A case report of Budd-Chiari syndrome with cardiac complications and low SPO2 successfully managed by an integrated-approach

Budd-Chiari syndrome [BCS] is a rare, potentially life-threatening condition characterized by the triad of abdominal pain, ascites, and hepatomegaly (with or without jaundice). There will be an underlying disorder in most cases. The diagnosis, as well as management of the case, requires a multidisciplinary approach. The treatment should aim at reducing the presenting symptoms as well as removing the underlying pathology. Here we explain a case report of a 21-year-old male patient in the subacute stage of BCS with its complications and considered as a candidate for liver transplantation. His liver enzymes, PT/INR, D- dimer, and homocysteine values were above normal levels. The arterial oxygen saturation level was subnormal, and he was on supportive oxygen supplement. Inferior venacava [IVC] Doppler revealed a non-obstructive intrahepatic thrombus. The patient was treated with Homoeopathic medicine Arsenicum album and Arnica montana, given as an adjuvant to conventional treatment.

Platelet count splenic diameter ratio as predictor for esophageal varices in patients with cirrhosis: a diagnostic evaluation study

Background: Esophageal variceal bleeding is one among the common complication of cirrhosis which is fatal. Latest studies are focusing more on using non-invasive techniques to classify cirrhotic patients according to their risk of having varices. The platelet count-splenic diameter ratio is considered as one such parameter and is used in predicting esophageal varices in patients with cirrhosis. Objectives of the study was to assess the utility of platelet count-splenic diameter ratio as a useful non- invasive parameter in predicting the presence/ absence /size of esophageal varices in patients with cirrhosis.Methods: Diagnostic evaluation study was done in a tertiary hospital of Kerala state India. 93 adults above the age of 18 yrs with diagnosis of cirrhosis was selected and detailed history, physical, systemic examination and imaging was done. The degree of correlation between platelet count-splenic size ratio and the presence/absence/size of esophageal varices was studied along with its utility as an independent non- invasive marker. Frequency was expressed in percentages.Results: Best cut-off for prediction of esophageal varices Grade 1 was platelet count/spleen diameter ratio of 954, which had Specificity of 85.7% and Positive predictive value of 94.1% Cut-off for prediction of Grade 2 esophageal varices was platelet count/spleen diameter ratio of 916 which had a Sensitivity of 78.9%, Specificity of 88.9%. Whereas cut-off for prediction of Grade 3 esophageal varices was a ratio of 899 which had a high Sensitivity of 88% and Negative predictive value of 93.6 % but Specificity was only 64.7% and Positive predictive value of 47.8% only.Conclusions: The platelet count splenic diameter ratio is accurate to be used as screening tool to predict the presence of Grade 2 Esophageal varices in Patients with Cirrhosis. More studies need to be done around the globe for more evidence.

Eosinophilic meningitis due to Angiostrongylus cantonensis.

Angiostrongylus cantonensis is a nematode parasite that inhabits the pulmonary arteries and heart of rodents. It is one of the causative agents of fatal eosinophilic meningoencephalitis in man. We present five cases of eosinophilic meningitis presumably due to infection with Angiostrongylus cantonensis . All the five patients gave history of ingestion of monitor lizard within ten days of onset of symptoms.

Effects of some trace heavy metals on Poecilia reticulata (Peters).

Three trace heavy metals viz., nickel, copper and zinc were studied for their toxic action against Poecilia retriculata (Peters). Among these, copper was found to be most active followed by zinc and nickel. Accumulations of these metals as well as behavioural studies were carried out after exposing fish to sub-lethal concentration of LC20. It was found that the highest quantity of nickel was accumulated in the fish body followed by zinc and copper. After exposure to sub-lethal concentration of metals some behavioural changes in fish were observed due to stress, such as mucus like secretion over gills, excessive excretion, anoretic condition and increased distance between gills and operculum. In all the cases fin movement was observed. Role and use of such changes as biological indicators or as biological early warning system in water quality assessment has been discussed.

Developmental inhibition and reproductive potential impairment in Musca domestica L. by heavy metals.

Post embryonic development and adult emergence of housefly, M. domestica L. was adversely affected in varying degrees on exposure of larvae to 6 different heavy metals. Of these, salts of mercury, aluminium and cadmium exhibited significant reduction in normal adult emergence. High decline in reproductive potential in terms of female fecundity and egg hatchability was also observed in the F1 progenies of treated larvae. The results are discussed in light of heavy pollution of environment by such contaminants.

