Study on Clinico – Etiological Co-Relation and Management Modalities in Children with Pleural Effusion

Introduction: Pleural effusion, abnormal accumulation offluid in pleural space, differ Signicantly in children from adultsin relation to etiology, management and outcome. Objective ofthis study is to identify common causes of pediatric pleuraleffusions; to describe the clinic-etiological profile and itsco-relation with radiological finding and management andearly outcome of pleural effusion in children. Study Design:Prospective Hospital based Observational study.Material and Methods: Patients with pleural effusion wereevaluated by chest X-ray and USG in all cases and CT scanthorax in difficult cases. Pleural fluid samples were analyzedfor glucose, protein, cytology and culture, CBNAAT (asand when required). Intercostal tube drainage was given inempyema cases VATS and decortications Was done in specificcase.Results: Commonest etiology of pleural effusion wasempyema (52% cases), followed by tubercular pleural effusion(26% cases). Most common organism isolated from pleuraleffusion was Mycobacterium tuberculosis (21.79%) followedby staphylococcus aureus. There is signicant correlationamong age and etiology (p value 0.015), tuberculosisoccurred more in older children and empyema occurredmore in younger children. There is no signicant correlationamong weight and etiology (p value 0.200), between genderand etiology of pleural effusion (p value >.05) in our study.There is signicant correlation of pleural fluid neutrophilcount (p value 0.001), lymphocyte count (p value 0.002)with etiology, but no correlation was seen with protein (pvalue 0.060), LDH (p value 0.353), glucose (p value 0.799)in our study. The successful management of pleural effusionlines in intravenous administration of antibiotics along withintercostals drainage tube.Conclusion: Regarding etiology of pleural effusion empyemaand tuberculosis are very commonly encountered in clinicalpractice. Staphylococcus aureus is the most common pathogen.Regardless of which treatment is used in pleural effusion, theoutcome for children is generally excellent.

Assessment of quality of life among elderly population of rural areas of Etawah district: a cross sectional study

Background: All the aspects of health status, lifestyle, life satisfaction, mental health and well-being together reflects the multidimensional nature of quality of life (QOL) in an individual. The objective of the study was to assess the quality of life among rural elderly population of Etawah district and their association with various socio demographic factors.Methods: A community based cross-sectional study was conducted among 316 elderly subjects in rural areas of Etawah district. QOL was assessed by using WHOQOL-OLD tool. Socio-demographic factors were assessed by using a self-structured questionnaire. Data was analysed by using Microsoft Excel 2010 and statistical software SPSS-22. Transformed facet sore were calculated using WHOQOL- OLD manual and Independent sample t- test were applied.Results: Majority (86%) were in the (?75) years of age. Among the study participants, 52.8% were females, 67.5% were illiterate, 72.5% belong to nuclear family. The mean scores of QOL domains was maximum in death and dying (83.20), followed by sensory ability (62.99).The lowest mean score was seen Intimacy domain (22.80). Gender, type of family, financial status and staying with partner were found to be the determinants of better QOL (p>0.05).Conclusions: The mean quality of life score was below average in intimacy domain. It was maximum in death and dying domain

Variant myopia: A new presentation?

Purpose: Variant myopia (VM) presents as a discrepancy of >1 diopter (D) between subjective and objective refraction, without the presence of any accommodative dysfunction. The purpose of this study is to create a clinical profile of VM. Methods: Fourteen eyes of 12 VM patients who had a discrepancy of >1D between retinoscopy and subjective acceptance under both cycloplegic and noncycloplegic conditions were included in the study. Fourteen eyes of 14 age- and refractive error-matched participants served as controls. Potential participants underwent a comprehensive orthoptic examination followed by retinoscopy (Ret), closed-field autorefractor (CA), subjective acceptance (SA), choroidal and retinal thickness, ocular biometry, and higher order spherical aberrations measurements. Results: In the VM eyes, a statistically and clinically significant difference was noted between the Ret and CA and Ret and SA under both cycloplegic and noncycloplegic conditions (multivariate repeated measures analysis of variance, P < 0.0001). A statistically significant difference was observed between the VM eyes, non-VM eyes, and controls for choroidal thickness in all the quadrants (Univariate ANOVA P < 0.05). The VM eyes had thinner choroids (197.21 � 13.04 ?) compared to the non-VM eyes (249.25 � 53.70 ?) and refractive error-matched controls (264.62 � 12.53 ?). No statistically significant differences between groups in root mean square of total higher order aberrations and spherical aberration were observed. Conclusion: Accommodative etiology does not play a role in the refractive discrepancy seen in individuals with the variant myopic presentation. These individuals have thinner choroids in the eye with variant myopic presentation compared to the fellow eyes and controls. Hypotheses and clinical implications of variant myopia are discussed.

