From neglect to peril: diabetic ketoacidosis unleashing colonic necrosis and perforation in an adolescent girl with type 1 diabetes mellitus

OBJECTIVES

Abdominal pain is a common presentation in patients of diabetic ketoacidosis (DKA). However, this pain generally resolves with resolution of dehydration and acidosis. Persistence of abdominal pain even after resolution of ketosis and acidosis should warrant careful reassessment to find evidence of sepsis and concomitant abdominal pathology.

CASE PRESENTATION

We report a rare case of type 1 diabetes mellitus in a 15 year old girl diagnosed 6 months ago who presented with mild DKA (pH 7.24, HCO3 - 13.5 mmol/L). Her hospital course was extremely stormy and despite best of our efforts she succumbed due to colonic ischemia and perforation peritonitis.

CONCLUSIONS

A high index of suspicion for gut ischemia or perforation should be kept if DKA is associated with septic shock and there is suboptimal response to standard treatment. Mesenteric ischemia can occur in pediatric patients even with mild DKA having very poor diabetes control.

Remote Mesoscopic Signatures of Induced Magnetic Texture in Graphene

Mesoscopic conductance fluctuations are a ubiquitous signature of phase-coherent transport in small conductors, exhibiting universal character independent of system details. In this Letter, however, we demonstrate a pronounced breakdown of this universality, due to the interplay of local and remote phenomena in transport. Our experiments are performed in a graphene-based interaction-detection geometry, in which an artificial magnetic texture is induced in the graphene layer by covering a portion of it with a micromagnet. When probing conduction at some distance from this region, the strong influence of remote factors is manifested through the appearance of giant conductance fluctuations, with amplitude much larger than e^{2}/h. This violation of one of the fundamental tenets of mesoscopic physics dramatically demonstrates how local considerations can be overwhelmed by remote signatures in phase-coherent conductors.

Allosteric Site Inhibitor Disrupting Auto-Processing of Malarial Cysteine Proteases

Falcipains are major haemoglobinases of Plasmodium falciparum required for parasite growth and development. They consist of pro- and mature domains that interact via 'hot-spot' interactions and maintain the structural integrity of enzyme in zymogen state. Upon sensing the acidic environment, these interactions dissociate and active enzyme is released. For inhibiting falcipains, several active site inhibitors exist, however, compounds that target via allosteric mechanism remains uncharacterized. Therefore, we designed and synthesized six azapeptide compounds, among which, NA-01 & NA-03 arrested parasite growth by specifically blocking the auto-processing of falcipains. Inhibitors showed high affinity for enzymes in presence of the prodomain without affecting the secondary structure. Binding of NA-03 at the interface induced rigidity in the prodomain preventing structural reorganization. We further reported a histidine-dependent activation of falcipain. Collectively, for the first time we provide a framework for blocking the allosteric site of crucial haemoglobinases of the human malaria parasite. Targeting the allosteric site could provide high selectivity and less vulnerable to drug resistance.

Evaluation of antiviral activity of Ocimum sanctum and Acacia arabica leaves extracts against H9N2 virus using embryonated chicken egg model

BACKGROUND

In the view of endemic avian influenza H9N2 infection in poultry, its zoonotic potential and emergence of antiviral resistance, two herbal plants, Ocimum sanctum and Acacia arabica, which are easily available throughout various geographical locations in India were taken up to study their antiviral activity against H9N2 virus. We evaluated antiviral efficacy of three different extracts each from leaves of O. sanctum (crude extract, terpenoid and polyphenol) and A. arabica (crude extract, flavonoid and polyphenol) against H9N2 virus using in ovo model.

METHODS

The antiviral efficacy of different leaves extracts was systematically studied in three experimental protocols viz. virucidal (dose-dependent), therapeutic (time-dependent) and prophylactic (dose-dependent) activity employing in ovo model. The maximum non-toxic concentration of each herbal extracts of O. sanctum and A. arabica in the specific pathogen free embryonated chicken eggs was estimated and their antiviral efficacy was determined in terms of reduction in viral titres, measured by Haemagglutination (HA) and real time quantitative reverse transcription polymerase chain reaction (RT-qPCR) assays.

