A cross sectional study of clinical profile and evaluation of pulmonary hypertension in Chronic Obstructive Pulmonary Disease patients in a tertiary care hospital of Mangalore, India

Background: The objectives was to study the clinical profile of COPD patients and to evaluate pulmonary hypertension in COPD patients by non-invasive methods.Methods: A prospective observational study of patients who satisfy all inclusion and exclusion criteria in OPD or admitted in medical wards of AJIMS Mangalore. The study was conducted from October 2017 to October 2018 with the sample size of 90 subjectsResults: Out of 90 subjects 53 (58.8%) of them had pulmonary hypertension. Among the subjects who had pulmonary hypertension 29 (54.72%) of them had moderate pulmonary hypertension, 17 (32.08%) of them had severe pulmonary hypertension and 7 (13.20%) of them had mild pulmonary hypertension. Mean age among the subjects who had pulmonary hypertension was 64.24+7.62yrs and mean age among the subjects who didn’t had pulmonary hypertension was 51.87+8.97yrs. There was a statistically significant difference found between mean age and pulmonary hypertension. Mean duration of diseases among the subjects who had pulmonary hypertension was 8.13+1.74yrs and Mean duration of diseases among the subjects who didn’t had pulmonary hypertension was 5.36+1.98yrs. There was a statistically significant difference found between mean duration of disease and pulmonary hypertension.Conclusions: Due to high prevalence of pulmonary hypertension we suggest screening for the all COPD patients for cardiac complications. This will help in identifying the individual who requires close monitoring and also in reducing the mortality.

Pediatric Appropriate Evaluation Protocol for India (PAEP-India): Tool for Assessing Appropriateness of Pediatric Hospitalization

Objectives: To develop and assess Pediatric AppropriatenessEvaluation Protocol for India (PAEP-India) for inter-rater reliabilityand appropriateness of hospitalization.Design: Cross-sectional study.Setting: The available PAEP tools were reviewed and adaptedfor Indian context by ten experienced pediatricians followingsemi-Delphi process. Two PAEP-India tools; newborn (?28 days)and children (>28 days-18 years) were developed. These PAEP-India tools were applied to cases to assess appropriateness ofadmission and inter-rater reliability between assessors.Participants: Two sets of case records were used: (i) 274cases from five medical colleges in Delhi-NCR [?28 days (n=51);>28 days to 18 years (n=223)]; (ii) 622 infants who werehospitalized in 146 health facilities and were part of a cohort (n=30688) from two southern Indian states.Interventions: Each case-record was evaluated by twopediatricians in a blinded manner using the appropriate PAEP-India tools, and ‘admission criteria’ were categorized asappropriate, inappropriate or indeterminate.Main outcome measures: The proportion of appropriatehospitalizations and inter-rater reliability between assessors(using kappa statistic) were estimated for the cases.Results: 97.8% hospitalized cases from medical colleges werelabelled as appropriate by both reviewers with inter-rateragreement of 98.9% (k=0.66). In the southerm Indian set ofinfants, both reviewers labelled 80.5% admissions as appropriatewith inter-rater agreement of 96.1% (k= 0.89).Conclusions: PAEP-India (newborn and child) tools are simple,objective and applicable in diverse settings and highly reliable.These tools can potentially be used for deciding admissionappropriateness and hospital stay and may be evaluated later forusefulness for cost reimbursements for insurance proposes.

Laser Treatment of a Tracheal Inflammatory Myofibroblastic Tumor

Background: Inflammatory myofibroblastic tumors of the trachea are rare childhoodquasi-neoplastic lesions. Case characteristics: 7-year-old boy with recurrent episodesof cough, breathing difficulty and wheeze, initially treated as asthma. Intervention: CTchest and flexible bronchoscopy revealed a mass lesion of the trachea, which wasexcised by diode laser through the ventilating bronchoscope. Histopathology confirmed itas the inflammatory myofibroblastic tumor. Message: Use of laser ensured completeendotracheal excision of the tumor.

