Impact of COVID-19 on heart failure hospitalization and outcome in India - A cardiological society of India study (CSI-HF in COVID 19 times study - "The COVID C-HF study")

OBJECTIVES

The presentation and outcomes of acute decompensated heart failure (ADHF) during COVID times (June 2020 to Dec 2020) were compared with the historical control during the same period in 2019.

METHODS

Data of 4806 consecutive patients of acute HF admitted in 22 centres in the country were collected during this period. The admission patterns, aetiology, outcomes, prescription of guideline-directed medical therapy (GDMT) and interventions were analysed in this retrospective study.

RESULTS

Admissions for acute heart failure during the pandemic period in 2020 decreased by 20% compared to the corresponding six-month period in 2019, with numbers dropping from 2675 to 2131. However, no difference in the epidemiology was seen. The mean age of presentation in 2019 was 61.75 (±13.7) years, and 59.97 (±14.6) years in 2020. There was a significant decrease in the mean age of presentation (p = 0.001). Also. the proportion of male patients decreased significantly from 68.67% to 65.84% (p = 0.037). The in-hospital mortality for acute heart failure did not differ significantly between 2019 and 2020 (4.19% and 4.,97%) respectively (p = 0.19). The proportion of patients with HFrEF did not change in 2020 compared to 2019 (76.82% vs 75.74%, respectively). The average duration of hospital stay was 6.5 days.

CONCLUSION

The outcomes of ADHF patients admitted during the Covid pandemic did not differ significantly. The length of hospital stay remained the same. The study highlighted the sub-optimal use of GDMT, though slightly improving over the last few years.

COVID-19 infected ST-Elevation myocardial infarction in India (COSTA INDIA)

OBJECTIVE

To find out differences in the presentation, management and outcomes of COVID-19 infected STEMI patients compared to age and sex-matched non-infected STEMI patients treated during the same period.

METHODS

This was a retrospective multicentre observational registry in which we collected data of COVID-19 positive STEMI patients from selected tertiary care hospitals across India. For every COVID-19 positive STEMI patient, two age and sex-matched COVID-19 negative STEMI patients were enrolled as control. The primary endpoint was a composite of in-hospital mortality, re-infarction, heart failure, and stroke.

RESULTS

410 COVID-19 positive STEMI cases were compared with 799 COVID-19 negative STEMI cases. The composite of death/reinfarction/stroke/heart failure was significantly higher among the COVID-19 positive STEMI patients compared with COVID-19 negative STEMI cases (27.1% vs 20.7% p value = 0.01); though mortality rate did not differ significantly (8.0% vs 5.8% p value = 0.13). Significantly lower proportion of COVID-19 positive STEMI patients received reperfusion treatment and primary PCI (60.7% vs 71.1% p value=< 0.001 and 15.4% vs 23.4% p value = 0.001 respectively). Rate of systematic early PCI (pharmaco-invasive treatment) was significantly lower in the COVID-19 positive group compared with COVID-19 negative group. There was no difference in the prevalence of high thrombus burden (14.5% and 12.0% p value = 0.55 among COVID-19 positive and negative patients respectively) CONCLUSIONS: In this large registry of STEMI patients, we did not find significant excess in in-hospital mortality among COVID-19 co-infected patients compared with non-infected patients despite lower rate of primary PCI and reperfusion treatment, though composite of in-hospital mortality, re-infarction, stroke and heart failure was higher.

Disparity in coronary artery dimensions in diabetic and non-diabetic population undergoing quantitative coronary angiography in South India: a 2-year prospective analysis

Diabetic subjects have higher prevalence as well as increased risk for coronary artery disease than non-diabetic counterparts. The study was aimed to seek the disparity of vessel diameters among diabetic and non-diabetic patients undergoing quantitative coronary angiography (QCA). The objectives were to compare coronary artery measurements (CAM) between diabetic and non-diabetic patients and also to find the respective segment of coronary artery affected greatest among diabetics by QCA. A cross sectional study was conducted in four cities of India after procuring the sanction for the same from the ethical committee of the pre-selected hospitals of four states in India. Informed consents were obtained. Post CABG, post PCI patients and patient being diabetic for ≥5 years were also excluded from the study. Among total sample population, non-flow limiting coronaries were seen in 1100(27.5%) cases [167 in NFL diabetic and 933 in NFL non-diabetic group]. We had 2890 (72.2%) patients with diseased coronaries. Ten segments of the coronary arteries were taken for diameter measurements namely, LMCA, LAD (O, P), DIAG, LCx (O, P), OM, RCA (O, P), RAM. These coronary diameters were indexed to body surface area (BSA) (mean diameter mm/m2BSA). For all arterial segments both indexed and non-indexed measurements of diabetic patients with NFL coronaries had significantly (p<0.01) smaller arterial segments except for RCA-o. Reduced dimensions after post balloon dilatations of PCI, diffused lesions can result in increased chances for in-stent restenosis among diabetics leading to poor outcome following PCI.

