Pleural fluid cytology in prompt diagnosis of pleuro-pulmonary nocardiosis masquerading as COVID-19

Introduction: There are few reports of nocardial infections among the Indian population. We report this case because of its rarity and unique presentation and to highlight the role of cytology in diagnosis. Case Details: A 74-year-old woman presented with fever and chest pain of a duration of 15 days. In view of the coronavirus disease (COVID) pandemic, she was given steroids. She developed breathlessness and was referred to a tertiary care hospital. Her pleural fluid cytology showed filamentous bacteria. A diagnosis of nocardia was confirmed by culture. Discussion: Nocardiosis refers to the localized or disseminated infection caused by filamentous aerobic bacteria of the genus Nocardia. The clinical presentation of nocardiosis is highly variable. In our case, clinical misdiagnosis as COVID-19 and steroid treatment would have caused deterioration of nocardiosis. Conclusion: All patients with pulmonary symptoms should be thoroughly evaluated before considering a diagnosis of COVID-19. Pleural fluid cytology can be of help in the diagnosis of nocardiosis.

Sociodemographic characteristics and aggression quotient among children in conflict with the law in India: A case–control study.

Background. The incidence of juvenile delinquency has increased in the past decade in India and juvenile crimes are increasingly being reported. This has been attributed to many biopsychosocial factors. It is essential to understand these issues in the context of India to determine the response of acts of children in conflict with the law. We aimed to assess the sociodemographic characteristics and the aggression quotient of children in conflict with the law (juvenile delinquents) in observation homes across India and compare them with those who were not. Methods. We did a case–control study in five juvenile homes in the cities of Hyderabad, Lucknow and Pune. Ninety inmates (74 boys, 16 girls) were included in the study. Sociodemographic characteristics and aggression quotient of children in conflict with the law were evaluated using two separate questionnaires, i.e. a sociodemographic questionnaire and the modified Buss and Perry aggression questionnaire. These were compared with a control group of similar age, sex and income status. Results. All the children in conflict with the law surveyed belonged to the lower socioeconomic strata, had a significantly higher chance (p<0.05) of coming from broken homes, have addictions, jailed family members and suffered physical and sexual abuse than controls. They also scored higher on all domains of the aggression questionnaire than controls. Conclusion. A collection of sociodemographic attributes such as broken homes, addictions and abuse seem to have an

Are Early Onset Alcoholics Different : A Cross Section Observational Study from a General Hospital Psychiatry Unit.

Introduction: Alcohol dependence syndrome has been fraught with significant biopsychosocial problems. Early age of onset of initiation has been seen to complicate the issues further. Method: Clinico-psycho-social profile of all patient of alcohol dependence syndrome admitted to a general hospital psychiatric unit was assessed. Results: Ment age of onset was 25.42 years and that of first medical contact was 38.29 years. Age of onset had significant association with increased amount of alcohol consumption, early age of medical consulation, Presence of delirium, coexisting depression and deranged liver enzymes. Conclusion: Early onset of alcohol consumption had significant impact on course and outcome of the alcohol dependence syndrome. Effective strategies be formulated for early referral and targeted management.

Studies on immunomodulatory effects of Salacia chinensis L. on albino rats.

India has a very rich diverse faunal and floral wealth spread across the length and breadth of country. Biodiversity hotspots like Himalayan region and Western Ghats are bestowed with innumerous number of potential medicinally important plants whose scientific research are yet to be taken up. Salacia chinensis is one among them and forms one of the known ethanobotanically used herbal drug for diabetes and aliments. A scientific study on physiological effect of Salacia chinensis can give baseline information about potency of plant drug formulae. Therefore this plant was taken up for the study of immunomodulatory effects on swiss albino rats. Rats were fed with a concentration of 1 mg/kg, 2 mg/kg, 4 mg/kg and 32 mg/kg body weight of aqoues extract of Salacia chinensis for a period of 14 days. Various hematological, serological and immunological parameters were studied at the end of 14days trial and compared with control group. Total leukocyte count, neutrophil percentage, blood glucose hemoglobin, hemagglutination antiboby titer against SRBC and delayed hypersensitivity reaction were found increased along the animals treated with 1mg/kg body weight of animal. On the contrary higher concentration of drug have reduced immune response compared to control group showing the negative effect of the higher concentration of drug on the immune response. The present study of Salacia chinensis evidently shows that concentration of 1mg/kg can boost the immune system and at the same time if used at higher concentration can determine the immune system.

A study on APO B100/APO A-I Ratio in uncontrolled type 2 diabetes mellitus.