RESULTS

All the extracts of O. sanctum (crude extract, terpenoid and polyphenol) and A. arabica (crude extract, flavonoid and polyphenol) showed significant virucidal activity, however, crude extract _ocimum and terpenoid _ocimum showed highly significant to significant (p < 0.001-0.01) decrease in virus genome copy numbers with lowest dose tested. Similarly, therapeutic effect was observed in all three extracts of O. sanctum in comparison to the virus control, nevertheless, crude extract _ocimum and terpenoid _ocimum maintained this effect for longer period of time (up to 72 h post-incubation). None of the leaves extracts of A. arabica had therapeutic effect at 24 and 48 h post-incubation, however, only the crude extract _acacia and polyphenol _acacia showed delayed therapeutic effect (72 h post-inoculation). Prophylactic potential was observed in polyphenol _acacia with highly significant antiviral activity compared to virus control (p < 0.001).

CONCLUSIONS

The crude extract and terpenoid isolated from the leaves of O. sanctum and polyphenol from A. arabica has shown promising antiviral properties against H9N2 virus. Future investigations are necessary to formulate combinations of these compounds for the broader antiviral activity against H9N2 viruses and evaluate them in chickens.

Proteases in Mosquito Borne Diseases: New Avenues in Drug Development

INTRODUCTION

Mosquito borne diseases continue to propagate and cause millions of deaths annually. They are caused either by protozoan parasites such as Plasmodium, Toxoplasma or by flaviviruses including Dengue and Zika. Among the proteome of such parasitic organisms, proteases play essential roles in events such as host invasion, hemoglobin hydrolysis, replication and immune evasion. Plasmepsin V (PMV), an endoplasmic reticulum resident aspartic protease of Plasmodium spp., is involved in the export of ~400 proteins containing the conserved Plasmodium Export Element motif (PEXEL). Interactions and cleavage of PEXEL proteins by PM V is necessary for export to and across the parasitophorous vacuole membrane. Protease System: Similarly in flaviviruses, a two-component protease system consisting of nonstructural proteins, NS2B and NS3, interacts with other non-structural proteins and plays a major role in viral replication, polyprotein cleavage and virion particle assembly. Thus, proteases involved in indispensable roles in pathogen machinery can be considered as attractive drug targets. Inhibitors against proteases are being used in clinical trials for other communicable and non-communicable diseases. Currently, hydroxyethylamine based inhibitors targeting the catalytic site of PM V with picomolar inhibitory concentrations have been tested in vitro.

CONCLUSION

For recently characterized disease such as Zika, no known treatments exist while compound such as Policresulen has high affinity for Dengue NS2B/NS3 complex. Understanding proteases structure-function relationship and protease-inhibitor interactions can provide new insights for novel chemotherapeutic strategies.

Comparative study of bronchoalveolar lavage, bronchial brushing, and FNAC in diagnosing malignant neoplasms of lungs

Background:

Lung cancer is the leading cause of death in developed countries and is increasing at alarming rates in developing countries. Cytological techniques such as bronchoalveolar lavage (BAL), bronchial brushing (BB), and fine needle aspiration cytology (FNAC) can aid in the early diagnosis of lung malignancies.

Materials and Methods:

A total of 67 cases, suspected of lung cancer between January 2010 and December 2012, were selected where samples of BAL, BB, FNAC, as well as biopsy were obtained and processed according to the standard procedures of cytology and histology. The aim of this study was to compare the diagnostic efficacy of the three modalities, i.e., BAL, BB, and FNAC in diagnosing malignant neoplasms of the lung. Biopsy was considered to be the gold standard diagnostic test.

Results:

Sensitivity of BAL, BB, and FNAC was found to be 47.61, 65.07, and 88.88%, respectively, whereas specificity of BAL, BB, and FNAC was 75, 75, and 100%, respectively.