Pulmonary Hypertension Registry of Kerala, India (PRO-KERALA): One-year outcomes

BACKGROUND

Short term outcomes of patients with pulmonary hypertension are not available from low and middle-income countries including India.

METHODS

We conducted a prospective study of 2003 patients with pulmonary hypertension, from 50 centres (PROKERALA) in Kerala, who were followed up for one year. Pulmonary hypertension (PH) was mainly diagnosed on the basis of Doppler echocardiography. The primary outcome was a composite end-point of all-cause death and hospital admission for heart failure. All cause hospitalisation events constituted the secondary outcome.

RESULTS

Mean age of study population was 56 ± 16 years. Group 1 and Group 2 PH categories constituted 21.2% and 59% of the study population, respectively. Nearly two-thirds (65%) of the study participants had functional class II symptoms. 31% of Group 1 PH patients were on specific vasodilator drugs.In total, 83 patients (4.1%) died during the one-year follow-up period. Further, 1235 re-hospitalisation events (61.7%) were reported. In the multivariate model, baseline NYHA class III/IV (OR 1.87, 95% C.I. 1.35-2.56), use of calcium channel blockers (OR 0.18, 95% C.I. 0.04-0.77), vasodilator therapy (OR 0.5, 95% C.I. 0.28-0.87) and antiplatelet agents (OR 1.80, 95% C.I. 1.29-2.51) were associated with primary composite outcome at one-year (p < 0.05).

CONCLUSION

In the PROKERALA registry, annual mortality rate was 4%. More than half of the patients reported re-hospitalisation events on follow up. Uptake of guideline directed therapies were suboptimal in the study population. Quality improvement programmes to improve guideline directed therapy may improve clinical outcomes of PH patients in India.

Pitfalls in comparison of coronary artery measurements of Indian population with different geographical area studies

Introduction

Coronary artery disease (CAD) is the most common cause of morbidity and mortality especially in the developing countries. Coronary artery measurements (CAM) are the most important factor affecting the procedure and outcome of coronary angioplasty (PCI) as well as coronary by-pass operations (CABG). In this study, we aimed to establish a database for the normal CAM as well as for gender difference among the Indian population using quantitative coronary angiography (QCA) with an objective of assessing normal coronary vessel morphology of patients with normal coronaries.

Materials and methods

Four thousand angiograms from patients of Indian origin were studied prospectively after procuring the sanction for the same from the ethical committee of the pre-selected hospitals of four states in India. Informed consents were obtained. Post CABG, post PCI patients and patient being diabetic for ≥5 years were also excluded from the study.

Results

Ten segments from right and left coronary arteries were taken for diameter measurements. These coronary diameters were indexed to body surface area (BSA) (mean diameter mm/m² BSA). Among, 4000 patients, 933(23.3%) [M:F-521:412] had normal coronaries and 3067 (76.7%) were diseased.

Discussion and conclusion

The dimensions of the coronary artery segments of Indians were smaller (in BSA indexed and non-indexed data), compared to studies from other continents which can be due to their smaller BSA.

A milestone in prediction of the coronary artery dimensions from the multiple linear regression equation

BACHGROUND /AIM

Coronary artery imaging is one of the most commonly used diagnostic methods. We aimed to investigate whether there is a correlation between left main coronary artery (LMCA), left anterior descending artery (LAD) and left circumflex artery (LCx) artery dimensions in normal cases and a possibility to express the coronary dimensions by multiple linear equations.

MATERIALS AND METHODS

Images of coronary angiograms of 925 normal cases selected from 3855 cases made up the study population (515 men and 410 women; age range, 30-75 years). The mean age of the patients was 55.50 ± 6.49 years. The mean body mass index was 24.79 ± 1.45 kg/m² (range, 31.30-21.26 kg/m²). The mean dimensions of LMCA, LAD and LCx were 4.18 ± 0.65 mm, 3.22 ± 0.63 mm and 3.07 ± 0.65 mm, respectively. Correlation between LMCA, LAD and LCx diameters was investigated. Multiple linear regression analysis was used to develop a model to elucidate the relationship between LMCA, LAD and LCx diameters.

