Cadmium tolerance and antibiotic resistance in Escherichia coli isolated from waste stabilization ponds.

The incidence pattern of cadmium tolerance and antibiotics resistance by Escherichia coli was examined periodically from the samples of water, sludge and intestine of fish raised in waste stabilization ponds in a sewage treatment plant. Samples of water and sludge were collected from all the selected ponds and were monitored for total counts of fecal coliform (FC), total coliform (TC) and the population of Escherichia coli, which was also obtained from the intestine of fishes. Total counts of both FC and TC as well as counts of E. coli were markedly reduced from the facultative pond to the last maturation pond. Tolerance limit to cadmium by E. coli tended to decline as the distance of the sewage effluent from the source increased; the effective lethal concentration of cadmium ranged from 0.1 mM in split chamber to 0.05 mM in first maturation pond. E. coli isolated from water, sludge and fish gut were sensitive to seven out of ten antibiotics tested. It appears that holistic functions mediated through the mutualistic growth of micro algae and heterotrophic bacteria in the waste stabilization ponds were responsible for the promotion of water quality and significant reduction of coliform along the sewage effluent gradient.

Cadmium tolerance and antibiotic resistance of Pseudomonas sp. isolated from water, sludge and fish raised in wastewater-fed tropical ponds.

The numbers of Pseudomonas sp. isolated were counted in samples collected from water, sludge and intestine of fishes raised in different wastewater ponds along an effluent gradient in a sewage treatment plant. Total fish yield in the last maturation pond increased by 73% over the yield in first maturation pond or facultative pond. The number of Pseudomonas sp. isolated from the intestine of the tilapia (Oreochromis mssambicus) raised in facultative pond, was more than three times the counts (7.22 × 108/g) observed in the last maturation pond (2.025 × 108/g). The effective lethal concentration of cadmium for Pseudomonas sp. isolated from the intestine of the tilapia was 0.6 mM and 0.08-0.09 mM when the fish was procured from facultative pond and last maturation pond, respectively. The Pseudomonas sp. isolated from the intestine of the tilapia did not have resistance to any of the ten antibiotics tested. However, the bacterium isolated from raw sewage, water and sediment of the anaerobic pond was resistant to seven out of ten antibiotics tested.

Nemaline rod myopathy: a rare form of myopathy.

Nemaline rod myopathy (NM) is a rare form of congenital myopathy characterized by slowly progressive or nonprogressive muscle weakness and pathognomonic rod-like structures within the muscle fibers. To the best of our knowledge, this is first documentation of the clinicopathological features of this rare entity from India. All cases of NM diagnosed in our laboratory were retrieved. Clinical and pathological features were reviewed. During a period of 1.5 years (Jan 2004 to June 2005), we received 750 muscle biopsies for various reasons. Of which, 15 were diagnosed as congenital myopathies and four as nemaline rod myopathies. Thus, NM comprises 0.53% of all muscle diseases and 22.6% of all congenital myopathies. All of them presented in childhood (first five years of life) with generalized hypotonia, feeding problems, repeated respiratory infections and muscle weakness. Both males and females were equally affected. The CPK levels were normal and EMG was myopathic. Microscopic examination revealed minimal changes but characteristic red-colored material was seen on modified Gomori trichrome staining which was immunopositive to alpha actinin. Ultrastructural examination confirmed this material to be nemaline rods. NM, although a rare form of congenital myopathies, should be suspected in children who present with generalized hypotonia, repeated chest infections and slowly progressive muscle weakness. This report highlights the importance of histochemistry and ultrastructural examination in the diagnosis of this entity, in the absence of the availability of methodology for genetic studies.

Etiology based prevalence of Budd-Chiari syndrome in eastern India.

BACKGROUND: Diagnosis of Budd-Chiari syndrome (BCS) is often missed unless its possibility has been kept in mind. Obstruction of inferior vena cava (IVC) is reportedly the most frequent cause of BCS in Afro-Asian variety. AIM: An attempt was made to classify BCS (in an eastern Indian population) etiopathologically. PATIENTS AND METHODS: Thirty consecutive cases of BCS presenting over a period of five years were included. Following a thorough physical examination, necessary investigations (including coagulation profile, ultrasonography (with Doppler study) of hepatobiliary tract, hepatic vein and IVC angiography (n = 22) and liver biopsy (n = 26, including autopsy in two cases) were performed. RESULTS: Mean age at presentation was 32.7 +/- 10.36 years (range 12-60 years) with M:F = 21:9. Clinical presentations included, hepatomegaly in 28 (93.3%), ascites in 27 (90%), splenomegaly in 15 (50%), pain in abdomen in 26 (86.6%), jaundice in 10 (33.3%), back veins in 20 (66.6%) and gastrointestinal bleeding in three (10%) cases. Amongst the total of 30 patients, four, six and 20 cases presented as fulminant, acute and chronic BCS respectively. Twenty four cases of BCS could be diagnosed by ultrasonography alone, while the remainder required angiography for diagnosis. IVC and hepatic vein angiography revealed membranous obstruction in nine, partial stricture of IVC in six, and IVC and/or hepatic vein block in others. The etiopathological nature in 30 cases were as follows: idiopathic membranous obstruction in nine (30%), hepatocellular carcinoma in six (20%), idiopathic stricture in six (20%) cases and one case (3.3%) each of the following: cholangiocarcinoma, renal cell carcinoma, chronic pancreatitis, hydatid cyst in liver, protein S deficiency, oral contraceptive use, nephrotic syndrome (with antithrombin III deficiency), polycythemia rubra vera and chronic lymphatic leukemia. CONCLUSION: Idiopathic membranous obstruction and stricture of IVC are the commonest cause of BCS in the eastern part of India. Hepatocellular carcinoma is also a common cause, presenting in the fulminant form. Ultrasonography may be a helpful screening test for BCS, but IVC and hepatic vein catheterisation is essential for a complete work up of these patients.

