Early Prediction of Coagulopathy in Acquired Bleeding Disorders - Revisited Using Rotational Thromboelastometry

Introduction: Acquired bleeding disorders are a major causeof mortality, both in the developed and developing countries.An acute haemorrhage should be managed immediately withblood products, factor concentrates or anti-fibrinolytics.Investigations to detect coagulopathies typically includebaseline screening tests like prothrombin time, activatedpartial thromboplastin time, platelet count and fibrinogenlevel. These tests have a long turn around time whichfrequently lead to a blinded approach towards blood productsupport leading to under or over transfusion. In contrast,rotational thromboelastometry (ROTEM) which assesseshaemostasis from the start of clot formation to fibrinolysisgives earliest results within ten minutes. This study wasdone to establish a correlation between ROTEM parametersand standard coagulation profile in the context of acquiredbleeding disorders.Material and Methods: A total of 138 subjects - 70 patientswho presented with acquired bleeding disorders and 68 subjectsdiagnosed to be normal on the basis of a complete coagulationwork up were included as the cases and controls respectively.All samples were subjected to standard coagulation profileand ROTEM analysis which included Clotting Time, ClotFormation Time, Alpha Angle, Maximum Clot Firmness andMaximum Lysis.Results: The Maximum Clot Firmness had a very goodco relation with serum fibrinogen levels (k value - 0.807;p<0.000; Sensitivity - 88%; Specificity - 92%), and goodcorrelation with platelet count (k value - 0.793; p< 0.000;Sensitivity - 86%, Specificity-92%), whereas Clot FormationTime showed moderate correlation with aPTT. Clotting timehad a poor correlation with prothrombin time and activatedpartial thromboplastin time.Conclusion: The achievement of haemostasis is a crucialfactor for determining patient outcomes in acquired bleedingdisorders. The gold standard test to diagnose coagulopathy is thestandard coagulation profile. Rotational thromboelastometrycorrelates well with standard coagulation parameters. Thistest which is performed on whole blood showed interpretableresults within 10 minutes, whereas standard coagulationprofile required an average of 45 – 75 minutes. In view of thegood correlation to the standard coagulation profile, it appearsthat Rotational Thromboelastometry results can be safely usedto implement early transfusion therapy for haemorrhage.

Autism spectrum disorder (ASD): A current review of assessment, risk factors and prevention

Autism spectrum disorders (ASDs) are extremely heritable neurodevelopmental disorders observed in 1-2% of children, usually seen before they reach 3 years of age. ASD is characterized by impaired social behavior, poor communication, stereotypic behavior, abnormal sensitivity to sensory stimuli and self-injurious behavior. The exact causes of ASD are unclear but increased oxidative stress; hyperserotonemia and loss of purkinje cell integrity in the cerebellum are some pathological findings in ASD. This article reviews trends in assessment of this neurodevelopmental disorder, autism risk factors, and preventions for autism. Screening tools for ASD, such as checklist for autism in toddlers (CHAT), modified checklist for autism in toddlers (M-CHAT), autism behavior checklist (ABC) and the autism spectrum screening questionnaire (ASSQ), social communication questionnaire (SCQ), australian scale for asperger syndrome (ASAS), are available for use by general pediatricians. Pregnant ladies exposure to some toxic chemicals and selective serotonin reuptake inhibitors (SSRIs) may increase the risk of ASDs. Mother and child cohort study (MoBa) found prenatal folic acid supplements reduce the risk of autism spectrum disorders in children, but these findings cannot determine whether they protect against other neurodevelopmental disorders.

