Don't skip a beat! Critical findings in imaging studies performed in adults with congenital heart disease.

With ongoing advances in both medical and surgical management, the population of adults with congenital heart disease (CHD) continues to grow each year and has surpassed the number of pediatric cases. These adult patients will present to adult emergency departments with increasing frequency. Adults with CHD are at increased risk of developing not only cardiovascular complications, such as aortic dissection and thromboemboli, but also abdominopelvic and neurologic processes at younger ages. These individuals are also more likely to develop less urgent but clinically significant complications including end-organ dysfunction, baffle leaks, or bleeding collateral vessels. Ultimately, imaging can play a critical role in determining the triage, diagnosis, and management of adult CHD patients. To accomplish this goal, radiologists must be able to distinguish acute and chronic complications of treated CHD from benign processes, including expected post-surgical changes or imaging artifacts. Radiologists also need to be familiar with the various long-term risks and complications associated with both treated and untreated forms of CHD, particularly those in adults with complex lesions.

In vitro and in vivo anthelmintic response of the seeds of Amomum subulatum roxb and Vitex negundo.

The current study was designed to check the anthelmintic activities of some local plants. Seeds of Amomum (A.) subulatum and Vitex (V.) negundo in different solvents were subjected to in vitro (adult motility assay; AMA and egg hatch assay; EHA) and in vivo (faecal egg count reduction test; FECRT) anthelmintic activity testing protocols using Haemonchus (H.) contortus as an experimental model. The results of AMA, EHA, and FECRT were statistically analysed through linear regression and Duncan multiple range test. In AMA test, at 50 mg mL-1 concentration, the percent mortality of H. contortus was higher in A. subulatum than V. negundo, whereas, in EHA test, A. subulatum was proven better ovicidal (LC50=14.2 µg mL-1) than V. negundo (LC50= 65.7405 µg mL-1). The FECRT also indicated the better efficacy of A. subulatum than V. negundo against natural infection of gastrointestinal (GI) parasites. The crude powder of plants used in this study showed 29.6% to 57.7% anthelmintic. The reduction rate was found higher for A. subulatum (3 g kg-1) as compared to V. negundo (7 g kg-1). Reagrding efficacy analysis of solvents used for plants extract, ethyl acetate and chloroform were found better in increasing ovicidal activity in adult worms (in vitro testing), whereas, the crude aqueous methanol was found better than the crude powders in in vivo testing. It will be beneficial to document the indigenous knowledge to standard scientific procedures for their validation. This study will help to motivate the farmers to make a better choice of cultivation of the indigenous plants because of their varying efficacies as an alternative preventive approach against the GI parasitic infections.

Estimation of production cross-sections, transmutation and gas generation from radionuclides (A ∼50-60) in fusion environment.

Degradation of material properties under neutron irradiation generates a requirement for studying effects on materials in a fusion environment and optimizing radiation-resistant materials for future applications. In the present work, the durability of stainless steel (SS) alloy used in ITER-like fusion devices is studied. We have predicted the amount of radionuclides produced in the material upon neutron irradiation at various locations is determined using the ACTYS, neutron activation code, for a typical one-dimensional geometry of ITER-like fusion reactor. The ACTYS code is further used to determine the gas production from 55Fe, 59Ni, and other long-lived radionuclides in the material. To further stress the importance of gas production in fusion materials, a comparative study of gas production cross-sections as given in various standard data libraries is examined using TALYS-1.8 and is presented in the paper.

CT for Evaluation of Hemoptysis.

Hemoptysis, which is defined as expectoration of blood from the alveoli or airways of the lower respiratory tract, is an alarming clinical symptom with an extensive differential diagnosis. CT has emerged as an important noninvasive tool in the evaluation of patients with hemoptysis, and the authors present a systematic but flexible approach to CT interpretation. The first step in this approach involves identifying findings of parenchymal and airway hemorrhage. The second step is aimed at determining the mechanism of hemoptysis and whether a specific vascular supply can be implicated. Hemoptysis can have primary vascular and secondary vascular causes. Primary vascular mechanisms include chronic systemic vascular hypertrophy, focally damaged vessels, a dysplastic lung parenchyma with systemic arterial supply, arteriovenous malformations and fistulas, and bleeding at the capillary level. Evaluating vascular mechanisms of hemoptysis at CT also entails determining if a specific vascular source can be implicated. Although the bronchial arteries are responsible for most cases of hemoptysis, nonbronchial systemic arteries and the pulmonary arteries are important potential sources of hemoptysis that must be recognized. Secondary vascular mechanisms of hemoptysis include processes that directly destroy the lung parenchyma and processes that directly invade the airway. Understanding and employing this approach allow the diagnostic radiologist to interpret CT examinations accurately in patients with hemoptysis and provide information that is best suited to directing subsequent treatment. ©RSNA, 2021.

