Cells Gone Wild: A Case Report on Missed Acute Leukemia and Subsequent Disseminated Intravascular Coagulation in the Emergency Department.

INTRODUCTION: Emergency physicians must maintain a broad differential when seeing patients in the emergency department (ED). Occasionally, a patient may have an undiagnosed, life-threatening medical condition not related to the presenting chief complaint. It is imperative to review all ordered laboratory tests and any available previous laboratory values to assess for any abnormalities that may warrant further evaluation. CASE REPORT: This case report is regarding the missed diagnosis of acute leukemia and subsequent disseminated intravascular coagulation in a 27-year-old male who presented to multiple EDs with the unrelated chief complaint of finger ring entrapment. This patient ultimately succumbed to his illness. CONCLUSION: When evaluating patients in the ED, it is important to review any prior available test results for abnormalities, even if the results do not specifically correlate with the chief complaint. Emergency physicians must remain vigilant to avoid missing a critical diagnosis.

Acute intentional caffeine overdose treated preemptively with hemodialysis.

Caffeine is the most commonly used central nervous system stimulant. While it has a high LD50 (150-200 mg/kg), when ingested in significant quantity, caffeine can lead to severe and even lethal side effects. Manifestation of toxicity include tachyarrhythmias, seizures, and metabolic derangements which can eventually lead to cardiovascular collapse and death. Studies have shown that lethal doses of caffeine (80-100 µg/mL) can be seen with the ingestion of approximately 10 g of caffeine. Due to the low number of reported cases, there is no consensus on the standard of care for treatment of suspected caffeine overdose. This case details a 39-year-old male who presented to the emergency department (ED) after having ingested 50 g of caffeine. Despite a high dose esmolol infusion, the patient exhibited worsening tachyarrhythmias. Hemodialysis was started empirically given the known amount ingested and ongoing hemodynamic perturbations. Initial pre-dialysis caffeine level was found to be 254 µg/ml. After treatment with two sessions of hemodialysis the patient's caffeine level decreased dramatically. We believe this is the first case report to demonstrate the success of preemptive hemodialysis, prior to cardiovascular collapse and/or renal failure, in a case of caffeine overdose and should be considered very early in patients presenting with recent toxic ingestion.

Controlled release of vitamin B1 and evaluation of biodegradation studies of chitosan and gelatin based hydrogels.

Thiamine, also known as vitamin B1, is a vitamin synthesized for dietary supplementation and medication. In order to improve dissolution, bioavailability and sustained release of Thiamine, we prepared Thiamine hydrochloride (TH) and beta-cyclodextrin (ß-CD) host-guest solid inclusion complexes by microwave irradiation and studied the chemical characteristics and drug delivery potential of the complex. Based upon the molecular docking and phase solubility studies, we proposed the most probable structure of 1:1 inclusion complex. The value of the apparent stability constant was found to be 122.437 ± 4 M-1. Furthermore, Chitosan-Gelatin hybrid polymer networks (HPNs) containing ß-CD: TH inclusion complexes (ICs) were synthesized and the drug release was studied. It was found that TH releases in a more controlled manner from the ICs compare to the directly loaded TH into the HPN. The continuous progress of biodegradation at different stages was tested through FTIR and SEM characterization, which showed HPNs synthesized are biodegradable and composting method was found to be more efficient than soil burial method. Overall, our study describes that microwave-induced synthesis of ICs is efficient, time-saving, and environment-friendly, and the ICs are useful for a controlled release of Vitamin B1; thus, highlighting their potential in therapeutics of Vitamin B1 deficiency.

Self-assembled GO incorporated CMC and Chitosan-based nanocomposites in the removal of cationic dyes.

The purpose of the present study is to synthesise a self assembled nanocomposite by incorporating GO nanosheets into the polymer network of carboxy methyl cellulose and chitosan without using any initiator and cross-linker system. By incorporation of GO nanosheets, a great enhancement in various properties likes surface roughness, percentage swelling (from 2347% to 4633.8%) and adsorbent properties. The nanocomposite samples were investigated for removal of various kinds of dyes from waste water sources and were found highly selective for different cationic dyes. The adsorbent showed 97.9% removal of BG in 7 h whereas 100% removal of MB in just 1.5 h. The adsorption kinetics statistics fitted well in pseudo-second order rate equation. The correlation values and favourable RL of adsorption data suggested better fit for Langmuir adsorption for both the dyes.

Comparative study on the behaviour of Chitosan-Gelatin based Hydrogel and nanocomposite ion exchanger synthesized under microwave conditions towards photocatalytic removal of cationic dyes.

The present work reports the comparison study of Chitosan-Gelatin based hydrogels with their nanocomposite ion exchangers synthesized under microwave conditions for the adsorption and photodegradation of the cationic dyes. In this report, the hydrogel based on Chitosan-Gelatin, more selective for anionic dyes is modified to nanocomposite ion exchanger by incorporating the zirconium (IV) selenophosphate to make it selective for cationic dyes. The nanocomposite was investigated with a tremendous hike in the degradation capacity (99% from 12%) of MB after being modified to nanocomposite ion exchanger. Adsorption process followed Langmuir adsorption (Qo = 10.46 mgg-1) and non linear PFO kinetic model with k1, qe (calculated), R2, RMSE = 0.011, 1.02 (mgg-1), 0.996, and 0.01709 respectively.

Studies on the properties and biodegradability of PVA/Trapa natans starch (N-st) composite films and PVA/N-st-g-poly (EMA) composite films.