Primary pulmonary hypertension in cirrhosis of liver.

BACKGROUND: Primary pulmonary hypertension (PPH) is a grave association of portal hypertension, and is potentially fatal in liver transplant candidates. AIM: To investigate the prevalence of PPH among cirrhotics with portal hypertension. METHODS: 43 cirrhotics with portal hypertension (Child B 22, C 14), after screening for cardiopulmonary diseases, were evaluated by hemodynamic study. RESULTS: PPH was detected in 2 cases (4.7%), both in Child B, hepatitis B and C viruses being the etiologies. Neither had portal axis thrombosis. Two other cases also had pulmonary hypertension, but with high pulmonary capillary wedge pressure (PCWP). The 41 cases without and 2 cases with PPH had, respectively, mean pulmonary artery pressure (MPAP) 16.3 (5.9) mmHg, 26 mmHg and 33 mmHg; PCWP 11.5 (6.7) mmHg, 12 mmHg and 11 mmHg; transpulmonary pressure gradient 4.8 (2.6) mmHg (n = 27), 14 mmHg and 22 mmHg; and pulmonary vascular resistance 80.2 (55.8) dyne.sec.cm-5 (n = 27), 155.6 dyne.sec.cm-5 and 366.7 dyne.sec.cm-5. No correlation of MPAP was found with either Child-Pugh scoring (r2 = 0.0347) or with hepatic venous pressure gradient (r2 = 0.0021). CONCLUSION: PPH has a prevalence of 4.7% among cirrhotics with portal hypertension; it bears no relation with severity of liver disease.

Effects of the menstrual cycle on timing and depth of breathing at rest.

Volume and timing components of resting ventilation were measured serially in 40 women aged 18 to 36 yr, during menstrual, follicular and luteal phases of menstrual cycle. Resting minute ventilation (VE) was significantly higher (P < 0.001) in luteal phase than in menstrual and follicular phases; in the two latter phases VE was almost equal. This increment in VE during the luteal phase was due to a significant rise (P < 0.001) in tidal volume (VT). Respiratory frequency (f) was unchanged throughout the cycle. Although there was a mean increases in inspiratory time (T1) during the luteal phase compared to the other two phases, the difference did not reach statistical significance. Duty cycle, T1/Ttot, was also unchanged throughout menstrual cycle. However, mean inspiratory flow, VT/T1, was significantly higher (P < 0.05 and P < 0.01) during luteal phase as compared to that during menstrual or follicular phases respectively. Pulmonary mechanics, as measured by forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and forced mid expiratory flow rate (FEF25%, 75%), were within normal limits and remained unaltered during the menstrual cycle. Therefore, in the absence of alteration of pulmonary mechanics, the luteal increase in ventilation and inspiratory flow suggests a possible role for progesterone in stimulating the respiratory drive, either centrally or through the peripheral chemoreceptors or by both.

Timing and magnitude of changes in basal energy expenditure during pregnancy in Indian women.

Basal energy expenditure (BEE) was determined in 291 pregnant women, age 20-35 years, using Benedict Roth Metabolism Apparatus. A control study was undertaken in 38 non pregnant women during both follicular and luteal phases of menstrual cycle respectively. The mean +/- SD of BEE were found to be 34.04 +/- 3.05, 35.85 +/- 2.60 and 39.69 +/- 2.75 Kcal/m2/hr during first, second and third trimesters of pregnancy respectively. BEE was progressively and significantly increased (P < 0.01). However, increase in BEE during first trimester of pregnancy compared to that of luteal phase of menstrual cycle was insignificant. The results indicate that Indian pregnant women should maintain energy requirements by increasing caloric intake throughout the gestation.

Role of circulating immune complexes in prognostic evaluation and management of genitourinary cancer patients.