Allergic Bronchopulmonary Mycosis due to fungi other than Aspergillus.

Summary: Allergic bronchopulmonary mycosis (ABPM) is a clinical syndrome associated with immune sensitivity to various fungi that colonize the airways. Early diagnosis and treatment with systemic corticosteroids is the key in preventing the progression of the disease to irreversible lung fibrosis. Although Aspergillus has progressively gained recognition as a causative agent in past few decades, other fungi, that have been reported to cause ABPM, are not yet widely evaluated. We studied hundred and two patients with asthma for occurrence of ABPM. Patients were tested for cutaneous hypersensitivity and serum precipitin to 12 common fungal antigens. The positive cases were further evaluated for ABPM using standard criteria. Out of 102 asthma patients screened, 18 patients had either skin prick test (SPT) and/or serum precipitin positive. While 14 patients were SPT positive for one or more fungal antigen, two patients were serum precipitin positive for one or more fungi. Two patients had both serum precipitin positive as well as SPT positive. Six (5.8%) patients were diagnosed as ABPM as they fulfilled the criteria. Three of these were because of Aspergillus sp. Two were because of fungi other than Aspergillus namely Schizophyllum and Curvularia. One patient had ABPM because of both Aspergillus and Curvularia. In our study absolute eosinophil count (AEC), total IgE, serum precipitin and SPT had sensitivity of 100%, 100% 50% and 83.3% respectively for diagnosing ABPM. The specificity of these tests was 44.79%, 64.58% 98.96% and 88.54% respectively. Specfic IgE was positive in 50% of patients with either serum precipitin or SPT positivity. SPT or serum precipitin followed by specific IgE had sensitivity of 100% and specificity of 96.88% for diagnosing ABPM. SPT alone followed by Specific IgE had a sensitivity of 83.33% and specificity of 96.88% for diagnosing ABPM. We found that fungi other than Aspergillus such as schizophyllum, and curvularia, can be implicated in ABPM. Multiple fungal agents may be responsible for ABPM in an individual. There is a subset of patients of BA who have fungal sensitization but do not fulfil the criteria for ABPM. SPT was the single most sensitive and specific test, AEC >350 and total IgE more than 417IU were most sensitive tests and SPT followed by specific IgE was most effective strategy for diagnosing ABPM.

Genetic polymorphisms in KCNJ11 (E23K, rs5219) and SDF-1ß (G801A, rs1801157) genes are associated with the risk of type 2 diabetes mellitus.

Background Type 2 diabetes mellitus (T2DM) is a global major health problem resulting from interaction of environmental and genetic factors, examples of the latter being KCNJ11 (coding for part of the ATP-sensitive potassium channel) and SDF-1ß (coding for chemokine CXCL12). Our case-control study was conducted to assess whether recessive, dominant or additive genotype model associations of KCNJ11 (E23K, rs5219) and SDF-1ß (G801A, rs1801157) were more strongly linked to type 2 diabetes. Subjects & Methods Genetic polymorphism analysis was performed by polymerase chain reaction-restriction fragment length polymorphism. Alleles and genotype frequencies between 200 cases and 200 controls were determined and compared. Results The dominant (EE v EK + KK, p = 0.022) and additive (EK v EE + KK, p = 0.021) models, but not the recessive model (KK v EE + EK, p = 0.727) of KCNJ11 were linked to diabetes. Similarly, the dominant (GG v GA + AA, p < 0.001) and additive (AG v GG + AA, p=<0.001) models, but not the recessive model (AA v AG + GG, p = 0.430) of SDF-1ß were linked to diabetes. The A allele (p = 0.006) of SDF-1ß was protective against the risk of T2DM. Conclusion Both dominant and additive models in both KCNJ11 (E23K, rs5219) and SDF-1ß (G801A, rs1801157) genetic polymorphisms are significantly associated with type 2 diabetes.