Variation Of Roots In The Formation Of Median Nerve

Background: Median nerve formation exhibits several variations in the form of additional roots and /orcommunications which are relevant to the surgical explorations of shoulder, axilla and arm.Aim: To study the variations in the formation of median nerve and its communications with musculocutaneousnerve in cadaveric upper limbs.Materials and Methods: The study was done in 34 formalin fixed cadavers (68 upper limbs) and 10 isolatedlimbs. All cadavers were conventionally dissected and observed for median nerve formation and dissected up tocubital fossa for presence of any communications.Observations: Out of the 78 upper limbs dissected, 12 limbs (15.38%) showed two lateral roots and one medialroot contributing to the formation of median nerve. One case of bilateral presence of extra lateral root wasfound. The extra lateral root or communication from the musculocutaneous nerve was arising distal tocoracobrachialis in 2 cases and proximal to the muscle in 10 cases. In three cases, absence of musculocutaneousnerve was observed and median nerve was supplying either all or some muscles of the flexor compartment. Oneof the cases of absent musculocutaneous nerve had two medial roots and one lateral root that is a very rarecombination of variation not reported in the literature. In all cases of two lateral roots, the median nerve wasformed medial or anterior to axillary artery. So we observed median nerve variation in 16 upper limbs [20.51%]Conclusion: Thorough understanding of variations in the formation and communications of median nerve and itsvascular relations is important for successful surgical outcome and clinical interpretation of lesions of thenerve.

Comparative study of serum iron and zinc levels in term and preterm babies delivered in RMMCH

Background: Malnutrition is an important factor that influences the course of pregnancy and fetal development. It is a serious international problem which leads to a deficiency of metals, trace elements, vitamins, and proteins. Much attention has been given to the effects associated with protein deficiency. Nowadays the effects due to the deficiency of trace elements have been given much importance. Trace elements are essential for life. Deficient intake- leads to impairment of some functions. The impairment may be corrected by intake of the element in physiological amount. With the deficiency of these elements, the organisms can neither grow nor complete its life cycle. Death of an organism results when there is an absolute deficiency. Aim: To compare serum iron and zinc level in term and preterm babies. Materials and methods: Sixty pregnant women who came from in and around Chidambaram who fulfilled the inclusion criteria during the period from July 2001 to March 2002 were included in this study. Among them, 50 delivered at term (37 to 42 weeks) and the rest delivered prematurely (< 37 weeks). Serum iron and zinc level were estimated by standardized technique. The results are analyzed accordingly. Results: The estimated mean iron value for the term babies was found to be 114.34 μg/dl with the standard deviation of 34 μg/dl. In case of preterm babies, the estimated mean value for iron was found R. Manimozhi Malathi, S. Ramesh, D. Rajkumar. Comparative study of serum iron and zinc levels in term and preterm babies delivered in RMMCH. IAIM, 2018; 5(9): 58-62. Page 59 to be 97.35 μg/dl with the standard deviation of 46 μg/dl. The mean zinc value of term babies was found to be 76.26 μg/dl with the standard deviation of 23 μg/dl. For preterm babies mean zinc value was found to be 56.53 μg/dl with the standard deviation of 29 μg /dl. Conclusion: Preterm birth deprives the fetus of a significant accumulation of iron in storage that occurs beyond 32nd week, total body iron deposits in tissues, Hb and zinc are low in premature babies. Iron deficiency affects perinatal growth, maturation, and function of multiple organ systems including the heart, skeletal muscle, gastrointestinal tract, and brain. Anemia of prematurity has been defined as low hematological constant levels of hemoglobin (Hb), hematocrit (Ht), serum iron, number of erythrocytes, the reticulocytes.

Comparative study of hemoglobin and packed volume levels in term and preterm babies delivered in RMMCH

Background: Most existing accounts of hemoglobin values in healthy premature infants covering the early weeks of life were written before many of the errors of such determinations were recognized. Because of these limitations, it was decided to review the normal values for the first three months of life. The results were compared with a small series of readings made on a group of healthy, full-term infants. Aim: To compare hemoglobin and packed volume levels in term and preterm babies. Materials and methods: Sixty pregnant women who came from in and around Chidambaram who fulfilled the inclusion criteria during the period from July 2001 to March 2002 were included in this study. Among them, 50 delivered at term (37 to 42 weeks) and the rest delivered prematurely (< 37 weeks). Hemoglobin and packed cell volume as measured by standardized technique. The results were analyzed accordingly. Results: The estimated mean hemoglobin concentration of the term babies was 10.88 gm% with the standard deviation of 1.5 gm%. For preterm babies, the mean hemoglobin concentration was 10.33 gm% with the standard deviation of 2 gm%. The mean calculated packed cell volume (PCV) of the term babies was 34.03% and the standard deviation was found to be 5%. The mean packed cell R. Manimozhi Malathi, S. Ramesh, R. Aravind Kumar. Comparative study of hemoglobin and packed volume levels in term and preterm babies delivered in RMMCH. IAIM, 2018; 5(9): 54-57. Page 55 volume of the premature babies in the present study was found to be 32.75% with the standard deviation of 6.5%. Conclusion: Anemia of prematurity is a multifactorial anemia characterized by low levels of erythropoietin (EPO), iatrogenic blood loss, low circulating blood volume and lack of erythropoiesis. It is a problem due to the high incidence, associated symptoms and increased transfusion requirements. It is a normochromic normocytic anemia hypo-regenerative that occurs between the 2nd and 6th weeks of age in premature infants with gestational age (GA) up to 35 weeks.

