Pathological changes in COVID-19 pneumonia on limited post-mortem sampling of lung: A saga of inflammation and thrombosis

We describe three postmortem open lung-biopsy findings among patients with COVID-19 pneumonia who were on anticoagulant therapy. The spectrum of histopathological findings included lung inflammation in the form of diffuse alveolar damage (DAD) in exudative and organizing phases, with or without pulmonary artery thrombosis in different stages of evolution. This spectrum of inflammation and thrombosis may be indicative of a natural history of severe COVID-19 pneumonia or demonstrative of variation in therapeutics.

Multi-spectroscopic investigation of the binding interaction of fosfomycin with bovine serum albumin☆ / 药物分析学报

The interaction between fosfomycin (FOS) and bovine serum albumin (BSA) has been investigated effectively by multi-spectroscopic techniques under physiological pH 7.4. FOS quenched the intrinsic fluorescence of BSA via static quenching. The number of binding sites n and observed binding constant KA were measured by the fluorescence quenching method. The thermodynamic parameters △G0, △H0 and △S0 were calculated at different temperatures according to the van't Hoff equation. The site of binding of FOS in the protein was proposed to be Sudlow's site I based on displacement experiments using site markers viz. warfarin, ibuprofen and digitoxin. The distance r between the donor (BSA) and acceptor (FOS) molecules was obtained according to the F?rster theory. The effect of FOS on the conformation of BSA was analyzed using synchronous fluorescence spectra (SFS), circular dichroism (CD) and 3D fluorescence spectra. A molecular modeling study further confirmed the binding mode obtained by the experimental studies.

Lipid Peroxidation, Sperm DNA Fragmentation Total Antioxidant Capacity and Semen Quality in Male Infertility.

Infertility is a major clinical problem, affecting people medically and psychosocially. Male factor plays a significant role in about 50% of infertile couples. Recent reports indicate that increasing male infertility could be due to genomic abnormalities. The etiology of sperm DNA damage is multi-factorial but compromised due to nuclear defects, protamine deficiency and oxidative stress. The present study was aimed to evaluate sperm DNA integrity and oxidative stress in infertile men. The study is prospective, comprises 96 infertile patients and 30 fertile controls. Sperm DNA integrity was assessed by flowcytometry. MDA and TAC were evaluated spectrophotometrically. The percentage of DNA Fragmentation Index and MDA were found to be significantly increased while TAC was significantly decreased in infertile men as compared to control. DFI and MDA were negatively correlated with TAC levels. Present study indicates significant increases in seminal MDA and sperm DNA damage in infertile men. Seminal MDA was significantly correlated with sperm DNA damage, TAC and standard sperm parameters. The elevated levels of seminal OS observed in these infertile patients could be responsible for poor sperm quality and sperm DNA fragmentation. Hence evaluation of DFI, MDA and TAC can be used for diagnosis, prognosis of male infertility in addition to routine semen parameters to decide the treatment strategies.

Clinico-Haematological Study of Dengue Cases.

Objectives: To study and establish clinical and haematological correlation in cases of dengue viral infection. Methodology: A total 169 serum samples were received from L.G. Hospital for the detection of Dengue IgM during the period of October 2013 to January 2014. They were tested for the same with ELISA method. The clinical -haematological case study was done and the data was analyzed retrospectively. Results: Total 169 serum samples were tested, out of which 44(26.03%) were positive for Dengue IgM antibodies. Out of the total serum samples, Male: Female ratio and Urban: Rural ratio was 1.6:1 and 2.8:1 respectively. Peak incidence of the disease is seen in October. Clinically fever was the commonest presentation in 39(88.6%) patients followed by headache and muscle pain i.e., 33(75%) and 16(36.3%) respectively; the least common was epistaxis in 4 (9.04%) patients. Retrobulbar pain was in 3(6.8%) rash was in 6 (13.6%) and hemorrhagic manifestations in 12 (27.2%) patients. Amongst total WBC count, the proportion of Lymphocyte was above 70% in 3(6.8%) cases, between 50-70% in 17(38.6%) cases, and between 35-49% in 16(36.3%) cases and below 35% was in 8(18.18%) cases. The platelet count less than 50,000 was observed in16(36.3%) cases, 50,000 to 1, 00000 in 15(34.09%) cases and greater than 1,00,000 was in 13(29.5%) cases.19(43.1%) patients had erythrocyte sedimentation rate less than 7mm/hr, While 15(34.09%) patients had8- 20mm/hrand 10(22.7%) had more than 20 mm/hr.

