Humic acid-nanoceria composite as a sustainable adsorbent for simultaneous removal of uranium(VI), chromium(VI), and fluoride ions from aqueous solutions

In this article, the multifunctional behavior of novel, efficient, and cost-effective humic acid-coated nanoceria (HA@CeO2 NPs) was utilized for the sorptive removal of U(VI), Cr(VI), and F- ions at different conditions. The production cost of HA@CeO2 was $19.28/kg and was well characterized by DLS, FESEM, HRTEM, FTIR, XRD, XPS, and TGA. Batch adsorption study for U(VI) (at pH ~ 8), Cr(VI) (at pH ~ 1), and F- (at pH ~ 2) revealed that the maximum percentage of sorption was > 80% for all the cases. From the contact time experiment, it was concluded that pseudo-second-order kinetics followed, and hence, the process should be a chemisorption. The adsorption study revealed that U(VI) and Cr(VI) followed the Freundlich isotherm, whereas F- followed the Langmuir isotherm. Maximum adsorption capacity for F- was 96 mg g-1. Experiments in real water suggest that adsorption is decreased in Kaljani River water (~ 12% for Cr(VI) and ~ 11% for F-) and Kochbihar Lake water (25.04% for Cr(VI) and 20.5% for F-) because of competing ion effect. Mechanism was well established by the kinetic study as well as XPS analysis. Because of high adsorption efficiency, HA@CeO2 NPs can be used for the removal of other harmful water contaminants to make healthy aquatic life as well as purified drinking water.

Adsorptive Elimination of a Cationic Dye and a Hg (II)-Containing Antiseptic from Simulated Wastewater Using a Metal Organic Framework

Several types of pollutants have acute adverse effects on living bodies, and the effective removal of these pollutants remains a challenge. Safranin O (a biological dye) and merbromin (a topical mercury-containing antiseptic) are considered organic pollutants, and there are only a few reports on their removal. Synthesized and well-characterized (through PXRD, FTIR, FESEM, and EDS analysis) MOF-5 was used for the first time in the removal of safranin O and merbromin from simulated wastewater and real wastewater. In both cases, MOF-5 effectively removed contaminants. We found that in simulated wastewater, the highest efficiency of removal of safranin O was 53.27% (for 15 mg/L) at pH 10, and for merbromin, it was 41.49% (for 25 mg/L) at pH 6. In the case of real wastewater containing natural ions (Na+, K+, F-, Cl-, SO42-, PO43-, Mg2+, and Ca2+) and other molecules, the removal efficiencies of these two dyes decreased (34.00% and 26.28% for safranin O and merbromin, respectively) because of the presence of other ions and molecules. A plausible mechanism for the removal of these pollutants using MOF-5 was proposed.

Bio-functionalized magnetic nanoparticles for cost-effective adsorption of U(vi): experimental and theoretical investigation

U(vi) removal using cost-effective (production cost: $14.03 per kg), biocompatible, and superparamagnetic Cinnamomum tamala (CT) leaf extract-coated magnetite nanoparticles (CT@MNPs or CT@Fe₃O₄ nanoparticles) from water resources was studied. From pH-dependent experiments, the maximum adsorption efficiency was found to be at pH 8. Isotherm and kinetic studies were performed and found to follow Langmuir isotherm and pseudo-second order kinetics, respectively. The maximum adsorption capacity of CT@MNPs was calculated to be 45.5 mg of U(vi) per g of nanoparticles (NPs). Recyclability studies suggest that over 94% sorption was retained even after four consecutive cycles. The sorption mechanism was explained by the point of the zero-charge experiment and the XPS measurement. Additionally, calculations using density functional theory (DFT) were carried out to support the experimental findings.

Current trends in carbon-based quantum dots development from solid wastes and their applications

Urbanization and a massive population boom have immensely increased the solid wastes (SWs) generation and are expected to reach 3.40 billion tons by 2050. In many developed and emerging nations, SWs are prevalent in both major and small cities. As a result, in the current context, the reusability of SWs through various applications has taken on added importance. Carbon-based quantum dots (Cb-QDs) and their many variants are synthesized from SWs in a straightforward and practical method. Cb-QDs are a new type of semiconductor that has attracted the interest of researchers due to their wide range of applications, which include everything from energy storage, chemical sensing, to drug delivery. This review is primarily focused on the conversion of SWs into useful materials, which is an essential aspect of waste management for pollution reduction. In this context, the goal of the current review is to investigate the sustainable synthesis routes of carbon quantum dots (CQDs), graphene quantum dots (GQDs), and graphene oxide quantum dots (GOQDs) from various types SWs. The applications of CQDs, GQDs, and GOQDs in the different areas are also been discussed. Finally, the challenges in implementing the existing synthesis methods and future research directions are highlighted.