Apert syndrome variant with overlapping features of Crouzon syndrome.

A rare variant of Apert syndrome having overlapping features of Crouzon syndrome is described. The salient features of the two syndromes are briefly discussed and overlapping features are highlighted. A possible genetic explanation for the same is mentioned.

In vitro evaluation on inhibitory nature of some Neem formulations against plant pathogenic fungi.

Different Neem formulations derived from the Neem tree (Azadirachta indica) have been found to be potential fungicides against a broad spectrum of plant pathogenic fungi. Some Neem formulations viz. Achook (0.15% EC), Bioneem (0.03% EC), Nimbecidine (0.03% EC) and Neemark (0.03% EC) were examined against some plant pathogenic fungi such as (Fusarium oxysporum, Alternaria solani, Curvularia lunata, Helminthosporium sp. and Sclerotium rolfsii). Among these Achook (0.15% EC) was found to be more active in terms of Minimum Inhibition Concentration (MIC) value followed by Bioneem, Neemark and Nimbecidine. Remarkably, although all these formulations are oil based, Neem oil itself did not exhibit any fungicidal activity.

Reactive oxygen species formation in peripheral blood neutrophils in different types of smokers.

The present study was envisaged to assess the state of oxidative metabolism of neutrophils, recovered from smokers (cigarette, beedi, hookah and mixed products) and non-smokers. Superoxide anion (O2.-) production was significantly higher in neutrophils from all groups of smokers (P < 0.001). Total leukocyte count (TLC) was significantly more in symptomatic subjects among the cigarette, hookah and mixed smokers (P < 0.05). Total neutrophil count (TNC) was significantly higher in symptomatic than asymptomatic subjects of hookah and mixed smoking groups (P < 0.05). In the pathogenesis of chronic obstructive pulmonary disease (COPD) in tobacco smokers, the role of leukocytosis, increased neutrophil sequestration into the lung, increased neutrophil toxic oxygen species including superoxide release in the lung may cause direct injury to lung tissues.

Laboratory evaluation of toxic baits for mosquito (Aedes aegypti) larvae.

Toxic bait discs were prepared by incorporating the larvicide Abate (Temephos) technical, with yeast and dog biscuit (1:1), the latter forming the attractant source. These were assessed in 1, 10 and 25 litre aquaria and 100 litre drums against Aedes aegypti larvae. Floating as well as sinking bait discs were found equally effective in controlling free moving larvae. Larvae confined in artificially suspended cages were not affected. The baits were found effective for 5 to 6 weeks. Toxic disc bait preparation methodology and evaluation protocols are discussed in this communication.

Laboratory and field evaluation of an insecticidal trap for houseflies.

Several substances/food baits and admixtures thereof were tested in a perspex trap, treated with insecticide K-othrine@0.01 mg/cm2. Bioefficacy for housefly trapping was evaluated. Combination of ingredients was found to be more effective than individual ingredients. A combination of some easily available and cheap ingredients were employed for field trials. The admixtures of milk powder, dog biscuit, jaggery and banana peeling was found very effective. The trap efficacy including persistence of the toxicant K-othrine was observed for more than 6 months. Observations on number of flies trapped and utility of such a trap in actual field situation are discussed.

Laboratory evaluation of an ovipositional trap for mosquito adults Aedes aegypti (L.) (Diptera: Culicidae).

A trap was designed, fabricated and evaluated for trapping and killing ovipositing females of the yellow fever mosquito Aedes. aegypti. Water in which larval stages had previously dwelt for 48 hrs. formed the attractant source for ovipositing mosquito females. The trap was evaluated under different experimental conditions. Single choice and double choice experiments were performed with or without glue applied to inner surfaces, to determine trap efficacy. Effect of population size and alteration in assay conditions on percentage catch are discussed.

Effect of some new insect growth regulators on metamorphosis & reproduction of Aedes aegypti.

Fourth instar larvae and pupae of Ae. aegypti were treated with four most active insect growth regulators from a new series of mixed alkyl and aryl diethers based on geraniol. Considerable reduction in fecundity and fertility of adults was obtained. Treatment of pupae or pharate adults did not affect adult emergence. Topical treatment of adult females caused great reduction in fertility and fecundity in older as compared to younger females. In addition to the effects on reproduction, adult survival was also reduced in the treated younger females.

