[Conventional paraffin embedding technique and double-embedding technique for minute oral biopsies and delicate pulp tissue - a comparative study]

BACKGROUND

Among oral biopsies, small incisional tissues, have to be preserved all through the processing and embedding to ensure optimal visualization of all the mucosal layers without compromise. Optimal tissue orientation is the most critical step in tissue processing for demonstration of definitive morphology in the sections, which is often more challenging in cases of minute/small or thinner sections using routine paraffin techniques to evaluate accurate diagnosis. Some modification is needed to handle these samples to get a better result. Double embedding technique with some modification has been widely used for small/ thin/ multiple biopsies and gives excellent results in many other fields like general pathology and biotechnology. The double embedding technique though produced excellent and significant results in mucosal biopsies yet, it is of minimal interest among oral pathologists. To best of our knowledge, this is the first study to use double embedding technique for pulp tissues.

OBJECTIVE

The present study was aimed to evaluate and compare the ease of embedding and sectioning sections using Agar-Paraffin double embedding technique for small oral mucosal biopsies and thin pulp tissues.

MATERIAL AND METHODS

A total of 40 oral tissue samples categorized into two groups were taken for the present study. Group I included 20 small oral mucosal biopsy samples of size ranging from 0.2 to 0.5 cm and Group II included 20 pulp tissues obtained from freshly extracted non carious tooth. 10 blocks were prepared by routine paraffin method and 10 blocks were prepared by modified double embedding method for each group. Scores were given by comparing all the criteria with that of the routine paraffin technique. Chi-square test was used for statistical analysis.

RESULTS

The average ease score for the Agar-Paraffin double embedded small/minute biopsies showed better scores than the pulp tissue with that of the routine technique. However, no statistically significant difference was seen among embedding and sectioning sections between the two groups.

CONCLUSION

Modified double embedding method is simple and reliable alternative technique that helps in better orientation, processing and sectioning especially for oral small or thin biopsies and delicate pulp tissues.

Molecular diagnosis and clinico-hemato-biochemical alterations and oxidant-antioxidant biomarkers in Babesia-infected dogs of Mizoram, India

BACKGROUND & OBJECTIVES

Babesiosis is a tick transmitted disease, infecting a wide variety of wild and domestic animals, as well as humans. This study was designed to investigate molecular diagnosis and clinic-hemato-biochemical and oxidant/antioxidant status in dogs of Mizoram, India.

METHODS

A total 1200 dogs screened for babesiosis during 2017-18 and 53 dogs suspected for babesiosis by clinical signs and were confirmed by molecular diagnosis. Clinical signs were recorded; also blood samples were taken to investigate hematologic changes, serum biochemical variations and oxidative stress biomarkers.

RESULTS

The overall incidence of babesiosis in dogs of Aizawl, Mizoram, India during the study period recorded was 1.25% (15/1200) and 28.3% cases confirmed from 53 suspected dogs (15/53). The most commonly observed clinical signs were fever, emaciation, depression and icterus and lymphadenopathy. Significant reduction in PCV, HB, RBCs, MCHC, total protein, and albumin along with significant increase in MCV, WBCs, monocytes and BUN were the most consistent hemato-biochemical changes. Oxidant/antioxidant assessment showed significant reduction in superoxide dismutase, catalase and total anti-oxidant (TAC) along with significant increase in lipid peroxidase (LPO) activities.

INTERPRETATION & CONCLUSION

The findings of this study demonstrated that the main causative agent of babesiosis in dogs in Mizoram Province is Babesia gibsoni which caused significant alteration of hemato-biochemical and oxidant-antioxidant status in dogs.