Dyslipidemia, a very common complication of diabetes mellitus (DM), is associated with life threatening complication like coronary artery disease (CAD). Apolipoprotein A-I and apo B100 are the protein components of high density lipoprotein (HDL-C) and low density lipoprotein (LDL-C) respectively. Apo B100/apo A-I ratio represents the balance between pro-atherogenic and antiatherogenic factors. Apolipoproteins have recently gained importance as they are said to be a better indicator of coronary artery disease as compared to other lipid and lipoproteins. This study was done to study the apo B100/apo A-I ratio in type 2 diabetes mellitus. Methods: Fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), extended lipid profile (total cholesterol (TC), triglyceride (TG), HDL, apoA-I and apoB100) were estimated in 34 non diabetic controls and 37 diabetic cases.The cases were further subdivided into 2 groups based on their glycemic control. LDL levels were calculated by Friedewald’s formula. Statistical analysis was done using SPSS software version 11.5. P value less than 0.05 was considered significant. Results: Poorly controlled diabetic cases had significantly lower levels of HDL and apoA-I and significantly higher levels of TG. Total cholesterol, LDL and apoB-100 were comparable in both the groups. ApoB100/apoA-I ratio was significantly elevated in poorly controlled diabetic. Apo B100/apo A-I ratio showed a strong positive correlation with glycated HbA1c Conclusion: Diabetes mellitus is associated with dyslipidemia. Strict glycemic control is capable of partially improving dyslipidmia. Apo B100/apo A-I ratio can be used as an additional parameter for assessment of risk of CAD in diabetes mellitus.

Avifaunal diversity of Anekere wetland, Karkala, Udupi district, Karnataka, India.

The avifaunal diversity and density in Anekere wetland, Karkala, Udupi district, Karnataka, India, was studied for a period of three years. Anekere pond inhabits several local and migratory bird species. Reduction in water retention in this pond in summer, weed infestation, variations in food availability in different seasons and threat of predation on the breeding activity of birds affected the avifauna diversity in the study area. This habitat attracted 44 bird species, which are local and migratory including aquatic birds, waders and others. Highest population of tree ducks (lesser whistling teal) was recorded in all the three years of study. Other prominent residents were Moorhens, Jacanas, Herons and Cormorants. The visitors include ringed plovers, wagtails and storks. It was evident that purple moorhen and tree ducks have developed high tolerance to this highly fluctuating habitat and human activity.

Influence of alignment of the pyramid on its beneficial effects.

The present study was aimed to find out whether a change in the alignment of the pyramid from the north-south axis causes any variation in the effects produced by it on plasma cortisol levels and markers of oxidative stress in erythrocytes of adult-female Wistar rats. Plasma cortisol and erythrocyte TBARS levels were significantly lower whereas erythrocyte GSH was significantly higher in rats kept in pyramid that was aligned on the four cardinal points--north, east, south and west, as compared to normal control rats. Although there was a significant difference in the plasma cortisol level between normal control group and the group of rats kept in randomly aligned pyramid, there was no significant difference between these two groups for the other parameters. Erythrocyte TBARS levels in the group of rats kept in the randomly aligned pyramid was significantly higher than that in the group kept in the magnetically aligned pyramid. The results suggest that the north-south alignment of the pyramid is crucial for its expected effects.

Effect of housing rats within a pyramid on stress parameters.

The Giza pyramids of Egypt have been the subject of much research. Pyramid models with the same base to height ratio as of the Great Pyramid of Giza, when aligned on a true north-south axis, are believed to generate, transform and transmit energy. Research done with such pyramid models has shown that they induced greater relaxation in human subjects, promoted better wound healing in rats and afforded protection against stress-induced neurodegnerative changes in mice. The present study was done to assess the effects of housing Wistar rats within the pyramid on the status of oxidative damage and antioxidant defense in their erythrocytes and cortisol levels in their plasma. Rats were housed in cages under standard laboratory conditions. Cages were left in the open (normal control), under a wooden pyramid model (experimental rats) or in a cubical box of comparable dimensions (6 hr/day for 14 days). Erythrocyte malondialdehyde and plasma cortisol levels were significantly decreased in rats kept within the pyramid as compared to the normal control and those within the square box. Erythrocyte reduced glutathione levels, erythrocyte glutathione peroxidase and superoxide dismutase activities were significantly increased in the rats kept in the pyramid as compared to the other two groups. There was no significant difference in any of the parameters between the normal control and rats kept in the square box. The results showed that exposure of adult female Wistar rats to pyramid environment reduces stress oxidative stress and increases antioxidant defense in them.

Lipid peroxidation and antioxidant systems in the blood of young rats subjected to chronic fluoride toxicity.

