Left-sided acute appendicitis in a patient with situs inversus totalis: A case report and a comprehensive review

AA is a frequent surgical condition that demands urgent intervention. It accounts for approximately 6% of all emergency department visits. Situs inversus is a rare condition in which the orientation of asymmetric organs is a mirror image of normal anatomy. It can be partial (involving either the abdominal or thoracic cavities) or complete (situs inversus totalis: transposition of both abdominal and thoracic organs). SIT is very rare, with an incidence of 1 per 5000 to 10,000 live births. It is inherited in an autosomal recessive pattern with incomplete penetrance. LSAA is very rare and can happen in association with other congenital abnormalities such as situs inversus, midgut malrotation (MM), or a usually long right-sided appendix projecting into the left lower quadrant. SIT is responsible for greater than 67% of left-sided appendicitis cases. Due to atypical clinical presentation, the diagnosis of AA can be difficult and often delayed. Hence, a complete medical history, physical examination, laboratory tests, and imaging tools are necessary to reach a correct diagnosis in a timely manner and prevent complications like abscesses, perforations, and peritonitis. We report a case of a 50-year-old male with symptoms of left lower abdominal pain along with fever, nausea, vomiting, and loose stools that were later diagnosed as LSAA in the setting of SIT.

Role of radiological corroboration in a locally aggressive inverted papilloma: a case report

Introduction and importance

Sinonasal inverted papilloma is a rare benign tumor of the nasal cavity and paranasal sinuses (PNS). Radiological evaluation is the key to management.

Case presentation

A 46-year-old male presented with complaints of right nasal congestion and occasional bleeding for 4 months. During anterior rhinoscopy, a pinkish fleshy mass occupying the right nasal cavity was seen. X-ray and computed tomography (CT) PNS view showed opacification in the right nasal cavity and maxillary sinus. An MRI of the nose and PNS revealed a peculiar convoluted striated/cerebriform pattern. Histopathology report described the features of an inverted papilloma. The patient underwent endoscopic removal of the mass under general anesthesia. Surgical resection of the tumor was performed along with adjacent normal mucosal tissues. The patient recovered well and was followed-up for recurrence.

Clinical discussion

Sinonasal inverted papilloma is commonly found in males in their fifth to sixth decade of life. A CT scan is the initial modality of choice to evaluate the extent of the disease. MRI is superior to CT in distinguishing tumors from other conditions as well as to evaluate soft tissue extensions. Involvement of the frontal sinus is a risk factor for recurrence. The first option for treating an inverted papilloma is complete surgical removal with the adjacent uninvolved mucosa.

Conclusion

In a biopsy-proven case, radiological assessments like CT and MRI play a pivotal role in studying the typical morphology, delineating the extension, and detecting recurrence.

Immunoglobulin A nephropathy in remission: a case report

Immunoglobulin A nephropathy is the most prevalent form of primary glomerulonephritis.

Case presentation

A 33-year-old military male presented with complaints of fever, headache, myalgia, chills, and haematuria for 10 years. His lab results showed elevated serum creatinine levels and proteinuria. A renal biopsy was done which was consistent with a diagnosis of immunoglobulin A nephropathy. He was managed with antihypertensive, including angiotensin-converting enzyme inhibitors, steroids and immunosuppressants, and Omega-3 fatty acids. There was remission of the symptoms and the patient's serum creatinine and sonogram findings returned to baseline.

Conclusion

Routine follow-up along with the appropriate use of medications can limit disease complications and progression.

Robustness of the EWMA Sampling Plan to Non-Normality

The effect of non-normality on the OC function of the sampling plan under EWMA is studied by deriving the OC function for a non-normal population represented by the first four terms of an Edgeworth series.

