Retrospective analysis of necropsy findings in patients of H1N1 and their correlation to clinical features.

India reported its first case of H1N1 in July 2009 in Pune and since then, the number of reported cases and deaths exploded in India. Since very little data is available about histopathological findings in patients of H1N1 fatal cases in India, a retrospective chart analysis of necropsy findings of 15 cases of 2009 H1N1 fatal cases was performed. Common clinical features were fever, cough, and breathlessness followed by sore throat and rhinorrhea. Common lung findings were mononuclear cell infiltration, thick alveolar septae, intraalveolar hemorrhage. The other findings were congested pulmonary blood vessels, pulmonary edema, cytomegaly, fibrin accumulation and formation of eosinophilic membrane. These findings are suggestive of diffuse alveolar damage (DAD) and DAD with hemorrhage. All patients who underwent necropsy had radiographic findings suggestive of unilobar or multilobar pneumonia. This clinical finding can be correlated pathologically in these patients as all of them had either polymorphonuclear or mononuclear infiltrate. Furthermore, necrotizing pneumonitis pattern seen on these patients is the likely cause of mortality in these patients. Although clinical ARDS pattern was noted in all these patients, it was well correlated in lung pathology in all these cases.

Trace element concentration in groundwater of Pesarlanka Island, Krishna Delta, India.

There is a growing concern over the potential accumulation of trace element concentration in groundwater of coastal aquifer owing seawater encroachment in the last several decades. A total of 29 groundwater samples collected from Pesarlanka Island, Krishna delta, Andhra Pradesh, India were analyzed for 13 trace elements (B, V, Mn, Fe, Ni, Co, Cu, Zn, As, Sr, Cd, Ba, and Pb) using inductively coupled plasma mass spectrometry. The results reveal that B, Fe, Ni, As, Sr, and Pb vary from 11.22 to 710.2, 1.25 to 684.6, 0.02 to 37.33, 27.8 to 282.3, 164.1 to 7,009, and 1.97 to 164.4 microg/l, respectively. Ba, Cd, Co, Cu, Ni, V, and Zn are almost within permissible limits for drinking water, but As, Fe, Mn, Pb, B, and Sr are above the permissible limit. The toxic element Pb is 1.64 times more than the maximum permissible limits of drinking water. The minimum value of As is also 2.78 times more, whereas the maximum is 28.2 times the permissible limit. The spatial distributions of alkaline earths (Sr, Ba), transition metals (V, Co, Ni, Fe), metallic elements (Cu, Pb), and (As) were found in considerable variation in the entire Island. Good cross-correlations were found between As, B, Co, and Sr with total dissolved solids and among other trace elements such as B, As, Co, and Sr. The variability observed within the groundwater samples is closely connected to the sea spray input; hence, it is primarily a consequence of geographical and meteorological factors, such as distance from the ocean and time of year. The trace element levels, in particular those of heavy metals, are very low, suggesting an origin from natural sources rather than from anthropogenic contamination. A few trace elements (Sr and B) are found as sensitive parameters responding to changes in fresh to saline groundwater environment. The highly elevated trace elements in this area which may be attributed to marine sediments or death and decay of plants are presented in this paper.

Residual solvent analysis in hydrochloride salts of active pharmaceutical ingredients.

GMP conditions commands to control adequately the quality of APIs by checking the levels of residual solvents. Organic solvents such as acetone, ethyl acetate, isopropyl alcohol, methanol, tetrahydrofuran and toluene frequently used in pharmaceutical industry for the manufacturing of Active Pharmaceutical ingredients (APIs). A selective Gas Chromatographic (GC) method has been developed and validated as per ICH guidelines for residual solvent analysis in 10 different hydro chloride salts of APIs. Residual solvents in APIs were monitored using gas chromatography (GC) with Flame Ionisation detector (FID). The separation was carried out on BP 624 column (30 mx0.53 mm i.d.x0.25 m coating thickness), using GC 17 A shimadzu, with nitrogen as carrier gas in the split mode by direct injection method. The method described is simple, sensitive, rugged, reliable and reproducible for the quantitation of acetone, ethyl acetate, isopropyl alcohol, methanol, tetrahydrofuran and toluene at residual level from hydrochloride chloride salts of APIs.