Gallbladder Scalloping, Mammillated Caudate Lobe, and Inferior Vena Cava Scalloping: Three Novel Ultrasound Signs of Cirrhosis.

PURPOSE: We aimed to present three new ultrasound signs-gallbladder scalloping, mammillated caudate lobe, and inferior vena cava scalloping-and determine their accuracy in diagnosing liver cirrhosis. MATERIALS AND METHODS: A total of 201 consecutive patients with a history of chronic liver disease who had undergone ultrasound imaging and liver biopsy were identified. A senior ultrasound radiologist blindly reviewed the ultrasound examinations. Specificity, sensitivity, positive predictive value, and negative predictive value of diagnosing cirrhosis were calculated for all evaluated ultrasound signs and selected combinations of signs, using the liver biopsy results as the reference standard. RESULTS: Of the 201 patients, 152 (76%) had either pathology-proven cirrhosis or significant fibrosis. Caudate lobe hypertrophy was the most specific (88%) and most positive predictor (90%) for cirrhosis, whereas mammillated caudate lobe was the most sensitive (78%). Inferior vena cava scalloping was the most specific (78%) of the three proposed ultrasound signs. When signs were combined, the presence of either gallbladder scalloping or liver surface nodularity was highly sensitive for cirrhosis (87%), whereas the presence of either gallbladder scalloping or inferior vena cava scalloping with caudate lobe hypertrophy was highly specific (93%). CONCLUSIONS: Gallbladder scalloping, mammillated caudate lobe, and inferior vena cava scalloping are three novel signs that improve the accuracy of ultrasound in diagnosing cirrhosis.

Effect of seaweeds occurring at Karachi coast on mosquito larvae and liver function in rats.

Seaweeds have been consumed as human food from thousands of years. In this study ethanol extract of 16 different seaweeds were tested for mosquito larvicidal activity against 4th instar larvae of Aedes aegyptii. The ethanol extracts of Padina pavonia and Sargassum ilicifolium caused 50% mortality at 1200ppm concentration. However other seaweeds Halimeda tuna, Ulva lactuca (Chlorophyta), Dictyota dichotoma var intricata, Jolyna laminariodes, Sargassum binderi (Phaeophyta), Melanothamnus afaqhusainii and Solieria robusta (Rhodophyta) showed LC50 at ≈1500 ppm concentration. The n-hexane fraction of Padina pavonia was most potent and produced lethality at minimum concentration (LC50 at 250ppm).The effect of ethanol and water extracts of S. binderii was also examined on liver function of healthy rats. The ethanol extract of Sargassum binderi given orally to rats @ 200mg/kg for 14 days slightly increased the concentration of liver enzymes (ALT, AST, ALP and LDH) and urea level as compared with normal control rats, but did not increase bilirubin, glucose, triglycerides, cholesterol and creatinine. Whereas water extract of S. binderi affected ALT while other biochemical parameters were near normal or slightly decreased as compared to normal control.

Identification of FUS p.R377W in essential tremor.

BACKGROUND AND PURPOSE: Exome sequencing analysis has recently identified a nonsense mutation in fused in sarcoma (FUS) segregating with essential tremor (ET) within a large French-Canadian family. Further characterization of FUS resulted in the identification of additional mutations in ET patients; however, their pathogenicity still remains to be confirmed. The role of FUS in an independent cohort of ET patients from Canada was evaluated. METHODS: The entire coding sequence of FUS in 217 patients diagnosed with ET was analyzed and two missense variants in 219 healthy controls were genotyped by Sanger sequencing. RESULTS: Sequencing of FUS identified a previously reported non-pathogenic mutation p.G174_G175del in one ET patient and two healthy controls, and a novel p.R377W in one patient with family history of disease. This mutation is highly conserved and strongly predicted to be damaging by in silico analysis. CONCLUSION: This study has identified a novel FUS p.R377W substitution in ET patients. Additional genotyping studies in a large number of ET patients and controls are necessary to conclusively define its pathogenicity.

Effect of vitamin D supplementation of low birth weight term Indian infants from birth on cytokine production at 6 months.