A study of serum magnesium levels to insulin in type2 diabetes mellitus

Back ground: Glucose homeostasis reflects a balance between hepatic glucose production and peripheral glucose uptake and utilization Insulin is the most important regulator of this metabolic equilibrium but neural input, metabolic signals, other hormones (e.g. Glucagon) results in integrated control of glucose supply and utilization. The ingested sugars are broken down which enters the digestive system and forms glucose. It enters the blood stream and leads to increase in blood glucose levels. When glucose molecules are high in the blood, these molecules will reach the pancreatic beta cells and enter in to the beta cells resulting in release of insulin which enters the blood stream and transported all over the body leads for glucose utilization. Serum magnesium levels are known to be lowered in diabetes and its supplementation in known to improve the out comes in terms of metabolic stability. Now we are in need to ensure the relation between serum magnesium levels and serum insulin levels. Very few studies have been done to establish a definite relationship between these two. This study puts in a since efforts to understand the relation between serum magnesium level to serum insulin level in diabetes mellitus type 2. Material and methods: The present study was carried out in south Indian population at PRS hospital Trivandrum on 150 recently diagnosed type 2 DM patients. 150 healthy individuals were taken as control group. Permission was obtained from institutional ethics committee. The patients included were who attended the Department of General Medicine outpatient department. History of the patient was obtained before including in to present study. Fasting samples for glucose were checked for confirmation of diabetic status. Insulin and magnesium levels were estimated. The Hb A1c was also measured and compared between diabetics and control group. Blood glucose levels analysis was performed by semi auto analyzer. Serum fasting insulin levels were measured by ELISA Method (Genx bio). Results: Low serum magnesium levels was observed and found to be statistically significant (P < 0.001) in cases of diabetics, when compared to the control group. Increased serum insulin levels in Sukesh RS. A study of serum magnesium levels to insulin in type2 diabetes mellitus. IAIM, 2018; 5(1): 77-81. Page 78 diabetic patients was recorded in statistically significant manner (P < 0.004) when compared to control group. The levels fasting glucose and magnesium in diabetic patients were observed to be inversely proportional. Conclusion: Type 2 diabetes which involves loss of insulin and leptin sensitivity is easily preventable disease. However preventing the disease requires a multi-faceted approach. Getting adequate magnesium is just one part of the formula. Others critical life style factors include diet, exercise and optimizing gut flora

Comparison of intrathecal isobaric ropivacaine with fentanyl and isobaric bupivacaine with fentanyl for spinal anesthesia for lower abdominal and lower limb surgery

Introduction: Subarachnoid block is commonly used for lower limb and lower abdominal surgeries. This study compares the efficacy of intrathecal ropivacaine and bupivacaine with fentanyl for these surgeries

Methodology: A prospective randomized controlled study was carried out on 100 randomly selected patients between 18-75 years, undergoing lower abdominal and lower limb surgeries under spinal anesthesia. Group R received plain ropivacaine [0.75%] 15 mg and Group B re-ceived plain bupivacaine [0.5%] 10 mg with 20 ug fentanyl each intrathecally. The upper and lower spread of sensory block was determined using loss of sensation to pin prick and motor block assessed with Modified Bromage Scale. Statistical analysis was performed using Stu-dent's t-test for quantitative data and Chi-square test for qualitative data

Results: The difference in age, height and weight was not statistically significant in the par-ticipants of the two groups. The gender distribution and ASA classification were comparable in two groups and there was no significant difference. The onset time of sensory block was 5.26 +/- .986 vs. 6.24 +/- 1.001min in Group B and Group R respectively [< 0.001]. Duration of senso-ry blockade was not significantly different [191.38 +/- 3.562 vs. 191.24 +/- 3.414 min [p = 0.841]] in two groups. The onset of motor blockade was significantly rapid in Group B compared to Group R [9.72 ± 1.691 vs. 3.18 +/- 2.569 min [p < 0.001]]. The mean duration of Grade III motor block was sig-nificantly low in Group R compared to Group B [102.04 min vs. 157.46 min], as was the mean duration for motor block [121.04 vs. 189.92 min] in Group R and Group B [p < 0.001]

Conclusion: Spinal anesthesia with intrathecal ropivacaine 15 mg provides faster motor re-covery as compared with bupivacaine 10 mg, making it more suitable for ambulatory lower extremity and lower abdominal surgeries of short duration?

t[8;14][q24.1;q32] and its variant translocations: a study of 34 cases

Background: The t[8;14][q24.1;q32] and its variants - the t[2;8][p12;q24.1] and t[8;22][q24.1; q11.2] are associated with B-cell neoplasia and result in MYC/immunoglobulin [IG] gene rearrangement