Comparison of shear bond strength of self‑etching fluoride releasing adhesives with and without pumice prophylaxis.

Context: Despite the advances in orthodontic material and treatment mechanics, the placement of fixed appliances increases the risk of enamel demineralization. The development of fluoride release adhesives has attracted considerable interests because the combined use of antimicrobials and fluoride enhances the cariostatic effect. Aim: To compare the shear bond strength (SBS) of fluoride release adhesives with established orthodontic adhesives and assess failure mode using adhesive remnant index (ARI). Settings and Design: The present study included 80 maxillary premolars which were randomly divided into four groups (n = 20) and were further subdivided into two subgroups A ‑ Pumice prophylaxis (PP) and subgroup B ‑ No PP (n = 10). Materials and Methods: Stainless steel brackets were bonded with Transbond XT, Transbond plus (TP) color change adhesive, Light Bond, and Clearfil protect bond. After debonding, the ARI was used to assess the mode of bracket failure. Statistical Analysis: The data were analyzed using two‑way analysis of variance, Post‑hoc Tukey Honest significant differences test, and Chi‑square test. Results: The mean SBS of Group 4 was comparably higher regardless of PP. Brackets bonded with TP showed a comparable SBS to conventional Transbond XT. The ARI scores were predominately 2. Conclusions: Fluoride releasing adhesives combined with antibacterial monomer can play a vital role in reducing white spot lesions by enhancing the cariostatic effect especially in noncompliant\medically compromised patients.

Significance of Expression of PSP94 Isoforms in Etiology of Benign Prostatic Hyperplasia and Prostate Cancer.

Background: Prostate Secretory Protein of 94 Amino Acids (PSP94) level is known to increase in benign prostatic hyperplasia (BPH) and decrease in prostate cancer (PCa). However, there has not been a consensus on the abundance and significance of the different isoforms of PSP94 during the development of BPH and PCa. Methods: Benign and malignant prostate tissue was ascertained histologically. Biplex polymerase chain reaction (PCR) and real-time PCR were employed to quantitate the two isoforms, PSP94 (MSMB1) and PSP57 (MSMB2). Results: Higher abundance of both MSMB1 and MSMB2 transcripts was observed in BPH as compared to PCa. Further, there was a strong positive correlation between the transcript levels of these isoforms, MSMB1 and MSMB2, in samples from both BPH and PCa patients. Conclusions: PSP57 (MSMB2) transcript may not be involved in the development of BPH or PCa and could have a physiological role in prostate cells.

Congenital Hypothyroidism Screening with Umbilical Cord Blood: Retrospective Analysis.

Incidence of congenital hypothyroidism varies across countries and different geographic regions. A retrospective analysis of cord blood thyroid stimulating hormone values, and their subsequent follow-up, was done in a tertiary-care center in Kerala, India. Congenital hypothyroidism was found at the rate of 1 in 244, which is higher than reported incidence from other centers.

Posterior reversible encephalopathy syndrome: A rare entity.

Posterior reversible encephalopathy syndrome(PRES) is a proposed reversible cliniconeuroradiological entity characterized by headache, altered mental status, cortical blindness, seizures, focal neurological signs and a diagnostic magnetic resonance image showing multiple hyperintense signal in cortical and subcortical white matter. We report a case of 25 year female who presented 2 days postdelivery with posterior reversible encephalopathy syndrome. Early diagnosis with MRI showing bilateral parietal and occipital hyperintensities and treatment with manitol, antiepileptics and supportive measure, the syndrome was fully reversible. Clinicians as well as radiologists should be familiar with this clinically frightening, underdiagnosed condition to assure timely diagnosis and treatment to prevent persistent neurological deficits.

Experimental Evaluation of the Anti-Ulcer Activity of Grape (Vitis Vinifera) Seed Extract in Wistar Albino Rats.

Peptic ulcer disease is a common condition of present day life, and its incidence is markedly increasing. The available drugs for the treatment are associated with adverse effects. Hence, there is a need for newer and better treatment for the same. Objectives: To evaluate the anti-ulcer activity of ethanolic extract of Vitis Vinifera (seed) by Water Immersion stress induced gastric ulcer model in Wistar albino rats using two doses (100, 200mg/kg body weight.) Methods: The antiulcer activity was assessed by estimating gastric volume, pH, free and total acidity; ulcer number and its inhibition, gastric lesion, ulcer severity and ulcer index; and comparing it with the control groups. Results: The present study revealed that grape seed extract of 100mg/kg and 200mg/kg showed a significant (p<0.05) reduction in the gastric volume, ulcer number, gastric lesion and severity. The ulcer index was 45.33 and 36.66 for 100 and 200mg/kg respectively. Ulcer inhibition for 100 and 200 mg/kg group was 32.79% and 44.86% when compared with the control group. Ulcer protection with 100 and 200mg/kg was 29.21% and 39.82% when compared with the control group. Conclusion: This present study indicates that Vitis vinifera seed extract have potential anti-ulcer activity in the model tested.