RESULTS

There was a strong correlation between LMCA dimensions and LAD and LCx dimensions (r = 0.526**, p < 0.001* and r = 0.469**, p < 0.001*, respectively). The positive correlation indicated that a regression analysis can be carried out by incorporating the measurements. Coronary artery dimensions were gender specific.

CONCLUSION

The present study explored the possibility of explaining the relationship with the LMCA and its branches by multiple linear equations, which may then be used to estimate the reference diameter of a stenosed coronary artery when the other two arteries are normal.

Gender-associated dimensional differences among normal to non-flow limiting coronary artery dimensions

Aim and objectives

To study gender-specific differences in coronary artery diameters among subjects with normal to non-flow limiting disease (NFLD) coronary arteries (up to 0 - 20% of stenosis) and to assess the possible association of body-mass index (BMI) with coronary dimensions, among the west coastal population of Karnataka and Kerala.

Materials and Methods

A prospective cohort study was conducted for a period of one year. Two thousand angiograms samples were collected and assessed from two study centers (one from each state), after obtaining the ethical clearance. Patients with past history of myocardial infarction and those with recanalized normal looking coronary arteries and those who had diabetes for more than five years were excluded. Ten segments of coronary arteries- left main coronary artery, ostial and proximal segments of left anterior descending artery and its first diagonal branch, ostial and proximal segments of left circumflex coronary artery and its obtuse marginal branch, ramus intermedius and the ostial and proximal segments of the right coronary artery- were included in diameter measurement. BMI values of the patients were calculated.

Results

Out of 2000 patients included in the study, 454 (22.7%; mean age 53.4 ± 14.2 years) had normal to NFLD coronaries of which 253 (55.7%) were males and 201 (44.3%) were females. As compared to women, men had larger diameters of coronary arteries for eight segments, except the obtuse marginal branch and the proximal right coronary artery. A weak, yet statistically significant, negative correlation existed between BMI and coronary artery diameters in total cohort, indicating that an increase in BMI was associated with a decrease in artery diameters. No such association was seen when men and women were assessed separately.

Conclusions

The present study indicates that men have higher caliber for coronary arteries compared to women. The study also indicates that when BMI increases there is a relative decrease in the coronary artery diameter.

Influence of Luminol Doping of Poly(o-phenylenediamine) on the Spectral, Morphological, and Fluorescent properties: A Potential Fluorescent Marker for Early detection and Diagnosis of Leishmania donovani

There has been a steady progress in the development of doped conjugated polymers to remarkably improve their photo physical properties for their application as biomarkers. With a view to enhance the spectral, morphological, and photo physical properties of poly(o-phenylenediamine) (POPD), the present work reports the synthesis of poly(o-phenylenediamine) and doping of this polymer using luminol. The formation of luminol-doped POPD was confirmed by infrared and ultraviolet-visible spectroscopies and X-ray diffraction studies. The energy band gap values and oscillator strength of luminol in acidic, basic, and neutral media were computed by density functional theory calculations using the B3LYP/6-31G (d) basis set and were compared with experimental data. The luminol doped POPDs show significant in vitro anti-leishmanial activity. Live cell imaging also proved that these molecules bind with the organelle of Leishmania also. These luminol doped POPDs were found non-toxic at the used concentrations on THP-1 derived human macrophage cells through methyl tetrazolium (MTT) assay. The results revealed that luminol doped POPDs were potentially non-toxic to human cells though exhibited immense potential to be used as a fluorescent marker to label Leishmania donovani for diagnostic and other studies.

Tuning the spectral, morphological and photophysical properties of sonochemically synthesized poly(carbazole) using acid Orange, fluorescein and rhodamine 6G

The lifetimes and quantum yields of organic dyes are widely investigated due to their potential application in organic light emitting diodes (OLEDs). With a view to explore the possibility of enhancing the fluorescent properties of organic conjugated polymers such as polycarbazole, the present preliminary study reports for the first time, dye modification of polycarbazole using as acid orange (AO), fluorescein (Fluo) and Rhodamine 6G (R6G) for improving its fluorescence properties. The modification of PCz via doping was confirmed by FTIR, UV-visible, XRD and TEM analyses. The fluorescence studies and confocal microscopy were carried out both in solution and solid states to investigate the behavior of the dye modified PCz. Doping was found to be governed by the chemical structure of the dye. PCz-AO revealed intense doping which was confirmed by FTIR and UV-visible studies. PCz-Fluo and PCz-R6G exhibited the highest quantum yield and fluorescence emission in the solid state. Hence, by tailoring the structure of these conjugated polymers, stable fluorescence emitting materials can be designed for their potential application in OLEDs.