Patients and methods: We correlated the cytogenetic, molecular and clinico-pathological findings of patients with 8q24 translocations seen in the Department of Haematology, Christian Medical College, Vellore, from January 2003 to December 2015

Results: There were 34 patients with 8q24 translocations [31, ALL and three myeloma]. The t [8;14] was seen in 25 patients, t[8;22] in seven and t[2;8] in two. The salient findings were as follows: 85% males; 79% adults, median age 37 years; L3 morphology in 61%; mature B immunophenotype in 77%; extra-medullary disease in 41%; additional abnormalities in 28 [85%], notably, structural abnormalities of chromosome 1q [41%] and 13q [9%] and monosomy 13 [15%]; complex karyotypes in 68%. There were two double-hit lymphoma/leukemia, one with a t[14;18][q32;q21] and the other with a t[3;14][q27;q11.2], associated with nodal high grade B cell lymphoma and dermal leukemic infiltrates respectively Only 13 samples were processed for DNA PCR and all these samples were positive for MYC-IgH [c-gamma type] rearrangement. Only in one patient, in addition to c-gamma, c-alpha rearrangement was also detected

Conclusion: The frequency [1.7%] and distribution of these translocations in our series and the association with 1q and 13q abnormalities is similar to the literature. Trisomies 7 and 12 were seen in less than 10% of our patients

Mean reticulocyte volume enhances the utility of red cell mean sphered cell volume in differentiating peripheral blood spherocytes of hereditary spherocytosis from other causes.

Context: Mean sphered cell volume (MSCV) and mean reticulocyte volume (MRV) are additional reticulocyte parameters generated while processing the blood samples on Beckman coulter LH 755 in the reticulocyte mode using the volume, conductivity and scatter technology. It has been observed that the difference between mean corpuscular volume (MCV) and MSCV is higher in the cases of hereditary spherocytosis (HS) and this difference is increasingly being utilized as a screening tool for spherocytes. In addition now there have been new observations that reticulocyte volume in cases of HS is less as compared to normal reticulocyte. Aims: Our aim was to test the usefulness of reticulocyte parameters like MSCV and MRV in distinguishing cases of HS and autoimmune hemolytic anemia (AIHA). Materials and Methods: This is a retrospective and partly prospective study where peripheral blood ethylenediaminetetraacetic acid samples from cases of HS (n = 57) and AIHA (n = 29) were processed on LH 755 in both the differential and the reticulocyte mode. The data generated were analyzed and compared with data from normal healthy donors (n = 46). Results: Using an algorithm of MCV — MSCV >10 and MRV — MSCV <25, a sensitivity of 84.2% and specifi city of 94.7% was observed in cases of HS. Conclusions: With the reticulocyte analysis, we may now have a simple and cheap additional tool for screening of HS.

V-raf murine sarcoma viral oncogene homolog B (BRAF) mutations in hairy cell leukaemia.

Introduction: Hairy cell leukemia (HCL) is a B-cell non-Hodgkin lymphoma with distinct clinical, morphological and immunophenotypic features; however, there are many other B-cell lymphomas, which closely mimic HCL. Accurate diagnosis of HCL is important as treatment with 2-chloro-2’-deoxyadenosine (cladribine) is associated with >80% chance of complete cure. The recent description of BRAF p.V600E mutations in almost all HCL cases in various studies has not only improved the pathogenetic understanding of this entity but also increased the diagnostic accuracy of this disorder. Aim: The aim of the study was to standardize a molecular test for diagnosis of HCL and compare with standard established morphological, cytochemical and immunophenotypic parameters for HCL diagnosis. Materials and Methods: The incidence of this mutation was sought in 20 patients with either classical HCL or HCL variant (HCLv) by Sanger sequencing and allele-specifi c polymerase chain reaction. BRAF p.V600E mutation was present in all HCL cases and absent in the only HCLv case. Results: A high degree of correlation was noted between the presence of BRAF p.V600E and established diagnostic criteria in 20/20 patients with HCL/ HCLv. Our data supports the observation that this mutation is present in all cases of HCL and is absent in HCLv. Hence, detection of the BRAF p. V600E mutation can be a useful adjunct in the diagnostic algorithm.

