Pneumopericardium, pneumomediastinum and surgical emphysema in spontaneous pneumothorax

Spontaneous pneumothorax leading to pneumomediastinum, pneumopericardium and surgical emphysema is a benign condition. Progression to the development of epidural pneumatosis is rare. We report a 19-year-old man who presented with dyspnoea and swelling of the chest wall following a bout of cough. Bilateral subcutaneous emphysema was palpated on the anterior chest wall from the sternum to the midaxillary regions. His chest X-ray revealed subcutaneous emphysema and pneumopericardium. His computed tomography of the thorax to rule out life-threatening conditions revealed bilateral subcutaneous emphysema, pneumomediastinum, pneumo-pericardium and pneumothorax. He was transferred to the intensive care unit. An intercostal drainage tube was inserted in the left pleural cavity. The patient was followed up with repeat chest X-rays. The patient’s symptom got relieved and was discharged after day 9. Diagnosis of pneumomedia-stinum may not be as lamentable as it is seen. Close cardio-pulmonary monitoring is mandatory for complications and accompanying conditions. Most patients with uncomplicated spontaneous pneumomediastinum respond well to oxygen and conservative management. In this case, the patient’s symptoms and severe tachypnoea prompted the insertion of an intercostal drainage tube.

A time and motion study in outdoor patient department of rural health training centre of tertiary medical college in Konkan region, India

Background: Purpose of time motion study is to know the time taken in different service delivery points in outpatient department (OPD), for specific activity, work function or mechanical process and to assess the perception of beneficiaries regarding the total time spent in the OPD. Therefore, the present study was conducted to study the operational efficiency and also to find the time required for various activities at different service points at rural health training centre attached to medical college.Methods: It was a cross-sectional study carried out in rural health training centre attached to BKL Walawalkar rural medical college, Sawarde), district Ratnagiri, Maharashtra, India over period of 6 month from July 2018 to December 2018. About 300 patients were included in the study.Results: According to 26.67% study participants, total time was too long. 26% study participants were not satisfied about the total time taken in the OPD while 50.34% study participants were satisfied regarding the total time.Conclusions: Patients satisfaction is the most important criterion to be met if more people are to be drawn into the hospital. Thus, improving the satisfaction of patients towards health care services by reducing their waiting time, by attending the patient in time will help to create a positive image of hospital in the mind of people and community.

Central obesity and lipid profile in North Indian Males.

Obesity is a known risk factor for metabolic syndrome in adults. Metabolic syndrome includes a group of cardiovascular disease risk factors namely impaired glucose tolerance, dyslipidaemia and hypertension. Central fat distribution, particularly intra-abdominal fat, is a greater risk factor than peripheral fat distribution. Anthropometric indices used to measure fat distribution have been shown to be associated with altered lipid profile. The objective of the present study was to compare the serum lipid profile levels in obese and non-obese males according to their Waist Circumference (WC) and Waist-Hip Ratio (WHR). A total of 60 males (aged 18-56 years, Mean age 31.00+11.81 years) were included in the study. WC and Hip Circumference (HC) were measured and WHR was calculated. An overnight fasting venous blood sample was drawn for lipid profile. Central obesity was defined as WC > 90 cm or WHR > 0.9. When compared according to WC and WHR, High Density Lipoprotein Cholesterol (HDL-C) was significantly decreased in obese compared to non-obese, while no significant change in Total Cholesterol (TC), Triglycerides (TG) and Low Density Lipoprotein Cholesterol (LDL-C) levels was observed. Both WC and WHR were positively correlated with TG, TC and LDL-C and negatively with HDL-C. The correlations with HDL-C were statistically significant. Thus, it can be concluded from our study that obesity measured either as WC or WHR is associated with altered lipid profile in the form of low HDL-C. In obese individuals the accompanying hyperinsulinaemia due to insulin resistance may be responsible for changes in lipid and lipoprotein concentration.

Comparison of common clinically used local anesthetics on animal models.