FNAC of Head and Neck Swellings.

Background : Fine Needle Aspiration Cytology is simple, quick, inexpensive, majority are on OPD basis and minimally invasive technique used to diagnose different types of swellings located in the head and neck commonly originate from cervical lymph node, thyroid, salivary glands and soft tissues. Aim : To assess the frequency of incidences at different sites of head and neck region, and amongst the sex group. To assess distribution amongst inflammatory and neoplastic lesions. Methodology: A retrospective study was conducted at a tertiary care hospital, Ahmedabad from October 2013 to January 2014. Patients between the ages of 1 to 80 years were enrolled into the study. A total of 146 patients with a head and neck swelling underwent FNAC. Fine needle aspiration diagnosis was correlated with detail of relevant clinical findings and investigations. Results : Out of 146 fine needle aspiration procedures, 107 (73.29%) were of lymph nodes, 25 (17.12%) were of thyroid gland, 08 (5.48%) from soft tissue and 06 (4.11%) from salivary glands. Amongst lymph node swellings (73.29%), tuberculous involvement was seen in 73 cases (68.22%) with a female preponderance. Out of total 146 lesions, 109 (74.66%) were inflammatory, 29 (19.86%) were benign and 08 (5.48%) were malignant. Conclusions : The head and neck swellings are very common conditions encountered, with most of them being on OPD basis. Our study found that FNAC is simple, quick, inexpensive and minimally invasive technique to diagnose different types of head and neck swellings. It could differentiate the infective process from neoplastic one and avoids unnecessary surgeries. In case of neoplastic conditions, patient may be referred to Regional Cancer Centre.

Pre-treatment of seeds with static magnetic field ameliorates soil water stress in seedlings of maize (Zea mays L.).

The effect of magnetic field (MF) treatments of maize (Zea mays L.) var. Ganga Safed 2 seeds on the growth, leaf water status, photosynthesis and antioxidant enzyme system under soil water stress was investigated under greenhouse conditions. The seeds were exposed to static MFs of 100 and 200 mT for 2 and 1 h, respectively. The treated seeds were sown in sand beds for seven days and transplanted in pots that were maintained at -0.03, -0.2 and -0.4 MPa soil water potentials under greenhouse conditions. MF exposure of seeds significantly enhanced all growth parameters, compared to the control seedlings. The significant increase in root parameters in seedlings from magnetically-exposed seeds resulted in maintenance of better leaf water status in terms of increase in leaf water potential, turgor potential and relative water content. Photosynthesis, stomatal conductance and chlorophyll content increased in plants from treated seeds, compared to control under irrigated and mild stress condition. Leaves from plants of magnetically-treated seeds showed decreased levels of hydrogen peroxide and antioxidant defense system enzymes (peroxidases, catalase and superoxide dismutase) under moisture stress conditions, when compared with untreated controls. Mild stress of -0.2 MPa induced a stimulating effect on functional root parameters, especially in 200 mT treated seedlings which can be exploited profitably for rain fed conditions. Our results suggested that MF treatment (100 mT for 2 h and 200 for 1 h) of maize seeds enhanced the seedling growth, leaf water status, photosynthesis rate and lowered the antioxidant defense system of seedlings under soil water stress. Thus, pre sowing static magnetic field treatment of seeds can be effectively used for improving growth under water stress.