CD44: A key player in breast cancer.

CD44 is a principal transmembrane hyluronate receptor, which acts as a hook between Extracellular Matrix and the cytoskeleton. CD44 is up regulated in breast cancer, which in turn helps in tumor progression and metastasis. There has been a lot of attention given to CD44 in recent years because of the discovery, CD44+/CD24- lineage marks breast cancer stem cells. Recent clinical and experimental findings show that CD44 is involved in the tumor associated proliferation, invasion, migration, and in many pathways involved in maintaining cancer cells which inturn are correlated with patient's survival. All these findings make CD44 as a potential target for breast cancer treatment. The methods of literature search for this article include Pubmed, BMC cancer and other printed journal article.

Comparison of shear bond strength of orthodontic brackets bonded using two different hydrophilic primers: An in vitro study.

Context: Salivary control and maintenance of a dry operating field is a prime requisite of orthodontic bonding. Moisture insensitive primer (MIP) with a clinical significant bond strength values have a better edge over the conventional hydrophobic bonding systems. Aim: The aim of this study is to investigate the effectiveness of two hydrophilic primers with respect to conventional hydrophobic primer by comparing their shear bond strength (SBS) and adhesive-failure locations after contamination with saliva and saliva substitute. Materials and Methods: A total of 150 extracted human premolars were randomly divided into five group s ; Group A (Transbond MIP/saliva substitute), Group B (Opal Primo/saliva substitute), Group C (Transbond MIP/natural saliva), Group D (Opal Primo/natural saliva), control group - Group E (Transbond XT/dry), adhesive-Transbond XT used for all five groups and bonded using stainless steel brackets. Shear forces were applied to the samples with a universal testing machine. SBSs was measured in megapascals. The mode of bond failure was determined using the adhesive remnant index (ARI). Results: The mean SBS produced by Transbond MIP was higher than Opal Primo, which was statistically significant according to one-way analysis of variance. Both the tested groups showed lesser bond strength values than Transbond XT (the control). ARI scores revealed that there was no statistically significant difference in the site of bond failure between study groups. ARI scores were found to be lower for study groups suggesting adhesive failure, compared to higher ARI scores for the control group suggesting cohesive failure. Conclusion: Transbond XT adhesive with Transbond MIP or Opal Primo have clinically acceptable bond strength in wet fields. Opal Primo is a viable option to use as a hydrophilic primer clinically.

Hydrobiogical Parameters Studies of the Alagankulam River, Ramanathapuram District, Tamil Nadu, India.

The present study was carried out to determine the pysico-chemical characteristics and nutrients in two stations of Alagankulam River, Ramanathapuram, and South East Coast of India during January to December 2012. All the pysico-chemical parameters were analyzed using standard methods (Apha, 1998). The minimum and maximum values of water temperature (°c), Dissolved oxygen (mg/lit), Salinity (ppt), PH, Calcium (mg/lit) was 26-35 (Station 1), 26-35 (Station 2), 5.0-7.1 (S1), 5.0-7.1 (S2), 0.01-0.06 (S1), 0.02-0.07 (S2), 7.0-8.2 (S1), 7.2-8.3 (S2), 22.1-29.4 (S1), 19.9-26,2 (S2) respectively. The range of Alkalinity (mg/lit), Silicate (mg/lit), Sulphate (mg/lit), Chloride (mg/lit), Ammonia (mg/lit), Phosphate (mg/lit) and nitrite (mg/lit) was 16.1-28.6 (S1), 18.5-26.8 (S2), 0.13-2.28 (S1), 0.81-1.74 (S2), 26.13-41.29 (S1), 28.9-49.70(S2), 6.1-8.7(S1), 5.5-7.9 (S2), 0.2-1.9 (S1), 0.2-1.9 (S2), 3.3-9.2 (S1), 1.3-8.5 (S2), 13-28 (S1) and 12-27 (S2) respectively.

Chromobacterium violaceum sepsis in an infant.

Chromobacterium violaceum is a rare pathogen that can cause potentially fatal infections in humans. Till date, 150 cases are reported worldwide including 7 from India. We report a 6 month old infant who presented with high grade fever, respiratory distress and multiple vesicular skin lesions. Chromobacterium violaceum was isolated from blood, bone marrow aspirate and from skin lesions. Infant responded to treatment with piperacillin and ciprofloxacin, and is doing well on follow up.