Conclusions:

FNAC is the best technique among the three for the diagnosis of lung cancers.

Comparison of scar thickness measurements using trans-vaginal sonography and MRI in cases of pregnancy with previous caesarean section. Do they correlate with actual scar thickness?

The aim of this study was to evaluate scar thickness in cases of pregnancy with previous caesarean section, by trans-vaginal sonography (TVS) and magnetic resonance imaging (MRI), and to correlate precision of radiologically-measured scar thickness with actual measurement of scar thickness. A total of 35 pregnant patients with previous caesarean section planned for elective caesarean section, were evaluated prospectively. Their scar thickness was measured by TVS and MRI on the day of elective repeat caesarean section. These measurements were correlated with each other and with scar thickness measured during elective repeat caesarean section by using a caliper. The correlation coefficients between scar thickness measured by TVS and MRI with peroperative evaluation with a caliper, were +0.72 and +0.59, respectively. The study concluded that as MRI is a costlier modality and TVS has better correlation coefficient with actual scar thickness, TVS can be considered to be the better modality for antenatal scar thickness measurement.

A linear study of pulmonary function tests in normal pregnant and non-pregnant women

Pregnancy is principally a phenomenon of maternal adaptation to the increasing demands of the growing foetus. Pregnancy causes many visible and invisible changes in human body and it represents one of the best example of selective adaptation in terms of respiratory physiology. To evaluate the changes in dynamic pulmonary function tests in all three trimesters of pregnancy and compare the results between normal pregnant women (case group) and normal non-pregnant women (control group) and also to compare the results of the study with other studies, 50 subjects were selected and divided into two groups, non-pregnant women (n = 20, mean age = 26.5 +/- 2.69 years) and normal pregnant women of all three trimesters (n = 30, mean age = 24.84 +/- 3.00 years). Pulmonary function tests were done by medspiror. Significant decrease in all the parameters of pulmonary function tests like forced vital capacity, forced expiratory volume in one second, peak expiratory flow rate, maximum ventilation volume, were noticed in all trimesters of normal pregnant women as compared to normal non-pregnant women. The data suggest that there is alteration in pulmonary function tests in pregnant women. Continuous Monitoring of pulmonary function tests may prove to be of great value in maternal healthcare as cases of restriction and obstruction in lungs during pregnancy can be identified early and its deterioration can be prevented by proper management.

Fat embolism syndrome

Fat embolism syndrome is an often overlooked cause of breathlessness in trauma wards. Presenting in a wide range of clinical signs of varying severity, fat embolism is usually diagnosed by a physician who keeps a high degree of suspicion. The clinical background, chronology of symptoms and corroborative laboratory findings are instrumental in a diagnosis of fat embolism syndrome. There are a few diagnostic criteria which are helpful in making a diagnosis of fat embolism syndrome. Management is mainly prevention of fat embolism syndrome, and organ supportive care. Except in fulminant fat embolism syndrome, the prognosis is usually good.

Frequency of oseltamivir resistance in Sydney, during the Newcastle outbreak of community transmitted oseltamivir-resistant influenza A(H1N1)pdm09 virus, Australia, June to August 2011

Although oseltamivir-resistant pandemic influenza A(H1N1)pdm09 is uncommon in immunocompetent individuals, a recent report from Newcastle, Australia, showed the first sustained community spread, from June to August 2011, of oseltamivir-resistant influenza A(H1N1)pdm09 virus carrying the H275Y neuraminidase (NA) mutation. To determine the frequency and the extent of this viral variant spread in the nearest major city to Newcastle, we performed a sequencebased genotypic assessment on samples from 143 oseltamivir untreated and 23 oseltamivir post-treatment individuals with influenza collected contemporaneously in Sydney, 120 km southwest of Newcastle. The detection of two of 143 (1.4%) community-derived samples containing H275Y suggests a low prevalence of oseltamivir-resistant influenza A(H1N1)pdm09 virus in the general community and no convincing evidence of spread of the NA H275Y-bearing influenza A(H1N1)pdm09 virus. In oseltamivir treated patients, oseltamivir-resistant influenza A(H1N1)pdm09 virus continue to emerge with three of 23 (13%) post-treatment samples containing the H275Y mutation. The observation of signature mutations and distinct phylogenetic relationship in full-length sequences of haemagglutinin and neuraminidase genes derived from 2011 strains against 2009 strains indicates continued genetic evolution and antigenic drift of the influenza A(H1N1)pdm09 viruses circulating in Australia.