Electrolytes alterations in plasma and urine after 28 days repeated oral dose toxicity of mercuric chloride in wistar rat.

An experiment was conducted to study the electrolytes alteration in experimentally induced mercuric chloride in wistar rat. For this rats were uniformly divided in four different dose group 0.0, 2.0, 4.0, and 8.0 mg/kg body weight ranging from asymptomatic to high dose for 28 consecutive days. In this experiment, blood was collected on 0, 14 and at the end of experiment. In mercuric chloride treated group dose dependent significant increase in plasma glucose, sodium, and chloride and creatinine level. Same parameters studied in urine showed significant increase in excretion of electrolytes and glucose in urine while urine creatinine was decrease. Mercuric chloride produced dose depended electrolytes alteration in wistar rat at given dose.

Effect of mercuric chloride on oxidative stress and target organ pathology in wistar rat.

Mercury is the highly toxic metal that exerts its adverse effect on health of human and animals through air, soil water and food. For the present study, the toxic effect was observed by oral administration of mercuric chloride daily for 4 weeks at doses ranging from of 0 to 8 mg/kg/day. Histopathology was also carried out of both for kidney and liver. Significantl increased in lipid peroxidation and decreased Superoxide dismutase enzymes were observed in treated groups as compared to control . The gross changes were characterized by swellingand paleness of kidney and liver. Microscopic examination has revealed liver revealed hemorrhage, leukocytic infiltration, hepatocyte hypertrophy, necrosis and increased vacuolization incidence and the severity increased with increase treatment dose. In addition kidney showed proteineous cast in the lumen of tubules, narrowing of lumen, infiltration and necrosis.

An Epidemiological Study of Snake Bite Cases in Children of Nepal.

Introduction: Snakebite is common in the Terai region of Nepal. Injury and mortality of humans due to Snake envenomation is a serious pubic health problem in Southeast Asia and Nepal. It has been thought that at least 50,000 people in the region die of snake bites (this includes India, Bangladesh and Nepal and Pakistan) per year. There are abundant venomous snakes present in the region. Studies in Nepal have identified 4 species of snake responsible for the majority of fatal bites. These are the Indian cobra (Naja naja), common krait (Bungaris caeruleus) Russell's viper (Viper ressellii) and greenpit viper. The incidence of snakebite varies from 300-500 bites per 100,000 human populations in forested regions to 50-100 bites per 100,000 in Sahara. Objective: To study the epidemiology of snakebite in the endemic regions of the terai, to analyse the morbidity and mortality data of snakebite cases in children for the year 2008. Method: National Zoonoses and Food Hygiene Research Centre (NZFHRC) started collection of secondary and primary information on snakebite cases in children recorded and reported by different media and hospitals, health post in Nepal during the year 2008. The data had been compiled, tabulated and analysed. This is the regular surveillance study carried out on snakes in general and venomous snakebite human cases recorded in Nepal. The team visited in 6 mid, hill districts and 24 terai districts of Nepal. Results: Total snakebite cases in children were 540 during the year 2008. Of which 10 cases were from six mid hill districts and 530 were from 24 terai and inner terai districts of Nepal. Total morbidity was 406 (75.19%) and mortality 134 (24.81%). Seasonal incidence of snakebite cases recorded in Bheri zonal hospital and medical college Banke district. Highest morbidity were recorded during the month of Jestha (May) to Aswin (August). Morbidity 12 (25%) and mortality 3 (20%) were recorded in the month of May/June 2008. Conclusions: Snakebite cases in children and deaths were recorded and reported along with adult cases of snakebite. Total adult cases were 2190 of which children were 540 (24.66%) during the year 2008. This means that about 25% of all cases of snakebites were seen in children every year in the endemic areas of snakes. Mass awareness school education programme about snakebite especially in endemic area of terai and inner districts should be advocated regularly so that parents along with children will take necessary precautions.