Biochemical Defense Response: Characterizing the Plasticity of Source and Sink in Spring Wheat under Terminal Heat Stress

Wheat is highly prone to terminal heat stress (HS) under late-sown conditions. Delayed- sowing is one of the preferred methods to screen the genotypes for thermotolerance under open field conditions. We investigated the effect of terminal HS on the thermotolerance of four popular genotypes of wheat i.e. WR544, HD2967, HD2932, and HD2285 under field condition. We observed significant variations in the biochemical parameters like protein content, antioxidant activity, proline and total reducing sugar content in leaf, stem, and spike under normal (26 ± 2°C) and terminal HS (36 ± 2°C) conditions. Maximum protein, sugars and proline was observed in HD2967, as compared to other cultivars under terminal HS. Wheat cv. HD2967 showed more adaptability to the terminal HS. Differential protein-profiling in leaves, stem and spike of HD2967 under normal (26 ± 2°C) and terminal HS (36 ± 2°C) showed expression of some unique protein spots. MALDI-TOF/MS analysis showed the DEPs as RuBisCO (Rub), RuBisCO activase (Rca), oxygen evolving enhancer protein (OEEP), hypothetical proteins, etc. Expression analysis of genes associated with photosynthesis (Rub and Rca) and starch biosynthesis pathway (AGPase, SSS and SBE) showed significant variations in the expression under terminal HS. HD2967 showed better performance, as compared to other cultivars under terminal HS. SSS activity observed in HD2967 showed more stability under terminal HS, as compared with other cultivars. Triggering of different biochemical parameters in response to terminal HS was observed to modulate the plasticity of carbon assimilatory pathway. The identified DEPs will enrich the proteomic resources of wheat and will provide a potential biochemical marker for screening wheat germplasm for thermotolerance. The model hypothesized will help the researchers to work in a more focused way to develop terminal heat tolerant wheat without compromising with the quality and quantity of grains.

Gene expression analysis of Solanum lycopersicum and Solanum habrochaites under drought conditions

Drought is one of the limiting environmental factors that affect crop production worldwide. Understanding the molecular mechanism of drought stress is the key to developing drought tolerant crop. In this experiment we performed expression profiling of tomato plants under water deficit conditions using microarray technology. The data set we generated (available in the NCBI/GEO database under GSE22304) has been analyzed to identify genes that are involved in the regulation of tomato's responses to drought.

Steady-state carbamazepine pharmacokinetics following oral and stable-labeled intravenous administration in epilepsy patients: effects of race and sex

Carbamazepine is a widely prescribed antiepileptic drug. Owing to the lack of an intravenous formulation, its absolute bioavailability, absolute clearance, and half-life in patients at steady state have not been determined. We developed an intravenous, stable-labeled (SL) formulation in order to characterize carbamazepine pharmacokinetics in patients. Ninety-two patients received a 100-mg infusion of SL-carbamazepine as part of their morning dose. Blood samples were collected up to 96 hours after drug administration. Plasma drug concentrations were measured with liquid chromatography-mass spectrometry, and concentration-time data were analyzed using a noncompartmental approach. Absolute clearance (l/hr/kg) was significantly lower in men (0.039 ± 0.017) than in women (0.049 ± 0.018; P = 0.007) and in African Americans (0.039 ± 0.017) when compared with Caucasians (0.048 ± 0.018; P = 0.019). Half-life was significantly longer in men than in women as well as in African Americans as compared with Caucasians. The absolute bioavailability was 0.78. Sex and racial differences in clearance may contribute to variable dosing requirements and clinical response.

Investigation of Sidewall Recombination in GaN Using a Quantum Well Probe

In this study, we use a quantum well (QW) probe structure to explore the size dependent effects of sidewall recombination in GaN. Mesas 0.8-7 μm in width with pitches of 4 μm, 8 μm, and 12 μm were etched into the QW probe structure, exposing the QW at the sidewalls. Several etch conditions were investigated. Room temperature photoluminescence (PL) measurements, using a He-Cd laser as an excitation source and laser spot size of approximately 230 μm, were taken before and after the mesas were etched. The effects of sidewall formation were quantified by comparing the maximum PL intensity of the QW before and after etch. Higher remaining PL intensity was observed for etch conditions which used both Ar ions and Cl2 gas instead of only Ar ions. The fraction of remaining PL decreased with decreasing mesa width, however the remaining PL intensity was relatively large even for small features. The preliminary data suggested that GaN is relatively insensitive to sidewall damage.

