Asymptomatic Renal Function Abnormalities in Patients having Silicosis

Background: A number of occupational exposures are associated with various types of renal dysfunction. Several studies for many years have drawn attention to renal dysfunction and nephrotoxicity among workers exposed to silica. This study was conducted to evaluate renal dysfunction, if any, among Indian patients having silicosis and its correlation with the duration of exposure to silica dust. Materials and methods: This study includes 52 eligible patients with a history of silica dust exposure and silicosis confirm on radiological examination by the pneumoconiosis board. Investigations like serum creatinine, urinary albumin creatinine ratio, etc. were done. The “modification of diet in renal disease” (MDRD) formula was used to calculate the glomerular filtration rate (GFR). Results: This study showed 53.84% of patients (n = 28) having albuminuria and a mean “urinary albumin to creatinine ratio” (UACR) of 101.88 ± 128.99 mg/gm. Isolated macroalbuminuria was detected in 11.5% of patients (n = 6) while 42.3% of patients (n = 22) presented with microalbuminuria. The mean GFR was 81.94 ± 22.09 mL/min/1.73 m2 among study patients of which four (7.7%) patients had GFR value <60 mL/min/1.73 m2 . We could also identify a significant association between the duration of exposure to silica dust and UACR and GFR (p < 0.01). Conclusion: Albuminuria and reduced estimated GFR in patients with silica dust exposure is not uncommon and reflect early underlying renal dysfunctions. Our study suggests a simple and cost-effective screening strategy for early detection of renal dysfunction among silicosis patients that may be considered as a tool to prevent further renal damage in such patients.

An improved method for isolation of high-quality RNA from starch-rich wheat grains

Aim: The aim of the present investigation was to develop a quick, easy and reliable method for isolation of RNA from starch rich mature wheat grains; and to check the quality of isolated RNA for downstream applications.Methodology: In the present protocol, highly efficient modified RNA extraction buffer [100 mM Tris (pH 9.0), 150 mM NaCl, 50 mM EDTA, 1.5% sodium dodecyl sulfate (SDS) and 1.5% 2-mercaptoethanol] was used, subsequently followed by TRIzol extraction. Carryover starch was effectively solubilized by adding NaCl before RNA precipitation step. RNA quality was assured by agarose gel electrophoresis, spectrophotometric analysis and quantitative real-time PCR. Results: The problem of co-precipitation of starch along with RNA was resolved effectively. Intact sharp bands of 18S and 28S rRNA on agarose gel confirmed the integrity of isolated RNA. The average A260/A280 ratios ranged from 2.06 to 2.11 and A260/A230 ratio was higher than the respective A260/A280 ratio, indicating high purity of isolated RNA. The isolated RNA was found suitable for gene expression analysis through quantitative real-time PCR. Interpretation: An improved quick, easy and reliable method developed for isolation of high-quality RNA from starch-rich mature wheat grains could be useful for downstream molecular analysis

Adult T-cell leukemia/lymphoma and acquired immunodeficiency syndrome - CD4+ T-cell malignancy in CD4+ T-cell deficient status: A paradox

CD4 counts along with viral loads are important parameters in the monitoring of human immunodeficiency virus (HIV) infection. Human T-cell lymphotropic virus type I (HTLV-I) is known to be an etiological agent for adult T-cell leukemia/lymphoma (ATLL). Coinfection of HTLV-I and HIV is well known in regions with high seroprevalence, and there is no published data in the Indian scenario. We present an interesting case of occurrence of CD4+ T-cell proliferation in a known beta thalassemia major with acquired HIV seropositivity accompanied by simultaneously increasing CD4+ counts and viral loads. Further workup revealed ATLL with an underlying HTLV infection.

Fixed Dose Combination Of Drugs: Are They Justified.

