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Introduction:An acute phase response to tissue injury leads to release of pro inflammatory and anti inflammatory cytokines. TNF alpha isan early pro inflammatory cytokine that released in SIRS and largely responsible for clinical manifestation of sepsis. The release of TNF alpha is influenced by messenger RNA transcription of TNF alpha gene. In patients with severe sepsis genomic polymorphism with in the TNF locus found to be associated with TNF alpha production and outcome.Objectives:To evaluate genetic polymorphism of TNF alpha gene at c 850 t locus, influence on TNF alpha expression and on outcome. Materials and Methods:A prospective cohort study conducted at our institute between June 2007 to 2009 in 100 cases. Serum TNF alpha levels measured by using ELISA .TNF alpha polymorphism done at c850t locus in 100 patients and were compared with 70 controls who were normal subjects. By using MEDCALC software mean and standard deviations were calculated, continuous variables were compared using t-test. ROC curves were used to determine the predictive capability of the variables.Results:The most common polymorphism observed was CT in 51 patients. The significant different TNF alpha level expression between the three groups were observed. Significant Tallele was observed in cases (100) when compared with controls (70), p= 0.0002. Conclusion: Genetic polymorphism of TNF alpha gene may play critical role in stress response and outcome of the patient but it needs to be validated in large number of population
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Background: The Thyroid hormones normal levels are very much essential for fetal neural development and good pregnancy outcome. Thyroid insufficiency during pregnancy may be associated with adverse obstetric outcome and fetal neurodevelopmental deficits. The main objective of the study is to estimate and establish the reference ranges of thyroid hormones as it varies from place to place and inter dependent on the iodine levels as the American Thyroid Association strongly recommends to refer to population defined trimester-specific reference ranges.Methods: A longitudinal study was conducted at obstetric clinic, Kakinada city, Andhra Pradesh over a period of 18 months. The total number of normal pregnancy subjects included in this study was 126. Thyroid hormones estimation was done by Competitive electrochemiluminescence (T3 and T4) and Sandwich electrochemiluminescence (TSH) at Thyorocare Laboratory. Only 47 subjects were having all three trimester thyroid hormone levels estimated during each trimester and were followed up to full term. The 2.5th and 97.5th percentiles were calculated as the reference intervals for thyroid hormone levels during each trimester.Results: The thyroid hormone levels during first, second and third trimesters median with reference intervals - Total Triiodothyronine (T3) : 163(100.2-230), 168(121-219.2), 168(110.2-222.6) ng/dl ,Total Thyroxine (T4) : 8.4(4.05-16.64) , 10.2(4.09-18.7), 11.2(3.8-16.7) μg/dl and Thyroid Stimulating Hormone (TSH ):2.52(1.6-7.9) 3.01(1.28-7.6) 3(1.5-8.4) μIU/mlConclusions: The trimester-specific reference intervals and median for thyroid hormones during normal pregnancy have been established for pregnant South Indian women in Andhra Pradesh by full term follow-up during pregnancy using 2.5th and 97.5th percentiles and median.
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Background: There is dearth of studies in India on the management of paediatric septic shock. So it is prudent to do a study on paediatric septic shock management. The objective of the study is to determine the correlation between Paediatric Assessment Triangle and serum lactate levels., to determine the role Paediatric Assessment Triangle in predicting mortality in septic shock and to the determine the role of elevated lactate levels in predicting mortality in septic shock.Methods: Descriptive study of 100 children from 31 days to 12 years of age who are admitted with septic shock in a tertiary care hospital are assessed with paediatric assessment triangle and clinical score and serum lactate was tested along with other standard tests and the children are managed as per the standard protocols. Outcome is analysed.Results: In this study, septic shock children with total clinical score >22 are having statistically significant low levels of diastolic blood pressure and low mean arterial pressure. There was a significant difference in median serum lactate levels between the survivors (28.08 mg/dl) and non-survivors (40.92 mg/dl).Conclusions: Paediatric assessment triangle and clinical scoring based on it more than 22 and serum lactate levels of more than 2mmol/L or 18mg/dl predict the mortality.