Mapping soil textural fractions across a large watershed in north-east Florida

Assessment of regional scale soil spatial variation and mapping their distribution is constrained by sparse data which are collected using field surveys that are labor intensive and cost prohibitive. We explored geostatistical (ordinary kriging-OK), regression (Regression Tree-RT), and hybrid methods (RT plus residual Sequential Gaussian Simulation-SGS) to map soil textural fractions across the Santa Fe River Watershed (3585 km(2)) in north-east Florida. Soil samples collected from four depths (L1: 0-30 cm, L2: 30-60 cm, L3: 60-120 cm, and L4: 120-180 cm) at 141 locations were analyzed for soil textural fractions (sand, silt and clay contents), and combined with textural data (15 profiles) assembled under the Florida Soil Characterization program. Textural fractions in L1 and L2 were autocorrelated, and spatially mapped across the watershed. OK performance was poor, which may be attributed to the sparse sampling. RT model structure varied among textural fractions, and the model explained variations ranged from 25% for L1 silt to 61% for L2 clay content. Regression residuals were simulated using SGS, and the average of simulated residuals were used to approximate regression residual distribution map, which were added to regression trend maps. Independent validation of the prediction maps showed that regression models performed slightly better than OK, and regression combined with average of simulated regression residuals improved predictions beyond the regression model. Sand content >90% in both 0-30 and 30-60 cm covered 80.6% of the watershed area.

A study on osmotic resistance of RBC and ESR in stored blood

The present work was undertaken to study the changes in osmotic resistance of stored blood, used for blood transfusion. Blood samples of 50 cases from Orissa Red Cross Blood Bank, Cuttack, were studied. The blood was collected in acid citrate dextrose solution and stored at 4 degrees C. Storage was done under usual condition followed in blood banks. Osmotic fragility was determined at 3 days interval up to 15 days. In each case ESR was determined and in 20 cases plasma fibrinogen level was determined. In this study there was gradual increase in fragility which was maximum on 9th day and then slowly declined, which was statistically significant. ESR decreased markedly after 6th day, which was also statistically significant.

Simultaneous analysis of flunixin, naproxen, ethacrynic acid, indomethacin, phenylbutazone, mefenamic acid and thiosalicylic acid in plasma and urine by high-performance liquid chromatography and gas chromatography-mass spectrometry

Simple and reproducible high-performance liquid chromatographic (HPLC) and gas chromatographic-mass spectrometric (GC-MS) methods have been developed for the simultaneous analysis of several acidic drugs in horse plasma and urine. Although the capillary GC-MS column provided better separation of the drugs than the reversed-phase C8 (3 microns, 75 mm) HPLC column, the total analysis time with HPLC was shorter than the total analysis time with GC-MS. The HPLC system equipped with a diode-array detector provided simultaneous screening (limit of detection 100-500 ng/ml) and confirmation (limit 1.0 micrograms/ml) of the drugs. The HPLC system equipped with fixed-wavelength ultraviolet and fluorescence detectors provided a relatively sensitive screening [limit of detection 50-150 ng/ml for ultraviolet and 10 ng/ml for fluorescence (naproxen only) detectors] of the drugs. However, the positive samples had to be confirmed by using either the diode-array detector or the GC-MS system. The GC-MS system provided simultaneous screening and confirmation of the drugs at very low concentrations (20-50 ng/ml).