Abstracts: Background:Fixed Dose Combinations (FDCs) are combinations of two or more active drugs in a single form. Prescribing FDCs has become a routine affair in medical practice. Combination drugs increase the compliance of patient to the treatment, decrease the pill burden, but may also lead to increase in the cost of the treatment and side effects. There has been increase in the irrational FDCs in the recent past. The rationality of a fixed dose combination is the most controversial and debated issue in today’s clinical practice. The eighteenth essential medicine list (EML) of WHO includes 25 FDCs while as the 2011 national list of essential medicines (NLEM) of India includes only18 FDCs. Contrary to this Indian market is flooded with FDCs, the scientific rationale for most of these remains unknown. In India, a fixed dose combination of drugs is considered a “NEW DRUG” and has to be approved by Drugs Controller General, India (DCGI). However, the Indian laws governing the approval and marketing of FDCs are not properly defined, the pharmaceutical manufactures take advantage of these loopholes and market combination that have no pharmacological rationale.

Sunitinib in patients with imatinib‑resistant gastrointestinal stromal tumor: A single center experience.

AIM: The outcome of patients with advanced gastrointestinal stromal tumor (GIST) has improved with the use of imatinib. Despite high response rates with this drug resistance eventually develops in nearly all patients. We present an analysis of prospectively collected data on sunitinib efficacy and safety in patients with imatinib‑resistant GIST. SUBJECTS AND METHODS: Between November 2006 and October 2007, patients with GIST were accrued in an approved sunitinib patient access protocol. Key eligibility criteria included tumor resistance to imatinib and/or patient intolerance to this drug. Patients received sunitinib at a starting dose of 50 mg once daily for 4 weeks in a 6 week cycle, with standardized dose modification titrated to toxicity. Patients were continued on sunitinib until disease progression or unacceptable toxicity. The endpoints were safety, overall survival (OS) and objective response rate (ORR). RESULTS: Fifteen patients, all of whom had imatinib resistance and none intolerance, with median age of 48 (26–69) years, were treated on the protocol. The most common sites of primary disease were small intestine (40%), stomach (26.7%) and retroperitoneal (26.7%). A median of 10 (1–47) cycles of sunitinib were delivered, 9 (60%) patients required dose reductions due to toxicity whereas dose delay of > 2 weeks was required in only one (6.7%) patient. There were no toxicity‑related drug discontinuations. Hypothyroidism (n = 4; 26.7%) and hand‑foot syndrome (n = 3; 20%) were the most common toxicities. There were no complete and 4 (26.7%) partial responses while prolonged disease stability was seen in 8 (53.3%) patients. At a median follow‑up of 81 months in surviving patients, the median progression‑free and overall survivals were 15.5 and 18.7 months, respectively. CONCLUSIONS: Sunitinib appears to be an effective and well‑tolerated treatment for Indian patients with imatinib‑resistant GIST with outcomes similar to that reported previously. Adverse effects can be reasonably well managed using a dose modification strategy.

A study on estimation of time since death after histological examination of kidney.

Background: Estimation of time since death is one of the most important object of post-mortem examination. Many degenerative changes begin to take place in the body immediately or shortly after death. Kidney is one of the most important excretory organs of human body, its undergo series of gross as well as histological changes. Methods: This study was performed in department of anatomy in close association with the department of forensic medicine & toxicology and pathology, Pt. J. N. M. medical college and DBRAM hospital Raipur (C.G.) India, during study period November 2012 to October 2013. Study was done on 50 human cadavers (Study subjects). Kidney was obtained from dead bodies during post-mortem examination. In each case kidney was studied histologically. Data was compiled in MS excel and checked for its completeness and correctness and then it was analyzed. Results: In 48-60 hour increasing temperature, one case show very severe change was seen. Microscopic changes in kidney were increasing (mild to moderate, moderate to severe, severe to very severe) as temperature increases. Conclusion: In the present study earliest remarkable postmortem histological changes were seen in DCT. Finding of present study will be useful for forensic experts.

Cerebroprotein hydrolysate: Innovation in Neurodegenerative disorders.

