Novel radiological technique to recognize acute liver failure caused by yellow phosphorous containing rodenticides

Yellow phosphorous rodenticide (YPR) poisoning is the commonest cause for acute liver failure (ALF) in southern and western India. Due to medicolegal issues, history of YPR ingestion may not be available. As early recognition of YPR poisoning is important and there are no specific biochemical assays, other early predictors to identify this entity is necessary. We evaluated the diagnostic role of plain computed tomography (CT) in identifying YPR-induced ALF. All patients admitted to the liver unit with a diagnosis of ALF underwent a plain CT scan abdomen. Demographic details, clinical history, laboratory parameters, liver attenuation index (LAI) calculated on CT scan, treatment details, need for liver transplantation and clinical outcome were analyzed. Parameters for YPR-induced ALF (ALF-YPR) and other causes (ALF-OTH) were compared. Ability of LAI to distinguish ALF-YPR and ALF-OTH was analyzed using receiver operating characteristic (ROC) curve analysis. Twenty-four patients (15 female [62.5%]) were included in the study. Thirteen patients (54%) had YPR poisoning, while the rest formed the ALF-OTH group (11,46%). ALF-YPR patients had higher transaminase levels, lower peak serum bilirubin levels. ALF-YPR livers had significantly lower LAI as compared to ALF-OTH (- 30 vs. - 8, p = 0.001). On ROC curve analysis, an LAI greater than - 18 ruled out YPR as the cause for ALF with 91% sensitivity and 85% specificity. On regression analysis, LAI was the only independent factor predicting ALF-YPR (odds ratio - 0.86, [0.76, 0.96] p = 0.008). Our data shows that LAI on plain abdominal CT scan can be used to quickly recognize ALF-YPR in unclear cases so that necessary treatment protocol can be activated, or patient transfer arranged. Our analysis shows that an LAI greater than - 18 can reliably rule out YPR ingestion as the cause for ALF.

Descriptive Epidemiology of Gastrointestinal Cancers: Results from National Cancer Registry Programme, India

Purpose:

This study aims to determine the incidence, histology, clinical extent of disease, and trends of gastrointestinal (GI) cancers in India.

Methods:

GI cancer cases diagnosed between 2012-2016 from 28 Population-Based Cancer Registries and 58 Hospital Based Cancer Registries under the National Cancer Registry Programme were included. Crude incidence rate and age-standardized incidence rates (AARs) were calculated. Joinpoint regression program, 4.0.1 was used for trend analysis for data from 1982 to 2016, and a P-value of <<0.05 was considered statistically significant.

Results:

GI cancers’ occurrence was more common among men (60.5%) than in women (39.5%). The incidence of GI cancer was highest in India’s northeast region, Aizawl district (AAR 126.9) among males, and in Papumpare district (AAR 75.9) among females. The commonest cancer among men was cancer of the esophagus (28.2%), followed by stomach cancer (21%) and rectum cancer (14.3%). Among women, cancer of the esophagus (25.7%), gallbladder (23.8%), stomach (14.8%), and rectum (14.6%) were common. Adenocarcinoma (57.83%) was the commonest type of GI tumors, followed by Squamous Cell neoplasms (25.99%). Majority of the GI cancers presented at the locoregional stage, but cancer of the gall bladder and pancreas presented at advanced stages. A rising trend for cancers of the colon, rectum, liver, gall bladder, pancreas was seen, while a declining trend was observed for stomach and oesophageal cancer.

Conclusion:

Our study highlights an increasing magnitude of GI cancers across different regions of India. Cancer registries form an essential tool for surveillance of GI cancers thus guiding prevention, early detection, and control programs.

Delayed Expulsion of biliary cast after hepaticojejunostomy for post-liver transplantation biliary stricture-better cut than canulate?

BACKGROUND

Biliary strictures after living donor liver transplantation (LDLT) are a significant cause of post-transplant morbidity. Endoscopic therapy is usually the first choice of treatment though surgical treatment may provide better biliary drainage.

METHODS

We report a case of LDLT performed in a child for acute liver failure who developed an anastomotic biliary stricture with biliary cast formation. We performed a Roux en Y hepaticojejunostomy to treat the stricture.

RESULTS

Allograft function improved after surgery with no further episodes of cholangitis. Two months after the surgery, the child passed a large biliary cast in the stools. This reiterates the advantage of wide biliary drainage provided through surgical therapy.

CONCLUSIONS

Surgery for biliary strictures following LDLT may provide superior long term biliary drainage- especially when biliary casts are present.

Capacity of the national influenza surveillance system in Afghanistan, a chronic conflict setting

Influenza surveillance is needed to monitor potential public health threats from the emergence of novel influenza viruses. This study assessed the capacity and performance of the national influenza surveillance system in Afghanistan from 2007 to 2014. Data were collected by review of hospital registers and the National Influenza Centre (NIC) database, interviews with influenza focal points at 9 influenza sentinel surveillance sites and the Centre staff, and observation of the sites. Out of 6900 specimens collected, influenza virus was detected in 253 (3.6%), predominantly H1N1 (63%); most of these cases were detected during the 2009 pandemic. The NIC had the capacity for virus isolation and PCR identification and performed reasonably until 2011 when support of the Naval American Medical Research Unit 3 was withdrawn. The limitations identified in the system indicated the need for: more complete data, improved technical competence and trained human resources, updating of the infrastructure/facilities, and the presence of standard operating procedures throughout surveillance.