The animal models used in this study were Plexus anesthesia in frogs, Infiltration anesthesia in guinea pigs, Surface anesthesia in rabbits. The drugs were diluted with normal saline. Lignocaine2%: xylocaine hydrochloride injection IP, Bupivacaine 0.5%: Bupivacaine hydrochloride injections IP were prepared. Plexus anesthesia: Frog was pithed and spinal cord was destroyed up to the 3 vertebra. The abdominal pouch was filled with local anesthetic solution. Reflex activity was tested by immersing both feet of the frog every two minutes for not longer than 10 seconds into N/10 Hydrochloric acid. The time was noted. Surface anesthesia: Albino rabbits of either sex weighing 2.5 – 3.0kg ware selected. The conjunctival sac of one eye was held open, thus formed a pouch. 0.5ml of solution of the anesthetic was applied into the conjunctival sac for 30 sec. Infiltration anesthesia: Preparation of guinea pig: Guinea pigs (either sex) weighing 250-300grams were used. Lignocaine produced rapid onset of plexus anesthesia in Frogs in comparison to the bupivacaine at concentration of 0.1% & 0.2% which is statistically significant. Bupivacaine is more potent than the lignocaine as a surface anesthetic agent in the Rabbit, where as lignocaine could produce surface anesthesia at concentration of 0.5% or 0.1% or both. Both bupivacaine and lignocaine produced infiltration anesthesia on intradermal injection in guinea pigs but the duration of infiltration anesthesia produced by bupivacaine is more prolonged which is statistically significant in comparison to the lignocaine at all the three concentrations tested i.e. 0.05%, 0.1% & 0.2%.

Splenic tumor presenting as pyrexia of unknown origin.

Pyrexia of unknown origin has always been a challenging problem to diagnose for physicians. Here we present a case of a splenic tumor, which after histopathology and immunohistochemistry, two possibilities were considered, a diffuse large cell lymphoma--plasmablastic variant and second an anaplastic plasmacytoma. The patient was treated with chemotherapy and on followup he has no evidence of recurrence or any residual lesion.

Influence of years since menopause on bone mineral metabolism in South Indian women.

BACKGROUND: Although an increase of bone turnover has been documented at the time of menopause, the subsequent abnormalities of bone resorption and formation in the elder women have not been investigated. AIM: To assess bone turnover among different YSM (years since menopause) groups of postmenopausal women. SETTINGS AND DESIGN: A case control study in a tertiary care hospital. MATERIALS AND METHODS: Forty-seven premenopausal (control) women and 257 postmenopausal women were included in this study. Based on YSM, the postmenopausal women were divided into four groups namely, 1-5 YSM (n = 82), 6-10 YSM (n = 77), 11-15 YSM (n = 58) and > 15 YSM (n = 40). The levels of calcium, phosphorus, total alkaline phosphatase, FSH, LH, estradiol, intact-paratharmone and 25-hydroxy vitamin D in serum and urine levels of calcium, phosphorus and bone resorption marker calcium/creatinine(Ca/Cre) ratios were analyzed in all subjects. STATISTICAL ANALYSIS USED: One way ANOVA followed by Duncan's multiple range test. RESULTS: Significantly increased levels of FSH (P < 0.001) and declined levels of urine calcium (P = 0.015) and Ca/Cre ratios (P = 0.006) were observed in > 15 YSM group over 1-5 and 6-10 YSM groups. An inverse correlation was observed between serum FSH levels and urine Ca/Cre ratios (r = -0.655, P < 0.001) in > 15 YSM group. Comparable deficient estradiol levels were observed in all YSM groups. CONCLUSIONS: The risk of bone resorption is greater in early years than late years of menopause. The decreased bone resorption risk in late postmenopausal women might be due to increased FSH levels. However, further studies are required to explore this finding.

Macrophage activation syndrome.

Macrophage Activation Syndrome is a rare and potentially fatal disease, to be considered in patients with a SIRS like clinical presentation. Falling ESR and hyperferritinemia in the appropriate clinical setting can be the greatest clues. We report a case in which a female admitted with fever and rash, initially had systemic inflammatory response syndrome (SIRS) like clinical presentation, but eventually proved to be a rare case of fatal Macrophage Activation Syndrome.

Effects of exogenous vitamin C on ethanol toxicity in rats.

The effect of a mega dose of ascorbic acid (200 mg/100 g body wt.) on alcohol-induced toxicity in rats was evaluated. In rats administered alcohol and ascorbic acid, malondialdehyde (MDA), hydroperoxide and conjugated dienes decreased in comparison with that given alcohol alone. The reduced activities of scavenging enzymes, e.g. superoxide dismutase (SOD) and catalase, in ethanol-administered rats were also enhanced by the co-administration of ascorbic acid and ethanol. Co-administration of ethanol and ascorbic acid reduced phospholipids and MDA levels of the erythrocyte membrane in comparison with that of the ethanol fed rats. The reduction in the activities of glutamic oxaloacetic transaminase (GOT), glutamic-pyruvic transaminase (GPT), gamaglutamyl transpeptidase (GGT) and the decrease in triglycerides levels also clearly showed the protective action of ascorbic acid in reducing ethanol induced toxicity.