Haemato-biochemical alterations and oxidative stress associated with naturally occurring porcine circovirus2 infection in pigs

Porcine circovirus2 (PCV2) infection in pigs is one of the major causes of economic loss to the farmers in terms of low production, slow growth and increase post-weaning mortality rate. The effect of PCV2 infection on haemogram, serum biochemical profile and oxidant/anti-oxidant status is not well established in pigs. In the present study, haemogram, serum biochemical profile and oxidant/anti-oxidant status were assessed in pigs confirmed positive for PCV2 infections as evidenced by commercially available enzyme-linked immunosorbent assay kit (n = 151) and polymerase chain reaction (PCR) (n = 42) among a total of 306 number of pigs included in the study. Non-infected healthy pigs (n = 6) served as healthy control. The total erythrocyte count (TEC), haemoglobin (Hb), packed cell volume (PCV), total leukocyte count (TLC), differential leukocyte count (DLC) and thrombocyte count were measured. The levels of total protein, albumin, globulin, total bilirubin, direct bilirubin, blood urea nitrogen (BUN), creatinine and glucose and enzymes viz. alanine transaminase (ALT), aspartate transaminase (AST), gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) were measured. Oxidative stress indicators such as plasma malondialdehyde (MDA) and total anti-oxidant activity (TAOA) were measured using commercially available kits. The mean values of TLC, lymphocytes and thrombocyte count were significantly (P < 0.05) low in PCV2-infected pigs. The levels of globulin, AST, GGT, BUN and creatinine were significantly increased (P < 0.05) whereas levels of albumin and glucose significantly (P < 0.05) decreased in PCV2-infected pigs. The significant increase (P < 0.05) in MDA level and significant decrease (P < 0.05) in TAOA level were noticed in PCV2-infected animals as compared with healthy control. The present study supports immunosuppression, possible multiple organ damage and oxidative stress associated with naturally occurring PCV2 infection in pigs. Timely vaccination and managemental practices can reduce PCV2 infection in farms. In spite of many research studies, there is still paucity of detailed systemic study on haemato-biochemical alteration and oxidative stress associated with PCV2 infection.

Accuracy of two dental age estimation methods in the Indian population - A meta-analysis of published studies

BACKGROUND

Dental age estimation using radiographic methods have gained considerable attention in the recent past. Although several such methods exist, Demirjian's method and Willems' method are very popular and have been used extensively. Whether these methods are applicable to the Indian population is not known.

METHODS

A search of Pubmed, Embase and Google Scholar search engines was done using specific keywords to identify studies using Demirjian's and Willems' methods in the Indian population. Studies published up to July 2018 were considered, and after thorough review, 20 eligible studies were identified. Meta-analysis of data obtained from these articles was conducted on 3668 children for Demirjian's method and 3144 children for Willems' method. The weighted mean differences for both of these methods at 95% confidence intervals were assessed to identify the accuracy of each method in predicting the chronological age.

RESULTS

Demirjian's method was found to consistently overestimate the age in Indian population, irrespective of the gender. The overestimation was in the order of few months. Willems' method resulted in underestimation of the age, although this was comparatively minimal in the order of 30 to 40 days.

CONCLUSION

Willems' method produced more accurate age which was very close to the chronological age, both in boys and girls. In contrast, Demirjian's method suffered from marked overestimation. Willems' method appears to be more suited to use in the Indian population.

Tuberculosis screening among persons with diabetes mellitus in Pune, India

BACKGROUND

Diabetes mellitus (DM) increases tuberculosis (TB) risk, and there is increasing concern over the public health implications of the convergence of these two epidemics. Screening for TB among people with DM is now recommended in India.

METHODS

People with DM seeking care at a large public sector tertiary care hospital clinic in Pune, India, were screened for TB from June 2015 to May 2016. All consenting people with DM were screened for TB at each clinic visit using a five-item, WHO-recommended questionnaire and those with TB symptoms and/or risk factors were tested for active TB using sputum smear microscopty, Xpert® MTB/RIF and TB culture. Categorical data and continuous variables were summarized using descriptive statistics. The x ² test or Wilcoxon rank-sum test was used to ascertain significant associations between categorical and continuous variables, respectively.

