Peripheral blood smear - An expeditious test in the preliminary diagnosis of bone marrow embolism in a case of multiple fractures: A case report.

ABSTRACT: Bone marrow embolism is known to occur after fractures of long bones such as the femur and pelvis. We report a case of multiple fractures in a 32-year-old female patient, demonstrating bone marrow elements in the peripheral blood as early as 2 hours after trauma. This is the first case being reported with an ante-mortem demonstration of circulating marrow emboli in the peripheral blood, while the previously reported cases have demonstrated the emboli in post-mortem examination. A careful correlation of the clinical history of trauma, hematology auto-analyzer results, and the presence of bone marrow particles and fat globules in peripheral blood helped in arriving at the diagnosis of fat embolism in our case irrefutably.

Pollutant removal from cheese processing effluent using effective indigenous natural scavengers.

The goal of this study was to come up with an efficient method for treating cheese production wastewater. Because the effluent has a higher concentration of organic and inorganic materials, the indigenous microbial treatment process was used to effectively remove total dissolved solids (TDS), chemical oxygen demand (COD), and color without the addition of any nutrients. The indigenous microorganisms were tested for color, TDS, and COD elimination by growing them in "nutrient broth medium" loaded with different amounts of cheese effluent. The isolates were identified by 16S rRNA sequencing, and the results revealed that strain 1 was Enterobacter cloacae, strain 2 was Lactococcus garvieae, and strains 3 and 4 were Bacillus cereus and Bacillus mycoides, respectively. After 36 h of incubation, the data were evaluated. Among all the microbes, E. cloacae reduced TDS and COD from the effluent the most (80 ± 0.2% and 87 ± 0.4% COD, respectively). When compared to individual species, consortia were more efficient (86 ± 0.2% TDS and 90 ± 0.3% COD). On treatment, the correlation coefficient "r" for TDS and COD elimination was found to be 1, resulting in a positive linear connection. The current study suggests that microbial therapies are both effective and environmentally beneficial.

Utilization of natural polysaccharide from Tamarindus indica L. seeds for the effective reduction of pollutants in cheese processed wastewater.

The present study was targeted to treat the cheese factory processed wastewater by using natural coagulants. The results were compared with the CPCB wastewater discharge limit and most of the parameters were exceeded the standard limit. In the present investigation, the processed wastewater was subjected to treatment with Tamarindus indica L. plant seed as a coagulating agent. The processed wastewater was treated with Tamarindus indica L. seed powder which is rich in polysaccharides. The proximate analysis confirmed the presence of higher content of carbohydrates, protein, and fiber. Different dosages were used for the treatment. Accurately 0.4 gm was recorded as optimum dosage for the effective removal of pollutants includes 71% of TDS and 75% of COD from the cheese processed wastewater. The GC-MS analysis of raw and treated cheese processed wastewater was carried out and the results showed the degradation of toxic compounds and reduction of pollutants from the processed wastewater. FTIR analysis of T.indica L. seed powder disclosed various chemical group presence and proved higher efficiency in seed treatment.

Histopathological Study of Central Nervous System Lesions: Emphasizing Association of Neoplasms with ABO Blood Groups.

INTRODUCTION: The Central Nervous System (CNS) lesions show considerable geographic and racial variations with respect to the incidence and the pattern of distribution of lesions. The ABO blood status is a readily accessible factor in genetic constitution of the patients. It has been shown to be associated with many diseases. But the influence of blood group status on the pathogenesis of brain tumours is still unclear. AIM: To study various histopathological patterns of CNS lesions and to evaluate the association of CNS tumours with the distribution of ABO blood groups in documented cases. MATERIALS AND METHODS: In the present study, 147 cases were analyzed. It was an analytical type of study, done at JSS Medical College, Mysore, over a period of 2 years and 8 months from January 2009 to August 2011. Histopathology slides were routinely stained by Haematoxylin and Eosin (H&E) stain. Special stains were performed in selected cases. Blood group of the patients and the control group were documented. Blood group distribution pattern was assessed in relation to histopathological diagnosis of various CNS tumours. RESULTS: Histopathological diagnosis of 147 cases included neoplastic lesions (84.35%) and non-neoplastic lesions (15.64%). Neoplastic lesions (84.35%) constituted the majority, which included neuroepithelial tumours (29.25%) as predominant pattern. Non-neoplastic lesions constituted only 15.64%, which included inflammatory lesion (8.16%) as the predominant pattern. ABO blood group data was available in 92 cases (84.4%) of neoplastic lesions, which included 71 cases (48.29%) of primary CNS neoplasms categorized according to WHO grades. The control group constituted 21,067 healthy voluntary donors. Blood group O was the most frequent blood group in neoplastic lesions (40.21%) and primary CNS neoplasms categorized according to WHO grades (45.07%). The association between the CNS neoplasms and ABO blood groups was not statistically significant (p = 0.055). But a definite change in the pattern of distribution of ABO blood groups observed between neoplastic lesions and control groups. CONCLUSION: The influence of blood group types on the development of brain tumours appears intriguing and needs to be well established. Though statistically insignificant, a definite change in the pattern of distribution of ABO blood groups was observed between neoplastic lesions and control groups. This necessitates attention and stratification of patients for effective management.