Evaluation of Lumber Vertebral Canal at Disc Level in Symptomatic and Asymptomatic subjects: A Radiological Evaluation.

Background: Spinal stenosis is defined as the narrowing of central spinal canal or its lateral recesses. Stenosis of spinal canal becomes important only when it results in interference with the normal functions of the contents of the canal. Narrowing of spinal canal seems to be a normal part of advancing age but certain uncertainties persist as regards to radiological definition of lumbar spinal canal stenosis. Material & Method: The present study was aimed to evaluate the clinical relevance of stenosis of spinal canal through the most recent technique, MRI. Fifty symptomatic and 18 asymptomatic subjects were included. Antero-posterior and transverse diameters of vertebral canal were compared between symptomatic and asymptomatic subjects and statistically analyzed. Results & Discussion: The present study clearly shows that in both symptomatic and asymptomatic subjects there is a gradual decrease in the antero-posterior diameter from above downwards . The minimum anteroposterior and maximum transverse diameter was seen at L4L5 level making this level susceptible to compressive symptomatology. Apparent stenosis was observed in some asymptomatic subjects.

Crossed Renal Ectopia Without Fusion: A Multidetector Computed Tomography Study.

Background: Congenital positional, rotational and fusion anomalies of the kidney are frequently encountered. Crossed renal ectopia is a condition in which the kidney is located on the side contralateral to its ureteral insertion into the urinary bladder. Crossed renal ectopia without fusion is a very rare anomaly sporadically reported in the literature. We have attempted to analyse such renal anomalies in a large series of patients. Materials & Methods: Contrast enhanced multidetector computed tomographic scans of 960 patients (491 males and 469 females, age range 4-90 years) were reviewed . Observations: Crossed renal ectopia without fusion was detected in three patients (0.31%; 1 in 320 cases). All three patients were males and left- to-right renal ectopia was noted in two cases and right-to-left ectopia in one case, in whom the ectopic right kidney was exhibiting multicystic dysplasia. An interesting observation was vascularisation of crossed ectopic unfused left kidneys by branches arising from the right common iliac artery. Conclusion: Crossed renal ectopia without fusion is an extremely rare anomaly and may remain asymptomatic without being detected. Multidetector computed tomography angiography is an excellent imaging modality to detect renal positional and rotational anomalies. To the best of our knowledge the present study is the first study to detect renal anomalies in a large series of cases.

statistical quantification of radiobiological metrics in intensity modulated radiation therapy evaluation

The dosimetric parameters from the DVH cannot predict the amount of tumor kill and normal tissue complications directly but it can assess the conformity and homogeneity of the physical dose distributions. For example, the D-V parameter V20 [Percentage of lung volume receiving 20Gy] is used to gauge the incidence of grade >/=2 or grade >/=3 radiation pneumonitis with the plan. But the complication can be correlated to more than one point in the DVH [eg. V5, V40, D50] and it is treatment technique dependent. The aim of this study is to quantify the uncertainty of physical dose metrics to predict the clinical outcomes of the radiotherapy treatments. The radiobiological estimates such as TCP and NTCP were made for a cohort of 50 patients [15-Brain; 20-H and N; 15-Pelvis] using the D-V parameters. A statistical analysis based on Spearman ranking coefficient correlation was performed to determine the correlation of the physical plan quality indicators with that of radiobiological estimates. The correlation between the Conformity Index and the Tumor Control probability was found to be good and the dosimetric parameters for optic nerves, optic chiasm, brain stem, normal brain and parotids correlated well with the Normal Tissue Complication Probability estimates compared to other normal structures. A follow up study [median duration: 28 Months] was also performed. There was no grade 3 or grade 4 normal tissue complications observed. Local tumor control was found to be higher in brain [90%] and pelvic cases [95%] whereas a decline of 75% was noted with Head and Neck cases. The EUD concept of radiobiological model used in the software determines the TCP and NTCP values which can predict precise outcomes with the use of dose volume data in the voxel level. The uncertainty of using physical dose metrics for plan evaluation is quantified with the statistical analysis. It is also helpful in ranking rival treatment plans