RESULTS

Among 630 adults approached for screening, median age was 60 (interquartile range (IQR), 57-64) years and 350 (56%) were females. Median hemoglobin A1c (HbA1c) was 8.7% (IQR, 6.7-9.9) and 444 (70.5%) were poorly controlled DM (HbA1c > 7). Forty-four (7%) had prior history of TB but the proportion with TB risk factors at screening was low (<5%). While 18% of participants reported any TB symptoms, none of these patients were diagnosed with culture confirmed TB.

CONCLUSIONS

Our study failed to yield any active TB cases using a WHO-recommended questionnaire among people with DM. High TB risk populations among people with DM must be identified if TB screening is to be feasible in settings such as India where the DM epidemic continues to rise.

Theileriasis in crossbred cows and its therapeutic management: first report from Lushai hill district of Mizoram

To know the prevalence of theileriosis infection, haemato-biochemical alteration and efficacy of Oxytetracycline in combination with Diaminazene aceturate injection against theileriosis in Lushai hill district of Mizoram; fifty five cross bred cattle were screened during July, 2013 to November, 2013. The prevalence of tropical theileriosis was 9.09 % based on blood smear examination. Clinical features of the disease were manifested by high rise of body temperature 104.8 ± 1.2 °F, lymphadenopathy, inability to walk, anorexia, listlessness, moderate anaemia, nasal discharge, edema of eye and corneal opacity. There were marked decline (P < 0.01) in the haemoglobin 5.28 ± 1.81 gm/dl, total erythrocytic count 2.14 ± 0.7 × 10(6)/ul, packed cell volume 18.10 ± 0.8 % and total leukocyte count 6.95 ± 1.05 × 10(3)/ul, respectively. Erythrocyte sedimentation rate was significantly increased (P < 0.01) up to 104.5 ± 12.4 mm/1st hour. The percentage of neutrophils increased 62.75 ± 2.77 and lymphocytes decreased drastically 28.69 ± 1.45 as compared with un-infected cross bred cattle. Clinically infected cattle with Theileria annulata had significantly low levels of total proteins and albumin, (P < 0.05) but AST, total, direct and indirect bilirubin, BUN, creatinine levels and Ck-MB activity were significantly high (P < 0.05). Oxytetracycline in combination with Diaminazene aceturate was found effective against T. annulata and could control fever and temperature returns to normalcy by 7th day post treatment along with some haemato-biochemical profiles. In brief, the study revealed that tropical theileriosis was prevalent in Lushai hill district of Mizoram especially among cross breed cattle and had effect on hepatic, renal and cardiac function which can be effectively controlled by Oxytetracycline and Diaminazene aceturate injection.

Acinic cell carcinoma of minor salivary gland showing features of high-grade transformation

Introduction:

Acinic cell carcinoma (AciCC) of salivary gland is a relatively infrequent tumor. Though known for its low-grade behavior, its unpredictable element of recurrence and malignancy should never be ignored.

Case Report:

A male patient with complaints of pain and swelling in the left jaw region since a year was operated based on the computed tomography (CT) and incisional biopsy report. Histopathology (routine staining, special staining, immunostaining and electron microscopy) of the excised specimen revealed it to be a variant of AciCC from minor salivary gland.

Discussion:

To the best of our knowledge, this is the first case of AciCC showing propensity for high-grade transformation (HGT), arising from minor salivary gland, being reported. The rarity of such variants and the importance of various investigative techniques in the diagnosis of such cases are discussed.