Histopathologic Findings in Autopsies with Emphasis on Interesting and Incidental Findings-A Pathologist's Perspective.

INTRODUCTION: Autopsy aids to the knowledge of pathology by unveiling the rare lesions which are a source of learning from a pathologist's perspective Some of them are only diagnosed at autopsy as they do not cause any functional derangement. This study emphasizes the various incidental lesions which otherwise would have been unnoticed during a person's life. AIM: The aim of this study was to determine the spectrum of histopathological findings including neoplastic lesions related or unrelated to the cause of death. It was also aimed to highlight various incidental and interesting lesions in autopsies. MATERIALS AND METHODS: A retrospective study of medicolegal autopsies for six years was undertaken in a tertiary care centre to determine the spectrum of histopathological findings including neoplastic lesions related or unrelated to the cause of death and to highlight various incidental and interesting lesions in autopsies. Statistical Analysis: Individual lesions were described in numbers and incidence in percentage. RESULTS: The study consisted of a series of 269 autopsy cases and histopathological findings were studied only in 202 cases. The commonest cause of death was pulmonary oedema. The most common incidental histopathological finding noted was atherosclerosis in 55 (27.2%) cases followed by fatty liver in 40 (19.8%) cases. Neoplastic lesions accounted for 2.47% of cases. CONCLUSION: This study has contributed a handful of findings to the pool of rare lesions in pathology. Some of these lesions encountered which served as feast to a pathologist are tumour to tumour metastasis, a case with coexistent triple lesions, Dubin Johnson syndrome, von Meyenburg complex, Multilocular Cystic Renal Cell Carcinoma (MCRCC), Autosomal Dominant Polycystic Kidney Disease (ADPKD), liver carcinod and an undiagnosed vaso-occlusive sickle cell crisis. Autopsy studies help in the detection of unexpected findings significant enough to have changed patient management had they been recognized before death.

Detection of pneumolysin in cerebrospinal fluid for rapid diagnosis of Pneumococcal meningitis.

BACKGROUND & OBJECTIVES: Pneumolysin, a toxin produced by Streptococcus pneumoniae is associated with virulence and is found in all invasive isolates. Its role as a diagnostic tool has recently been exploited. Most of the methods used are based on molecular techniques and are not cost-effective. The present study was undertaken to evaluate a simple, rapid and cost-effective method to detect pneumolysin in CSF as a diagnostic test for pneumococcal meningitis. METHODS: A total of 75 CSF samples from children with presumptive diagnosis of acute pyogenic meningitis or encephalitis were subjected to Gram stain, culture and pneumolysin detection by Cowan 1 staphylococcal protein A co-agglutination technique. RESULTS: Pneumolysin was detected in 26(78.8%) of 33 culture proven CSF samples and 4(9.5%) of 42 culture negative samples. Antigen detection by Co-A had a specificity of 90 per cent and a sensitivity of 79 per cent when compared with culture. Compared to Gram stain, pneumolysin Co-A had a specificity and sensitivity of 91.0 and 92.0 per cent respectively. INTERPRETATION & CONCLUSION: Detection of pneumolysin was found to be a simple, low cost antigen detection assay for rapid diagnosis of pneumococcal meningitis, for routine use in the developing countries.

Pneumolysin in urine: a rapid antigen detection method to diagnose pneumococcal pneumonia in children.

PURPOSE: Etiological diagnosis of pneumococcal pneumonia is difficult in small children in whom blood culture cannot be done or who have already been started on antibiotics. A simple technique which can be applied at the bedside or in the outpatient department may help in obviating this problem. Detection of pneumolysin, a product of invasive pneumococci is being exploited as a diagnostic tool. METHODS: An attempt was made to detect this protein in urine of seventy children, clinically suspected and radiologically diagnosed cases of pneumonia. Seventy age and sex matched controls were included in the study. Purified pneumolysin was prepared from clinical isolates of invasive pneumococcal infections. This was used to raise polyclonal antisera in rabbits. The antisera was used to sensitise Cowan 1 Staphylococcus aureus (CoA). A slide agglutination was performed with 25 microL urine and equal quantity of the reagent. RESULTS: Results were compared with CoA reagent sensitised with antisera raised against a genetically derived pneumolysoid and capsular polysaccharide for antigen detection in the urine. Pneumolysin could be detected in 42.9% (30/70) urine samples from cases with pneumonia by the genetically derived antigen and in 37.1% samples by the in house prepared antigen, in contrast to 2.1% in healthy controls and 4.2% in children with infections other than pneumonia. The result was statistically significant. Detection of pneumolysin was slightly better than detection of capsular polysaccharide antigen in urine although the result was not statistically significant. Blood culture proved to be positive in only 29.5% cases. CONCLUSIONS: Pneumolysin detection in urine showed promising results and was found to be simple and rapid. It will help in quickening the diagnosis of pneumococcal pneumonia.