Development and validation of an HPLC-MS/MS analytical method for quantitative analysis of TCBA-TPQ, a novel anticancer makaluvamine analog, and application in a pharmacokinetic study in rats / 中国天然药物

We have recently designed and synthesized several novel iminoquinone anticancer agents that have entered preclinical development for the treatment of human cancers. Herein we developed and validated a quantitative HPLC-MS/MS analytical method for one of the lead novel anticancer makaluvamine analog, TCBA-TPQ, and conducted a pharmacokinetic study in laboratory rats. Our results indicated that the HPLC-MS/MS method was precise, accurate, and specific. Using this method, we carried out in vitro and in vivo evaluations of the pharmacological properties of TCBA-TPQ and plasma pharmacokinetics in rats. Our results provide a basis for future preclinical and clinical development of this promising anticancer marine analog.

New mathematical derivations for calculation of ATP yield due to the complete oxidation of different types of fatty acids.

During the complete oxidation of fatty acids, the electrons removed from fatty acids in different forms (FADH2 and NADH2) pass through the respiratory chain, driving the ATP synthesis. Generally, the ATP yield due to the complete oxidation of fatty acids is calculated by sum total the ATPs obtained due to the oxidation of FADH2 and NADH2 due to lack of any particular method. This calculation is simple for saturated even numbered fatty acids, but in the case of saturated and unsaturated odd numbered fatty acids the calculation of ATP yield is difficult and needs mathematical calculations due to some changes in their β-oxidation pathway when compared to the pathway of saturated even numbered fatty acids. These calculations are made simple by our derivations and following formulae where we require only number of carbon atoms and double bonds present in a fatty acid. Our method is superior and easier in comparison to long mathematical calculations that are in the practice.

Inhibition of dextransucrase activity in Streptococcus mutans by plant phenolics.

Streptococcus mutans is responsible for causing dental caries in humans and utilizes sucrose for its growth. The dextransucrase (EC 2.4.1.5) is responsible for sucrose metabolism, which exhibits both hydrolytic and glucosyltransferase activities. In this study, we examined the effects of the plant phenols, namely gallic, tannic and syringic acids and aqueous extracts of certain traditionally used chewing sticks (Acacia arabica, Azadirachta indica, Pongamia pinnata and Salvadora persica) for prevention of dental caries on hydrolytic activity of dextransucrsae in S. mutans. Gallic acid (4-5 mM) produced 80-90% inhibition of the enzyme, while tannic acid (0.2 mM) and syringic acid (5 mM) inhibited the enzyme activity 80% and 48%, respectively in vitro. The aqueous extracts of chewing sticks produced 35-40% inhibition of dextransucrase activity at 5 mg phenol concentration. Kinetic analysis revealed mixed-type of enzyme inhibition by polyphenols, where both Km and Vmax were altered. The value of Ki for tannic, gallic and syringic acids were 0.35, 1.6 and 1.94 mM, respectively. The enzyme inhibition by polyphenols was optimum at pH 7-7.5, while by plant extract was maximum at pH 5-6. These results suggest that plant polyphenols may find potential applications in the prevention and control of dental caries by inhibiting dextransucrase activity in S. mutans.

Environmental monitoring of adulterated gasoline with kerosene and their assessment at exhaust level.