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@#Patients with mandibular deficiency and skeletal class II malocclusions exhibit a wide spectrum of esthetic, cephalometric, and occlusal characteristics. The structure of chin determines facial attractiveness and is directly linked to a quality of life. Correction of dentoalveolar protrusion of maxilla is done by anterior maxillary subapical osteotomy by which anterior segment can be moved superiorly or inferiorly and posteriorly as indicated. Augmentation genioplasty is advocated to improve the overall facial esthetics of patient with mandibular deficiency. In skeletal class II malocclusions cases best results are obtained with double jaw surgery combined with the orthodontic treatment. This is a case report of skeletal class II malocclusion with mandibular deficiency and protruded maxilla in 22 year old female patient who was treated surgically by anterior maxillary subapical osteotomy and augmentation genioplasty along with the orthodontic treatment
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The role of oil cakes in maintaining soil beneficial biota and suppressing harmful pathogens is also widely recognized in different soil as well as different ecosystems. Annual growth in oil cake production is projected to average 2.3% annually over the decade to 2010. Oil cakes especially non-edible in nature are more viable option to meet this demand significantlyas edible oil cakes cannot be utilized for agriculture purposes . Utility of oil seed cakes are recognized in different spheres.In this studies concentrate the isolation and identification of mycoflora of Neem, Illupai, Coconut, Sesame and Groundnut oil cake and which biomass and amylase production characteristic features were carried out. Keywords: Mycoflora, Amylase.
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Background & objectives: Human parainfluenza virus (HPIV) accounts for a significant proportion of lower respiratory tract infections in children as well as adults. This study was done to detect the presence of different subtypes of HPIV from patients having influenza like illness (ILI). Methods: Throat and nasal swabs from 232 patients with ILI who were negative for influenza viruses were tested by multiplex reverse transcription polymerase chain reaction(mRT-PCR) for the detection of human parainfluenza virus. All samples were inoculated in rhesus monkey kidney (LLC-MK2) cell line. Results: Of the 232 samples, 26(11.2%) were positive by mRT-PCR and nine (34.6%) showed cytopathic effect with syncytium formation for HPIV and all were HPIV-3 serotype, other serotypes like 1,2,4 were negative. The HPIV-3 strains (HN gene) were sequenced and analysed. Two novel mutations were identified at amino acid residues 295 and 297. Interpretation & conclusions: The mRT-PCR assay offers a rapid, sensitive and accurate diagnostic method for detection of HPIV which enables early detection and control. In our study there was a predominance of HPIV among 1-5 yr age group and the school going age group was less affected. Further studies need to be done to characterize HPIV isolated from different parts of the country.
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Background: Management guidelines are not yet clear for these patients who present late with displaced supracondylar fracture. The aim of this prospective study was to evaluate the clinical, radiological and functional outcome following closed reduction and percutaneous pinning of widely displaced supracondylar fractures of the humerus presenting 24 hours or more after injury. Patients and Methods: This prospective study was conducted at the Orthopaedic and Trauma Department of Dr Pinnamaneni Siddartha Institute of Medical Sciences and Research Foundation, Chinnoutpalli from January 2010 to July 2011. A total of 44 children were included in this study who had displaced supracondylar fracture of humerus presenting late ie, after 24 hours after injury and within a week. They were treated with closed reduction of the fracture and percutaneous pinning. Follow-up was done up to 12 months. Results: Patients were assessed on the basis of Flynn’s criteria, there were 37 excellent, 6 good results and fair results in 1 case. There were 25 boys and 19 girls. The average age of the patients was 7.5 years (range: 4 to 12 years). Fall on the outstretched hand was the mechanism of injury in 36 patients, and the other 8 patients were pedestrians struck by a motor vehicle. Non-dominant extremity was more commonly involved (30 patients). In 24 patients the fracture was displaced posteromedially (54.54%), in 18 patients posterolaterally (40.90%), and 2 patients had isolated posterior displacement (2.54%). The average delay in presentation was 57.56 hours (range: 1 day to 6 days). The mean time to surgery after presentation was 9.83 hours (range: 4 hours to 13 hours) and the mean time to surgery after trauma was 67.39 hours. Sixteen patients had one or more attempts of reduction by massaging by a quack and in 2 patients it was attempted by a qualified surgeon before they presented to us. 26 patients (59.09) visited a quack prior to presentation to us. There was a direct relation between duration of delayed presentation and the times of manoeuvre. Sixteen patients (36.36%) had neurologic complications at presentation to the emergency room of which three had median nerve palsy (6.81%) where as seven (15.90%) had isolated anterior interosseous nerve palsy and six (13.6%) had radial nerve palsy all patients showed total neurological recovery at 12 weeks follow-up. Six patients (13.63%) had vascular compromise at initial presentation of which five patients had feeble radial pulse and one had absent radial pulse, but capillary filling was adequate in all. The pulse was restored within 24 hours in all patients following reduction. Conclusion: Our preliminary results support our recommendation ie, closed reduction and percutaneous pin fixation as an effective treatment option for grossly displaced supracondylar fractures presenting late but requires good and careful judgment and also technique by the surgeon to avoid complications. Our results also support the chances of spontaneous recovery of peripheral nerve palsy and brachial artery spasm post reduction over a period of time in majority of cases though they present late.