Characteristics of a widespread community cluster of H275Y oseltamivir-resistant A(H1N1)pdm09 influenza in Australia

Background. Oseltamivir resistance in A(H1N1)pdm09 influenza is rare, particularly in untreated community cases. Sustained community transmission has not previously been reported.

Methods. Influenza specimens from the Asia–Pacific region were collected through sentinel surveillance, hospital, and general practitioner networks. Clinical and epidemiological information was collected on patients infected with oseltamivir-resistant viruses.

Results. Twenty-nine (15%) of 191 A(H1N1)pdm09 viruses collected between May and September 2011 from Hunter New England (HNE), Australia, contained the H275Y neuraminidase substitution responsible for oseltamivir resistance. Only 1 patient had received oseltamivir before specimen collection. The resistant strains were genetically very closely related, suggesting the spread of a single variant. Ninety percent of cases lived within 50 kilometers. Three genetically similar oseltamivir-resistant variants were detected outside of HNE, including 1 strain from Perth, approximately 4000 kilometers away. Computational analysis predicted that neuraminidase substitutions V241I, N369K, and N386S in these viruses may offset the destabilizing effect of the H275Y substitution.

Conclusions This cluster represents the first widespread community transmission of H275Y oseltamivir-resistant A(H1N1)pdm09 influenza. These cases and data on potential permissive mutations suggest that currently circulating A(H1N1)pdm09 viruses retain viral fitness in the presence of the H275Y mutation and that widespread emergence of oseltamivir-resistant strains may now be more likely.

Study of AP endonuclease (APEX1/REF1), a DNA repair enzyme, in gallbladder carcinoma

AIM

This study investigated the levels of Apurinic/Apyrimidinic Endonuclease (APEX1) in gallbladder carcinoma (CaGB) tissue and co-related these levels with various clinicopathological parameters.

PATIENTS AND METHODS

Twenty cases of CaGB and cholelithiasis were included in the study. Western blot analysis of APEX1 protein was performed using actin as the reference point. Densitometric analysis and the integrated density value (IDV) of APEX1 protein samples were determined. The ratio of IDV of APEX1/actin was determined.

RESULTS

The mean IDV ratio of APEX1 in CaGB was 0.63±0.33 and 0.45±0.19 in cholelithiasis. The mean IDV ratio of a variant of APEX1 (ΔAPEX1) in CaGB was 0.50±0.09, whereas it was 0.40±0.16 in cholelithiasis. Calculating the mean IDV ratio of total APEX (APEX1+ΔAPEX1) in CaGB was 1.13±0.31 whereas in cholelithiasis, 0.85±0.23. The differences were statistically significant (p<0.05).

CONCLUSION

A significant correlation was found between the relative expressions of APEX1 in cancer as compared to that in cholelithiasis patients. There was significant association between APEX1 expression and perineural invasion. A variant of APEX1 correlated with tumor infiltration. Hence APEX1 may be of use as a prognostic marker in patients with CaGB.

Celiac disease in children: an old disease with new features

Celiac disease is an underdiagnosed condition in children with variable manifestations. Presenting symptoms in children are changing over time, are impacted by age and geography, and are distinct from those of adults with this disease. Prompt diagnosis of celiac disease in affected children may avoid growth and nutritional deficits in addition to preventing long term disease complications such as infertility and malignancy. Diagnosis and management of celiac disease in children requires expert medical and nutritional care to maximize positive outcomes.