Stroke, traumatic brain injury and neurodegenerative disorders are one of the leading causes of death and disability in both developing and developed countries. A number of drugs including neurotrophic drugs are available for these disorders. Cerebroprotein hydrolysate is the latest one offering new hopes to patients suffering from these disorders. Its superiority is because of different actions which help in faster and more complete nerve repair and growth than other neurotrophic agents. It acts by multiple mechanisms viz.-regulation and improvement of the neuronal metabolism, modulation of the synaptic plasticity, promoting neuronal differentiation and protection against ischemic and neurotoxin lesion, reducing excitotoxic damage, blocking over activation of calcium dependent proteases, and scavenging free oxygen radicals. Till now no serious adversity has been reported.

Preparation and evaluation of calcium silicate based floating microspheres of amoxicillin.

The aim of the present study was to prepare and evaluate floating microspheres consisting of (i) calcium silicate (CS) as porous carrier; (ii) famotidine and (iii) hydroxypropyl methylcellulose (HPMC) and ethylcellulose (EC) as polymers. The floating microspheres were evaluated for particle size, micromeritic properties, percent drug content, in vitro floating behavior, and in vitro drug release. The percentage yield of floating microspheres of formulations (AM1 to AM9) was found to be in the range of 78.21 ± 1.09 to 93.56 ± 2.79 %. Percentage drug content of formulations (AM1 to AM9) were found in the range of 79.89 ± 2.19 % to 87.74 ± 1.24 %. In Vitro Buoyancy percentage of the microspheres was found to be 98.75±3.62 At pH 1.2, drug release from floating microsphere containing amoxicillin formulation AM4 was found to be 98.87 ± 0.67 % at the end of 12 hr. While at pH 7.4, Formulation AM4 released 99.23 ± 0.94 % of drug at 12 hr respectively. The SEM photographs of formulation AM4 showed that the fabricated microspheres were spherical with a smooth surface and exhibited a range of sizes within each batch. The results suggested that Calcium Silicate is a useful carrier for the development of floating and sustained release preparations.

Nasal spirometery.

Nasal obstruction is a common symptom which is difficult to quantify clinically. Rhinomanometry, Acoustic Rhinometry and Forced Oscillation methods are available for estimating nasal resistance but, these require sophisticated machines. Because of limited availability of these techniques, this potential physiological measure has not been tapped fully for research and clinical purposes. Here, we describe the use of pulmonary spirometer with little modification for quantification of nasal flow. Nasal inspiratory and expiratory flow rates along with oral inspiratory and expiratory flow rates are used to derive different nasal resistance indices. This way of reporting nasal resistance is not new but, the data for these variables is currently not available in published literature. The reproducibility of nasal flow rates were tested as variation after one day and the interclass coefficient for inspiratory and expiratory nasal flow rates were found to be with in acceptable limits. Thus, nasal spirometery is able to describe the nasal resistance in a reliable manner and may be used to quantify nasal obstruction in pathological condition and also to study the physiological phenomenon like nasal cycle.

Circadian rhythm of peak expiratory flow rate in healthy north Indian men.

Peak expiratory flow rate (PEFR) variability follows a specific pattern in asthmatics as well as in healthy individuals. There is scarcity of data for Indian healthy subjects. The PEFR (L/min.) was measured with Wright's portable peak flow meter at 05:00, 8:00, 11:00, 14:00, 17:00, 20:00 and 23:00 hours in 42 healthy, non-smoking adults of age group between 18-26 years. The variability of PEFR revealed a circadian pattern. PEFR levels tend to increase from morning at 5:00 hours till evening at 17:00 hours, with peak PEFR in evening at 17:00 hours, after which there was a progressive fall in PEFR levels, till morning 5:00 hours. This study provides the preliminary reference data of circadian pattern of PEFR in healthy individuals.

Comparison of scholastic performances of left handed and right handed students.

An attempt was made to compare the scholastic performance among left and right handed students. Both academic and extra curricular areas were studied among 3608 students from 6th to 12th class, from 10 schools in a rural subdivision of north east Rajasthan. General incidence of left handedness was 8.6% among students, higher in females (12.4%) as compared to males (8.1%). Right handed students performed better in aggregate as well as in individual academic areas (p < 0.05). Left handed students were extreme performers as far as sports and games area was concerned, while right handed students tended to be average performers. Overall handedness affected both the academic and extra-curricular activities except behavior and discipline area (p > 0.05).