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Back ground: The vulnerability of the buffalo to the luxation of the hip articulation previous to and during parturition encouraged the investigation in this species. The literature reviewed did not reveal complete anatomical descriptions of the coxofemoral articulation of buffalo. Hence the study was undertaken. Purpose: to study the different anatomical aspects of the hip joint which are specific to buffaloes. Methods and Results: A total number of fifteen hip joints of buffalo calves procured from the local slaughter house and department of VeterinaryAnatomy were studied in the Department of Veterinary Anatomy,College of Veterinary Science, Tirupati irrespective of breed, sex and nutritional status. The gross morphology of joints and relations were studied. The round ligament of buffalo was stronger compared to cattle. A thick fibrous stratum of articular capsule was present. A few arched and semi-circular fibers were seen in the articular capsule but zona orbicularis was absent. The best developed periarticular ligament in the buffalo hip was the iliofemoral ligament. It was a thick cord of connective tissue extending from a nodule below and behind the ischiatic spine and spreaded over the capsula articularis and finally attached to the trochanter major and trochanteric ridge. The pubocapsular ligament was located on the ventral surface of the joint capsule and blended with it. Compared to the most of other quadripeds the periarticular ligaments were well developed in buffalo. The iliofemoral ligamentwasmostly helpful in preventing the hip fromexcessive extension and adduction. The relative development of the periarticular ligaments in the biped and quadrupedswere probably in accordance with comparative weight that this articulation must support. Potential implications: An understanding of the basic anatomy of the hip helps in understanding pathology and can greatly assist the surgeon in appropriately diagnosing and treating the problems.
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Group A Rotaviruses with serotypes G1-G4 and G9 are the common Rotavirus types of clinical importance. This study aimed at determining the different Rotavirus genotypes in stool sample of children below 5 years. A total of 300 children with acute gastroenteritis were tested for group specific VP6 antigen of group A Rotaviruses by Enzyme Linked Immunosorbent Assay. 47 of these samples were positive for Rotavirus antigen. Out of these, 20 positive samples were subjected to Reverse Transcriptase Polymerase Chain Reaction for genotyping. The identified genotypes were G9P8, G1P8, G2P4, G9P4 (non-vaccine genotype), G1P6, and G1 (P types not identified in 5 samples).
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Background & objectives: Dengue is one of the most important Arboviral diseases in man with outbreaks in Southeast Asia and India. We report a retrospective analysis of the dengue positivity in the referred samples for three years period (2006 to 2008) at the Department of Virology, King Institute of Preventive Medicine, Chennai, Tamil Nadu, India. Methods: Serum samples from 1593 suspected cases (968 male and 625 female) were obtained. Of the 1593 cases screened, 1204 (75.5%) were paediatric cases and 389 (24.4%) adults. The samples were subjected to MAC ELISA and IgG ELISA. Results: Of the 968 patients, 686 (43.0%) were positive, of which 579 (84.0%) were in the paediatric age group (<14 yr) and 107 (15.5%) were adults. The IgM positivity being 356 (36.7%) in males and 330 (52.8%) in females. Of the 686 positives, 113 (16.47%) were positive for both IgM and IgG denoting secondary infection. There was a noticeable increased occurrence during the cooler months and during the monsoon and post-monsoon months. Interpretation & conclusions: The dengue IgM seropositivity among the suspected cases indicates active dengue virus activity. Increase in the probable secondary infections especially in a country like ours where multiple serotypes are prevalent raises concern over probable increase in the incidence of the more serious DHF/DSS. Studies need to be done to identify circulating serotypes of dengue virus to design preventive strategies.