HIV infection amongst leprosy patients in south India.

In a pilot study, 463 leprosy patients (374 males and 89 females) were investigated for HIV-1 and HIV-2 antibodies by screening tests. Sera positive by the screening tests were subjected to confirmatory tests. Three cases were confirmed to be positive for HIV, two for HIV-1 and one for HIV-2. All the three positive cases were young males, who had visited commercial sex workers. No correlation was found between the type of leprosy and HIV infection. This is the first report of HIV infection amongst leprosy patients from South India.

A device for monitoring and control of mosquitoes by behaviour manipulation.

A trap was designed and fabricated for capturing mosquito larvae based on their behavioural responses to food and light. The larvae upon entering the trap died ultimately due to asphyxiation. Maximum success was achieved with Aedes aegypti larvae in lesser water volumes. The usefulness of the device for studying the response of mosquito larvae and aquatic organisms to chemicals, baits, light, various stimuli and possible pest/vector monitoring and management in aquatic eco-system is discussed.

Comparative repellent properties of certain chemicals against mosquitoes, house flies and cockroaches using modified techniques.

Several terpenoids were assessed for their repellent/toxic properties against mosquitoes (Aedes aegypti), house flies (Musca domestica) and cockroaches (Periplaneta americana). Impregnated wide mesh netting was used in the case of the Dipterans, while treated filtered paper was employed for the bioassays with cockroaches. Persistence of the repellent chemicals was studied. Doses ranged from 5-20 gm/M2 for the Dipterans and 25-100 mg per 4 x 4 cm filter paper for the cockroaches. Dimethyl phthalate (DMP) offered the maximum protection of the chemicals tested against mosquitoes but was not so effective against house flies and cockroaches. Citral and Eugenol were effective against all the three test insects. Other test compounds afforded varying degrees of protection. Application strategy and utility of the findings are discussed.

Toxicity of newly synthesized pyrethroids against the yellow fever mosquito larvae, Aedes aegypti (Diptera: Culicidae).

Synthesis of p-substituted benzyl esters of (+/-) cis 2,2-dimethyl-3-(2,2-dichlorovinyl)cyclopropane-carboxylic acid has been reported. (+/-) cis Dichlorovinyl acid esters of p-substituted phenols acquired insecticidal activity after introduction of methylene group. The insecticidal activity shown against mosquito larvae A. aegypti by compounds having electron withdrawing groups such as -NO2, -CN was substantially higher than that of the compounds having electron-donating groups such as -CH3, -OCH3.

Vapour toxicity & repellence of some essential oils & terpenoids to adults of Aedes aegypti (L) (Diptera: Culicidae).

Bioefficacy of commercially used synthetic insecticides/repellents and potential of selected essential oils and terpenoids were assessed against mosquitoes. Essential oils and terpenoids, were vapourised in commercially manufactured mosquito repellent electronic assemblies and effects of such vapours were tested on 6-7 days old adult female Aedes aegypti. Commercially available 'mats' (coir rectangles) impregnated with allethrin were used as standards for comparison of Kt50 and Kt90 values. Fastest knock-down was seen in case of allethrin, followed by terpeneol (anhydrous) and (-) carvone. Maximum knock-down time was observed for beta citronellol. All compounds exhibited a repellent effect also, terpeneol (anhydrous) being the best, followed by (-) carvone and citronellal. In repellent tests, no mortality was caused by terpenoids, but allethrin caused > 80 per cent knock-down.

Action of some new insect growth regulators on mosquito vectors. Part II: Geraniol based diethers.

Biological activity of saturated diethers viz. 1-benzyloxy/phenoxy-8-alkoxy and 1-alkoxy-8-benzyloxy-3,7-dimethyl-1, 8-octanes (IIa-IIq) prepared from Geraniol, were studied on three mosquito species and the bug Dysdercus koenigii. These diethers exhibited oviposition deterrent and developmental inhibition activities of greater magnitudes than the compounds based on citronellol reported in Part I of this paper. Some of these new compounds inhibit development of mosquitoes at 0.05 ppm and deter oviposition at 0.05 per cent doses. Tests were extended to field simulated conditions in selected cases.