Serotype distribution & antimicrobial resistance in Streptococcus pneumoniae causing invasive & other infections in south India.

BACKGROUND & OBJECTIVES: Streptococcus pneumoniae continues to be a major cause of morbidity and mortality in developing countries. The emerging resistance to some common antibiotics compounds the problem. There arises a need to monitor the resistance pattern and map serotype distribution in different geographic locations. The present study was undertaken to determine the serotype prevalence and antibiotic susceptibility of clinically significant S. pneumoniae isolated from a tertiary care hospital in south India. METHODS: A total of 150 clinical isolates from invasive and other clinically significant pneumococcal infections were serotyped and screened for susceptibility to commonly used antibiotics by standard and modified laboratory procedures. RESULTS: Majority (59.3%) of the isolates belonged to one or other of the serotypes 1, 6, 19, 5, 23 and 7. Serotype 1 was the commonest isolate from patients of meningitis and empyema followed by pneumonia. Nineteen isolates (12.6%) were nonvaccine type. Eleven (7.3%) isolates were relatively resistant to penicillin (minimum inhibitory concentration was between 0.1 and 1 microgram/ml) and 64 were resistant to one or more antibiotics. Resistance was distributed equally among the predominant serotypes. INTERPRETATION & CONCLUSION: The common serotypes responsible for significant infections were similar to those reported in some other studies from India, with minor variations. Resistance to cotrimoxazole and tetracycline was predominant followed by chloramphenicol. Low level resistance to penicillin was observed but no isolate had absolute resistance. This calls for monitoring of resistance and mapping of serotype distribution from various parts of India.

Cost-effective method of serotyping Streptococcus pneumoniae using staphylococcal co-agglutination.

Typing of Streptococcus pneumoniae to determine the serotype prevalence has paved the way for polyvalent vaccines to prevent invasive pneumococcal infection. Variation of serotype prevalence in different geographical areas necessitates typing of strains from these areas for effective vaccine protection. High cost of antisera very often is a hindering factor in undertaking this exercise. We have tried to evaluate typing by co-agglutination to reduce cost. Clinical isolates of S.pneumoniae from Pondicherry and surrounding Tamil Nadu were serotyped using antisera coated Staphylococcus aureus Cowan I strain and compared with standard quellung reaction. There was hundred percent correlation. By this method we could determine the serotypes causing invasive infections in this area. A commercially available Pneumotest kit was used as source of type specific antisera. Serotype 1 was found to be the major isolate (20.1%) by both the tests. Twenty-four isolates (13%) belonged to the nonvaccine types. Rest of the isolates was made up by serotypes 6, 5, 19, 23 and 12. Co-agglutination method was found to be a simple rapid and economical technique. Ten milliliters of the reagent could be made, using 0.1 ml of standard antisera. Shelf life was found to be six months at 40C.

Throat carriage of pneumococci in healthy school children in the Union Territory of Pondicherry.

BACKGROUND & OBJECTIVES: Colonisation of Streptococcus pneumoniae in the throat is common among children the world over. Little is known about the relationship of nasopharyngeal carriage and invasive disease or the way it spreads within the households and close confines. There is a paucity of data on the colonization of Strep. pneumoniae in the throat of healthy children in India. To determine the prevalence of pneumococcal carriage in school children of urban and rural Pondicherry, a study was undertaken. METHODS: Throat swabs of healthy school-going children between 5-10 yr of age were examined for pneumococcal carriage, by standard bacteriological techniques. RESULTS: A prevalence rate of 24.3 per cent was noted. There was no difference in the carriage rate among the rural children when compared to urban children. No age, sex or geographical predilection of pneumococcal carriage was noted. A statistically significant seasonal variation, however, was seen. Carriage rate increased during the colder months and was found to be the highest in the months of March and November. INTERPRETATION & CONCLUSIONS: Strep. pneumoniae circulates in the community among healthy children. Carriage rate is influenced by seasonal variation.