Thiazolidinedione precipitated thyroid associated ophthalmopathy

Thyroid associated ophthalmopathy (TAO), a cardinal clinical pointer to diagnose Graves' disease (GD), is seen less frequently in our country than in the West, but can have sight threatening consequences. Smoking, diabetes, male gender, increasing age and radioactive iodine treatment for thyrotoxicosis are known precipitating factors for TAO. We report four cases of thiazolidinediones (TZD) precipitated TAO. All were male, had autoimmune thyroid disease (three had Graves' disease and one had Hashimoto's thyroiditis) and type 2 diabetes mellitus (T2DM). They developed eye symptoms three to four months after taking TZDs for glycaemic control. Two of them responded to medical treatment, the other two underwent surgical decompression.

Endovascular management of infective intracranial aneurysms with acrylic glue. A report of two cases

SUMMARY

Cerebral mycotic aneurysms (MAs) also called infective aneurysms, are uncommon and are usually encountered in patients with infective endocarditis. These aneurysms often present with intracranial hemorrhage. MAs may resolve on treatment with antibiotics alone. However prognosis with medical management alone is unpredictable. Good prognosis with surgery has been reported for single accessible ruptured MAs. However surgery is associated with significant morbidity. Endovascular treatment of MAs along with appropriate antibiotics is emerging as an acceptable option for these patients. We describe two cases of infective endocarditis complicated by ruptured MA treated successfully by liquid embolic glue material.

In vivo proton MR spectroscopy evaluation of pyogenic brain abscesses: a report of 194 cases

BACKGROUND AND PURPOSE

The combination of nonspecific clinical findings and similarities in morphologic appearances on imaging often makes it difficult to distinguish abscesses from other brain lesions. We present a retrospective analysis of in vivo (1)H-MR spectroscopy data for characterization of the etiology of the brain abscess based on the established criteria and demonstrate the sensitivity and specificity of metabolite markers assigned to specific bacterial groups defined by the microbial culture in 194 patients.

MATERIALS AND METHODS

Conventional MR imaging and in vivo (1)H-MR spectroscopy data were evaluated from patients with pyogenic brain abscesses, with ages ranging from 3 to 60 years. Imaging and (1)H-MR spectroscopy were performed on a 1.5T scanner. After MR imaging was performed and analyzed, pus aspirates were obtained in all patients. The causative organisms were confirmed by pus cultures.

RESULTS

Resonance of AAs with or without other metabolites on in vivo (1)H-MR spectroscopy was observed in 80% of abscesses, with a sensitivity and specificity of 0.72 and 0.30, respectively. Most obligate anaerobes and some facultative anaerobes showed the presence of Lac/Lip, AAs, and Ac with or without Suc. Mostly obligate aerobes or facultative anaerobes showed the presence of Lac and AAs, with or without lipids.

CONCLUSIONS

The presence of AAs on in vivo (1)H-MR spectroscopy is a sensitive marker of pyogenic abscess, but its absence does not rule out a pyogenic etiology. The presence of Ac with or without Suc favors an anaerobic bacterial origin of the abscess; however, this may also be seen in some of the abscesses secondary to facultative anaerobes.

Evaluation of polymer inclusion membranes containing crown ethers for selective cesium separation from nuclear waste solution

Transport behaviour of (137)Cs from nitric acid feed was investigated using cellulose triacetate plasticized polymer inclusion membrane (PIM) containing several crown ether carriers viz. di-benzo-18-crown-6 (DB18C6), di-benzo-21-crown-7 (DB21C7) and di-tert-butylbenzo-18-crown-6 (DTBB18C6). The PIM was prepared from cellulose triacetate (CTA) with various crown ethers and plasticizers. DTBB18C6 and tri-n-butyl phosphate (TBP) were found to give higher transport rate for (137)Cs as compared to other carriers and plasticizers. Effect of crown ether concentration, nitric acid concentration, plasticizer and CTA concentration on the transport rate of Cs was also studied. The Cs selectivity with respect to various fission products obtained from an irradiated natural uranium target was found to be heavily dependent on the nature of the plasticizer. The present work shows that by choosing a proper plasticizer, one can get either good transport efficiency or selectivity. Though TBP plasticized membranes showed good transport efficiency, it displayed poor selectivities. On the other hand, an entirely opposite separation behaviour was observed with 2-nitrophenyloctylether (NPOE) plasticized membranes suggesting the possible application of the later membranes for the removal of bulk (137)Cs from the nuclear waste. The stability of the membrane was tested by carrying out transport runs for nearly 25 days.