Consensus Recommendation for India and Bangladesh for the Use of Pneumococcal Vaccine in Mass Gatherings with Special Reference to Hajj Pilgrims

Respiratory tract infections are prevalent among Hajj pilgrims with pneumonia being a leading cause of hospitalization. Streptococcus pneumoniae is a common pathogen isolated from patients with pneumonia and respiratory tract infections during Hajj. There is a significant burden of pneumococcal disease in India, which can be prevented. Guidelines for preventive measures and adult immunization have been published in India, but the implementation of the guidelines is low. Data from Bangladesh are available about significant mortality due to respiratory infections; however, literature regarding guidelines for adult immunization is limited. There is a need for extensive awareness programs across India and Bangladesh. Hence, there was a general consensus about the necessity for a rapid and urgent implementation of measures to prevent respiratory infections in pilgrims traveling to Hajj. About ten countries have developed recommendations for pneumococcal vaccination in Hajj pilgrims: France, the USA, Kuwait, Qatar, Bahrain, the UAE (Dubai Health Authority), Singapore, Malaysia, Egypt, and Indonesia. At any given point whether it is Hajj or Umrah, more than a million people are present in the holy places of Mecca and Madina. Therefore, the preventive measures taken for Hajj apply for Umrah as well. This document puts forward the consensus recommendations by a group of twenty doctors following a closed-door discussion based on the scientific evidence available for India and Bangladesh regarding the prevention of respiratory tract infections in Hajj pilgrims.

Double layered hydroxides as potential anti-cancer drug delivery agents

The emergence of nanotechnology has changed the scenario of the medical world by revolutionizing the diagnosis, monitoring and treatment of cancer. This nanotechnology has been proved miraculous in detecting cancer cells, delivering chemotherapeutic agents and monitoring treatment from non-specific to highly targeted killing of tumor cells. In the past few decades, a number of inorganic materials have been investigated such as calcium phosphate, gold, carbon materials, silicon oxide, iron oxide, and layered double hydroxide (LDH) for examining their efficacy in targeting drug delivery. The reason behind the selection of these inorganic materials was their versatile and unique features efficient in drug delivery, such as wide availability, rich surface functionality, good biocompatibility, potential for target delivery, and controlled release of the drug from these inorganic nanomaterials. Although, the drug-LDH hybrids are found to be quite instrumental because of their application as advanced anti-cancer drug delivery systems, there has not been much research on them. This mini review is set to highlight the advancement made in the use of layered double hydroxides (LDHs) as anti-cancer drug delivery agents. Along with the advantages of LDHs as anti-cancer drug delivery agents, the process of interaction of some of the common anti-cancer drugs with LDH has also been discussed.

Unruptured middle cerebral artery aneurysm in a patient with systemic lupus erthematosus: a diagnostic challenge

A 22-year-old female patient presented to the Emergency Department of a tertiary care hospital with symptoms of headache and nausea. She has been on a regular follow-up for the preceding three and a half years after being diagnosed as systemic lupus erythematosus (SLE). She had been treated earlier for SLE nephritis in the same institution, and had two relapses of nephrotic syndrome in the last three and a half years for which she had been treated and had achieved complete remission. All possibilities of headaches in background of SLE were considered. CNS examination was inconclusive. There was no nuchal rigidity or no cranial nerve deficits. Fundoscopy and Plain CT scan of brain were normal. The possibility of CNS-lupus was considered considering the high values of antiphospholipid antibodies (APLA). Treatment was initiated accordingly; however, there was no improvement in her symptoms. Although being rare in a patient with SLE, the possibility of an aneurysm was considered. Four vessel digital substraction angiography revealed two unruptured aneurysms of 7.2 mm and 3.9 mm in the left middle cerebral artery (MCA) territory. Craniotomy and aneurysmal clipping was done successfully, and the patient was relieved of her symptoms. A high degree of suspicion towards a rarer cause clinched the diagnosis of a left MCA territory stem artery aneurysm. This rationale of strong suspicion and discussion of differential diagnosis brought a change in the management of the patient.

Measles with acute disseminated encephalomyelitis (ADEM)

We report a seven year old male with measles associated acute disseminated encephalomyelitis (ADEM) despite having received measles vaccination in infancy. The diagnosis was based on serum antimeasles antibodies and MRI brain. The patient was managed with high dose corticosteroids along with supportive measures. There was a complete neurologically and physica recovery.

