Clinical Profile and Treatment Outcomes of Patients with Malaria Complicated by Acute Kidney Injury

As Odisha is an endemic region for malaria with many acute kidney injury (AKI) cases, this study evaluated the clinical profile and treatment outcomes of patients with malaria complicated by AKI. This prospective observational study was conducted between December 2015 and September 2017. Detailed histories and clinical examinations were recorded. On admission, tests for routine hematology, plasma glucose, liver function, renal function, serum electrolytes, thick smears, thin smears, and malarial parasites were performed. Of the 958 AKI malarial patients admitted, 202 (82.6 % males) were included in the study, with a mean age of 38.37 years. In total, 86.14%, 3.46%, and 10.39% of patients had Plasmodium falciparum, Plasmodium vivax, and mixed malaria, respectively. Headache and decreased urination (83.66% each) were the most common symptoms after fever (100%). Anuria and oliguria were reported in 5.95% and 67.82% of patients, respectively, whereas 26.23% reported a urine output of >400 mL/24 h. All patients had raised serum creatinine and urea levels, and >60% had anemia, proteinuria, and/or hyponatremia. Multiple organ dysfunction syndrome was observed in 62.87% of patients. Acute tubular necrosis was seen in 60% of renal biopsy specimens (n = 15). Of the 75.75% of patients requiring dialysis, 82.12% and 17.88% of patients required hemodialysis and peritoneal dialysis, respectively, during which 11 patients died. AKI, a serious complication of P. falciparum or P. vivax malaria, is a life-threatening condition. Fever, anemia, oligo/anuria, hepatic involvement, cerebral malaria, high serum creatinine and urea, and disseminated intravascular coagulation were the main predictors of mortality in our study.

Video-assisted anal fistula treatment: a high volume unit initial experience

Introduction Perianal fistulas are a common problem. Video-assisted anal fistula treatment is a new technique for the management of this difficult condition. We describe our initial experience with the technique to facilitate the treatment of established perianal fistulas. Methods We reviewed a prospectively maintained database relating to consecutive patients undergoing video-assisted anal fistula treatment in a single unit. Results Seventy-eight consecutive patients had their perianal fistulas treated with video-assistance from November 2014 to June 2016. Complete follow-up data were available in 74 patients, with median follow-up of 14 months (interquartile range 7-19 months). There were no complications and all patients were treated as day cases. Most patients had recurrent disease, with 57 (77%) having had previous fistula surgery. At follow-up, 60 (81%) patients reported themselves 'cured' (asymptomatic) including 5 patients with Crohn's disease and one who had undergone 10 previous surgical procedures. Logistical stepwise regression did not demonstrate any statistically significant factors that may have been considered to affect outcome (age, gender, diabetes, previous I&D, Crohn's disease, smoking, type of fistula). Conclusions Our data have shown that video-assisted anal fistula treatment is safe and effective in the management of perianal fistulas in our patients and this suggests it may be applied to all patients regardless of comorbidity, underlying pathology or type of fistula.

Tannery effluent effect on the haematological parameters of freshwater fish, Channa punctatus

The present investigation was undertaken to evaluate the tannery effluent toxicity stress symptoms in fish blood during a long term of exposure period. The effect of tannery effluent on various haematological parameters were evaluated exposing fresh water fish, C. punctatus to different concentration i.e., [Control, 5% Tannery effluent (TE), 10% TE and 20% TE] of tannery effluent. Exposed of fish to tannery effluent showed a significant decrease in the haemoglobin (Hb) content (9.16± 0.08), red blood cells (3.32 ± 0.12), packed cell volume (34.66 ± 0.33) and mean corpuscular haemoglobin (MCH) values, whereas significant increase in the white blood cells (WBC), erythro-cyte sedimentation rate (ESR) and clotting time was recorded with increase in exposure periods as compared to control respectively. Hb, RBC and MCHC values showed fluctuating results. The haematological parameters were decreases from 15th days of exposure periods to 45th days of exposure period. The decrease in haematological parameters clearly indicates that the exposed fishes have become anemic due to tannery effluent exposure.

Endoscopic pilonidal abscess treatment: a novel approach for the treatment of pilonidal abscess

INTRODUCTION Pilonidal abscess is a common surgical emergency. Conventional treatment with incision and drainage is associated with significant postoperative morbidity. We report our initial experience of using minimally invasive endoscopic technique for the treatment of pilonidal abscesses, referred to as endoscopic pilonidal abscess treatment (EPAT). MATERIALS AND METHODS A prospective database of all patients undergoing EPAT between January 2015 and March 2016 at Whiston Hospital was maintained. Data regarding patient demographics, peroperative variables and postoperative follow-up were recorded. RESULTS Nineteen patients were included, male to female ratio was 53 : 47 and median age of the cohort was 24 years (interquartile range 22-25 years). EPAT was the primary procedure for 10 patients and 9 had EPAT for recurrent pilonidal abscesses. There were no readmissions and none needed further surgery within 6 weeks of having the procedure. In all patients, complete wound healing was achieved within 6 weeks; all reported minimal postoperative pain (median postoperative visual analogue scale score 1) and immediate return to the activities of daily life. Four of the nineteen patients (21%) required definitive intervention for pilonidal disease in the follow-up period. CONCLUSIONS EPAT is a novel, minimally invasive technique for the treatment of acute pilonidal abscesses. It is safe, associated with reduced postoperative morbidity, recurrence rate and quick wound healing. Initial encouraging results require further investigations on a larger group of patients in a multicentre setting.