Is degradation of dyes even possible without using photocatalysts? - a detailed comparative study

Herein, catalyst-free, eco-friendly, photo-triggered, self-degradation of malachite green (MG) and crystal violet (CV) dyes in comparison to photocatalytic degradation were investigated. To the best of our knowledge, this is the first systematic study to demonstrate the reactive oxygen species (ROS), electron (e^-) and hole (h⁺) generation ability of dyes to initiate self-degradation in the presence of direct solar energy (a free source of UV radiation) and UV light (254 and 365 nm). Various experimental conditions, e.g., different dye concentrations, pH, vessel-materials (borosilicate glass and quartz) were optimized to achieve the optimum degradation outcomes. The degradation kinetics of dyes suggested the applicability of second-order-kinetics to all kinds of applied light sources. Investigation of the thermodynamic approach reveals that the self-degradation procedure was endothermic, with activation energies of 46.89 and 52.96 kJ mol^-1, respectively, for MG and CV. The self-degradation mechanism was further corroborated by the quantum calculations, while the formation of final degraded products for dye-degradations was established on the basis of mass spectroscopy and total organic carbon (TOC) analysis. The computed emission energies for MG and CV advocate that the excitation energy occurs due to the sole-attribution electron excitation from the Highest Occupied Molecular Orbital (HOMO) to the Lowest Unoccupied Molecular Orbital (LUMO). The close energy difference between the hydroxyl anions and the dyes also facilitates the creation of the hydroxyl radical. In a similar manner, the excited electrons from the aforementioned dyes may readily be transferred to triplet molecular oxygen, which makes it possible to generate super oxide. The radical generated in the process facilitates the self-degradation of the dyes.

Bio-modified magnetic nanoparticles with Terminalia arjuna bark extract for the removal of methylene blue and lead (II) from simulated wastewater

This study reports a greener, cheaper and convenient approach to synthesize Terminalia arjuna bark extract coated magnetite nanoparticles (TA@MNPs) using the co-precipitation method and efficient removal of methylene blue (MB) and lead ions [Pb(II)] from simulated wastewater. The synthesized nanoparticles (NPs) were characterized by various techniques such as DLS, XRD, FTIR, HRTEM, AGM, and TGA. From TGA analysis, TA@MNPs was found to be stable even after 500 °C. Using the batch method, maximum removal was achieved at pH 9.0 for MB and pH 3.0 for Pb(II) solutions, respectively. Adsorption study showed that TA@MNPs followed pseudo-second-order kinetics by both adsorbates while isotherm modeling towards adsorption of Pb(II) and MB exhibited Langmuir and Freundlich isotherm respectively. The maximum adsorption capacity for Pb(II) on TA@MNPs was 210.5 mg g^-1. The thermodynamic study proved the spontaneity of the physisorption process. Regeneration studies were also performed using five different eluents for the two adsorbents. Overall, TA@MNPs effectively removed pollutants from wastewater and thus could be potentially useful in providing clean water in a cheaper way.

Blood pressure variability in hypertension patients in Indian clinical settings

Funding Acknowledgements

Type of funding sources: None.

Background

 Blood pressure variability (BPV) is a potential predictor for complications such as coronary artery disease, heart failure, stroke, and all-cause death, independently of mean blood pressure (BP) in patients with hypertension.(1)

Objective

 The survey was carried out to seek the opinion of Indian clinicians on the burden, measurement  and management of BPV in patients with hypertension.

Method

 This PAN-India survey used a structured web-based objective questionnaire that was administered to 200 clinicians via google forms. The responses were analyzed descriptively.

Results

 This study suggests that >80% of the clinicians reported that 10-40% of their hypertensive patients experience BPV while 13% and 6.5% respectively, reported having BPV issues in <10% and >40% of their patients.

A large majority of the clinicians (88.5%) agreed that effective control of BPV in hypertensive patients exerts benefits to prevent complications like target organ damage, cardiovascular disease and mortality.