Saving the patient with post-ACS cardiogenic shock

The adoption of early revascularization as the preferred strategy in all ST-elevation myocardial infarctions (STEMI) and high risk acute coronary syndromes (ACS) without ST elevation resulted in a considerable reduction in the incidence of post-ACS cardiogenic shock (CS) however the incidence of CS on hospital arrival has not changed. In-hospital and 30 day mortality from CS remains excessively high in facilities with coronary revascularization capabilities. Trials investigating the incremental value of either intra-aortic counter-pulsation (IACP) or advanced MCS did not demonstrate a meaningful mortality reduction. Mortality remains 45-60% and depends on clinical characteristics of the patient, timely and successful revascularization and advanced MCS in suitable candidates. Most CS survivors demonstrate satisfactory functional capacity and quality of life. The authors propose the "Guthrie classification" for post-ACS CS. This classification promotes better characterization of CS patients enrolled in clinical trials and registries. It also allows the clinician to better define the goals and benefits of therapy for the CS subjects. The precise pathophysiology of post-ACS CS remains poorly understood at the biochemical and cellular level. Uncovering and modifying these processes remains key to any fundamental change in post-ACS CS outcomes.

Fractional flow reserve at 2013: an update

Fractional flow reserve (FFR) has become an extremely valuable tool for assessing the hemodynamic significance of intermediate coronary lesions in patients with stable coronary syndromes. This manuscript delineates the current data supporting FFR use to guide cardiovascular interventions in comparison to other invasive and non-invasive modalities. The correlation between FFR, symptom severity and likelihood of future major cardiovascular events are critically examined in view of the FAME-2 study results. The authors delineate the scientific gaps, potential pitfalls and misconceptions related to FFR with regards to current and emerging indications. Described are the most important developments related to FFR in 2012: instantaneous wave free ratio and non-invasive CT angiography based FFR. The manuscript proposes areas of future research to enhance the scientific data supporting current FFR clinical algorithms and strategies.

Mathematical model for osteobstruction in bone regeneration mechanisms: a headway in skeletal tissue engineering

In this paper, we formulate a mathematical model for the evaluation of parameters responsible for the retardation and eventual acceleration of bone regeneration on the contralateral side of the mandible of experimental animals, following the discovery of a new mechanism of bone regeneration called the osteobstruction mechanism (a negative mechanism of bone regeneration as opposed to the well established and extensively documented positive mechanisms such as osteogenesis, osteoinduction and osteoconduction). This osteobstructive mechanism was demonstrated by episodes of overtaking and reovertaking on single photon emission computed tomography (SPECT) following evaluation of osteoblastic activities in a sequential animal experiment to validate both the Ogunsalu sandwich technique (a double guided tissue technique; D-GTR) and the interceed membrane technique (a single guided tissue regeneration technique; S-GTR) utilizing SPECT, histological and histomorphometric evaluation. This work is now given special attention in terms of mathematical analysis because of limited experimental observations since experiments cannot be observed infinitely. Mathematical modelling is as such essential to generalize the results of this osteobstructive mechanism in bone regeneration. We utilize the Fisher's equation to describe bone cell mobilization during bone regeneration by two different techniques: the Ogunsalu sandwich bone regeneration technique (D-GTR) and the S-GTR.

Evolution of dental informatics as a major research tool in oral pathology

Bioinformatics is a relatively new field of science that incorporates the principles of biology and computer science. It is mainly concerned with collecting, storing, and retrieving data from large databases. Ever since the successful completion of the Human Genome Project, there has been an exponential growth in the volumes of biological data that is being generated worldwide. The evolution of bioinformatics has made it possible to access these databases and apply the information for better research. One discipline that has been benefitted from the advent of bioinformatics is oral pathology. Oral pathology is a branch of dentistry which deals with the diseases of the head and neck region. Remarkable progress has been made in the diagnosis and treatment of diseases with the aid of bioinformatics. This article attempts to review the evolution and progress of dental informatics as a specialty and its applications in oral pathology.