A model approach to calculate cancer prevalence from 5 years survival data for selected cancer sites in India--part II

OBJECTIVE

Prevalence is a statistic of primary interest in public health. In the absence of good follow-up facilities, it is often difficult to assess the complete prevalence of cancer for a given registry area. An attempt is made to arrive at the complete prevalence including limited duration prevalence with respect of selected sites of cancer for India by fitting appropriate models to 1, 3 and 5 year cancer survival data available for selected registries of India.

METHODOLOGY

Cancer survival data, available for the registries of Bhopal, Chennai, Karunagappally, and Mumbai was pooled to generate survival for the selected cancer sites. With the available data on survival for 1, 3 and 5 years, a model was fitted and the survival curve was extended beyond 5 years (up to 30 years) for each of the selected sites. This helped in generation of survival proportions by single year and thereby survival of cancer cases. With the help of estimated survived cases available year wise and the incidence, the prevalence figures were arrived for selected cancer sites and for selected periods. In our previous paper, we have dealt with the cancer sites of breast, cervix, ovary, lung, stomach and mouth (Takiar and Jayant, 2013).

RESULTS

The prevalence to incidence ratio (PI ratio) was calculated for 30 years duration for all the selected cancer sites using the model approach showing that from the knowledge of incidence and P/I ratio, the prevalence can be calculated. The validity of the approach was shown in our previous paper (Takiar and Jayant, 2013). The P/I ratios for the cancer sites of lip, tongue, oral cavity, hypopharynx, oesophagus, larynx, nhl, colon, prostate, lymphoid leukemia, myeloid leukemia were observed to be 10.26, 4.15, 5.89, 2.81, 1.87, 5.43, 5.48, 5.24, 4.61, 3.42 and 2.65, respectively.

CONCLUSION

Cancer prevalence can be readily estimated with use of survival and incidence data.

What is the Most Suitable Time Period to Assess the Time Trends in Cancer Incidence Rates to Make Valid Predictions--an Empirical Approach

Projections of cancer cases are particularly useful in developing countries to plan and prioritize both diagnostic and treatment facilities. In the prediction of cancer cases for the future period say after 5 years or after 10 years, it is imperative to use the knowledge of past time trends in incidence rates as well as in population at risk. In most of the recently published studies the duration for which the time trend was assessed was more than 10 years while in few studies the duration was between 5-7 years. This raises the question as to what is the optimum time period which should be used for assessment of time trends and projections. Thus, the present paper explores the suitability of different time periods to predict the future rates so that the valid projections of cancer burden can be done for India. The cancer incidence data of selected cancer sites of Bangalore, Bhopal, Chennai, Delhi and Mumbai PBCR for the period of 1991-2009 was utilized. The three time periods were selected namely 1991-2005; 1996-2005, 1999-2005 to assess the time trends and projections. For the five selected sites, each for males and females and for each registry, the time trend was assessed and the linear regression equation was obtained to give prediction for the years 2006, 2007, 2008 and 2009. These predictions were compared with actual incidence data. The time period giving the least error in prediction was adjudged as the best. The result of the current analysis suggested that for projections of cancer cases, the 10 years duration data are most appropriate as compared to 7 year or 15 year incidence data.

Synthesis, antiviral and cytotoxic investigation of 2-phenyl-3-substituted quinazolin-4(3H)-ones

OBJECTIVES

A series of 3(benzylideneamino)-2-phenyl quinazoline-4(3H)-ones was synthesized by reaction of 3-amino-2-phenyl-3H-quinazoline-4-one with various carbonyl compounds.

MATERIALS AND METHODS

Chemical structures of the synthesized compounds were confirmed by IR, 1H-NMR and mass spectral analysis. Title compounds were investigated for cytotoxicity and antiviral activity against herpes simplex virus-1 (KOS), herpes simplex virus-2 (G), vaccinia virus, vesicular stomatitis virus, herpes simplex virus-1 TK-KOS ACVr, para influenza-3 virus, reovirus-1, Sindbis virus, Coxsackie virus B4, Punta Toro virus, feline corona virus (FIPV), feline herpes virus, respiratory syncytial virus, influenza A H1 N1 subtype, influenza A H3N2 subtype, influenza B and vesicular stomatitis virus.

RESULTS AND CONCLUSION

Compound 3d was found inhibit viral replication of para influenza-3virus, reovirus-1, Sindbis virus, Coxsackie virus B4, Punta Toro virus in Vero cell cultures.

Observer experience and Cup:Disc ratio assessment

BACKGROUND

The validity of the Cup:Disc (C:D) ratio as a clinical measure depends on the level of agreement among observers. In this study, we investigated the effect of observer experience on interobserver and intraobserver agreement in C:D ratio estimation.