Activity ratios of (234)U/(238)U and (226)Ra/(228)Ra for transport mechanisms of elevated uranium in alluvial aquifers of groundwater in south-western (SW) Punjab, India

The concentrations of total dissolved uranium (U), its isotopic composition ((234)U, (235)U, (238)U) and two long lived Ra isotopes ((226)Ra and (228)Ra) in alluvial aquifers of groundwater were determined to investigate the groundwater flow pattern in the south-western (SW) Punjab, India. Particular attention was given to the spatial variability of activity ratios (ARs) of (234)U/(238)U and (226)Ra/(228)Ra to predict the possible sources and supply process of U into the water from the solid phase. The measured groundwater (234)U/(238)U ARs were ∼1 or >1 in the shallow zone (depth < 30 m) with high U concentration and <1 in the deeper zone (depth > 30 m) with relatively low U concentration. The simultaneous elevated U concentration and (234)U/(238)U ARs in waters were possibly due to differences in imprints of rock-water interactions under hydrologic conditions. However, (234)U/(238)U ARs < 1 clearly indicate the lack of recharge from surface water to groundwater leading to (234)U deficit in groundwater. This deficit might be also attributed to alpha recoil processes under strong dissolution. Overall, the decreasing pattern of (234)U/(238)U ARs observed from SE to SW or NW ward clearly indicates a groundwater flow paths from SE to SW/NW. Similarly, (226)Ra/(238)U ARs < 1 for all water samples reflect that the precursor (238)U is fairly mobile relative to (226)Ra. This might be due to unusually high amount of (238)U in groundwaters and subsequently the different geochemistry of the two isotopes. On the other hand, (226)Ra/(228)Ra ARs in groundwaters varied widely and observed about 50-300 times higher than (238)U/(232)Th ARs in granitic rocks or soils. Such elevation in ARs might be attributed to different dissolution properties of their parents during water-rock interactions or lattice damage during decay or local enrichments of uranium in the aquifers.

Classification of and cytoreductive surgery for low-grade appendiceal mucinous neoplasms

BACKGROUND

Low-grade appendiceal mucinous neoplasm (LAMN) is a precursor lesion for pseudomyxoma peritonei (PMP), which, if treated suboptimally, may later disseminate throughout the abdominal cavity. The role of cytoreductive surgery for these relatively early lesions is unclear.

METHODS

Clinicopathological details and treatment outcomes of patients with a LAMN and disease limited to the appendix or immediate periappendiceal tissues, referred to a national treatment centre between 2002 and 2009, were evaluated prospectively.

RESULTS

Of 379 patients with a diagnosis of PMP, 43 (median age 49 years) had LAMNs localized to the appendix and periappendiceal tissue. Thirty-two patients initially presented with symptoms of acute appendicitis or right iliac fossa pain. Two distinct lesions were identified: type I (disease confined to the appendiceal lumen) and type II (mucin and/or neoplastic epithelium in the appendiceal submucosa, wall and/or periappendiceal tissue, with or without perforation). Type I lesions were managed by a watch-and-wait surveillance policy with serial measurement of tumour markers and computed tomography in 14 of 16 patients. Seventeen of 27 patients with type II lesions underwent risk-reducing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with low morbidity. After a median follow-up of 40 months, there was no disease progression in either treatment pathway.

CONCLUSION

This study identified two LAMN subtypes. Type II lesions have pathological features of increased risk for dissemination and should be considered for risk-reducing cytoreductive surgery.

Treatments and outcomes of peritoneal surface tumors through a centralized national service (United kingdom)

PURPOSE

Treatment of peritoneal surface malignancies with combined cytoreductive surgery and heated intraperitoneal chemotherapy may improve oncologic outcome. To better define treatment pathways, five-year results in patients referred to one of two centralized national treatment centers in the United Kingdom were analyzed.

METHODS

A prospective database of patients referred to the Manchester Peritoneal Tumor Service, established in 2002, was analyzed. Outcomes were evaluated using Kaplan-Meier life tables and Cox models.