Coxiella burnetii causing haemophagocytic syndrome: a rare complication of an unusual pathogen

We describe an unusual presentation of Q fever with associated haemophagocytic syndrome, confirmed by bone marrow aspirate, Q fever polymerase chain reaction (PCR) and serological testing. Clinical recovery was observed after the commencement of doxycycline with normalisation of the patient's full blood count and serum biochemistry. Serial monitoring of the Q fever serology revealed the subsequent development of sustained high phase 1 IgG antibodies, suggestive of chronic Q fever. Although many infectious aetiologies have been associated with haemophagocytosis, Q fever has only rarely been described in this context. The diagnosis of Q fever is often overlooked, especially when the presentation is atypical. We describe how the use of PCR testing significantly shortened the interval to definitive diagnosis and helped elucidate the underlying cause of the patient's haematological disorder.

Allergic bronchopulmonary aspergillosis presenting with cavitary lesion and simulating a lung abscess

A case of allergic bronchopulmonary aspergillosis (ABPA) is being described in a 52-year-old female patient who presented with a cavitary lesion on skiagram chest and simulating a lung abscess. Patient responded with the oral corticosteroid therapy with complete resolution of the initial radiographic abnormality. Despite various radiological presentations described in the literature, a lung abscess like presentation in ABPA is very rare and significant, because an early and correct diagnosis by the clinicians will help in early management of these cases to prevent the development of end-stage pulmonary fibrosis.

Tolosa hunt syndrome: A case report

Tolosa-Hunt syndrome (THS) is a painful ophthalmoplegia caused by nonspecific inflammation of the cavernous sinus or superior orbital fissure. We present a case of THS disease evaluated on a 1.5 Tesla MR scanner.

Narrowing of the preprophase microtubule band is not required for cell division plane determination in cultured plant cells

In most higher-plant cells, cortical microtubules form a tightly focused preprophase band (PPB) that disappears with the onset of prometaphase, but whose location defines the future location of the cell plate at the end of cytokinesis. It is unclear whether the PPB microtubules themselves designate the precise area where the cell plate will insert, or rather if these microtubules are responding to a hierarchical signal(s). Here we show that narrowing of the microtubules within the PPB zone is not necessary for proper division plane determination. In cultured tobacco BY-2 cells in which PPB microtubules are depolymerized, the phragmoplast can still accurately locate and insert at the proper site. The data do not support a role for PPB microtubule narrowing in focusing the signal that is used later by the phragmoplast to position the cell plate; rather, proper phragmoplast positioning is more likely a consequence of a non-microtubule positional element. Although the PPB microtubules do not directly mark the division site, we show that they are required for accurate spindle positioning, an activity that presets the future growth trajectory of the phragmoplast and is necessary for insuring high-fidelity cell plate positioning.

Spatio-temporal relationship between nuclear-envelope breakdown and preprophase band disappearance in cultured tobacco cells

Cell division involves the coordinated progression of karyokinesis and cytokinesis, which is accomplished by communication between the nucleus and the cytoplasm. We have utilized green-fluorescent-protein technology to generate a line of tobacco 'Bright Yellow 2' (BY-2) cells labeled for both microtubules and the nuclear envelope. This cell line allowed us to use living cells to investigate the relationship between nuclear-envelope breakdown and preprophase band disappearance with high spatial and temporal resolution. Our observations demonstrate that nuclear-envelope breakdown always precedes preprophase band disappearance in BY-2 cells. In addition, the rate of preprophase band disappearance, and the attenuation of perinuclear microtubule fluorescence, correlates with the proximity of the nucleus to the preprophase band site. These results indicate the presence of communication between the nucleus and the preprophase band and suggest a causal relationship between nuclear-envelope breakdown and preprophase band disappearance.