Regeneration of periodontal tissues in non-human primates with rhGDF-5 and beta-tricalcium phosphate

The application of growth factors has been advocated in support of periodontal regeneration. Recombinant human growth and differentiation factor-5 (rhGDF-5), a member of the bone morphogenetic protein family, has been used to encourage periodontal tissue regeneration. This study evaluated the dose response of rhGDF-5 lyophilized onto beta-tricalcium phosphate (bTCP) granules for periodontal tissue regeneration in a baboon model. Periodontal defects were created bilaterally in 12 baboons by a split-mouth design. Plaque was allowed to accumulate around wire ligatures to create chronic disease. After 2 mos, the ligatures were removed, and a notch was placed at the base of the defect. Two teeth on each side of the mouth were randomly treated with bTCP only, 0.5, 1.0, or 2.0 mg rhGDF-5/g bTCP. Animals were sacrificed 5 mos post-treatment, with micro-CT and histomorphometric analysis performed. After 5 mos, analysis showed alveolar bone, cementum, and periodontal ligament formation in all treatment groups, with a dose-dependent increase in rhGDF-5-treated groups. Height of periodontal tissues also increased with the addition of rhGDF-5, and the amount of residual graft material decreased with rhGDF-5 treatment. Therefore, rhGDF-5 delivered on bTCP demonstrated effective regeneration of all 3 tissues critical for periodontal repair.

Morphologic and cytomorphometric analysis of exfoliated buccal mucosal cells in diabetes patients

BACKGROUND

It is now known that the disease process of diabetes has effects on various tissues of the body. The following study was done to analyze the effects of diabetes on oral tissues.

AIMS

To study the morphology and cytomorphometry of the cells obtained in cytologic smears from the buccal mucosa of diabetic patients.

MATERIALS AND METHODS

Smears were obtained from clinically normal buccal mucosa of 50 randomly selected diabetic patients attending the diabetic clinic and the out-patient department and of five healthy subjects as control. Smears were stained using Papanicolaou method, and using a micrometer mean values of nuclear diameter (ND), cell diameter (CD), cytoplasmic diameter (CyD) and nucleus: cytoplasm ratio (N: C ratio) were obtained for each patient. Diabetic patients were divided into four groups based on the glycosylated hemoglobin (GHb) values for comparison.

STATISTICAL ANALYSIS USED

Student's T-test and Fisher's F-test.

RESULTS

Statistically significant increase in ND (P=0.0367) was found in diabetic patients compared to controls. Degree of glycemic control significantly affected ND (P=0.0042) and N: C ratio (P=0.0055). In general, as the severity of diabetes increases, ND and N: C ratio rise gradually.

CONCLUSIONS

Diabetes produces definite morphologic and cytomorphometric changes in the buccal mucosa of patients. However, further research in this direction is indicated, to analyze the significance of these findings as a tool for diabetes detection, as well as to obtain deeper insights into its effects on various tissues.

Global manipulation of digital images can lead to variation in cytological diagnosis

Background:

With the adoption of a completely electronic workflow by several journals and the advent of telepathology, digital imaging has become an integral part of every scientific research. However, manipulating digital images is very easy, and it can lead to misinterpretations.

Aim:

To analyse the impact of manipulating digital images on their diagnosis.

Design:

Digital images were obtained from Papanicolaou-stained smears of dysplastic and normal oral epithelium. They were manipulated using GNU Image Manipulation Program (GIMP) to alter their brightness and contrast and color levels. A Power Point presentation composed of slides of these manipulated images along with the unaltered originals arranged randomly was created. The presentation was shown to five observers individually who rated the images as normal, mild, moderate or severe dysplasia. Weighted κ statistics was used to measure and assess the levels of agreement between observers.

Results:

Levels of agreement between manipulated images and original images varied greatly among observers. Variation in diagnosis was in the form of overdiagnosis or under-diagnosis, usually by one grade.

Conclusion:

Global manipulations of digital images of cytological slides can significantly affect their interpretation. Such manipulations should therefore be kept to a minimum, and avoided wherever possible.