RESULTS

Two hundred seventy-eight patients (median age, 56.9 (range, 16-86) years) were considered by a dedicated multidisciplinary team and tracked on seven clinical pathways. Among the 118 surgically treated, the most common diagnosis was pseudomyxoma peritonei (101 patients, 86%). Major complications occurred in 11 patients (9%); there was no 30-day mortality. Where complete cytoreduction was achieved, three-year and five-year tumor-related survival rates were 94% and 86%, respectively. In the Cox model, incompleteness of cytoreduction (P = 0.001) and high-grade tumor (P < 0.0001) were independent prognosticators of poor outcome.

CONCLUSION

The establishment of a national treatment center has allowed refinement of techniques to achieve internationally recognized results. Having achieved low levels of morbidity and mortality in the treatment of mainly pseudomyxoma peritonei of appendiceal origin, the technique of cytoreductive surgery and heated intraperitoneal chemotherapy may be considered for peritoneal carcinomatosis of colorectal origin.

A phase II study evaluating the use of concurrent mitomycin C and capecitabine in patients with advanced unresectable pseudomyxoma peritonei

Pseudomyxoma peritonei (PMP) is a rare neoplastic process characterised by progressive intra-abdominal dissemination of mucinous tumour, and generally considered resistant to systemic chemotherapy. A phase II study in patients with advanced unresectable PMP was undertaken to evaluate the combination of systemic concurrent mitomycin C (7 mg m(-2) i.v. on day 1) and capecitabine (1250 mg m(-2) b.d. on days 1-14) in a 3-weekly cycle (MCap). Response was determined by semiquantitative assessment of disease volume on serial computed tomographic (CT) scans and serum tumour marker (CEA, CA125, CA19-9) changes at 12 weeks. Between 2003 and 2006, 40 patients were recruited through a national centre for the treatment of peritoneal surface tumours. At baseline, 23 patients had progressive disease and 17 had stable disease. Of 39 assessable patients, 15 (38%, 95% confidence intervals (CIs): 25, 54%) benefited from chemotherapy in the form of either reductions in mucinous deposition or stabilisation of progressive pretreatment disease determined on CT scan. Notably, two patients, originally considered unresectable, following MCap and re-staging underwent potentially curative cytoreductive surgery. Grade 3/4 toxicity rates were low (6%, 95% CIs: 4, 9%). Twenty out of 29 assessed patients (69%, 95% CIs: 51, 83%) felt that their Global Health Status improved during chemotherapy. This is the first trial to demonstrate an apparent benefit of systemic chemotherapy in patients with advanced unresectable PMP.

Magnetotransport and structural properties of nanocrystalline FeAgAl thin films

Structural and magnetotransport properties of metallic Fe(x)Ag(y)Al(z) nanogranular thin films were studied. These films with several compositions were prepared by dc magnetron sputtering. X-ray diffraction (XRD) measurements carried out on the samples show only Ag(111) peaks. The d-spacings determined from the Ag(111) peaks are smaller than the standard value for bulk Ag indicating a partial substitution of Fe and Al atoms in Ag matrix. Transmission electron diffraction (TEM) patterns show a number of Ag rings. Both XRD and TEM studies did not reveal any diffraction peaks due to Fe or Al. The average particle size determined from the TEM micrograph is 5.9 nm. This value is in good agreement with the grain size determined from the XRD patterns for the Al substituted samples. The MR was found to increase for smaller Al concentration and it decreases with further increase in Al content. In the samples investigated magnetoresistance ratio reaches a maximum value of about 4.5% for the Fe27Ag63Al10 film.

Structure, morphology and magnetization of Fe-Pd thin films

Several Fe(100-x)Pd(x0 thin films with x = 24-35 have been investigated to understand their structural, morphological and magnetic properties. The lattice spacing d111 obtained from the X-ray diffraction peaks shows a gradual increase with increasing x and this behaviour is attributed to the increasing substitution of Pd with larger atomic radius. While the atomic force microscopy images on selected samples showed surface roughness in the range 2-4 nm the scanning electron microscopy image of a Fe71Pd29 sample showed slightly dark and bright regions due to the large undulations of the surface of the films. We presume that these undulations are due to shape memory twin variants. In-plane magnetization measurements were carried out on selected films in applied magnetic fields up to 30 kOe. For three samples, the saturation magnetization is about 1300 emu/cc whereas for the Fe71Pd29 film it is about 950 emu/cc. The remanence ratio of the films is approximately in the range 50-70%. The behaviour of coercivity of our samples is believed to be due to grain size effect that generally plays a predominant role in thin films with nanometer size grains.