Japanese Encephalitis Vaccination in Children Population of Nepal During the year 2005, 2006 and 2008.

Japanese Encephalitis (JE) is caused by a Flavivirus that, in a proportion of human cases, causes severe encephalitis leading to death or sometimes permanent disablement. It is a zoonotic disease, transferred from animals (commonly pigs or wild birds) by a mosquito vector to humans. In Southeast Asia it is thought to cause up to 50000 clinical cases and 10000 deaths per year. JE vaccination programme was carried out in high risk districts of Nepal. Japanese encephalitis vaccination was carried out during the years 2005, 2006, 2008 and 2009. The data collected from primary and secondary sources from the District Health Offices and other concerned central offices of the Department of Health Services, was tabulated and analysed. Thirty-five lakh of JE vaccine doses was procured by the Ministry of Health during the year 2006/2007. This vaccine was used in children under 15 years of age of 12 districts of JE risk and high-risk areas of Nepal. It was found that during the year 2005; 85% children in Banke and 81% in Kailali were vaccinated against JE. In Kailali and Banke districts it was found to be about 103% coverage in children population targeted, in Dang district it was 100% coverage, and in Bardiya district it was 73% coverege but in Rupandehi and Kanchanpur districts it was only about 40% and 41% respectively. JE vaccine coverage was very low in two Rupandehi and Kanchanpur districts during 2005 and 2006 and very high coverage during the year 2008. JE vaccination coverage results for the year 2009 have not been made available yet due to unavailability of data. This type of mass vaccination campaign needs regularlity, mass awareness and health education programme should be carried out before JE vaccination campaign in the children in the future.

Study of Visceral Leishmaniasis (Kala-azar) in Children of Nepal.

Introduction: Visceral leishmaniasis (VL) or Kala-azar is a potentially fatal vector-borne (sand fly phlebotomies spp) zoonotic disease caused by a protozoan parasite, Leishmania donovani. In Nepal, the disease is restricted to the Eastern Terai region which lies adjacent to the Bihar state of India. Although leishmaniasis is regarded as a significant health problem in Nepal by the Ministry of Health, there is no active case detection programme in the country. Objective: Objectives of this study were to determine the up-to-date morbidity and mortality trend for VL in children of Nepal. Method: The epidemiological surveillance team from the NZFHRC visited to eight zonal hospitals in Terai region during the month from September to December of each year 2003 to 2007. The morbidity and mortality data up to the year 2007 were collected every year. The team has also collected 66 blood serum samples of which 18 samples from children were collected for the diagnosis. Results: A total 25890 cases with 599 deaths were reported during the year 1980-2006. The case fatality rate (CFR) varied from 0.23% to 13.2%. Districtwise analysis showed that, during 2003, highest incidence was in Mahottari district (184/100,000), followed by Sarlahi (100/100,000) and Sunsari (96/100,000). The highest CFR was in Dhanusha (2.9%) followed by Bara (2.4%) and Saptari (2.0%). Majority (70.9%) of persons affected by VL were aged 15 years and above, followed by 10-14 years (13.9%), 5-9 years (11.9%) and 1-4 years (3.3%). VL cases recorded from different district of Nepal for the year 2004, 2005, 2006 and 2007 are recorded. CFR for the year 2004, 2005, 2006 and 2007 were 3.2%, 3.7%, 16.67% and 11.42% respectively. Conclusions: There should be regular surveillance research work to be carried out in endemic area. Mass public health education, to make the people aware about preventive aspects of the disease is important. The possibility of the existence of animal reservoirs as zoonotic disease should also be considered. This disease is very much serious in children below 15 years of age both in male and female, therefore it is essential to have paediatrician post at least in all VL six endemic districts.

Alcohols and other substance use/abuse among junior doctors and medical students in a teaching institute.