BACKGROUND/OBJECTIVES: Vitamin D deficiency has been associated with impaired resistance to infection, which may be mediated by alterations in cytokine responses. We investigated the effect of vitamin D supplementation to infants on whole blood in-vitro cytokine production and on the inflammatory marker, plasma C-reactive protein (CRP). SUBJECTS/METHODS: Blood samples were taken at 6 months of age from infants participating in the DIVIDS (Delhi Infant Vitamin D Supplementation) randomized controlled trial of weekly vitamin D supplements (1400 IU = recommended intake) from birth to 6 months with the aim of decreasing mortality and severe morbidity. We measured plasma CRP and whole blood in-vitro production of tumour necrosis factor-α (TNFα), interferon-γ (INFγ), interleukin (IL)-10 and IL-13 following no stimulation or stimulation with lipopolysaccharide or phytohemagglutinin. RESULTS: Although the intervention improved vitamin D status in a severely deficient population, there were no differences between treatment groups in plasma CRP or in the production of any of the cytokines in either unstimulated or stimulated cultures. Recent illness had limited association with immunological markers. Plasma 25-hydroxyvitamin D levels were not associated with CRP or production of any cytokines. CONCLUSIONS: Vitamin D supplementation did not affect plasma CRP or whole blood cytokine production of vitamin D-deficient low birth weight infants. This is consistent with the lack of effect of vitamin D on mortality and severe morbidity among infants in the DIVIDS trial.

Essential tremor is not dependent upon cerebellar Purkinje cell loss.

UNLABELLED: The pathophysiology of essential tremor (ET) is unknown but recent studies report that the majority of ET cases has cerebellar Purkinje cell (PC) degeneration and its sequelae. OBJECTIVE: To perform PC counts in ET, and normal and Parkinson's disease (PD) controls to determine the relationship of PC loss to ET. METHODS: All ET cases and PD controls were followed at our clinic. Normal controls had no history of neurological disease and had normal standard neuropathological studies. The PC counts were done by a neuropathologist who was blinded to the clinical diagnosis. Three different methods were used for counting PC; section through any part of the PC, through any part of the PC nucleus, and through any part of PC nucleolus. The counts were done in five non-contiguous microscopic fields. RESULTS: 59 brains were studied. These included 12 ET, 41 PD controls, and six normal controls. The mean age at death was 82.7 in ET, 79.1 in PD, and 75.7 years in the normal controls. The mean duration of symptoms was 34 years in ET and 15.7 years in the PD cases. The mean PC counts through any part of the neuron were 64.8 in ET, 56.2 in PD, and 58.0 in normal controls. Differences were not significant. CONCLUSION: Cerebellar PC loss does not distinguish ET from controls. It is concluded that PC loss is neither a pathological basis for, nor the distinctive feature of ET.

CEPHEUS SA: a South African survey on the undertreatment of hypercholesterolaemia.

AIM: The aim of the CEntralised Pan-South African survey on tHE Under-treatment of hypercholeSterolaemia (CEPHEUS SA) was to evaluate the current use and efficacy of lipidlowering drugs (LLDs), and to identify possible patient and physician characteristics associated with failure, if any, to achieve low-density lipoprotein cholesterol (LDL-C) targets. METHODS: The survey was conducted in 69 study centres in South Africa and recruited consecutive consenting patients who had been prescribed LLDs for at least three months. One visit was scheduled for data collection, including fasting plasma lipid and glucose levels. Physicians and patients completed questionnaires regarding their knowledge, awareness and perceptions of hypercholesterolaemia and the treatment thereof. RESULTS: Of the 3 001 patients recruited, 2 996 were included in the final analyses. The mean age was 59.4 years, and 47.5% were female. Only 60.5 and 52.3% of patients on LLDs for at least three months achieved the LDL-C target recommended by the NCEP ATP III/2004 updated NCEP ATP III and the Fourth JETF/South African guidelines, respectively. Being male, older than 40 years, falling into the lower-risk categories, compliance with the medication regimen, and patient knowledge that the LDL-C goal had been reached, were associated with the highest probability of attaining LDL-C goals. CONCLUSION: The results of this survey highlight the sub-optimal lipid control achieved in many South African patients taking lipid-lowering therapy.

Fibrinolytic activity of kaempferol isolated from the fruits of Lagenaria siceraria (Molina) Standley.