Simultaneous determination of salbutamol sulphate and bromhexine hydrochloride in tablets by reverse phase liquid chromatography.

A simple reverse phase liquid chromatographic method has been developed and subsequently validated for simultaneous determination of salbutamol sulphate and bromhexine hydrochloride. The separation was carried out using a mobile phase consisting of acetonitrile, methanol and phosphate buffer, pH 4 in the ratio 60:20:20 v/v. The column used was SS Wakosil-II C-18 with a flow rate of 1 ml/min and UV detection at 224 nm. The described method was linear over a concentration range of 10-110 mug/ml and 20-140 mug/ml for the assay of salbutamol sulphate and bromhexine hydrochloride, respectively. The mean recovery was found to be 95-105% for salbutamol sulphate and 96.2-102.1% for bromhexine hydrochloride when determined at five different levels.

RPLC Determination of Tinidazole and Diloxanide Furoate in Tablets.

A simple reverse phase liquid chromatographic method has been developed and subsequently validated for simultaneous determination of tinidazole and diloxanide furoate. The separation was carried out using a mobile phase consisting of acetonitrile, methanol and 0.2 M potassium dihydrogen phosphate (pH 5) in the ratio 2:3:2.The column used was SS Wakosil-II C-18 with a flow rate of 1 ml/min and UV detection at 282 nm. The described method was linear over a concentration range of 10-70 µg/ml and 10-90 µg/ml for the assay of diloxanide furoate and tinidazole, respectively. The mean recovery was found to be 100-101% for tinidazole and 97-103% for diloxanide furoate when determined at three different levels.

FNAC of salivary gland lesions with histopathological correlation.

HYPOTHESIS: Analysis of salivary gland lesions by FNAC and correlation with histopathology. To evaluate utility of FNAC in salivary gland lesions.Back ground: Salivary gland lesions form about 2-6.5% of all head and neck neoplasms in adults. They are easily accessible for FNAC (Fine Needle Aspiration Cytology) and risks of fistula formation or tumour implantation are low compared surgical biopsy. Also, cytology can provide a distinction between asalivary and non salivary lesion, benign and malignant lesions so also specific and non specific inflammation. METHODS: Seventy patients were studied prospectively over two years. FNAC was done using 10 cc syringes and 20-22 no. needle. Histomorphology was assessed on routine H & E (haemotxylin and eosin) stained paraffin sections. SPAS (periodic acid Schiff) and mucicarmine satins were also done. RESULTS: 80% of the lesions were neoplastic (61% benign, 31% malignant) and 20% were neoplastic. Pleomorphic adenoma was the most frequent benign neoplasm while mucoepidermoid carcinoma was the most frequent malignant lesion. Among the non neoplastic lesions, the maximum number of cases were of chronic sialadentis. In the present study, FNAC has a sensitivity of 94.54% and specificity of 80.95% for neoplastic lesions. CONCLUSIONS: FNAC was found to be a useful diagnostic tool in the evaluation of salivary gland lesions because of its simplicity, excellent patient compliance and rapid diagnosis. This cost effective tool is invaluable in planning the surgical management of the patient.

Galanin immunohistochemistry and electron microscopic studies in developing human fetal mammillary bodies.