Multiple traumatic bone cysts of jaws. Report of a case.

An unusual case of bilateral traumatic bone cyst occurring simultaneously in both jaws is being reported. The clinical features and treatment plan for these cysts have been discussed. It has been seen that exploration of such cystic cavity results in a rapid healing of the defect in a short span of time.

Effect of chemotherapy on cell counts in peripheral blood & bronchoalveolar lavage of patients with pulmonary tuberculosis.

Cell counts in peripheral blood and bronchoalveolar lavage fluid were estimated in 38 patients with active tuberculosis; 12 patients with tuberculosis who had successfully completed more than 9 months of chemotherapy with isoniazid, rifampicin, and ethambutol; 10 Mantoux negative bronchitic subjects; and 6 control subjects. There were 50 males and 16 females aged 16-50 yr. Age, haemoglobin, total and differential serum proteins, were comparable in the various groups. Patients with active tuberculosis had higher ESR and significantly raised absolute (2.24 +/- 0.13 x 10(3); P less than 0.05), B (0.56 +/- 0.03 x 10(3); P less than 0.01) and Null lymphocyte counts (0.56 +/- 0.05 x 10(3); P less than 0.01) in blood. After chemotherapy there was no significant change in lymphocyte counts (2.43 +/- 0.21; P greater than 0.05). In bronchoalveolar lavage (BAL) total cell counts were increased five fold in patients with active disease (40.8 +/- 5.79 x 10(4)/ml) and although these showed considerable reduction after therapy they were higher (18.33 +/- 4.73 x 10(4)/ml) than those in controls (8.3 +/- 1.2 x 10(4)/ml; P greater than 0.05). In bronchitic subjects, total cell counts and macrophage counts in BAL fluid were elevated (P less than 0.01; less than 0.05 respectively) but lymphocyte counts were comparable to controls (3.4 +/- 1.35 x 10(4)/ml vs 1.09 +/- 0.19 x 10(4)/ml; P greater than 0.05). Lymphocytosis in the bronchoalveolar lavage fluid of patients with pulmonary tuberculosis persisted even after adequate treatment.

Monocyte/macrophage functions & humoral response in blood & bronchoalveolar lavage fluid of pulmonary tuberculosis patients.

Subsegmental bronchoalveolar lavage (BAL) was performed in 33 patients with active pulmonary tuberculosis and five control subjects. Phagocytosis by monocytes and alveolar macrophages was studied, and in addition serum and BAL immunoglobulin and complement levels were also determined. The phagocytic activity of blood monocytes was depressed in pulmonary tuberculosis patients as compared to controls, 37.8 +/- 2.3 per cent; 50.7 +/- 4.2 per cent and 32.9 +/- 3.6 per cent for sheep RBC's, latex and Staphylococcus aureus respectively compared to 66.7 +/- 6, 54.8 +/- 2.2 and 68.3 +/- 3.5 per cent respectively in controls; the differences being significant for sheep RBC's (P less than 0.05) and Staph. aureus (P less than 0.001). However, phagocytosis was not impaired in BAL macrophages (P greater than 0.05). In patients no significant alteration in serum immunoglobulin and complement levels was observed except that levels of C4 component of complement were increased in patients with far advanced lesions (98.5 +/- 33.7 mg/dl compared to 78.7 +/- 7.9 mg/dl; P less than 0.05). While IgM and C4 component of complement could not be detected in BAL fluid the levels of IgA were significantly increased in pulmonary tuberculosis patients (65.5 +/- 50.5 mg/dl compared to 39.9 +/- 13.3 mg/dl in control; P less than 0.05). Since IgA secreted in the BAL fluid is mostly synthesised locally, increased levels of this immunoglobulin could be of value in determining activity of the disease.