Synthesis, characterization, antibacterial and corrosion protective properties of epoxies, epoxy-polyols and epoxy-polyurethane coatings from linseed and Pongamia glabra seed oils

The aim of this paper is to investigate the structures and properties of epoxidized linseed and Pongamia glabra oils (LOE/POE), their derived products-epoxy-polyols (HLOE/HPOE), epoxy-polyurethanes (EU=LOPU/POPU) and EU coatings. Changes in epoxy equivalent, iodine value, hydroxyl value and percent saturation of oil backbone in due course of epoxidation and hydroxylation reactions, were plotted as a function of time. Spectral (IR, (1)H NMR and (13)C NMR), physico-chemical and thermal (TGA and DSC) analyses of aforementioned resins were performed by standard methods. Physico-mechanical and chemical resistance tests reveal that coatings of LOPUs perform better than those of POPUs. It was found that properties of oil epoxy-polyurethane coatings are mainly governed by: (i) fatty acid composition and nature of starting oils, (ii) extent of epoxidation, (iii) number and location of hydroxyls and residual double bonds in the final product and (iv) the presence of long dangling chains. PO, HLOE and LOPUs exhibit good antibacterial activity against Escherichia coli at very small MIC. These EU systems can be safely employed unto 220 degrees C.

Waterborne diseases of bacterial origin in relation to quality of water in a suburb of Uttar Pradesh

Waterborne disorders of bacterial origin, e.g. typhoid, bacillary dysentery and diarrhea are one of the major global health problems, especially in developing countries like India. The prevalence of these diseases is largely dependent on the quality of water consumed by people. The quality of water in India is still below the WHO recommendation of zero fecal coliform/100 ml of water. The present study was conducted in a suburb of Aligarh District of U.P. (India). A total of 1270 persons were selected by paying home visits and followed up for a period of one year. The study revealed that morbidity was higher in standpost group, i.e., 88.3% while in piped water group it was 51.8%. The average episode of typhoid for both source of water was one while dysentery had 3 average episodes. The average episodes of diarrhea was 4 in stand post and 3 in piped water group. In standpost group the majority of people, (87.6%) were using unsatisfactory water as compared to 74.4% for piped water supply. The frequency of typhoid was 1.4% bacillary dysentery 3.4% and diarrhea 7.7%. The occurrence of waterborne disorders of bacterial origin was common for typhoid in the 5-12 years age group bacillary dysentery for the 1-5 years, and diarrhea for the 0-5 years age group. The morbidity rate in standpost group was comparatively higher, i.e., 79.6%. The frequency for the standpost group and piped water group for different diseases were, typhoid 1.1% and 0.7%, bacillary dysentery 2.7% and 2.2%, and diarrhea 6.1% and 5.1%, respectively.

Interaction of decavanadate polyanions with proteins

The binding of polymeric decavanadate anion [V10O28]6- with bovine serum albumin and gelatin was studied at pH 4.0 and 3.0, the region of thermodynamic stability of oligomeric vanadate anion. The binding of decavanadate anion at pH 4.0 with bovine serum albumin (BSA) and gelatin was found to be 9 and 32 gmol of decavanadate per gram mole of the proteins. The binding at pH 3.0 was found to be 12 and 38 gmol, respectively. Freshly formed BSA decavanadate precipitate was particulate in nature while that of gelatin-decavanadate made a gummy mass. This indicates a different mode of binding of decavanadate anions with globular and fibrillar proteins. Infrared spectra of the adducts endorses electrostatic binding between proteins and decavanadate. Scanning electron microscopy micrographs reveal extended crosslinked binding between decavanadate and gelatin and aggregation of the uncharged BSA-decavanadate molecules to make a granular adduct. The mode of binding was also correlated with the structure of decavanadate anions, BSA, and gelatin.

Effect of acute occlusion of left renal vein on the kidney: an experimental study in dogs

To study the effects of acute ligation of the left renal vein an experimental study was carried out on 16 Mongrel dogs out of 18 of which 2 had died postoperatively. The right kidney served as control. Changes immediately after ligation were recorded; subsequently the dogs were sacrificed in 4 groups comprising 4 in each at intervals of 24 hours, one week, 4 weeks and 6 weeks. Both the kidneys were removed and gross and microscopic changes were noted. In all cases atrophy of the ligated kidney due to tubular atrophy and fibrosis were seen in spite of good collaterals. It is concluded that left renal vein ligation in dogs is not safe for the kidney, though it is not fatal.