Development and maturation of nuclear groups in the mammillary complex of second and third trimester human fetal hypothalamus were studied using Nissl stain, galanin immunocytochemistry and transmission electron microscopy. While the identity of the supra and medial mammillary nucleus was established at 24 weeks of gestation (w.g.) in Nissl stained preparation, galanin immunoreactive (Gal-ir) neurons were seen in the supra and medial mammillary nucleus of 27 through 39 w.g. fetuses. Immunoreactive perikarya in the lateral mammillary nucleus appear later at 34 w.g. and show relatively meager population. Gal-ir neurons of the supramammillary nucleus were divisible in dorsal and ventral subgroups. There was a progressive increase in galanin expressing neurons in more and more ventral positions, along the medial margin of either mammillary body so that in term fetal specimens, the ventral subgroup appeared to be continuous with the medial mammillary nucleus. Galanin positive neurons were relatively sparse in the core of the mammillary bodies. Transmission electron micrographs revealed neurons with varying degree of indentation of the nuclear envelope. Vigorous synaptogenesis was seen in the supramammillary region of the mammillary bodies. The height and width of the synaptic complex also showed a progressive increase. Although galanin neurons were reported from the supramammillary nucleus of adult human mammillary complex, no immunoreactivity was detected in the medial and lateral components of the mammillary body. We suggest that expression of galanin in the medial and lateral components may be of transient occurrence and may serve a significant role in the synaptogenesis.

Primary thyroid lymphoma: a report of two cases.

Primary thyroid lymphomas (PTLs) are rare neoplasms which in the past have been classified by various schemes. Clinicopathological findings of two cases which were diagnosed in the past one year in our institute are presented using the Revised European and American classification (REAL) for lymphomas. Both cases presented as enlarging neck masses in elderly female patients, in association with lymphocytic thyroiditis. One case was diagnosed as a MALT (mucosa associated lymphoid tissue) lymphoma while the other was a diffuse large cell lymphoma (DLCL).

How will the two-weeks-wait rule affect delays in management of urological cancers?

The UK National Health Service has now specified a maximum interval of two weeks between general practitioner (GP) referral and specialist assessment for patients with suspected cancer. We examined progress through the cancer pathway in 160 patients with potentially curable cancers of the prostate, bladder, kidney and testis before implementation of this rule. Median intervals with interquartile ranges were quantified from the first GP consultation to hospital referral, then to the first hospital consultation, confirmation of diagnosis and definitive surgery. 34% of patients were seen at the hospital within two weeks of referral. The overall median interval from GP consultation to radical surgery was 137 days, the longest being for prostate cancer (median 244). For prostate, bladder and renal cancers the principal element of delay was from the time of diagnosis to surgery (76, 73 and 26 days respectively). These results indicate that, under the two-weeks-wait rule, 2 out of every 3 patients achieve earlier initial assessment. However, the overall delay will not be substantially reduced without concomitant increases in diagnostic facilities, theatre time and human resources.

Clear cell adenocarcinoma of the maxillary sinus: a case report.

A variety of salivary gland tumours histologically show the presence of clear cells. Clear cell adenocarcinoma of salivary glands (CCASG) is a distinct clinico-pathologic entity arising in the minor salivary glands of mainly the oral cavity in elderly women and having a low grade malignant potential. A case occurring in the maxillary sinus and extending to the nasal cavity is reported.

Entomopthoromycosis--report of four cases.

Entomopthoromycosis is a rare subcutaneous infection and manifests in two clinically distinct forms. Subcutaneous zygomycosis which manifests as a painless nodule on the trunk or the extremities and rhinofacial zygomycosis which is a locally progressive infection of the nasal cavity, paranasal sinuses and soft tissues of the face. Neither of these two forms occur in patients with underlying disease or defective immunity. Here we report four cases of entomopthoromycosis.

Mixed streams wastewater treatment using adsorption.

Mixed samples prepared from known pure solutes are reported to have synergetic efforts with respect to single solute and multi-solute adsorption. Attempt is made to extend the theory of enhancement ratios to the mixed stream wastewater samples collected from dyes manufacturing industries. Synergetic effect of the multi-solutes as well as of mixture of adsorbents is observed for mixed streams of wastewater samples, containing a number of pollutants, on given inexpensive adsorbents. The Rathi Puranik model developed for single wastewater streams can be extended to the mixed stream wastewater samples using the rate of COD reduction prediction. The concept of average apparent enhancement factor is discussed.