Anti-mosquito ovary antibodies reduce the fecundity of Anopheles stephensi (Diptera:Insecta)

Rabbit antibodies to five antigens (AJ** 29, 35, 43, 64, and 80 kDa) derived from the ovaries of Anopheles stephensi tended to reduce the number of eggs produced. Ingestion of anti-mosquito ovary antibodies did not show a detectable effect on the mortality of mosquitoes. Antisera raised against An. stephensi ovaries showed cross-reactivity in other tissues and in the ovaries of other Anopheles spp. by Western blotting. The results indicate that anti-mosquito ovary antibodies have the potential to disrupt the reproductive physiology of mosquitoes, and indicate the need for further studies with target antigens.

Application of rat hepatocyte culture to predict in vivo metabolic auto-induction: studies with DFP, a cyclooxygenase-2 inhibitor

The drug candidate DFP [5,5-dimethyl-3-(2-isopropoxy)-4-(4-methanesulfonylphenyl)-2(5H)-furanone] is a selective cyclooxygenase-2 inhibitor under evaluation for analgesic and anti-inflammatory therapy. The in vitro metabolic pathways (rat microsomes) involve hydroxylation of the isopropyl side chain at either of two positions, the methyl or the methine, thus producing a hydroxylated metabolite (DFHP) or a dealkylated metabolite (DFH). DFH formation was the major pathway. Using hepatic microsomes from rats treated with agents that induce specific CYP isozymes, it was shown that the dexamethasone-inducible rat CYP3A isozyme(s) play a major role in DFH formation. The roles of CYP3A1 and -3A2 were confirmed with genetically engineered rat CYP enzymes. The potential for induction of rat CYP3A by DFP was evaluated by incubating DFP in rat hepatocyte cultures and measuring the CYP3A levels. Both CYP3A immunoreactive protein and enzyme activity were induced in a dose-dependent manner. The induction was confirmed in vivo by dosing rats with DFP at 100 mg/kg for 4 days. Microsomes prepared from the excised livers showed that DFP gave approximately 55% of the induction observed with dexamethasone, as determined by Western blot. In vitro metabolic auto-induction of DFP was assessed by measuring the metabolism of DFP in hepatocytes treated with DFP. DFH formation was significantly enhanced in the DFP-treated cells. In vivo, treating rats with DFP at doses of 10 to 100 mg/(kg.day) for 13 weeks indicated that DFP induced its own metabolism. The C(max) and plasma drug area under the curve values during the thirteenth week were significantly lower than that on the first day, and the effect was dose-dependent.

The brassica MIP-MOD gene encodes a functional water channel that is expressed in the stigma epidermis

In crucifers, the ability of the stigma to differentially modulate hydration of pollen grains, depending on whether the pollen is recognized to be compatible or incompatible, represents a crucial stage in pollination. Our recent analysis of the mod mutation of Brassica, which results in a breakdown of the self-incompatibility response, led to the isolation of a gene linked to the MOD locus which is expressed at low levels in mod mutants. The gene is predicted to encode a plasma membrane-localized aquaporin-like protein and has been designated MIP-MOD. We utilized reporter gene analysis to demonstrate that the MIP-MOD promoter is active in Brassica papillar cells as well as in some vegetative tissues. The encoded protein is also likely to be plasma membrane-localized based on the observation that all plasma membrane-intrinsic aquaporin-like proteins in Brassica leaves are enriched in plasma membrane fractions. The MIP-MOD protein results in a low but measurable enhancement in osmotic water permeability of Xenopus oocytes and hence represents a functional aquaporin. The results are consistent with the notion that MIP-MOD is involved in the regulation of water transport across the stigma epidermal cell membrane.

Post-transcriptional maturation of the S receptor kinase of Brassica correlates with co-expression of the S-locus glycoprotein in the stigmas of two Brassica strains and in transgenic tobacco plants