Extraction of the uranyl ion with 3-phenyl-4-benzoyl-5-isoxazolone (HPBI) and neutral donors from dilute nitric acid medium

The extraction behaviour of Uranium (VI) from aqueous nitric acid medium employing 3-phenyl-4-benzoyl-5-isoxazolone (HPBI) has been studied in the presence of various amides, e.g , di-2-ethylhexylacetamide (D2EHAA), di-2-ethylhexylpropanamide (D2EHPrA), di-2-ethylhexylisobutylamide (D2EHiBA) and di-2-ethylhexylpivylamide (D2EHPvA) in toluene medium. The extraction constant (log k ex) for the binary species UO2(PBI)2·nH2O was found to be 1.42±0.14 which is by far the largest amongst the corresponding values known for the other β-diketones. The overall equilibrium constant (log K) for the ternary species UO2(PBI)2·D2EHAA, UO2(PBI)2·D2EHPrA, UO2(PBI)2·D2EHiBA and UO2(PBI)2·D2EHPvA were estimated to be 6.51, 6.21, 6.11 and 5.77 respectively. This trend in equilibrium constants was in accordance with the substitution of the amides as sterically crowded amides show relatively lower equilibrium constant values. The extraction constants follow an inverse correlation with the pK a values of the β-diketonates while the equilibrium constants vary linearly with the size of the amides. The steric factors have been found to play a significant role in the co-ordination of the amides to the uranyl β-diketones when the carbonyl group is a part of the heterocyclic ring. The distribution ratios of the metal were measured in the temperature range 15 to 52 °C using each of the amide donors in combination with HPBI. Calculation of enthalpy and entropy therefrom indicated that the extraction was thermodynamically favoured process and maximum extraction resulted in the case of UO2(PBI)2·D2EHAA.

Extraction of tetravalent neptunium isoxazolonates as their TOPO adducts

The extraction behaviour of Np(IV) by 3-phenyl-4-benzoyl-5-isoxazolone (HPBI) in the presence of tri-n-octyl phosphine oxide (TOPO) was investigated from nitric acid medium. The speciation studies, carried out by the slope analysis method, yielded binary species of the type Np(PBI)4 when only HPBI was used as the extractant and ternary species of the type Np(PBI)4·TOPO when both HPBI and TOPO were used as the extractants. The two-phase extraction constant for the binary species (log k ex) was calculated to be 10.11±0.03, while that for the ternary species was found to be 17.24±0.05. Thermodynamic parameters for the binary and ternary extraction systems were also determined. Both the binary and ternary extraction systems were found to be highly spontaneous processes with predominant enthalpy stabilization. The very high negative entropy factor suggested contribution of unfavourable steric factors.

Anomalous magneto-transport behaviour near the first order phase transition in Gd(5)Ge(3.8)Ga(0.2) alloy

We study the effect of Ga doping at the Ge site of the metamagnetic compound Gd(5)Ge(4). For 5% Ga doping, the resulting alloy (Gd(5)Ge(3.8)Ga(0.2)) shows antiferromagnetic ordering around 130 K, and a thermally driven first order magneto-structural transition at low temperature leading to the ferromagnetic ground state. The alloy shows a noticeable amount of training effect in resistivity when thermally cycled through this first order phase transition (FOPT). The training effect is present in the case of isothermal field cycling. The FOPT region is found to be metastable and extremely sensitive to the applied magnetic field with a clear signature of a metamagnetic transition in the magnetization and resistivity. The metastability is further supported by the large relaxation observed in the resistivity. The giant magnetoresistance observed in the sample is found to be positive near the FOPT, while below the transition it is negative. The resistivity shows irreversibility due to field cycling, which is related to both a field-induced arrested state and some permanent micro-structural changes in the sample.

Dark after cholecystectomy

We report a patient who complained of becoming darker after an abdominal surgery. The index patient not only had a darker complexion after cholecystectomy, but his glycaemic control was also getting better after operation to the extent that he could stop insulin, which he had been taking for five years. Also, he had lost significant weight after operation. Later, we found that he had developed primary hypocortisolism due to unrecognized bilateral adrenal haemorrhage in the immediate postoperative period.

High-rising epiglottis in children: should it cause concern?

An omega-shaped epiglottis is frequently associated with laryngomalacia. However, an elongated high-rising epiglottis can represent a normal variation of the larynx in a majority of pediatric patients. It is important to consider this in a healthy child with no complaints apart from the sensation of a foreign body in throat. This will avoid triggering any unnecessary investigation or treatment. An elongated epiglottis projecting in the oropharynx can appear as a foreign body and be a source of anxiety for the parents as well as the unaware family practitioner. We present such a case, with a brief discussion of the pediatric larynx and the omega-shaped epiglottis.

Design and testing of a disposable microfluidic chemiluminescent immunoassay for disease biomarkers in human serum samples

This paper presents the development of a plastic microfluidic immunosensor for rapid, reliable and on-the-spot detection of disease biomarkers in human sera. The microfluidic chips were fabricated in cyclic polyolefin by hot-embossing with a silicon master mold. The master itself was made using photolithographic techniques and Deep Reactive Ion Etching (DRIE). As a platform model, serum concentrations of C-reactive protein (CRP), a cardiac and inflammation marker, was measured on-chip using chemiluminescence based immunoassay. The assay results were read via an on-board instant photographic film, and with an imager capable of detecting chemiluminescent signals. The on-board detection module obviates the need for any dedicated bench-top analyzer for reading the immunoassay results, and therefore makes the device self-sufficient for point-of-care diagnostics when simple positive/negative results are sought. The microfluidic chemiluminescence results were compared with standard microplate ELISA analysis to assess the accuracy of the developed microfluidic immunoassay. Screening of CRP in human serum samples showed good correlation with ELISA analysis and the mean difference between the two methods using the Bland and Altman method was -0.079 +/- 0.858 mg/L for hsCRP. With approximate assay times of 25 min, the developed microfluidic immunoassay approach shows great potential for rapid plus sensitive detection of disease markers at the point-of-care.