Profile of pediatric bicycle injuries.

BACKGROUND: Bicycle injury data from local communities are important for developing injury prevention and control programs. This study represents the efforts of one community trauma center to describe bicycle injuries. METHODS: We conducted a retrospective analysis of bicycle injury data from hospital charts, emergency medical services reports, and medical examiner reports. The review encompassed a 4-year period. The study sample included 211 trauma alert patients, ages 1 through 15 years, who were treated for bicycle-related injuries at our level II pediatric trauma center. RESULTS: Bicycle injuries accounted for 18% of all pediatric trauma alert patients. The mean age of injured children was 10 years, and 79% were males. Bicycle-motor vehicle collisions caused 84% of injuries. Only 3 children (1.4%) wore bicycle helmets. Resulting injuries included external wounds (86%), head injuries (47%), fractures (29%), and internal organs (9%). Six children died. CONCLUSIONS: Bicycle injuries are a significant cause of mortality and morbidity for children in our community. Use of safety helmets by child bicyclists is inadequate. The data from this study can be used as a baseline in testing the effectiveness of local and state interventions, including new legislation mandating helmet use by children in our state.

Parental perception of injury prevention practices in a multicultural metropolitan area.

INTRODUCTION: This study was conducted to survey parents of children seen in the emergency department regarding parent and child safety-related behaviors, parents' perceptions of their children's risks for injury, and educational needs. METHODS: The descriptive design involved three questionnaires with age-specific items related to children in groups 0-4 years, 5-12 years, and 13-15 years. Parents voluntarily completed the questionnaires in the emergency department waiting area. Data were analyzed by descriptive statistics, parametric tests, and content analysis. RESULTS: The culturally diverse sample included 81% minority group representation. Parents tended to underestimate their children's risks for injury from motor vehicle crashes. Less than one half of caretakers believed that most injuries can be prevented. Only one third of parents listed needs for future learning, although parents of younger children listed more needs. High response rates were received for knowing how to call 911, use of child car seats and seat belts, and smoke detectors in the home. DISCUSSION: Survey results provide evidence that parents have misconceptions about childhood injury. Through strategic planning, we have expanded our community education programs to focus on cardiopulmonary resuscitation and activating the emergency medical system, water safety, use of safety helmets, and injury prevention in the home.

Experiences in the first year. Community hospital pediatric trauma center.

Demographic and outcome variables of children seen in a community hospital Level II pediatric trauma center are described and patterns of injury classified according to different mechanisms. Records were reviewed retrospectively of 184 patients seen over a one year period, 63% were male and the peak age group was 13-15 years (31%). Descriptive and nonparametric statistics were used to analyze the data. Mechanisms of injury included pedestrian vs auto (27%), falls (23%), motor vehicle occupants (18%), bicycle vs auto (17%), sports injuries (3%), motorcycle crashes (2%), gunshot wounds (2%), and stabbings (2%). Penetrating injuries had higher average trauma scores but blunt injuries were associated with higher mortality. Demographics and mechanisms of injury were similar to national studies. Emphasis on the use of pediatric trauma scores by emergency medical personnel is suggested to decrease the over-triage rate. The frequency of bicycle injuries and lack of helmet use prompted a major helmet promotion campaign.

Oral malignant melanoma. A case report.

Oral malignant melanoma is a rare aggressive neoplasm of middle age, has predilection for the palate and maxillary gingiva or alveolar ridge and about 1/3rd of these neoplasms may develop from existing melanosis. A case of malignant melanoma in a 55 year old male is being reported. The patient was treated surgically. It is emphasised that the presence of pigmented oral mucosa must alert the clinician to the possibility of malignant melanoma.