Circulating immune complexes (CIC) were estimated in 48 Patients of genitourinary cancer by polyethylene glycol precipitation (PEG pptn.) test and latex agglutination inhibition (LAI). The results were compared with 25 healthy control volunteers. Pathological levels of CIC were observed in 79.18 percent patients of genitourinary cancer by combination of PEG pptn. and LAI tests, while no seropositivity for CIC was observed in control group (p < 0.001). Sequential increase in seropositivity for CIC was observed with advancing stage of genitourinary cancer i.e. number of seropositive patients in cancer stage I were 60 percent, stage II-71.42 percent, stage III-85.71 percent and stage IV-100 percent. Variation IN CIC levels in different patients within the same stage are compared. Circulating antigen antibody complexes have a significant role as prognostic monitors in management of genitourinary cancer patients. Statistical evaluation of data on intra- and inter-assay variation has been given. CIC levels rise with increases in tumor burden in vivo hence variation in CIC levels within the same stage in different patient have a significant role as prognostic monitors in management of individual patients.

Primary pulmonary hypertension in non-cirrhotic portal fibrosis.

BACKGROUND: Primary pulmonary hypertension (PPH) has been reported in association with cirrhosis and extrahepatic portal venous obstruction; reports of PPH in noncirrhotic portal fibrosis (NCPF) are few. AIM: To evaluate pulmonary arterial pressure in patients with NCPF. METHODS: Twenty two patients with NCPF underwent hemodynamic studies for pulmonary arterial pressure after excluding secondary causes of pulmonary hypertension. Hemodynamic studies were carried out through the femoral route using 7F Swan-Ganz catheter. Splenoportal venography was done by percutaneous splenic puncture. RESULTS: The mean pulmonary arterial pressure was 12.9 +/- 3.1 mmHg with pulmonary capillary wedge pressure of 8.3 +/- 2.1 mmHg in 20 of 22 cases; in the remaining two cases, the corresponding pressures were 30 mmHg and 28 mmHg and 13 mmHg and 12 mmHg, respectively. CONCLUSION: Two of 22 patients with NCPF had PPH. PPH can thus develop without hepatocellular failure or recurrent embolization from portal axis thrombosis as has been described in cirrhosis.

Serum calcium, magnesium and inorganic phosphorous levels during various phases of menstrual cycle.

Serum Calcium (Ca), Magnesium (Mg) and Inorganic phosphorous (Pi) were investigated serially during menstrual, follicular, ovulatory and luteal phases of menstrual cycle in 25 healthy medical student volunteers. The result shows significant cyclic variations within physiological limits in all parameters. Ca level was highest during ovulation (P < 0.001) and lowest during luteal phase (P < 0.001) compared to other phases. Exactly opposite result was observed for Ca level. It is lowest during ovulation (P < 0.001) and highest during the luteal phase (P < 0.001). However, the highest level of Pi was seen during menstrual phase (P < 0.001) and lowest during the luteal phase (P < 0.001). These changes are probably brought about under the influence of cyclic variations of the ovarian hormones.

Prognostic significance of circulating immune complexes in malignant tumours of head and neck.

Circulating immune complexes (CIC) were estimated in 31 cases of head and neck malignancies by polyethylene glycol (PEG) precipitation and latex agglutination inhibition (LAI) techniques. Results were compared with 25 age and sex-matched control volunteers. Seropositivity for CIC by PEG precipitation test was 54.83% compared to 61.29% by LAI test. No positive case was detected in control group. Seropositivity for CIC by combination of both test results was 67.74%. In stage I cancer seropositivity for CIC by both techniques was 33.33%. In stage II it was 36.36% by PEG precipitation test and 45.45% by LAI test. In stage III it was 64.28% by PEG precipitation test and 71.42% by LAI test. In stage IV all cases were seropositive by both techniques. LAI test was more sensitive in CIC detection in cancer stages II and III. PEG precipitation test had the advantage of detecting quantitative CIC levels by PEG index. Follow-up in 10 postoperative cases revealed significant decline in CIC levels by both tests (p < 0.01) after 3 months of surgery; 90% patients became seronegative for CIC by PEG precipitation technique while 80% became seronegative by LAI technique. However, 15 patients were followed up after 3 1/2 years of surgery; 75% patients remained seronegative while 25% patients became seropositive by both tests and manifested clinical recurrences.

Maternal airways function during normal pregnancy.

Forced vital capacity, Forced expiratory volume in 1 second, expiratory flow rates and V max at different lung volumes were statistically unchanged during the course of pregnancy compared to non pregnant control group. There was no restrictive or obstructive defects during the course of pregnancy despite the added mechanical load to the respiratory apparatus by the gravid uterus.

Basal oxygen consumption during different phases of menstrual cycle.

Basal oxygen consumption was measured serially in 32 women aged 17 to 28 yr, during the menstrual, follicular and luteal phases of the menstrual cycle, using Benedict-Roth Metabolism Apparatus. The mean (+/- SD) total body oxygen consumption was found to be 166.54 +/- 13.904, 166.24 +/- 13.688 and 176.51 +/- 14.780 ml/min during the menstrual, follicular and luteal phases respectively. The oxygen consumption was significantly higher (P less than 0.001) in the luteal phase as compared to the other two phases whereas it was almost identical in the menstrual and follicular phases. The rise in oxygen consumption was found to be a post-ovulatory phenomenon possibly mediated through hormones, mainly progesterone. This rise in oxygen consumption was mainly metabolic and related to the pattern of food intake behaviour during the menstrual cycle.