This study was undertaken to isolate a flavonol, kaempferol, from the fruits of Lagenaria siceraria (bottle gourd) as a sole compound and to explore the fibrinolytic potential of the methanolic extract of the fruits of L. siceraria and the isolated compound using their in vitro activity. The fibrinolytic activity in terms of percentage of plasma clot liquefaction was determined by plasma clot lysis at 37°C in 24 h. The fibrinolytic activity of both substances was compared to the well-known thrombolytic agent streptokinase (30,000 IU). The percentage of fibrinolytic activity of the extract and isolated compound were found to be 54.72 ± 0.7210 and 77.37 ± 1.3010, respectively. Streptokinase was considered as the standard fibrinolytic enzyme for comparative purposes and had 91.46 ± 0.7625% fibrinolytic activity. The conclusion drawn in our study after testing the hypothesis by experimental procedures is that in vitro fibrinolytic activity on plasma clots is an inherent property of kaempferol isolated from the fruits of L. siceraria, and its comparison with streptokinase is a new aspect for further study.

Formulation and evaluation of verapamil hydrochloride loaded solid lipid microparticles.

The present study aimed to produce verapamil hydrochloride-loaded solid lipid microparticles (SLM) by the w/o/w emulsion solvent evaporation technique, using diethyl ether as solvent phase, glyceryl monostearate as biodegradable polymer and Span 60 as surfactant. SLM of spherical shape were prepared by simple dilution of the emulsion with water. To increase the lipid load the process was conducted at 50 degrees C, and in order to reach sub-micron size, a high-shear homogenizer was used. The encapsulation efficiency of prepared SLM reached 74.29 +/- 0.76%. Particle size (98.55 +/- 1.42 microm), surface morphology (spherical) and drug loading efficiency (18.57 +/- 1.25% w/w) were investigated. And optimization of drug polymer ratio (3:1), nature and concentration of emulsion stabilizer in the external aqueous (0.1%), phase viscosity of external aqueous phase (0.5%), volume of external aqueous phase and stirring rate (1000 rpm) were detected. Analysis of microsphere content after processing showed that verapamil did not undergo any chemical modification within the micro-particles. The in-vitro release of verapamil from the microparticles was very low and an initial burst effect of 17% of the dose was observed. The slow release may help to avoid a high frequency of administration. The prepared solid lipid microparticles appear to have interesting perspectives as delivery systems for the oral administration of verapamil hydrochloride with improved half-life, improved bioavailability, and minimized local and systemic gastrointestinal disturbances of the drug.

Perioperative outcomes of laparoscopic radical nephroureterectomy and regional lymphadenectomy in patients with upper urinary tract urothelial carcinoma after neoadjuvant chemotherapy.

OBJECTIVES: To determine the effect of neoadjuvant chemotherapy on the surgical outcomes in patients undergoing laparoscopic radical nephroureterectomy (LNUX) for upper urinary tract urothelial carcinoma (UTUC). METHODS: We performed a retrospective review of all patients with UTUC who had undergone LNUX at our institution from January 2003 to June 2010. We compared the differences in demographic, clinicopathologic, and operative parameters, including the estimated blood loss, duration of surgery, length of postoperative hospitalization, and number of complications, between the patients who had undergone LNUX after neoadjuvant chemotherapy and those who had undergone LNUX without neoadjuvant chemotherapy. Logistic regression analysis was performed to identify the predictors of complications. RESULTS: We identified 82 patients with UTUC who had undergone LNUX. Of these patients, 26 had received neoadjuvant chemotherapy. The patients who had undergone LNUX after neoadjuvant chemotherapy had a greater body mass index, greater biopsy tumor grade, and longer operative time than those who had undergone LNUX without neoadjuvant chemotherapy. The patients who received neoadjuvant chemotherapy had undergone regional lymphadenectomy more often, with more lymph nodes and lymphoadipose tissue removed, than those who had not received neoadjuvant chemotherapy. Neoadjuvant chemotherapy resulted in a 15% complete remission rate. No differences in the median estimated blood loss, intraoperative transfusion rate, or length of hospitalization between the 2 groups were found. The perioperative complication rates were similar in both groups. CONCLUSIONS: We found no differences in the surgical outcomes between those patients who had undergone LNUX after neoadjuvant chemotherapy and those who had undergone LNUX without neoadjuvant chemotherapy. Our findings support the use of LNUX for selected patients undergoing neoadjuvant chemotherapy for UTUC.