Prenatal exposure of an alcoholic beverage (Arrack) on fetal lipid metabolism in rats.

The objective of this study was to determine the effects of a country liquor (Arrack) and the equivalent quantity of ethanol on liver function and lipid metabolism in utero. Female rats of average weight 125 g were exposed to Arrack (12 ml/kg body weight/day) and ethanol (3.2 ml/kg body weight/day) for 15 days before conception and throughout gestation. On 13th day and 19th day of gestation, altered liver function and hyperlipidemia was seen in the fetus of both the treated groups. Altered liver function was evidenced by the increased activity of alcohol dehydrogenase and glutamic pyruvic transaminase or alanine amino transferase (GPT). Hyperlipidemia was caused by increased biosynthesis since the incorporation of 14C acetate to lipids and activities of HMG CoA reductase and lipogenic enzymes were elevated. Arrack seemed to potentiate the toxicity induced by alcohol indicating the role of non ethanolic portion. Hepatic functions of the 13th day fetuses were effected to a lesser degree than the 19th day hepatic liver.

Effect of ethanol/arrack on the lipid metabolism of mammary gland during pregnancy and lactation in rats.

Female rats were exposed to arrack (12.0 ml/kg body weight/day) and ethanol (4.0 g/kg body weight/day) before conception and throughout gestation and lactation. On 19th day of gestation and 21st day of lactation there was increase in the cholesterol phospholipids, triglycerides and free fatty acids in the mammary gland of rats administered arrack/ethanol in comparison with the controls. The lipoprotein lipase activity showed significant increase in the treated groups, in which the activity decreased on 21st day in comparison with 19th day. The absolute and relative weight of mammary gland also showed a significant decrease in ethanol/arrack treated group. The biochemical alterations produced in the mammary gland by arrack and its equivalent alcohol were different showing that non-alcoholic portion of arrack interferes with the toxicity induced by alcohol. Arrack was found to be a potent hyperlipidemic agent than ethanol.

Interaction of ethanol and ascorbic acid on lipid metabolism in guinea pigs.

Influence of excessive intake of ascorbic acid (AA) on alcohol induced hyperlipidemia was investigated. In the present study four groups of male guinea pigs were maintained for 30 days as follows: (1) Control group (1 mg AA/100 g body wt). (2) Ethanol group (I mg AA + 9 g ethanol/100 g body wt). (3) AA group (25 mg AA/100 g body wt). (4) AA + Ethanol group (25 mg AA/100 g body wt + 9 g ethanol 100 g body wt). It was shown that tissue ascorbic acid concentration increased with the intake of mega dose of AA. Alcohol administration depleted tissue ascorbic acid content. But coadministration of AA and alcohol enhanced AA levels in comparison with the ethanol group. Alcohol induced hyperlipidemia was reduced in almost all the tissues by the intake of ascorbic acid. This was observed to be due to increased hepatic catabolism of cholesterol to bile acids. However cholesterogenesis was enhanced as evidenced by the increased HMG CoA activity. Thus the results indicate that the mega dose of AA ingestion is beneficial in reducing alcohol induced hyperlipidemia and AA deficiency.

Diamine oxidase of Lathyrus sativus seedlings. Purification and properties.

Diamine oxidase (EC 1.4.3.6) was purified from 5-day-old etiolated seedlings of Lathyrus sativus by MnCl2 treatment, (NH4)2SO4 and acetone fractionations, DEAE-Sephadex chromatography followed by gel filtration on Sephadex G-200. A single step purification of the enzyme was achieved by using an immunoaffinity column, wherein rabbit antibodies to the homogeneous diamine oxidase were coupled to CNBr-activated Sepharose. The enzyme thus obtained was homogeneous by electrophoretic, immunological and ultracentrifugal criteria. It had an Mr of 148,000 (6·46S) and was a dimer with similar sub-units (Mr 75,000). Amino acid analysis showed the absence of cysteine residues although it contained five disulphide bonds. The enzyme had copper (2·7 g atom/mol enzyme) but was not a glycoprotein. No absorption maximum in the visible region was detectable. Ethylenediamine 1,3-diaminopropane and histamine were potent competitive inhibitors for the substrate putrescine. The addition of monospecific antibodies to the enzyme increased the Km for benzyl amine without any change in the Vmax. Diamine oxidase from pea seedling, partially purified, exhibited complete crossreactivity with the antibodies to the L. sativus enzyme.