Substance related disorders have become matters of global concern because of its negative impact on individual health, familial, social and professional life. This study aims to assess prevalence of alcohol and other substance use among students and junior doctors at teaching institute. This descriptive study conducted on medical students, following convenient sampling method. Results revealed the prevalence rates of 'ever used', 'last year used' and 'last month used' were 63.5%, 56.5% and 42.5% respectively. The most preferred substance was alcohol (90.9%) and only 32.2% females 'ever used' substance. Cannabis use was seen exclusively among male (15.0%) students and opioid use was not found. Alcohol is most prevalent substance of use/abuse and was common among house officers and medical students.

Etiological spectrum of non-traumatic myelopathies: experience from a tertiary care centre.

AIM: This study aimed to identify the clinical and radiological profile of non-traumatic myelopathies and various etiologies associated with them. MATERIAL AND METHODS: Two hundred and four patients of non-traumatic myelopathy were prospectively studied in different wards of Sir Sundar Lal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, from September 2002 to March2004. Patients underwent a detailed clinical evaluation followed by laboratory investigation and neuroimaging studies. RESULTS: Among 204 patients of non-traumatic myelopathy, 108 patients presented with paraplegia and 96 patients with quadriplegia. Tuberculosis was the commonest cause of compression paraplegia in this series and was observed in 42 cases (33.33%) while quadriplegia was seen in only 3 cases (2.38%). In the present study, acute transverse myelitis formed the major bulk of non-compressive myelopathy. CONCLUSION: Tuberculosis of spine was the most common cause of compressive myelopathy and among the non-compressive group acute transverse myelitis and SACD were the important etiology.

Prevalence of pulmonary tuberculosis in far Western Nepal.

Keeping in view of high prevalence of tuberculosis in far western development region in different reports, a door to door survey of 125 household was carried out randomly in Mahendra Nagar municipality ward no 13 of Kanchanpur district to pick up symptomatics suggestive of pulmonary tuberculosis and find the prevalence in the target population. A total of 200 sputum specimens from 70 symptomatics within the age range of 10-80 years were collected and subjected to smear microscopy by Ziehl - Neelsen's method. Out of 10 positive cases (14.28%), infection in males and females was 80% and 20% respectively. The infection was found in the productive age group 20-69. The highest prevalence was obtained in 20-29 age group (25%) followed by 40-49 (11%), 30-39 (9%), 50-59 (8%) and 60-69 (8%). The diagnostic yield of single sputum specimen examined was insufficient in field condition, especially where the sputum positivity was low. Of the three sputum smears examined, the early morning specimen had the best result.

Polyneuropathy with osteosclerotic myeloma--POEMS syndrome.

A 55-years-old male, who presented with insidious onset gradually progressive sensorimotor polyneuropathy, POEMS-syndrome was diagnosed based on polyneuropathy, splenomegaly, hypothyroidism, the presence of IgG-monoclonal serum protein with osteosclerotic lesions and hyperpigmention of skin. Biopsy of the osteosclerotic lesion from the right superior pubic rami was consistent with plasmocytoma. Electrophysiological studies revealed demyelinating sensorimotor neuropathy and biopsy from sural nerve showed demyelinating neuropathy with secondary axonopathy. The patient showed improvement with radiotherapy. This is a rare systemic disease from the clinical spectrum of plasma cell dyscrasias with polyneuropathy. The importance of POEMS syndrome in the differential diagnosis of polyneuropathies has been emphasized.

Neuronal stem cells.

Stem cells are self regenerating multipotential cells, found in the human brain which have the potential to differentiate into neurons, astrocytes and oligodendrocytes, and to self renew sufficiently to provide adequate number of cells in the brain. Neural stem cell grafts have been studied in a variety of animal models for various diseases like metabolic disorders, muscular dystrophies, neurodegenerative disorders, spinal cord repair, brain tumors and demyelinating disease. Stem cells may be derived from autologus, allogeneic or xenogenic sources. Histocompatibility is prerequisite for transplantation of allogeneic stem cells. Fetal tissue is the best current tissue source for human neural stem cells, however ethical issues are a major concern. Thus the prospect that stem cells could potentially be used to promote neurogenesis following injury and disease may seem attractive, yet the inherent problems associated with isolation and rejection in case of stem cells from another source, the potential to form tumors and ethical issues are the major challenges.