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Dengue/epidemiology , Enzyme-Linked Immunosorbent Assay , Female , Humans , Immunoglobulin G/blood , Immunoglobulin M/blood , India/epidemiology , Male , Retrospective StudiesABSTRACT
Primary hyperparathyroidism is not uncommon. It has varied presentations ranging from asymptomatic disease to the classic "stones, groans, moans". This is a case report of a 49 year-old woman, who presented with sensory obtundation, abdominal pain, associated with vomiting and denovo detected diabetes mellitus. She had a past history of bilateral nephrolithiasis, and was found to have hypercalcemia [serum corrected calcium 12.8 mg/dL] with elevated serum intact parathormone [183 pg/mL, normal range 13-54 pg/mL]. The 99m-Tc MIBI scintigraphy localized the source of parathormone to the right inferior parathyroid gland. Being dehydrated, she was treated with saline diuresis, salmon calcitonin and intravenous pamidronate. Her blood sugar was reported to be 421 mg/dL, and the glycemia was controlled with insulin therapy. A 2 X 2 cm sized right inferior parathyroid adenoma was later removed. The glycemic status improved dramatically after parathyroidectomy and the patient was euglycemic on low doses of glimepiride. This case study suggests that primary hyperparathyroidism might also contribute to hyperglycemia in subjects with diabetes mellitus
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Arrhenoblastoma or Sertoli-Leydig cell tumor is a rare androgen secreting ovarian tumor of unknown pathogenesis, has been reported to co-exist with other neoplasms of the female genital tract. Mostly benign, the tumor originates from the ovarian stromal sex cords, its tissue structure being similar to the Sertoli and Leydig testicular cells. Followed in detail, around one-fifth of these ovarian tumors are found to be malignant. We describe a case of slow growing Sertoli-Leydig cell tumor presenting with androgenic alopecia and virilization, associated with cervical carcinoma in-situ
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Humans , Female , Adult , Ovarian Neoplasms/diagnosis , Carcinoma in Situ , 31574 , Sertoli-Leydig Cell Tumor/diagnosis , Virilism/diagnosis , Virilism/etiologyABSTRACT
The surface of coir pith, an agricultural solid waste was modified using a cationic surfactant, hexadecyltrimethylammonium bromide (HDTMA) and the modified coir pith was investigated to assess the capacity for the removal of phosphate from aqueous solution. Optimum pH for maximum phosphate adsorption was found to be 4.0. Langmuir and Freundlich isotherms were used to model the adsorption equilibrium data. Kinetic studies showed that the adsorption obeyed second order kinetics. Thermodynamic parameters were evaluated and the overall adsorption process was spontaneous and endothermic. Effect of coexisting anions has also been studied. The feasibility of using spent adsorbent as fertilizer carrier to control phosphate release was also investigated.
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Adsorption , Agriculture/methods , Cellulose/chemistry , Computer Simulation , Conservation of Natural Resources/methods , Fertilizers , Industrial Waste/prevention & control , Lignin/analogs & derivatives , Materials Testing , Models, Chemical , Phosphates/chemistry , Surface-Active Agents/chemistryABSTRACT
Effect of respirable fly ash particles inhalation on lungs of rats was investigated by exposing them to respirable aerosols of size classified power plant fly ash at average concentrations of up to 14.4 +/- 1.77 mg/m3 for 4 hr/day for 28 consecutive days. A remarkable increase was found in blood eosinophil counts of fly ash exposed animals. Biochemical indicators of pulmonary damage viz. lactate dehydrogenase (cytoplasmic enzyme used as a measure of cell injury), gamma-glutamyl transferase (Clara cell damage) and alkaline phosphatase (potential measure of Type 11 cell secretions) in broncho alveolar lavage fluid (BALF) of fly ash exposed group showed significant elevation. Clumping of fly ash particles in the lungs was observed as evidenced by fly ash ladened macrophage accumulation in the alveolar region. The results suggest a damage, local inflammation and remodelling of lung as indicated by hypertrophy and hyperplasia. These changes reflect the toxic effects of the fly ash inhalation.
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Air Pollutants/toxicity , Animals , Bronchoalveolar Lavage Fluid/chemistry , Carbon/toxicity , Lung/drug effects , Male , Particulate Matter , Rats , Rats, WistarABSTRACT
A 70-year old diabetic with history of swelling and pain in the right maxillary and orbital region is reported. The diagnosis, clinical findings and trpatmpnt are discussed
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Humans , Male , Amphotericin B , Mucormycosis/therapyABSTRACT
A nine-year old boy with Haemoglobin S Oman trait, a sickling variant, is presented. The laboratory haematological findings are elaborated, diagnostic markers high lighted, family studies documented and increased pathogenicity of this variant depending upon the percentage of Haemoglobin S Oman is stressed