An assessment of root cementum in cleidocranial dysplasia

The purpose of this prospective study was to determine if there is a difference between the amount of cellular and acellular cementum on the roots of 2 teeth extracted from a subject with cleidocranial dysplasia (CCD) compared to 10 teeth extracted from 10 subjects unaffected by CCD. The cementum of 2 permanent teeth, which had been extracted from the CCD subject, was examined and histomorphometrically analyzed for comparison to the cementum of 10 anterior teeth that had been extracted from individuals who were unaffected by CCD. The percentage of the root covered by cellular or acellular cementum was quantified to determine if patients affected by CCD typically lack cellular cementum. In the roots of the 2 permanent teeth of the subject with CCD, a mean of 18.05 +/- 10.67% was covered by cellular cementum and 76.90 +/- 3.53% was covered by acellular cementum. In the 10 permanent teeth from subjects without CCD, a mean of 19.12 +/- 15.60% of the root was covered by cellular cementum and 80.34 +/- 15.71% was covered by acellular cementum. The findings indicate that there is no statistically significant difference between the amount of either cellular or acellular cementum covering the roots of the study subject with CCD and the roots of the 10 control teeth. The presumption that a lack of cellular cementum causes the increased number of unerupted teeth in patients with CCD is not supported by the findings of this study.

Impact of Spherix (Bacillus sphaericus B-101, serotype H5a, 5b) spraying on the control of mosquito breeding in rural areas of Farrukhabad District, Uttar Pradesh

Spray impact of Spherix (Bacillus sphaericus B-101, Serotype H5a, 5b) was assessed against larval and adult populations of mosquito species in rural areas of Farrukhabad district, Uttar Pradesh. High mortality (> 95%) was observed against anopheline and culicine larvae within 48 h of spray @ 1 g/sq m. But the biolarvicidal effect declined within a week which indicated nonrecycling capacity and weekly reapplications were required. The encouraging results obtained through weekly sprays were short-lived because of decline in efficacy in some perennial intradomestic Culex breedings after 15 rounds of spray. The two year intensive field trials, however, had no appreciable impact on adult densities of both malaria vector An. culicifacies and bancroftian filariasis vector Culex quinquefasciatus. Environmental disturbances and manmade problems also affected the efficacy of the biolarvicide.

Prevalence of intestinal parasites in rural areas of district Shahjahanpur, Uttar Pradesh

A stool survey was carried out in some of the villages of Dadraul and Bhawal Khera PHC's of district Shahjahanpur (Uttar Pradesh). Out of 381 individuals examined 111 (29.2 per cent) were found positive for one or the other intestinal parasite. Ascaris lumbricoides superseded all the parasites by showing a positivity of 17.85 percent. Other parasites found were Hookworm, Hymenolepis nana, Tapeworm, Trichuris trichiura, Enterobius vermicularis, Entamoeba histolytica, E. coli and Giardia lamblia. Parasitic load was slightly higher in females (33.59 per cent) than males (28.18 per cent). The highest positivity was encountered in the age groups between 6 to 14 years. This high prevalence of intestinal parasites may be due to the lack of awareness about personal cleanliness and hygiene and illiteracy among rural women. Majority of them had helminthic infections. It is concluded that in rural areas of district Shahjahanpur intestinal helminthic infections are more prevalent that protozoan infections.

Control of mosquito breeding through Gambusia affinis in rice fields

Studies on mosquito breeding and its control through Gambusia affinis in nursery and paddy fields after transplantation of seedlings were carried out during June to October 1991 in about 10 ha rice field area. Six anopheline species, viz. An. culicifacies, An. annularis, An. subpictus, An. nigerrimus, An. barbirostris and An. aconitus, and four culicine species, viz. Cx. tritaeniorhynchus, Cx. bitaeniorhynchus, Cx. quinquefasciatus, and Aedes sp. could be identified. These were found breeding in rice fields with fluctuations in their percentage composition, exhibiting species succession in different months. G. affinis survived well in submerged rice fields and provided 87.8% mosquito larval control. In rice fields which exhibited intermittent drying up leading to formation of pools, puddles etc., moderate larval control was achieved. However, in nursery rice fields, this method was not applicable. Mosquito larval control through larvivorous fish in rice fields can be achieved but the method has limitations.