Wistar albino rats were exposed to 30 or 100 ppm fluoride in drinking water during their fetal, weanling and post-weaning stages of life up to puberty. Extent of lipid peroxidation and response of the antioxidant systems in red blood cells and plasma to prolonged fluoride exposure were assessed in these rats in comparison to the control rats fed with permissible level (0.5 ppm) of fluoride. Rats treated with 100 ppm fluoride showed enhanced lipid peroxidation as evidenced by elevated malondialdehyde (MDA) levels in red blood cells but, 30 ppm fluoride did not cause any appreciable change in RBC MDA level. 30 ppm fluoride-intake resulted in increased levels of total and reduced glutathione in red blood cells and ascorbic acid in plasma while 100 ppm fluoride resulted in decreases in these levels. The activity of RBC glutathione peroxidase was elevated in both the fluoride-treated groups, more pronounced increase was seen with 100 ppm. Reduced to total glutathione ratio in RBC and uric acid levels in plasma decreased in both the groups. RBC superoxide dismutase activity decreased significantly on high-fluoride treatment. These results suggest that long-term high-fluoride intake at the early developing stages of life enhances oxidative stress in the blood, thereby disturbing the antioxidant defense of rats. Increased oxidative stress could be one of the mediating factors in the pathogenesis of toxic manifestations of fluoride.

An open comparative clinical trial to assess the efficacy and safety of losartan versus enalapril in mild to moderate hypertension.

OBJECTIVES: To compare the efficacy and safety of losartan with enalapril, in mild to moderate hypertension. METHODS: An open, enalapril controlled study was conducted in 30 patients with mild to moderate hypertension. Losartan 50 mg was administered to patients for eights weeks. Throughout the study blood pressure was measured every two weeks. Routine laboratory investigations were performed before entering the trial, fourth week and at the end of the study. Adverse effects were recorded. After eight weeks losartan was stopped and enalapril 10 mg daily was administered to the same patients after two weeks washout period. The same methodology that was followed for losartan trial was repeated for enalapril trial also. RESULTS: Losartan treatment resulted in a highly significant reduction in the mean sitting diastolic blood pressure. Comparison with enalapril showed that both drugs are equally efficacious in reducing blood pressure in mild to moderate hypertension. The percentage of responders was slightly more with losartan than enalapril (86.7% vs 76.7%). Adverse events reported with losartan were mild. Enalapril also was well tolerated like losartan but there was high incidence of dry cough, which was reported in nine patients (30%). CONCLUSIONS: Losartan is an effective antihypertensive drug with an excellent safety and tolerability profile. It shows similar blood pressure lowering efficacy to that of enalapril. In contrast to enalapril, losartan does not cause dry cough.

Safety and efficacy of Hartone in stable angina pectoris--an open comparative trial.

OBJECTIVES: To evaluate the safety and efficacy of 'Hartone'--a proprietary herbal product primarily containing Terminalia arjuna in stable angina pectoris patients. PATIENTS AND METHODS: Ten patients with stable angina pectoris were given Hartone 2 caps twice daily for 6 weeks and 1 cap twice daily for the next 6 weeks. Haematological and biochemical investigations to assess safety were carried out on day 0, day 42 and day 84. Serum lipid profile was done before and after therapy. Efficacy was assessed by considering the reduction in the number of anginal episodes and improvement in stress test. The results were compared with 10 patients of stable angina pectoris on isosorbide mononitrate (ISMN) 20 mg twice daily. RESULTS: Hartone afforded symptomatic relief in 80% of patients and ISMN in 70%. The number of anginal attacks were reduced from 79/wk to 24/wk by Hartone and from 26/wk to 7/wk by ISMN. Although patients of both groups showed improvement in several stress test parameters compared to base line, the difference was not statistically significant. Hartone improved BP response to stress test in two patients and ejection fraction in one. Hartone was better tolerated than ISMN and showed no evidence of hepatic or renal impairment. Its effects on lipid profile was not consistent. CONCLUSION: Hartone is a safe and effective anti-anginal agent comparable to ISMN and is better tolerated. Large scale, randomised, double blind trials are needed to prove its efficacy.

Evaluation of safety and efficacy of azithromycin in lower respiratory tract infections (LRTI)

Azithromycin was given to 55 cases of lower respiratory tract infections in the doses of 500 mg on day 1, followed by 250 mg on days 2-5. It produced bacteriological cure in 70.8% patients and clinical cure or improvement in 69.09% of patients. 4.27% of patients had throat colonisation with new organisms, of which 9.09% needed a second antibiotic. The drug was well tolerated and minor side effects were noted. Gastrointestinal disturbances (16.36%) headache and giddiness (14.55%), rash (3.64%) were the noted side effects. Reduction of platelet count by 50% occurred in 12.29% of the cases compared to 0.2% reported earlier. But this thrombocytopenia was clinically not significant, as it did not cause any symptoms.

Single-step bulk purification of synthetic tetrapeptide tuftsin by high performance liquid chromatography.

A protocol on reversed phase high performance liquid chromatogrpahy (RP-HPLC) using water-acetonitrile gradients under lesser stringent conditions, has been devised to obtain highly purified tuftsin in bulk amount. The protocol was also tested for two different preparations of tuftsin to yield identical quality of peptide.