Cerebellar Purkinje cell loss is not pathognomonic of essential tremor.

BACKGROUND: Most of the literature on pathology of essential tremor (ET) has reported no consistent abnormalities. Some recent studies however indicate that cerebellar Purkinje cell (PC) loss is the pathological basis of ET in most patients. OBJECTIVE: To compare cerebellar PC loss in ET, with normal and tremor dominant Parkinson's disease [PD] control brains. METHODS: Cerebellar PC counts were performed in seven ET, six PD and two normal control brains. Three different counting methods - sectioned through nucleolus, through nucleus and through any part of PC body, were used to count the PC. RESULTS: There were individual differences in the PC counts both in the ET and the PD cases. In all three subgroups, there was a reduction in the number of PC with advancing age. When the individuals of comparable age in the three subgroups were considered, there was no clear distinction between ET, PD and normal control subjects. There was no association between the degree of PC loss and the severity or the duration of ET. CONCLUSION: Our study militates against the hypothesis that PC loss is pathognomonic of ET.

Measurement of natural radioactivity in sand samples collected along the bank of rivers Indus and Kabul in northern Pakistan.

Radioactivity is a part of the natural environment. The presence of natural radioactivity in sand and other building materials results in internal and external exposure to the general public. Therefore, it is desirable to determine the concentration of naturally occurring radionuclides, namely (232)Th, (226)Ra and (40)K in sand, bricks and cement which are commonly used as building materials in Pakistan. In this context, sand samples were collected from 18 different locations covering an area of ∼1000 km(2) along the banks of river Indus (Ghazi to Jabba) and river Kabul (Nowshera to Kund) in the northern part of Pakistan, whereas bricks and cement samples were collected from local suppliers of the studied area. In order to measure the specific activities in these samples, a P-type coaxial high-purity germanium-based gamma-ray spectrometer was used. In sand samples, the average specific activities of (226)Ra, (232)Th, and (40)K were found to be 30.5±11.4, 53.2±19.5 and 531±49 Bq kg(-1), whereas in brick samples, specific activities of 30±14, 41±21 and 525±183 Bq kg(-1) were observed, respectively. In cement samples, measured specific activity values were 21±5, 14±3 and 231±30 Bq kg(-1), respectively. Radium equivalent activities were calculated and found to be 143.8±38.6, 124±49.8 and 56.69±7 Bq kg(-1) for sand, brick and cement samples, respectively. The annual mean effective dose for the studied sand samples was found to be 0.40 mSv. External and internal hazard indices were less than unity for all the studied samples. The present results have been compared with those reported in the literature.

Microspheres in cancer therapy.

Cancer microsphere technology is the latest trend in cancer therapy. It helps the pharmacist to formulate the product with maximum therapeutic value and minimum or negligible range side effects. Cancer is a disease in which the abnormal cells are quite similar to the normal cells, with just minute genetic or functional change. A major disadvantage of anticancer drugs is their lack of selectivity for tumor tissue alone, which causes severe side effects and results in low cure rates. Thus, it is very difficult to target abnormal cells by the conventional method of the drug delivery system. Microsphere technology is probably the only method that can be used for site-specific action, without causing significant side effects on normal cells. This review article describes various microspheres that have been prepared or formulated to exploit microsphere technology for targeted drug therapy in various cancers. We looked at the usefulness of microspheres as a tool for cancer therapy. The current review has been done using PubMed and Medline search with keywords.

Isolation and characterization of stress induced Ty1-copia like retrotransposable elements in chickpea (Cicer arietinum L.).

Almost all active plant retroelements are known to be induced by various biotic and abiotic stresses. Here, we show the presence of transcriptionally active Ty1-copia like retroelements in chickpea and their induction in response to abiotic stress. Eight Ty1-copia retrotransposon like mRNA sequences were reverse transcribed, amplified, cloned and characterized from stressed plants. These mRNA sequences were not detected in chickpea plants grown under normal conditions. Basing on the similarity analysis, these RT transcript sequences were classified into three families. It is proposed that all sequences except CARE7 might be transcript sequences of functional retrotransposons. The mRNA sequence CARE3 shows 99% nucleotide identity to a genomic Ty1-copia like sequence present in the Genbank with accession no. AJ535883.