The S-locus-encoded S receptor kinase (SRK) is an intrinsic plasma membrane protein that is viewed as the primary stigma determinant of specificity in the self-incompatibility response of Brassica spp. We analyzed two self-compatible mutant strains that express low levels of the S-locus glycoprotein (SLG), a cell wall-localized protein also encoded at the S locus that is coordinately expressed with SRK. We found that mutant stigmas synthesized wild-type levels of SRK transcripts but failed to produce SRK protein at any of the developmental stages analyzed. Furthermore, SRK was shown to form aberrant high-molecular mass aggregates when expressed alone in transgenic tobacco (Nicotiana tabacum) plants. This aggregation was prevented in tobacco plants that co-expressed SRK and SLG, but not in tobacco plants that co-expressed SRK and SLR1, an SLG-related secreted protein not encoded at the S locus. In analyses of protein extracts under reducing and non-reducing conditions, evidence of intermolecular association was obtained only for SLG, a fraction of which formed disulfide-linked oligomers and was membrane associated. The data indicate that, at least in plants carrying the S haplotypes we analyzed, SRK is an inherently unstable protein and that SLG facilitates its accumulation to physiologically relevant levels in Brassica stigmas.

Comparative study of visceral and parietal pleural biopsy in the etiological diagnosis of pleural diseases

OBJECTIVE

The present study was planned to evaluate the efficacy and diagnostic reliability of conoctional parietal pleural biopsy to a technique of visceral pleural biopsy.

METHOD

Study comprises of 54 diagnosed cases of pleural effusion and after establishing the clinical diagnosis for probable etiological causes. Then parietal pleural biopsy using absents punch biopsy needle and vesceral pleural biopsy using Prabhudesai et al technique was taken in all these patients. Size of the tissue yield; percentage of biopsies; diagnostic yield and sensitivity for these two techniques were compared.

RESULTS

A definitive etiological diagnosis could be reached in 52 out of 54 patients on the basis of pleural biopsy (33 tuberculous, 16 malignant and 3 pyogenic), 23 (69.7%) tuberculous effusion patients were diagnosis by visceral pleural biopsy and 14 (42.4%) by parietal pleural biopsy out of 33 diagnosed tuberculous effusion cases. While for the 16 malignant effusions the visceral pleural biopsy showed suggestive histological change in 13 (81.25%) patients and the parietal pleural biopsy in seven (43.8%) with five (31.25%) of these patients being positive by both. All three pyogenic effusions showed only nonspecific inflammatory change in both pleurae.

CONCLUSION

The mean size of biopsy sample obtained with modified Prabhudesai et al technique was significantly larger than that of the parietal pleural biopsy with Abrams punch (4.85 mm2 V/s 2.5 mm2 with P < 0.01). Adequate pleural tissue was identifiable in 94.4% and 90.7% of cases, respectively. The modified Prabhudesai et al technique proved to be effective safe and easily learnt. Visceral pleural sampling using this technique is a definite superior addition to the present diagnostic armamentarium of an idiopathic pleural effusion and its routine application together with parietal pleural biopsy will help to establish a definitive diagnosis in majority of patients with idiopathic pleural effusions.

Sclerosing hemangioma of the lung

An extremely rare case of sclerosing hemangioma lung is described in a patient who presented as right sided pleural effusion with recurrence.

Development of pleural effusion in patients during anti-tuberculous chemotherapy: analysis of twenty-nine cases with review of literature

Twenty-nine cases of tuberculosis developing pleural effusion (PE) during antituberculous chemotherapy (ATT) were analysed for clinical presentation and management outcome. Sixteen (55%) patients had pulmonary tuberculosis alone while rest had associated or isolated extrapulmonary tuberculosis. Thirteen (44.8%) patients developed PE during the 5th-8th week of chemotherapy and nine (31%) during 9th-12th week. Eighteen (62%) patients were on either HRZE or HRE while five (17.2%) were on SHRZ regimen before developing PE. All cases had exudative PE. Pleural fluid centrifuge was smear positive for AFB in two (6.8%) cases and culture positive for Mycobacterium tuberculosis in four (13.7%) cases. Pleural biopsy sections were negative for either AFB or tuberculous histology in 15 out of the 24 biopsies done. Twenty-four (82.7%) patients showed good response on the same ATT without modification. Development of PE during successful ATT seems to be an extension of paradoxical events having an immunological basis, which does not necessarily require any modification in chemotherapy.