Female form of persistent mullerian duct syndrome: rare entity

Persistent Mullerian duct syndrome [PMDS] is a rare form of Disorder of sex development in which Mullerian duct derivatives [fallopian tubes, uterus and the proximal vagina] are present in an otherwise normally differentiated 46 XY male. In the majority of cases, PMDS is a surprise finding either during orchidopexy or during inguinal hernia repair. We report a case of 4 year child with female type [Type III] PMDS. We are discussing the presentation, management and review of the literature

Morphological Characterization and Mass Production of Nematophagous Fungus Nematoctonus Robustus.

The plant parasitic nematodes infect the root tissues of the plant causing root galls that lead to reduced water and mineral uptake in the plant root system. Nematophagous fungus are used as biocontrol for the nematodes. Among those Nematoctonus are one of the species used as bioagent. Nematoctonus species produces an extensive mycelium and capture many nematodes with hour glass shaped adhesive knobs on the hyphae. Nematodes become attached to these adhesive knobs and the cuticle of nematode is penetrated by the infective hyphae. This isolate of Nematoctonus robustus is characterized by hyaline mycelium, dikaryotic in nature containing genetically two different nuclei in each cell, having distinct clamp connection. The fungus has better colonizing ability on natural solid substrates like wheat straw and rice straw. It also show good ability to colonize on different cereal grains and various other waste products like coconut coir and FYM etc. This species is one of the best used for mass production and effective for control of plant parasitic nematodes.

Role of Sclerotia, Plant Debris and Different Hosts on Survival of Rice Sheath Blight Pathogen, Rhizoctonia Solani.

The survival of sclerotia stored under different conditions revealed that when they were kept in laboratory survived fully up to 7 months. However in soil at 5 cm and 10 cm depth, it survived 100 percent up to 8 and 10 months. The pathogen was viable in the sclerotial form for 17 months in the lab conditions however; it survived for 19 months and 20 months when kept at 5 cm and 10 cm depth in soil respectively. The survival of pathogen along with plant debris stored under different conditions revealed that it survived fully up to 3 months under lab conditions. However in soil at 5 cm and 10 cm depth, it survived 100 percent up to 5 and 6 months respectively. The pathogen survived in diseased plant debris for 9 months in lab conditions. However, the pathogen survives in plant debris up to 11 months and 13 months when kept at 5 cm and 10 cm depth of soil respectively. The viability of pathogen in plant debris was lost gradually. This states sclerotia and plant debris served as source of primary inoculum. Out of fourteen plant species belonging to three families tested, the pathogen produced disease symptoms on all the tested plants and stating pathogen has wide host range.

Crossed Fused Renal Ectopia Multidetector Computed Tomography Study.

Crossed renal ectopia is one of the rarest congenital malformations where a kidney is located on the side opposite to the side of its ureteral insertion into the urinary bladder and is generally fused with the normally located ipsilateral mate. Generally this anomaly remains as a silent clinical entity and is incidentally detected during evaluation for other conditions. We report here three such cases of crossed fused renal ectopia detected by multidetector row contrast enhanced computed tomography. Crossed fused renal ectopia of inferior type was observed in a male on the right side with the ureter of the ectopic left kidney crossing the midline. In two female patients, L-shaped or tandem kidney was noted, one on the right and another on the left side. Over all in two cases the left kidney was ectopic and in one the right kidney. No renal pathologies like urinary tract infection, nephrolithiasis or hematuria were found in our patients.

In vivo and in vitro effect of Acacia nilotica seed proteinase inhibitors on Helicoverpa armigera (Hübner) larvae.

Acacia nilotica proteinase inhibitor (AnPI) was isolated by ammonium sulphate precipitation followed by chromatography on DEAE-Sephadex A-25 and resulted in a purification of 10.68-fold with a 19.5% yield. Electrophoretic analysis of purified AnPI protein resolved into a single band with molecular weight of approximately 18.6+1.00 kDa. AnPI had high stability at different pH values (2.0 to 10.0) except at pH 5.0 and are thermolabile beyond 80°C for 10 min. AnPI exhibited effective against total proteolytic activity and trypsin-like activity, but did not show any inhibitory effect on chymotrypsin activity of midgut of Helicoverpa armigera. The inhibition kinetics studies against H. armigera gut trypsin are of non-competitive type. AnPI had low affinity for H. armigera gut trypsin when compared to SBTI. The partially purified and purified PI proteins-incorporated test diets showed significant reduction in mean larval and pupal weight of H. armigera. The results provide important clues in designing strategies by using the proteinase inhibitors (PIs) from the A. nilotica that can be expressed in genetically engineered plants to confer resistance to H. armigera.