A histomorphologic and ultrastructural study of the malignant tumours of the renal pelvis

The study was carried at two different centres. Only 9 cases of primary malignant tumours of the renal pelvis could be collected during the period of 7 years (1984-1990). Renal pelvis malignancies constituted 0.21% of all the malignancies and 12.16% of all the malignant growths of the kidney (9 out of 74 cases). The age of these patients ranged from 24 to 70 years; the mean being 41.7 years. Male/female ratio was 8:1. Common triad of complaints (pain, haematuria and lump) was noticed in 22.2% of patients. Individually they were noticed in 77.8%, 66.7% and 44.4% of patients respectively. Transitional cell carcinoma was the commonest, seen in 7 patients (77.8%) whereas squamous cell carcinoma and adenocarcinoma were noticed in one patient (11.1%) each. Hydronephrosis, chronic pyelonephritis and nephrolithiasis were noticed in 66.7%, 44.4% and 22.2% of patients respectively. Ultrastructural study of urothelial tumours revealed tumour cells in various stages of differentiation with loss of intercellular junctions and dense collection of rough endopasmic reticulum fibrils around the nucleus.

Primary malignant lymphoma of the gastro-intestinal tract: a clinicopathological study of 24 cases

Twenty-four cases of primary lymphoma of the gastro-intestinal tract were diagnosed during the period 1970 to 1991. There was a preponderance of males and the male to female ratio being 1.4:1. Age ranged from 9-70 years, mean 32.2 years. Small intestine was involved in 50% cases, large bowel in 9 cases (37.5%) and stomach in 3 cases (12.5%). There were 5 cases (20.8%) of Hodgkin's disease and 19 cases (79.2%) were of non-Hodgkin's lymphoma. All cases of gastric lymphoma complained of epigastric pain, weight loss and vomiting. In lymphoma of small intestine, 8 patients complained of pain associated with vomiting and 6 patients complained of distension of abdomen. In large bowel lymphoma, pain in right iliac fossa was complained by 4 patients and bleeding per rectum by 3 patients. Out of all the 24 cases, changes in bowel habit were noted in 15 patients and occult blood was positive in 13 cases. Palpable abdominal mass was noted in 14 patients. Histomorphologically, all the 3 cases in the stomach were of lymphocytic lymphoma diffuse type. Out of 19 non-Hodgkin's lymphoma, 15 were of lymphocytic lymphoma and 4 were of histiocytic lymphoma.

Heterotopic bone formation in renal cell carcinoma (a case report)

A case of renal cell carcinoma with heterotopic bone formation occurring in a female aged 55 years has been reported. There was no haematuria and the morphological picture showed only ossified stroma and no sarcomatoid appearance.

Chronic granulomatous cholecystitis: a clinicopathological study of 17 cases

In a clinicopathological study of 376 cases of gall bladder diseases, chronic granulomatous cholecystitis was diagnosed in 17 specimens (4.52%). All these cases presented with pain in the right hypochondrium and a non-functioning gall bladder. Besides cholegranulomas and xanthogranulomas, 5 cases presented with localised yellowish brown areas in the wall of the gall bladder which revealed on histology proliferation of histiocytes containing abundant granular brown pigment (as seen in ceroid granulomas), intermingled with lymphocytes, plasma cells and occasional foreign body giant cells. The average age of the patients was 41.3 years. Cholelithiasis was present in 12 cases (70.6%). In one case the gall bladder was bilocular, having granulomatous lesion on one side of the septum and papillary adenocarcinoma on the other side.

Interaction of vanadium(V) oxoanions with ovalbumin and transfusion gelatin

Vanadate(V) anions have been found to modulate the activity of a large number of enzymes. To elucidate these interactions, a physico-chemical study of the binding of meta-vanadate(V) with two typical proteins ovalbumin and transfusion gelatin has been taken up. The binding has been investigated by polarographic method at pHs 7.5 and 9.3, and at 30 degrees C. Values of intrinsic association constant, standard Gibb's free energy change, and the number of amino acids involved in these bindings are reported. Analysis of the binding sites has been done.

Programme development of drug abuse control in Baluchistan, Pakistan

The drug abuse control programme in Baluchistan is inter-disciplinary and progressive. Its main thrust consists of constant vigilance on border check-points by law enforcement agencies, developing in-patient and out-patient facilities for treatment and rehabilitation of addicted persons, and a preventive education programme using the mass media and students from higher educational institutions.