done after tracheotomy. Histopathological diagnosis was lymphangioma of the larynx. After a follow up of 15 months the patient is free of recurrence with all functions of larynx being normal.

Bleomycin sclerotherapy in a rare case of adult-onset cervical lymphangioma

Cervical lymphangioma in adults is a rare, benign tumor. Traditionally, the most accepted treatment has been surgical excision. However, when lymphangioma infiltrates vital neurovascular structures, excision is difficult and recurrence rates are high. The most common alternate treatment is intralesional injection of sclerosing agents, which has resulted in good outcomes in children. However, until now, no report of such treatment in adults has been published. We describe the case of a 60-year-old woman who presented with two lymphangiomas in the cervical area-one in the upper cervical area just below the angle of the mandible and the other in the submental area. She was treated with an intralesional injection of 1 mg/kg of bleomycin at both sites. Fifteen days later, the submental swelling had remitted completely and the other swelling had been reduced by 50%; 2 weeks later, a second injection was administered to the remaining swelling. At 6 months of follow-up, both lymphangiomas were in complete remission.

Extranasopharyngeal Angiofibroma from the Nasal Septum: A Case Report and a Minireview

Extranasopharyngeal angiofibromas are rare tumors with only 65 cases being reported in the world literature. The most common sites involved are maxillary sinus, ethmoid sinus, sphenoid sinus, nasal septum, middle turbinate, inferior turbinate, cheek, conjunctiva, pterygomaxillary fissure, infratemporal fossa and laryngotracheal tree. We report on a case of 18 years old male patient of extranasopharyngeal angiofibroma of nasal septum.