Evaluation of high performance liquid chromatography (HPLC), enzyme linked immunosorbent assay (ELISA) and particle concentration fluorescence immunoassay (PCFIA) methods for the screening, quantitation and pharmacokinetic study of furosemide in horses

Equine plasma and urine samples were analyzed by using a high-performance liquid chromatography (HPLC), enzyme-linked immunosorbent assay (ELISA) and particle concentration fluorescence assay (PCFIA). Although ELISA and PCFIA were rapid, simple and sensitive for the screening of furosemide, they did not give reproducible quantitative results. The HPLC method, which required relatively longer analysis time, provided simple and reproducible quantitative analysis of furosemide in plasma and urine. The performance of the three methods was compared for the quantitation of furosemide in plasma obtained from thoroughbred mares dosed intravenously with furosemide (500 micrograms/kg (n = 7) and 1.0 mg/kg (n = 5)). Although the plasma furosemide profiles determined by ELISA, PCFIA and HPLC were similar, ELISA and PCFIA methods exhibited considerable variation in values. At high furosemide concentrations, the PCFIA method gave better quantitative values than ELISA. However, at trace furosemide concentrations the PCFIA method gave false positive values which were not confirmed by HPLC or ELISA. The pharmacokinetic values obtained from the HPLC data and the pharmacokinetic values obtained previously from the gas chromatographic data were comparable. The data obtained by ELISA and PCFIA were not suitable for the pharmacokinetic calculations.

Screening of steroids in horse urine and plasma by using electron impact and chemical ionization gas chromatography-mass spectrometry

Gas chromatography with chemical ionization mass spectrometry and selected-ion monitoring provided a sensitive method for the screening and confirmation of steroids in horse urine and plasma. Chemical ionization mass spectrometry was more sensitive than the electron impact ionization mass spectrometry for most of the steroids except for testosterone, prednisone-metabolite-2 and prednisolone-metabolite-2. The chromatographic conditions used in this study provided clean separation of different natural and synthetic steroids. Approximately 75-85% of the steroids added to plasma and approximately 65-70% of the steroids added to urine were recovered by the extraction procedure used in this study.

Screening and confirmation of drugs in horse urine by using a simple column extraction procedure

A simple and reproducible column (Clean Screen-DAU, copolymeric bonded-phase silica column) extraction procedure has been described for the screening and confirmation of drugs in horse urine. The recovery of drugs by the column extraction was better than or comparable to the recovery by the liquid-liquid extraction, which is commonly used in the equine analytical laboratories. The column extraction provided broad coverage of drugs, separated extracts into three fractions (acidic/neutral, steroids, basic), produced a cleaner extract, and eliminated the need for special liquid-liquid extraction procedures for different drugs. The column extract was cleaner and did not contain impurities, whereas, the liquid-liquid extract was relatively impure and the extract required further thin-layer chromatographic cleanup. The column extraction procedure was used to confirm the presence of several potent drugs, such as fentanyl, etorphine, and mazindol.

Analysis of detomidine in horse blood, plasma and urine samples utilizing a sensitive gas chromatography-mass spectrometry method

Chemical ionization- and electron impact ionization-selective ion monitoring provided a simple and sensitive method for measuring detomidine (Domosedan), a potent sedative-analgesic drug for horses and cattle. Chemical ionization was at least 10 times more sensitive than electron impact ionization. By using propranolol as an internal standard, we found that the recovery of detomidine from the extraction procedure used in this study was greater than 75% for plasma, whole blood, or urine samples. Approximately 68% of detomidine was bound to plasma protein and 53% was bound to red blood cells.

The fine structure of the sieve tubes of Salix caprea (L.) and its relation to the electroosmotic theory

The sieve plate pores of Salix caprea in preparations fixed in glutaraldehyde are normally found to be occupied by slime fibrils showing periodic banding such as occur in a number of other species. Arguments are put forward to suggest that the occurence of fibrils in this position is natural and not an artefact of preparation. The sieve tubes further possess prominent and persistent nucleoli showing a radiating structure of tubules. The endoplasmic reticulum often occurs in parietal stacks reminiscent of other species.This evidence is discussed in relation to the electroosmotic theory of translocation.