Fuel adulteration increases the emission of total hydrocarbons, carbon monoxide, nitrogen oxides and respirable particulate matter , and thus adds to air pollution. The study examined the effects of mixing of different percentage of kerosene with petrol on the motorized rickshaw exhausts in terms of volatile organic compounds (benzene, toluene, xylene and ethyl benzene) and total suspended particulate matter (SPM). The personal sampler was used for sampling, and gas chromatography-mass spectrometry for quantification of compounds. Concentration of volatile organic compounds significantly decreased (p<0.001) along with the increase in fraction of kerosene in petrol. The level of benzene in exhausts while, using petrol (100 %) was significantly higher (p<0.001) than that of three combinations used in this study (75% petrol + 25% kerosene, 50% petrol + 50% kerosene and 25% petrol + 75% kerosene). Similar trend was observed for toluene, xylene and ethyl benzene also. The mean concentration of benzene, toluene, xylene and ethyl benzene were 31.34, 160.93, 10.07 and 5.58 mg m-3 in pure petrol, while 12.30, 51.41,4.89 and 3.16 mg m-3 for fuel combination 75% petrol + 25% kerosene. The observed levels of benzene, toluene, xylene and ethyl benzene were 9.12, 41.04, 4.33 and 2.91 mg m-3 for fuel mixture having 50% petrol with 50% kerosene and levels were 8.36, 20.05, 3.82 and 2.95 mg m-3 were for 25% petrol with 75% kerosene fuel combination. The levels of suspended particulate matter (SPM) increased along with the increase in fraction of kerosene in petrol. The data generated is useful to understand the common volatile organic compounds trend with the increasing fraction of kerosene in petrol.

Effect of ethanolic extract of plectranthus amboinicus leaf on healing of burn wound in wistar rats.

Objectives: To study the effect of ethanolic extract of the leaf of Plectranthus amboinicus on the healing of burn wounds in wistar rats and compare it with silver sulfadiazine treated group.Materials and Methods: Five groups of rats were used in the study. Partial thickness burn wounds were made on each rat under ketamine anesthesia.The wounds in the five groups of rats were treated topically with petroleum base, silver sulfadiazine,1%, 2% and 3% ointment of ethanolic extract of Plectranthus amboinicus, respectively, once daily for 21 days or till complete healing whichever was earlier. The wound contraction rate and period of epithelization were monitored. Results: The rate of wound contraction was significantly more in Plectranthusamboinicustreated groups in comparison to the control. The mean period of epithelization was significantly decreased in Plectranthus amboinicus treated group when compared to control (P < 0.01) and silver sulfadiazine (P =0.02) treated group. Conclusion: The ethanolic extract of Plectranthusamboinicuspromoted healing of burn wound in wistar rats.

Extraarticular bony ankylosis in a child with supracondylar fracture of humerus / 中华创伤杂志(英文版)

Myositis ossificans is defined as formation of bone at the site of injured muscle. It is one of the rare complications of supracondylar fracture of humerus in children. Myositis mass usually develops on the anterior aspect in the brachialis muscle and produces restriction of range of motion, but complete ankylosis is rare. To the best of our knowledge, this is the first case to be reported in the literature as a consequence of myositis ossificans traumatica. In this case, a six-year-old child presented to the casualty department with pain in the right elbow after a fall on outstretched hand during play. After surgical excision through the anterior approach, the child had no symptoms referable to the elbow and a residual flexion deformity of 15 degrees with further painless flexion up to 100 degrees at last follow-up of one year after surgery.

Concentration of nitrite in respirable particulate matter of ambient air in Vadodara, Gujarat, India.

Water extract of respirable particulate matter (RPM) was analyzed by Ion chromatography technique to investigate the presence of nitrite (NO2) as secondary aerosol in ambient environment. The nitrite particulates undergo photo hydroxyl radical reaction in environment produce nitrous acid, which reacts with metal and absorbs on RPM as water-soluble metal salt. The mean concentration of nitrite was 20.86 .g m-3 in ambient environment. Regression analysis showed that the relationship for respirable particulate matter and nitrite (RPM-NO2, R2=0.742) was positively significant. We are reporting the presence of nitrite as an aerosol in ambient environment.

A Study of Mass Psychogenic Illness in a High School of West Bengal.

Twenty students were affected in an epidemic of mass psychogenic illness occured in a high school of West Bengal, India in 2004. Our objective was to study and find out any related cause which may help in spread of illness and various management issues. We isolated the patients in hospital wards and interviewed each, arranged a group discussion with students, guardians, teachers and local leaders to alleviate the anxiety. Social stress due to rapid urbanization, individual stressful factors were associated with the event. Proper knowledge of mass psychogenic illness and its management is must for both psychiatrists, and primary care physicians.