The morphological modification of Trapa natans starch was done by grafting the methylmethacrylate (EMA) using ferrous ammonium sulphate­potassium persulphate as a redox initiator. Different reaction parameters such as reaction temperature, time, monomer concentration, pH and solvent were optimized to get maximum graft yield (56%). The graft copolymers thus formed were characterized by Fourier transform infrared, scanning electron microscopy, X-ray diffraction and TGA/DTA/DTG techniques. PVA/starch (N-st) composite films and PVA/N-Starch-grafted-poly (EMA) composite films were prepared separately by using glycerol as a plasticizer. The effect and content of grafted starch on the mechanical properties, water uptake (%), and biodegradability of the composite films were observed. Elongation at break % of PVA/starch-grafted-poly (EMA) (1:1) increased up to 38.9% of pure PVA/N-starch composites (1:1). With further increase in the ratio of grafted starch from (50% to 70%) Elongation at break, % increased to a great extent. There was 223.14% increased in PVA/starch-grafted-poly (EMA) (3:7) as compared to pure PVA/N-starch (3:7) composite films. The Max stress increased up to 100% in PVA/N-starch-grafted-poly (EMA) (3:7) composite film of pure PVA/N-starch composite films (3:7). There were 41.63% decreases in water uptake in PVA/N-starch-grafted-poly (EMA) (3:7) composite films as compared to PVA/N-starch composite films.

Development and characterization of novel microsatellite markers in Trillium govanianum: a threatened plant species from North-Western Himalaya.

Trillium govanianum is a temperate forest understory plant species of high value belonging to the family Melanthiaceae. It is endemic to Himalayan region and facing a bottleneck situation due to reckless extractions from its natural strands. In the present study, 21 microsatellite markers were developed and characterized in 20 accessions of T. govanianum. Collectively, the polymorphic markers amplified 31 alleles in a range of 2-4 with an average of 2.6 alleles per marker. The mean observed heterozygosity (H o), expected heterozygosity (H e), and Shannon information index (I) were 0.46, 0.48, and 0.73, respectively. Average polymorphism information content (PIC) was 0.385. The cross-transferability in a related species, namely, Polygonatum verticillatum, showed amplification of ten markers. The newly developed microsatellite markers efficiently distinguished the different accessions on the basis of their geographic origin. Thus, these microsatellites can be useful in exploring genetic diversity in various existing populations of T. govanianum in north-western Himalaya, which may be useful for their conservation, management, and improvement in future.

Development of novel SSR markers for evaluation of genetic diversity and population structure in Tribulus terrestris L. (Zygophyllaceae).

Tribulus terrestris L., commonly called puncture vine and gokhru, is an important member of Zygophyllaceae. The species is highly important in context to therapeutic uses and provides important active principles responsible for treatment of various diseases and also used as tonic. It is widely distributed in tropical regions of India and the world. However, status of its genetic diversity remained concealed due to lack of research work in this species. In present study, genetic diversity and structure of different populations of T. terrestris from north India was examined at molecular level using newly developed Simple Sequence Repeat (SSR) markers. In total, 20 primers produced 48 alleles in a size range of 100-500 bp with maximum (4) fragments amplified by TTMS-1, TTMS-25 and TTMS-33. Mean Polymorphism Information Content (PIC) and Marker Index (MI) were 0.368 and 1.01, respectively. Dendrogram showed three groups, one of which was purely containing accessions from Rajasthan while other two groups corresponded to Punjab and Haryana regions with intermixing of few other accessions. Analysis of molecular variance partitioned 76 % genetic variance within populations and 24 % among populations. Bayesian model based STRUCTURE analysis detected two genetic stocks for analyzed germplasm and also detected some admixed individuals. Different geographical populations of this species showed high level of genetic diversity. Results of present study can be useful in identifying diverse accessions and management of this plant resource. Moreover, the novel SSR markers developed can be utilized for various genetic analyses in this species in future.

Dansyl-anthracene dyads for ratiometric fluorescence recognition of Cu2+.

Dansyl-anthracene dyads 1 and 2 in CH(3)CN-H(2)O (7:3) selectively recognize Cu(2+) ions amongst alkali, alkaline earth and other heavy metal ions using both absorbance and fluorescence spectroscopy. In absorbance, the addition of Cu(2+) to the solution of dyads 1 or 2 results in appearance of broad absorption band from 200 nm to 725 nm for dyad 1 and from 200 nm to 520 nm for dyad 2. This is associated with color change from colorless to blue (for 1) and fluorescent green (for 2). This bathochromic shift of the spectrum could be assigned to internal charge transfer from sulfonamide nitrogen to anthracene moiety. In fluorescence, under similar conditions dyads 1 and 2 on addition of Cu(2+) selectively quench fluorescence due to dansyl moiety between 520-570 nm (for 1)/555-650 nm (for 2) with simultaneous fluorescence enhancement at 470 nm and 505 nm for dyads 1 and 2, respectively. Hence these dyads provide opportunity for ratiometric analysis of 1-50 µM Cu(2+). The other metal ions viz. Fe(3+), Co(2+), Ni(2+), Cd(2+), Zn(2+), Hg(2+), Ag(+), Pb(2+), Li(+), Na(+), K(+), Mg(2+), Ca(2+), Ba(2+) do not interfere in the estimation of Cu(2+) except Cr(3+) in case of dyad 1. The coordination of dimethylamino group of dansyl unit with Cu(2+) causes quenching of fluorescence due to dansyl moiety between 520-600 nm and also restricts the photoinduced electron transfer from dimethylamino to anthracene moiety to release fluorescence between 450-510 nm. This simultaneous quenching and release of fluorescence respectively due to dansyl and anthracene moieties emulates into Cu(2+) induced ratiometric change.