METHODS

Nine 3rd-year (Yr3) and nine 4th-year (Yr4) optometry students and nine optometrists (Opt), determined C:D ratios from 26 optic disc photographs viewed monoscopically and stereoscopically. Observer agreement was investigated using weighted kappa (Kw) analysis.

RESULTS

Interobserver agreement was higher (p < 0.01) among optometrists than among 4th-year students and higher (p < 0.01) among 4th-year than among 3rd-year students (mean Kw: Opt = 0.61; Yr4 = 0.51; Yr3 = 0.39). Stereoscopic estimates of C:D ratios were higher (p < 0.0001) than monoscopic estimates, and interobserver agreement was higher (p < 0.001) when evaluating the vertical rather than the horizontal C:D ratio. Intraobserver agreement (mean Kw: Opt = 0.67; Yr4 = 0.66; Yr3 = 0.62) did not vary significantly (p = 0.78) with experience.

CONCLUSIONS

The extent to which an observer reproducibly assesses the C:D ratio from optic disc photographs (intraobserver agreement) does not increase with experience. However, the agreement between different observers in assessing the C:D ratio (interobserver agreement) increases with experience.

Pain on intramuscular injection of bupivacaine, ropivacaine, with and without dexamethasone

BACKGROUND AND OBJECTIVES

We wished to determine which long-acting local anesthetic would produce the least pain on injection for treatment of myofascial pain disorders. We compared the pain on intramuscular injection of bupivacaine, ropivacaine, bupivacaine with dexamethasone, ropivacaine with dexamethasone, and needle placement alone.

METHODS

Thirty volunteers received 5 injections each: (1) needle only, (2) bupivacaine 0.5%, (3) ropivacaine 0.5%, (4) bupivacaine 0.5% with dexamethasone 0.13 mg/mL, and (5) ropivacaine 0.5% with dexamethasone 0.13 mg/mL. The injections were made in the volunteers' upper trapezius muscles; there was a 15-minute interval between injections. The sequence of injections was randomized by Latin square design. The intensity of pain was rated on a 0 to 10 cm visual analogue scale (VAS) score. Neither the investigator nor the volunteer was aware of the nature of the injectate. The pH of the injected solutions was checked to determine if differences in the intensity of pain on injection were due to differences in the pH of the solutions.

RESULTS

The VAS pain scores were 3.1 +/- 2.4 for needle only, 4.4 +/- 2.8 for bupivacaine, 2.5 +/- 2.0 for ropivacaine, 4.7 +/- 2.7 for bupivacaine/dexamethasone, and 3.7 +/- 2.2 for ropivacaine/dexamethasone. The pain on injection of ropivacaine was significantly less than the pain on injection of bupivacaine or bupivacaine/dexamethasone. The pH values of the solutions were as follows: (1) bupivacaine, 5.50; (2) ropivacaine, 5.57; (3) bupivacaine/dexamethasone, 6.64; and (4) ropivacaine/dexamethasone, 6.60.

CONCLUSIONS

The pain on intramuscular injection of bupivacaine is significantly more intense than with ropivacaine. The difference in the intensity of the pain on injection between bupivacaine and ropivacaine does not appear to be related to differences in pH. The results of our study have implications on the choice of the local anesthetic used in trigger point injections.

AN EPIDEMIOLOGICAL STUDY OF BLOOD PRESSURE AMONG SCHOOL CHILDREN

Blood pressure was measured in 1170 school children between 5 and 15 years of age. Mean blood pressure was significantly higher in boys than girls in all age groups and a steady increase in blood pressure with age was seen in both the sexes. Mean blood pressure was significantly higher among children with positive family history of cardiovascular morbidity. Children from higher socio-economic strata and overweight children also showed higher blood pressure. Nine (0.77%) children had persistent hypertension. However, the degree of hypertension was mild and all these children were asymptomatic. Baseline investigations failed to detect any underlying pathology or target organ involvement. This study suggests that childhood could be a reasonably profitable time to look for such factors and to selectively screen children belonging to the high risk group for hypertension.

RESURGENCE OF MT MALARIA AMONGST TROOPS SERVING IN THE NORTH EAST

Cases of MT malaria amongst troops serving in the North East are on the increase. Study of the malaria morbidity and mortality data of the past five years covering a population of about 1.65 lakhs revealed that there is a definite resurgence of malaria from an incidence of 0.39 per thousand in 1989 to 0.54 per thousand in 1992. Death due to malaria is a cause for concern especially since most of the troops are on chemoprophylaxis. A more realistic epidemiological approach to malaria control would be required to contain malaria.

Study of leprosy among slum dwellers in Pune. Part II--Disabilities

While conducting a leprosy survey in an urban slum in Pune 45 cases of leprosy were detected in a population of 4915 and only 7 of these cases had some disability. Disability rate in the leprosy cases was 15.56 percent, and maximum number had Grade 2 disability of hands or feet. Disability was higher in the higher age groups, males, Hindus, widower/widows, unemployed and lower socio-economic classes. Majority of the cases had a very low Disability Index DI (2) between 0.10 to 0.69 which is heartening and proves the successful implementation of the National Leprosy Eradication Programme.