A combination of home and office BP monitoring was the most recommended approach for the measurement of BPV by 28% of the clinicians, followed by home monitoring (23%) > ambulatory monitoring (22.5%) > combination of ambulatory and office monitoring (21%) > office monitoring (4.5%) of BP. A majority of clinicians opted for angiotensin receptor blocker (ARB) + calcium channel blocker (CCB), ARB + beta blocker (BB) and ARB + diuretic as most preferred antihypertensive combination for effective control of BP and BPV (Figure 1). In particular, the clinicians opined for Telmisartan + Amlodipine (45.5%) > Telmisartan + Chorthalidone (27%) > Telmisartan + Cilnidipine (14%) > Telmisartan + Hydrochlorothiazide (13%) as the preferred antihypertensive combinations.

41% and 30.5% of the clinicians reported that they would shift their patients with high BPV to a dual and a triple combination of antihypertensives, respectively followed by increasing the antihypertensive dose (18%) and shifting to new antihypertensive medication (8.5%).

Conclusion

 The survey underlined the considerable prevalence of BPV in hypertensive individuals and that its control can be beneficial in reducing the risk of future complications. The study also reflects that both home and office BP monitoring are important to identify BPV while ARBs particularly, Telmisartan in combination with CCB or a diuretic is the preferred regimen for effective control of BP and BPV. Abstract Figure 1

Impact of genetic potential for residual feed intake and diet fed during early- to mid-gestation in beef heifers on carcass characteristics and meat quality attributes of their castrated male offspring

Carcass attributes of steers were examined for influences of selection for residual feed intake (RFI), and exposure to different levels of prenatal nutrition. Heifers characterized for RFI corrected for backfat were mated to bulls with genetic potential for either High-RFI or Low-RFI, such that the progeny were expected to be H/H or L/L RFI (sire/dam). Pregnant heifers were assigned to a low diet (Ldiet; 0.40 kg/d ADG), or moderate diet (Mdiet; 0.57 kg/d ADG), from 30 to 150 days of gestation, after which all heifers were managed similarly. Steer offspring (n = 23) were also managed similarly until slaughter. Dressing percentage of steers from H-RFI dams/sires exposed to Ldiet during gestation was lower than all other groups (P = 0.02). Marbling was greater for steers from H-RFI parents, as was fat content of longissimus thoracis et lumborum and triceps brachii (P ≤ 0.02). Results suggest that parental selection for RFI and prenatal maternal diet can influence carcass characteristics of progeny.

Ayurvedic Balarista ameliorate anti-arthritic activity in adjuvant induced arthritic rats by inhibiting pro-inflammatory cytokines and oxidative stress

BACKGROUND AND AIM

Balarista is a fermented ayurvedic liquid preparation recommended as a good therapy for the treatment of rheumatoid arthritis. In the present investigation, the anti-arthritic activity of in-house Balarista formulation and marketed M1, M2, M3 and M4 Balarista formulations at the dose of 2.31 ml/kg were studied on Complete Freund's adjuvant-induced arthritic rat model.

EXPERIMENTAL PROCEDURE

Measurement of paw diameter, arthritic index, arthritic score, and body weight were made to assess the anti-arthritic activity. Alterations in hematological and biochemical parameters were carried out to ascertain the disease progression. The inflammatory mediators (TNF-α, IL-1β, and IL-6) were measured by the ELISA method. The oxidative stress parameters were evaluated in tissues of joint, liver, spleen and kidney. The histological and radiological changes in the ankle joint of rats were also studied.

RESULTS AND CONCLUSION

Administration of in-house and marketed formulations exhibited significant anti-arthritic activity by reducing all the arthritic parameters. The anomalous alterations in hematological and biochemical parameters were remarkably restored. The expression level of serum pro-inflammatory cytokines was significantly suppressed in treated animals. The oxidative stress, indicated by an increase in lipid peroxidation, decreased in antioxidant enzyme i.e. superoxide dismutase and catalase along with non-enzymatic reduced glutathione in tissues, were strongly counteracted by the formulation. Abnormal changes in arthritic ankle joints shown by X-ray and histological examination were significantly protected by the formulation. The present study suggests that the administration of in-house and marketed Balarista formulations have produced a significant anti-arthritic effect by inhibiting free radicals and inflammatory cytokines.