Nanogranular Fe-Cu-Ag thin films: structure, microstructure and giant magnetoresistance

Fe(x)Cu(y)Ag(z) granular thin films with several compositions were prepared by dc magnetron sputtering. These films consist of small Fe magnetic particles embedded in a nonmagnetic CuAg matrix. Structure, microstructure, morphology and magnetotransport properties were studied. The compositions of these samples were determined by energy-dispersive X-ray analysis. X-ray diffraction results showed strong Ag(111) peaks and broad Cu(111) peaks in all the samples. The variation of the (111) lattice spacings indicates a partial intermixing of Fe, Cu and Ag atoms. Microstructural studies using transmission electron microscopy (TEM) on a selected sample showed only Ag reflections and no reflection from Cu and Fe. Both XRD and TEM studies did not reveal any diffraction peak due to Fe and Cu for this sample. The fitting of the experimental grain size data obtained from TEM micrograph to the lognormal distribution function has allowed an estimation of the average grain diameter of 3.7 nm. The surface image of the Fe22Ag78 film observed using a scanning electron microscope showed the presence of droplet like Ag particles on the film surface. The Cu substitution results in smooth films without any Ag particles on the surface. Surface morphology by atomic force microscopy shows that the Fe39Cu13Ag48 film has a surface roughness of 0.75 nm. Finally, we have obtained a maximum giant magnetoresistance ratio of 3.2% in these films measured at 300 K for an in-plane magnetic field of 20 kOe.

Free radical scavenging, anti-glycation and tyrosinase inhibition properties of a polysaccharide fraction isolated from the rind from Punica granatum

The present investigation deals with the isolation of a polysaccharide fraction from Pomegranate (PFP), which was found to inhibit 1,1-diphenyl-2-picrylhydrazyl (DPPH) and 2,2'-Azinobis[3-ethylbenzothiazoline-6-sulfonate] ABTS(+) radical activities by 69% and 88%, respectively with 4 microg/ml concentration. The activity of PFP for free radical scavenging was also evaluated by electron spin resonance (ESR) Spectrophotometer and DPPH dot blot test. Anti-glycation ability of PFP was tested using BSA, which inhibited the formation of advanced glycation end-products (AGEs) by 28% and also inhibited the formation of fructosamine in the BSA/Glucose system. The inhibition of mushroom tyrosinase by 43% at 10 microg/ml concentration of PFP strongly suggested its efficacy as a possible skin whitener.

Comparative profiles of alpha-amylase production in conventional tray reactor and GROWTEK bioreactor

GROWTEK bioreactor was used as modified solid-state fermentor to circumvent many of the problems associated with the conventional tray reactors for solid-state fermentation (SSF). Aspergillus oryzae IFO-30103 produced very high levels of alpha-amylase by modified solid-state fermentation (mSSF) compared to SSF carried out in enamel coated metallic trays utilizing wheat bran as substrate. High alpha-amylase yield of 15,833 U g(-1) dry solid in mSSF were obtained when the fungus were cultivated at an initial pH of 6.0 at 32 degrees C for 54 h whereas alpha-amylase production in SSF reached its maxima (12,899 U g(-1) dry solid ) at 30 degrees C after 66 h of incubation. With the supplementation of 1% NaNO(3), the maximum activity obtained was 19,665 U g(-1) dry solid (24% higher than control) in mSSF, whereas, in SSF maximum activity was 15,480 U g(-1) dry solid in presence of 0.1% Triton X-100 (20% higher than the control).

Structure, microstructure, and giant magnetoresistance in nanogranular FeAgNi thin films

Structural, microstructural, and magnetoresistive properties of metallic Fe(x)Ag(y)Ni(z) granular thin films were studied. These films with several compositions were prepared by dc magnetron sputtering. X-ray diffraction (XRD) measurements carried out on the samples show only Ag(111) peaks. The d-spacings determined from the Ag(111) peaks are smaller than the standard value for bulk Ag indicating a partial intermixing of Fe and Ni atoms in Ag. The diffraction pattern obtained using Transmission electron microscope (TEM) shows a number of Ag rings. Both XRD and TEM studies did not reveal any diffraction peaks due to Fe or Ni. The average particle size determined from the TEM micrograph is 5.5 nm whereas that determined from the XRD patterns is always higher. The magnetoresistance ratio for all the samples lies in the range 3 to 4.3%, except for a sample.

Right-sided Bochdalek hernia obstructing in an adult: case report and review of the literature

Bochdalek hernias on the right side of the diaphragm are very rarely diagnosed in adults. We review a case of a 35-year-old female who presented acutely with intestinal obstruction. Plain and cross-sectional imaging identified a large right-sided Bochdalek hernia, containing colon, causing a mechanical obstruction and, surprisingly, concurrent appendicitis. The patient underwent an emergency laparotomy. At surgery the colon was reduced and was viable. The diaphragmatic defect was repaired using non-absorbable sutures and an appendicectomy was then performed for purulent appendicitis. She made an uneventful recovery and remains well at 9-month follow-up. We discuss what we believe to be the first reported case of an obstructed right-sided Bochdalek's hernia associated with appendicitis in an adult and review the published literature on this rare condition.