Baseline Widal titres in healthy children.

OBJECTIVE: To determine the baseline Widal titres in apparently healthy children in Davangere. METHODS: Cross-sectional study was done on 250 children. Widal titers were found using tube agglutination test. RESULTS: Out of 250,64.2% had a titre of less than 1:20,22.4% had a titre equal to 1:20,9.6% had a titre of 1:40 and 3.6% had a titre of 1:80 to 'O' antigen and 67.2% had a titre of less than 1:20, 21.2% had a titre equal to 1:20, 8% had a titre of 1:40 and 3.6% had a titre of 1:80 to 'H' antigen of S. enterica subsp. enterica ser. Typhi. No children in age group 6 months-2 years had a titre of 1:80 to either antigen. All children in this age group had a titre of less than 1:20 to AH antigen and older children had a titre upto 1:40 dilution. CONCLUSION: Baseline titres for either S. enterica subsp. enterica ser. Typhi antigen in 6 month-2 year was 1:40 and older children was 1:80. Baseline titres for H antigen of S. enterica subsp. enterica ser. Paratyphi A in 6 month-2 year was less than 1:20 and for older children was 1:40 dilution.

Cytokine network and its manipulation in rheumatoid arthritis.

Studies of the inflammatory process in the inflamed synovium from rheumatoid arthritis patients have shown an intricate network of molecules involved in its initiation, perpetuation and regulation trial balances the pro- and anti-inflammatory process. This system is self-regulating though the action of anti-inflammatory and pro-inflammatory cytokines cytokine receptor antagonists and naturally occurring antibodies cytokines. Inflammatory synovitis in rheumatoid arthritis (and possibly in other inflammatory arthritidies) appears to be the result of an imbalance in the cytokine network with either an excess production of pro-inflammatory cytokines or from inadequacy of the natural anti-inflammatory mechanisms. Using this knowledge the newer therapeutic approaches to RA and other inflammatory arthritides are being aimed at correcting this imbalance. Monoclonal antibodies to INF-alpha (humanised form of this is called infliximab), soluble TNF-alpha receptors (etanercept) are already in clinical use and adalimumab (humanised TNF-alpha antibody). IL-1Ra is undergoing clinical trials. Other promising therapeutic agents that could regulate the cytokine network are in various stages of laboratory and clinical evaluation. These studies promise to yield therapeutic targets that could dramatically change the way inflammatory diseases would he treated in the future. The now established efficacy of infliximab and etanercept in inflammatory arthritides could be considered just a glimpse of the exciting scenario of the future.

Use of simple hematological, biochemical and clinical parameters to monitor response of multiple myeloma patients on high dose thalidomide therapy.

BACKGROUND: Evidence of increased bone marrow vascularity in multiple myeloma (MM) has led to the use of anti-angiogenic drugs especially thalidomide in relapsed or refractory patients. Currently, parameters such as serum/ urine electrophoresis for M (monoclonal) proteins, bone marrow biopsy with touch preparation and b2 microglobulin are routinely used to assess response to therapy. These investigations are expensive, invasive and require high technical setup. AIM: To correlate simple and routine hematological and biochemical parameters with the key marker of disease i.e. M proteins. SETTINGS AND DESIGN: This is an open label, uncontrolled, single-arm study. MATERIALS AND METHODS: Twenty nine refractory or relapsed multiple myeloma patients of both sexes (M=20, F=9) with age ranging between 35-72 years were initiated on 200 mg/day of thalidomide with fortnightly increments of 200 mg to a maximum tolerated dose not exceeding 800 mg/day. All hematological and biochemical parameters were monitored at monthly intervals for one year. STATISTICAL ANALYSIS: Correlation analysis was performed between hemoglobin (Hb), total leukocyte count (TLC), absolute neutrophil count (ANC), platelet count (PC), total proteins (TP), serum albumin and serum globulin on one hand and M protein levels on the other using Pearsons Correlation test by SPSS version 7.5. RESULT: Hb, TLC, ANC, PC and serum albumin levels showed a significant negative correlation with M proteins. A highly significant positive correlation existed between M proteins on one hand and TP and globulin levels on the other. Dryness of skin indicated positive response to therapy. These correlations were found to be significant at the end of one month of therapy in all the above-mentioned parameters except in TLC where it was significant after 2 months of thalidomide therapy. CONCLUSION: Results suggest that sustained efficacy of thalidomide therapy may be amenable to monitoring by these simple, inexpensive and easily available investigations after ascertaining an initial response by M protein and marrow plasmacytosis as these parameters closely follow M protein levels. However more studies are required to further substantiate these findings.