Silver-Based Nanomaterials as Therapeutic Agents Against Coronaviruses: A Review

Since the identification of the first human coronavirus in the 1960s, a total of six coronaviruses that are known to affect humans have been identified: 229E, OC43, severe acute respiratory syndrome coronavirus (SARS-CoV), NL63, HKU1, and Middle East respiratory syndrome coronavirus (MERS-CoV). Presently, the human world is affected by a novel version of the coronavirus family known as SARS-CoV-2, which has an extremely high contagion rate. Although the infection fatality rate (IFR) of this rapidly spreading virus is not high (ranging from 0.00% to 1.54% across 51 different locations), the increasing number of infections and deaths has created a worldwide pandemic situation. To provide therapy to severely infected patients, instant therapeutic support is urgently needed and the repurposing of already approved drugs is presently in progress. In this regard, the development of nanoparticles as effective transporters for therapeutic drugs or as alternative medicines is highly encouraged and currently needed. The size range of the viruses is within 60-140 nm, which is slightly larger than the diameters of nanoparticles, making nanomaterials efficacious tools with antiviral properties. Silver-based nanomaterials (AgNMs) demonstrate antimicrobial and disinfectant effects mostly by generating reactive oxygen species (ROS) and are presently considered as a versatile tool for the treatment of COVID-19 patients. Other metal-based nanoparticles have been primarily reported as delivery agents or surface modifying agents, vaccine adjuvant against coronavirus. The present review summarizes and discusses the possible effectiveness of various surface-modified AgNMs against animal coronaviruses and presents a concept for AgNM-based therapeutic treatment of SARS-CoV-2 in the near future.

Cytohistological correlation in pituitary tumor and immunological assessment with the help of Ki-67

Background:

Tumors of the pituitary gland and sellar region represent approximately 10–15% of all brain tumors. Pituitary adenoma (PA), the most common pathology of the pituitary gland, can be effectively subclassified only with the help of immunohistochemistry (IHC). This is important and needed for individual patient management.

Aims and Objectives:

The objective of the study was to analyze the importance of intraoperative imprint smear cytology and correlating with final histopathological diagnosis. Furthermore, to classify the different types of PA with the help of IHC, prolactin (PRL), adrenocorticotropic hormone (ACTH), and growth hormone (GH) and to predict the benign, atypical, or malignant nature of the tumor with the help of prognostic marker Ki-67.

Materials and Methods:

A prospective study was done in 34 cases. The patients whose pituitary gland samples are referred from the endocrine and the neurosurgery department to the pathology department for histopathological examinations were selected. We have studied the clinical features, radiology and touch imprint cytology, histopathology, and IHC with the help of PRL, ACTH, GH, and Ki-67 of PA over 2 years.

Results:

In our study, we had 32 cases of PA of 34 cases over a span of 2 years. We have seen that there is a correlation between cytological and histological diagnosis of the subtypes of PA in 62% cases, and the Kappa statistics show a moderate extent of agreement (Kappa - 0.320, 95% confidence interval = 0.031–0.609). Ki-67 when compared to the radiological grading showed a high degree of comparability (Chi-square test: P < 0.001). All cases with invasion had a higher Ki-67. On using the Fisher's exact test, we found that the Ki-67 expression with GH-producing adenomas and ACTH-producing adenomas was comparable (P = 1.000) while in PRL-producing adenomas too this was not significant (P = 0.269).

Conclusion:

PA can be effectively classified with the help of IHC. Intraoperative cytology is important in diagnosing PA, but histopathology remains the gold standard in diagnosing and differentiating PA from other pathologies of the pituitary gland. The radiological grading together with immunological classification and the prognostic markers of Ki-67 is important in deciding the benign or atypical nature of the adenomas thus helping in better patient management.

Phrenic Nerve Palsy in Severe Tetanus

Unilateral or bilateral raised hemidiaphragms were observed on chest X-ray in three patients with severe tetanus. Diaphragmatic movement was absent on ultrasonography and fluoroscopy. Nerve conduction study confirmed phrenic nerve palsy. Bilateral involvement caused delayed weaning from the ventilator, whereas unilateral involvement was asymptomatic. There was complete recovery from phrenic nerve palsy in all patients.

Type 2 diabetes and influence of diabetes-specific distress on depression

AIMS

Common psycho-social emotional reactions of patients with diabetes may be termed as diabetes-specific distress which is conceptually distinctive from depression. In patients with type 2 diabetes, different screening methods for depression may get influenced by simultaneous presence of diabetes distress. This study was planned to assess magnitude and relationship of depression and diabetes specific distress in patients with type 2 diabetes.