Availability and utility of local fishes of Shahjahanpur for mosquito control

A survey of fishes in Shahjahanpur in different aquatic habitats revealed 35 indigenous fish species. Out of 35 fish species, 24 were found feeding on mosquito larvae of which 6 species, viz. Chela bacaila, Puntius stigma, Rasbora daniconius, Esomus danricus, Colisa fasciatus and Danio sp., had good larvivorous potential. Most of the fish species preferred to feed on III and IV instar larvae. In the presence of planktonic food, the consumption capacity of fishes for mosquito larvae was lesser on third day (D3) of observation than on first day (D1). The difference in the consumption of mosquito larvae between D1 and D3 was significant (P < 0.01). Similarly, difference in the feeding capacity of fishes in the months of September and January was highly significant (P < 0.001). But there was no seasonal variation in the preference of instar-wise consumption. Indigenous fish species such as C. fasciatus, E. danricus, P. stigma, R. daniconius and Danio sp. could therefore play a significant role in controlling mosquito breeding in this area.

Gambusia affinis: dispersal due to floods and its failure to colonize new water bodies in Shahjahanpur District (U.P.)

In villages of District Shahjahanpur, 122 decentralized Gambusia multiplication ponds were established to cover the need of the entire district. Profuse breeding of Gambusia was observed in these ponds. The fishes are being successfully used in mosquito control all over the district. In July 1990 there was a widespread flood due to which 70 Gambusia multiplication ponds were affected and the fish was washed away in large numbers, leaving only a scanty population in the flood-affected ponds. We utilized this opportunity to study the natural dispersal and colonization of Gambusia in different aquatic habitats. The study revealed that Gambusia was either not found in most habitats or was present in very small numbers, and on its own Gambusia was unable to eliminate the local fauna to become a dominant species. Predatory fishes and birds played a major role in eliminating Gambusia. Gambusia is therefore unlikely to pose any ecological hazard in vector-control programmes.

Culture of Gambusia affinis with food fishes

Culture of Gambusia affinis along with carps in fish culture practice in village ponds in Shahjahanpur distt., U.P., has revealed very little difference in fish productivity (1539 kg/ha in ponds with Gambusia, 1572 kg/ha in ponds without Gambusia). The growth and survival of Gambusia were found to be good in most of the composite fish culture ponds. Culture of Gambusia along with edible fish in village ponds is, therefore, recommended to get the dual benefit of fish production and control of mosquito proliferation in village ponds.

Detection of multiple invasion of erythrocytes by Plasmodium vivax

An attempt was made to detect multiple invasion of erythrocytes by Plasmodium vivax in district Shahjahanpur, India. Out of 33,027 P. vivax cases examined, 84 showed multiple invasion of erythrocytes. There were 14 cases who showed more than five rings in an erythrocyte. Maximum invasion of an erythrocyte was observed in a 50 year old male patient, a single erythrocyte was harbouring 12 rings. In 5 patients more than one schizonts were present in single erythrocyte. The number of merozoites per schizont varied from 2-28. In some of the cases erythrocytes were having more than one stage of the malarial parasite. Such variations are probably related to the P. vivax strain found in this area.

Application of a simplified in-vivo test system for determining chloroquine resistance in Plasmodium falciparum

A simplified in-vivo test system was applied to detect chloroquine resistance in malaria patients in Shahjahanpur district (Uttar Pradesh) in India. In 27.6% of cases RIII resistance was observed. This in-vivo method is a simple and useful test for the early detection of chloroquine-resistant falciparum infections and for the management of these patients with alternative therapy.

Charcoal hemoperfusion for the treatment of a combined diltiazem and metoprolol overdose

We describe the management of a 49-year-old woman who ingested 1,200 mg diltiazem and 500 mg metoprolol. The patient was bradycardic and hypertensive, requiring large doses of inotropic agents and temporary transvenous pacing. Charcoal hemoperfusion was used as an adjunct technique to hasten drug elimination; it rapidly lowered plasma drug levels, with a parallel improvement in the patient's clinical condition.