HIV & smoking in India.

There are approximately 2.5 million people living with HIV/AIDS (PLWHA) in India - the young being particularly vulnerable. The prevalence of smoking has increased in India especially among rural, lower socio-economic and illiterate men. Studies have shown that HIV-infected smokers may be at additional risk for several infectious and non-infectious complications, including malignancies and cardiovascular events. Smoking alters immunological mechanisms and suppresses host defenses in the alveolar environment. HIV-infected smokers have also been found to have a poorer response to antiretroviral therapy and a higher risk of death. HIV-infected individuals who smoke could be at a greater risk for developing TB and subsequently suffer higher morbidity and mortality than those who do not smoke. Currently available smoking cessation interventions like physician’s advice, nicotine replacement therapy and pharmacological agents like bupropion and varenicline have had varying degrees of success. Smoking cessation intervention in the HIV-infected population might be more complex because of associated psychosocial problems like drug addiction, alcoholism, depression, etc. More research including clinical trials testing the efficacy of smoking cessation interventions in HIVinfected persons is required in India. In addition to public health measures like banning smoking in public places and raising tobacco tax, comprehensive guidelines for health workers can help address this problem. Counselling on smoking cessation should be one of the main components of primary care, especially in the management of HIV-infected persons. This review highlights the importance of smoking cessation among HIV-infected persons in India.

Pollution migration study in subsurface environment

The sources of groundwater pollution such as, industrial effluents, sewage and extensive farming have lead to agrochemical pollution. Mathematical modeling helps to analyze the existing situation, allows forecasting, and to evaluate the effects of changes in the surrounding water quality. The present research has been focused mainly towards understanding the various processes affecting the transport of chemicals in soils. Dispersion coefficient for the sandy loam soil was found to be 0.247 m[2]/d, 0.150 m[2]/d and 0.01 m[2]/d for nitrates, phosphates and chlorpyriphos through column, and 0.337 m[2]/d, 0.217 m[2]/d and 0.077 m[2]/d for nitrates, phosphates and Chlorpyriphos through channel studies, respectively. For similar analysis of the breakthrough curves, dispersion coefficient for the clay soil was found to be 0.0835 m[2]/d, 0.0632 m[2]/d and 0.008 m[2]/d for nitrates, phosphates and Chlorpyriphos through column and 0.147 m[2]/d, 0.0848 m[2]/d and 0.022 m[2]/d for nitrates, phosphates and Chlorpyriphos through channel studies, respectively. The one-dimensional analytical model has been used and validated with the experimental data obtained from column and channel studies in sandy loam and clay soils and compared with model output [in which total elimination rate "K" is considered as zero. From this a variation of about 40-60 percent in the leaching characteristics of pollutants was being observed [nitrates, phosphates and chlorpyriphos]

A Case of Reversible Blindness in Systemic Lupus Erythematosus

We report a case of reversible blindness in a lady with systemic lupus erythematosus (SLE) with nephritis and accelerated hypertension. CT scan brain revealed a symmetric hypodense lesion of the occipital lobes , which disappeared in two weeks time with treatment.

PCR analysis of Yq microdeletions in infertile males, a study from South India / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To estimate the frequency of microdeletions in the long arm of Y-chromosome of 20 infertile males from South India.</p><p><b>METHODS</b>Polymerase chain reaction (PCR) amplification using Y-specific STS of azoospermia factor (AZF) regions i.e., SY 84 for AZFa, SY 127 for AZFb and SY 254 for AZFc.</p><p><b>RESULTS</b>Of the 20 infertile subjects 3 (15 %), one azoospermic and two oligozoospermic, showed microdeletions in the AZF region of Y-chromosome.</p><p><b>CONCLUSION</b>The frequency of deletions involving AZF region of the Y-chromosome is 15 % in azoospermic and severely oligozoospermic infertile men. PCR amplification of AZF locus is useful for the diagnosis of microdeletions in the Y-chromosome.</p>