METHODS

Two hundred and fifty (250) adult patients with type 2 diabetes (T2DM) were assessed for depression based on Beck Depression Inventory (BDI) and Diagnostic and Statistical Manual, Fourth edition (DSM IV) criteria. Diabetes specific distress was assessed as per Diabetes Distress Scale (DDS) score.

RESULTS

Among study population of 250 adult T2DM patients, based on BDI score, 97 (38.8%) patients were found to suffer from depression and based on DSM IV criteria, prevalence of depression was 29.2%. A total of 62 (24.8%) patients were found to suffer from diabetes specific distress based on DDS score. Patients with severe diabetes specific distress had associated matching of symptoms with mild depression based on BDI score which was also statistically significant (p < 0.0001). However, these same individuals were non-depressed as per DSM-IV criteria.

CONCLUSION

Recognizing depression with self-administered questionnaires may be influenced by concomitant presence of symptoms due to diabetes specific distress. Therefore, proper diagnosis of depression may be established by structured clinical interview and psycho-social management of type 2 diabetes should possibly include both assessment of depression and diabetes specific distress.

Hospital referral of detainees during police custody in Amsterdam, The Netherlands

This study describes how many detainees have been referred to emergency departments for further evaluation or emergency care while in police custody in Amsterdam (years 2012/2013). It provides insights into the diagnoses assigned by forensic doctors and hospital specialists and the appropriateness of the referrals. We made use of the electronic registration system of the Forensic Medicine Department of the Public Health Service Amsterdam. This department is in charge of the medical care for detainees in the Amsterdam region. Hospital diagnoses were obtained through collaboration with several Amsterdam-based hospitals. According to our results, in 1.5% of all consultations performed, the detainee was referred to hospital. The most frequent reasons for referral were injuries (66%), intoxication/withdrawal (11%) and cardiac problems (7%). In 18% of all referrals, hospital admission (defined as at least one night in the hospital) was the consequence. After review of hospital files, the indication for referral as stated by the forensic physician was confirmed in 77% of all cases. A minority of referrals was considered unnecessary (7%). The identified cases allow for a discussion of cases of over-referral. Future research should focus on the problem of under-referral and associated health risks.

In situ XPS study of the surface chemistry of MAPI solar cells under operating conditions in vacuum

Organic–inorganic hybrid perovskite solar cells achieved a record efficiency of almost 23% in only a short time span of time.

Incidental Thyroid Carcinoma in Patients Treated Surgically for Presumably Benign Thyroid Disease

Incidental Thyroid Carcinoma (ITC) is quite high as been reported in the world's Journal. This study reviews the frequency of the ITC in patients treated surgically for otherwise benign Thyroid disease in one of the Endocrine surgery unit of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. This study was developed by the investigating the outcome of one hundred and twenty seven patient who underwent partial or total thyroidectomy for benign thyroid pathology in a single Endocrine Surgery Unit of BSMMU from January 2011 to July 2015. This observational study was done to find out the actual incidence of thyroid malignancy among the patients admitted for surgical management with thyroid pathology. All patients underwent at least FNAC and Ultrasonography of the Neck before surgery. Patients with undetermined cytology and follicular nodules were excluded from the study. Overall 19(14.96%) incidental thyroid carcinoma was recorded. Among the ITC 11(8.66%) Papillary Carcinoma, 7(5.51%) Follicular Carcinoma & 1(0.79%) is poorly differentiated carcinoma. The Overall incidence of papillary carcinoma is higher among the incidental carcinoma of Thyroid. Increased incidence associated with follicular adenoma present as an isolated thyroid nodules or multifocal lesion and should be considered malignant potential and total thyroidectomy would be the right choice as surgical management of the both cases. In case of multinodular goiter, total thyroidectomy is currently practiced in majority of the centers and our observations reinforced the attitude further.

[Recognising positional asphyxia: not always the cause of death in victims in an unusual position]

Deceased individuals may be found in a position that raises the question of whether or not the individual died from being in that position. We describe 3 victims of 35, 84 and 54 years of age, respectively. All were found in an unusual position that may have impeded breathing. Breathing may be impaired by compression of the thoracic wall or by extrathoracic airway obstruction caused by the position. Reduced independence, with causes varying from dementia to inebriation, is a risk factor for positional asphyxia. Restraining a person in the so-called "hogtie position" does not lead to positional asphyxia. Positional asphyxiation in individuals dying in the hogtie position must not be confused with excited delirium syndrome (EDS). On the other hand, the diagnosis of positional asphyxia must be seriously considered in deceased individuals found in a position that may impede breathing.