A case of carcinoma rete testis: histomorphological, immunohistochemical and ultrastructural findings and review of literature.

A 72-year-old man presenting with a secondary hydrocoel underwent orchidectomy. Gross examination revealed a tumor arising in the region of the rete testis, which on histopathology proved to be a papillary adenocarcinoma. The patient did not have evidence of any other neoplasia elsewhere in the body. The lesion fulfilled the anatomic criteria elucidated by Nochomovitz et al to be labelled as adenocarcinoma of Rete testis. Electron microscopy revealed characteristic nuclear infoldings and microtubules with two different arrangements. The tubules were either seen to form concentric circles or were in irregular groups with filaments interspersed. The lesion on immunohistochemistry was negative for germ cell markers AFP and HCG, and was positive for cytokeratin and epithelial membrane antigen. A review of literature is also presented.

Controlling Taenia solium in Nepal using the PRECEDE-PROCEED model.

Taenia solium is a predominant food-borne parasitic zoonosis (FBPZ) in Nepal. Using the PRECEDE framework, as defined by Green and Kreuter, we can identify the factors behind the high incidence of this disease. Armed with this information, we can define the actions necessary to control T. solium. In accordance with the first step of PRECEDE, social assessment, we set the goal of decreasing the potential for T. solium transmission in Nepal by the year 2003. This goal has yet to be endorsed by policy makers. However, an epidemiological assessment based on hospital data alone showed that T. solium is an endemic problem in urban Nepal that must be addressed. Based on behavioral and environmental assessments (Steps 1 and 2 of PRECEDE-PROCEED), we defined the following action objectives to be achieved by 2003: 1) Train meat producers and sellers to detect contaminated pork and avoid selling it, 2) Improve pig husbandry to limit the animals' access to human feces, 3) Construct hygienic model slaughterhouses. These improvements could control the meat-producing environment, thus limiting the potential for cross-carcass contamination and other hygiene deficiencies associated with the spread of T. solium. An educational and ecological assessment shows all predisposing, reinforcing and enabling factors are present in Nepal, consistent with PRECEDE requirements. While T. solium is clearly defined as a health problem according to PRECEDE, there remain significant hurdles to controlling it. These hurdles lie in administration and policy, where standardized law-enforcement and meat inspection practices are needed. Finally, the government of Nepal must assign high priority to T. solium control, as it is a preventable, yet prevalent disease.

Health promotion approach for the control of food-borne parasitic zoonoses in Nepal: emphasis on an environmental assessment.

Green and Kreuter define health promotion as the use of both education and ecology to encourage and support living conditions conducive to good health. Their PRECEDE-PROCEED model delineates a practical way to cope with health problems using this definition. Applying PRECEDE to Nepal helps identify the steps needed to control the ever-increasing incidence of food-borne parasitic zoonoses (FBPZ) there and in other South Asian countries. In executing the first five steps of the model, we focused on behavioral and environmental assessments to find a method for controlling FBPZ. Through these two assessments, we identified the following behavioral and environmental objectives: establish a meat inspection system by 2003, establish training programs on safe meat production and selling practices by 2003, improve slaughterhouses and slaughtering practices by 2003. The educational and ecological assessments revealed that the necessary predisposing, reinforcing and enabling factors for appropriate control of FBPZ are present in Nepal, while an administration and policy assessment shows Nepal meets PRECEDE requirements through its recent meat inspection legislation. Although the data for each element of the PRECEDE-PROCEED model are limited in Nepal, they clearly tell us to move forward to the PROCEED stage to control FBPZ there as well as in all of South Asia.