Successful management of a refractory case of postoperative herniorrhaphy pain with extended duration pulsed radiofrequency

Chronic postsurgical pain (CPSP) is a distressful condition following hernia surgery. A 25-year-old, 55 kg male patient presented with severe pain on the right side of the lower abdomen that radiated to the testicle and the inner side of the thigh. Patient was symptomatic since 5 months following inguinal herniorrhaphy surgery. The pain was not relieved with pharmacological and interventional nerve blocks. An ultrasound-guided ilioinguinal-iliohypogastric (II-IH) block with extended duration (42°C, four cycles of 120 s each) pulsed radiofrequency (PRF) and a diagnostic genital branch of genitofemoral nerve (GGFN) block provided pain relief. After 1-month, an extended duration PRF in GGFN resulted in complete resolution of symptoms. During a regular follow-up of 9 months, patient reported an improved quality-of-life. We believe the successful management of CPSP following hernia repair with single extended duration PRF of II-IH and GGFN has not been described in the literature.

Comparison of Effectiveness and Safety of Add-on Therapy of Saroglitazar and Fenofibrate with Metformin in Indian Patients with Diabetic Dyslipidaemia

INTRODUCTION

Diabetic dyslipidaemia poses a therapeutic challenge. New therapies have emerged in this patient subgroup to enhance outcome and improve compliance.

AIM

The aim of this study was to compare the effectiveness and safety of add on therapy of saroglitazar and fenofibrate with metformin in Indian patients with diabetic dyslipidaemia.

MATERIALS AND METHODS

Adults patients with diabetic dyslipidaemia fulfilling the inclusion criteria were randomized in two groups. Group A patients received metformin (1000 mg/ day) and fenofibrate (160 mg/day) while group B patients received metformin (1000 mg/day) and saroglitazar (4 mg/day). Glycosylated haemoglobin (HbA1C), triglyceride (TG), LDL- cholesterol (LDL-C), HDL-cholesterol (HDL-C) levels were measured at baseline and week 12 visits. Fasting plasma glucose (FPG) and post prandial plasma glucose (PPPG) were measured at baseline and on week 4, 8 and 12 visits.

RESULTS

TG and HbA1C levels decreased significantly at week 12 from their respective baseline values (p< 0.05) in both groups. FPG and PPPG levels significantly decreased at weeks 4, 8 and 12 compared to their pretreatment values (p< 0.05) in both groups. TG and HbA1C levels in group B decreased significantly compared to group A at week 12. FPG and PPPG levels in group B also decreased significantly compared to group A at every interval. Inter group analysis did not show any statistically significant change in body weight, LDL-C and HDL-C at week 12.

CONCLUSION

Add on therapy of saroglitazar with metformin significantly decreased TG, HbA1C, FPG and PPPG levels compared to add on therapy of fenofibrate with metformin in Indian patients with diabetic dyslipidaemia.

An observational study of cutaneous manifestations in diabetes mellitus in a tertiary care Hospital of Eastern India

BACKGROUND

Diabetes mellitus and its impact on the human body have been extensively dissected over the years. However, skin which is the largest organ in the body, has received minimum attention. Therefore, this study was designed to analyze the prevalence and pattern of skin disorders among diabetic patients from Eastern region of India.

MATERIALS AND METHODS

This is an observational study, conducted in the General Medicine and Endocrinology departments of a Medical College and Hospital in Eastern India. The data were collected prospectively and systematically in a pre-established proforma designed by us, where clinical findings along with investigations were recorded.

RESULTS

Six hundred and eighty (680) diabetic patients were examined, there were (64.8%) male and (35.1%) were female, of them 95.3% were Type 2 diabetics while 4.7% were Type 1. Five hundred and three patients (503) out of six hundred and eighty. i.e. 73.9% were found to have skin lesions. Thirteen (13) (41%) Type1 diabetics demonstrated skin lesions commonest being diabetic xerosis, infections and diabetic hand. Among Type2 diabetics 490(75.61%) showed skin lesions. Here infections, xerosis, hair loss beneath the knees, diabetic dermopathy were the most frequent. Majority of patients (67%) had combination of more than one type of skin lesion. There was statistically significant correlation of skin lesions with duration of diabetes, however similar correlation could not be demonstrated regarding metabolic control.

CONCLUSION

Involvement of skin is inevitable and multifarious in diabetes mellitus. Higher prevalence is seen in Type 2 diabetic population. The duration of diabetes is positively correlated with lesions and infective dermatologic manifestations were associated with higher HbA1C values.

Unusual presentation of Klinefelter syndrome

INTRODUCTION

Klinefelter syndrome usually presents in the puberty and adulthood with its characteristic features. We report a boy who had Klinefelter syndrome with hypospadias and hydrocele.

CASE NOTE

Six and half year old boy had complaints of genitourinary problem in the form of hypospadias, small phallus and hydrocele. Karyotyping showed 47,XXY.

CONCLUSION

This case illustrates that Klinefelter syndrome was presented in the infancy with hypospadias and hydrocele which are very uncommon presentation of the disease.

An unusual case of episodic quadriparesis

The natural history of untreated asymptomatic primary hyperparathyroidism (PHPT) remains incompletely understood. Increased level of parathyroid hormone produces the characteristic biochemical phenotype of hypercalcemia, hypophosphatemia and the various clinical sequelae of chronic hypercalcemia. Periodic paralysis (PP) is a group of disorders of different etiologies with episodic, short-lived and hyporeflexic skeletal muscle weakness, with or without myotonia, but without sensory deficit and without loss of consciousness. However, PHPT has rare association with episodic quadriparesis mimicking as PP.

Polyion-counterion interactions in sodium carboxymethylcellulose-ethylene glycol-water ternary solutions

Polyion-counterion interactions in sodium carboxymethylcellulose-ethylene glycol-water ternary system have been investigated with special reference to their variations with the polyelectrolyte concentration, the medium relative permittivity and the temperature using electrical conductance measurements. The experimental data have been analyzed on the basis of a model for semidilute polyelectrolyte conductivity which takes into account the scaling arguments proposed by Dobrynin et al. Concentration-dependent moderate counterion condensation (24-33%) was observed. Counterion condensation is found to be spontaneous which depends upon the EG-content of the medium and the temperature. A major proportion of the current is transported by the carboxymethylcellulose polyions. The results further demonstrated that the monomer units experience more frictional resistance in solution as the EG-content increases or as the temperature decreases.

A case of normotensive pheochromocytoma with management dilemma

INTRODUCTION

We report an unusual case of normotensive pheochromocytoma detected incidentally, presenting a pre-operative management problem.

CASE NOTE

A 40-year-old lady with vague abdominal symptoms was initially discovered with a left adrenal incidentaloma by ultrasound abdomen, which was also revealed in computed tomography (CT). After exclusion of all the causes with possible necessary investigations, pheochromocytoma was confirmed with elevated 24 hour urinary metanephrine and normetanephrine. Her blood pressure was in low to normotensive range all throughout. She was attempted to be prepared with combined alpha and beta blockade but could not tolerate this regimen due to symptomatic hypotension. Subsequently, surgical preparation was planned cautiously with alpha-adenergic blockade only. With intensive monitoring, she underwent uneventful left adrenalectomy, and surgical pathology was consistent with pheochromocytoma.

CONCLUSION

This case illustrates an unusual presentation of normotensive pheochromocytoma as adrenal incidentaloma. Pre-operative preparation in these patients can be achieved with alpha-adrenergic blockade, adequate hydration, and liberal salt intake.

Etiology of anemia in primary hypothyroid subjects in a tertiary care center in Eastern India

INTRODUCTION

The association of anemia with primary hypothyroidism has been common knowledge for many years. However; its pathogenesis is far from clear in many cases. Often the causes of anemia are manifold.

AIMS AND OBJECTIVES

In this study, we evaluated the causes of anemia in patients with primary hypothyroidism.

MATERIALS AND METHODS

Sixty adult nonpregnant untreated primary hypothyroid patients with anemia without any obvious cause were included. All patients were subjected to full medical history, clinical examination, biochemical and imaging studies. Serum iron profile, vitamin B12, folic acid, anti parietal cell antibody, anti TPO antibody, bone marrow study, and stool for occult blood, Coomb's test, HPLC for hemoglobinopathies and complete hemogram with reticulocyte count were done and analyzed.

RESULTS

Normocytic, normochromic anemia was present in 31 patients (51.6%) followed by microcytic anemia in 26 patients (43.3%). Six patients (10%) had megaloblastic anemia with vitamin B12 deficiency including 3 cases of pernicious anemia. Two patients had combined deficiency of iron and vitamin B12.

CONCLUSION

Normocytic normochromic anemia with normal bone marrow was commonest type of anemia in this study, followed by iron deficiency anemia.

A study of the incidence and causation of deafness among the children in the tribal population of Manipur and its prevention

In a clinico-audiological study of 6,674 children in 24 tribal villages in the hills of Manipur in a total population of 18,565, the incidence of deafness is found to be 6.62% The incidence of the conductive deafness is 98.64% and that of the sensori-neural is 1.35%. Episodes of cold attacks and running nose are found to be precursurs of the prevalent conductive deafness. Preventive measures are worked out.

Total proctocolectomy with ileal pouch-anal anastomosis by stapling technique

An ileal pouch-anal anastomosis (IPAA) has become the gold standard procedure for ulcerative colitis and familial adenomatous polyposis coli. Construction of an ileal pouch reservoir is now standard, usually in the form of J pouch. The aim of this study was to assess the outcome of ileal pouch-anal anastomosis by stapling technique after total proctocolectomy. This prospective observational study of six patients who underwent proctocolectomy followed by an ileal pouch-anal anastomosis by stapling technique. Whole colon and rectum was mobilized and resected; J pouch created by GIA device and pouch-anal anastomosis done by staplers. All patients were continent. Patients with familial adenomatous polyposis (FAP) and ulcerative colitis showed excellent outcome regarding their disease after proctocolectomy. The ileal pouch-anal anastomosis has become a feasible alternative to the conventional permanent ileostomy after total proctocolectomy. Satisfactory results have been reported, although the procedure is associated with considerable morbidity. Excision of all the affected mucosa is an essential part of the procedure. Our experience with the ileal pouch-anal anastomosis using stapling devices without mucosectomy.

A case of dyskeratosis congenita with primary amenorrhea and adenocarcinoma of stomach

Dyskeratosis congenita (DC) is a rare disease characterized by hyperpigmentation, nail dystrophy and mucous membrane abnormality. Commonly occurring in males, the patients die young usually due to bone marrow suppression. Malignancies of various descriptions have been reported in this disease, the commonest being solid tumors of head/neck (squamous cell carcinoma). We report the case of a female patient with DC, who presented to us with severe wasting and primary amenorrhea and died of carcinoma stomach in our hospital 3 weeks later.

A descriptive study of hyponatremia in a tertiary care hospital of Eastern India

BACKGROUND

Hyponatremia is one of the commonest electrolyte disturbances encountered in medical wards and contributes to substantial morbidity and mortality. However, early recognition and management drastically alters prognosis. Therefore, this observational study was taken up to explore the clinical profile of hyponatremia.

AIM

To assess the incidence and clinical profile of hyponatremia in medically ill patients.

MATERIALS AND METHODS

This observational study was conducted in the medical ward of a tertiary care hospital from March 2010 to April 2011. All patients underwent routine hemogram, blood biochemistry, serum electrolytes, thyroid function tests, and morning serum cortisol estimation. This was followed by a plasma and urinary osmolality determination (osmometer 800 CL) as well as urinary sodium estimation. Patients were diagnosed to have syndrome of inappropriate antidiuretic hormone secretion (SIADH) if they satisfied the Bartter and Schwartz criteria.

RESULTS

201 patients (16.4%) had a serum Na < 135 meq/l. There were 126 (62.69%) male patients and 75 (37.31%) female patients. Severe hyponatremia (Na < 120 meq/l) was detected in 30 patients (2.4%). The largest group of hyponatremic patients were euvolemic [102 (50.74%)], followed by hypervolemic [54 (26.86%)] and hypovolemic [45 (22.4%)]. Sixty-six patients fulfilled the criteria for SIADH. The most common underlying predisposing factor for hyponatremia in our case series was fluid loss by vomiting/diarrhea. During the hospital stay, 13.5% (15/201) hyponatremic patients died, while the corresponding figure in normonatremic patients was 8.5% (87/1020).

CONCLUSION

The incidence of hyponatremia in our series was higher than values mostly reported in western literature. Euvolemic hyponatremia was the most common type, a significant fraction of which is SIADH.