A comparative study of microwave oven-assisted tissue processing and conventional method of tissue processing on turnaround laboratory time and morphological quality of tissue sections

INTRODUCTION

The purpose of tissue processing is to fix the tissue in a solid medium toenable thin sections. Conventional method of tissue processing is the standardized method of tissue processing which has been used for more than 10 decades. However, the conventional method is time-consuming, and the overall turnaround time for the histopathology report is at least two days. The objective of this study is to identify the protocol for tissue processing procedure using domestic microwave oven. To determine the tissue processing time when using domestic microwave oven. To compare the morphological quality of tissue slides made by domestic microwave oven and conventional method using automated tissue processor.

MATRIALS AND METHODS

The conventional protocol and three microwave protocols of tissue processing were used in this study. A pilot study was done prior to the real run to determine the baseline timing for microwave protocol. The baseline timing was fixed at 2 minutes,30 minutes,5 minutes and 25 minutes. The processing time of the microwave protocol was adjusted from 62 minutes to 70 minutes to 77 minutes by increasing the dehydration and wax impregnation time while the time for tissue fixation and clearing remain the same throughout all the microwave protocols.

RESULTS

The group 2 microwave protocol produced the sections that is closely comparable to group 1 conventional protocol. The morphological quality of histopathology slides is best observed when the processing time of microwave protocol is 62 minutes.

CONCLUSION

The most appropriate microwave protocol for tissue processing is group 2 as the morphological quality of histopathology slides are more superior than that of group 1 with an overall percentage of 80% of satisfactory slides in group 2 and 76.68% in group 1.

Acute pulmonary embolism: in hospital outcome from a prospective observational registry (M-PER) from a low-and middle-income country

Background

Acute Pulmonary embolism the third most common cause of cardiovascular death in the world. Despite the large burden of acute pulmonary embolism, there is a paucity of prospective data from low-and middle-income countries.

Purpose

To study the clinical characteristics, treatment strategies employed, in-hospital outcome, one-year follow up results, and the prognostic factors in patients with acute pulmonary embolism from a low-and middle-income country.

Methods

All consecutive patients diagnosed with and treated for acute pulmonary embolism at our institution from November 2016 to November 2021 were included in the registry. Pulmonary embolism was diagnosed using clinical features (Wells' criteria of ≥3) supported by either CT angiogram or echocardiogram. Detailed history, clinical examination, preliminary basic blood investigations, cardiac troponins along with coagulation workup, ECG and ECHO were done for all patients. Patients were classified as having massive or high risk, submassive or intermediate risk and low risk pulmonary embolism based hemodynamic status, sPESI score, echocardiogram and cardiac troponins. Treatment was at the discretion of treating physician. In general, all patients with massive pulmonary embolism were considered for thrombolysis. All patients received anticoagulation with unfractionated heparin. Outcomes included hospital lengths of stay, all-cause in-hospital mortality and one year mortality

Results

186 patients with acute pulmonary embolism were prospectively enrolled during period. 62% were male. Mean age was 42.38±13.4 years. The risk factors noticed include prior history of venous thromboembolism, active malignancy, recent surgery, trauma, immobilisation, diabetes, hypertension, and chronic obstructive pulmonary disease in 18%, 5%, 10%, 8%, 14%, 17%, 10% and 3% of our patients respectively. Shortness of breath (98%), chest pain (37%), leg swelling (37%), cough (33%), shock (27%), syncope (15%) and haemoptysis (12%) were the reasons for presentation. Sinus tachycardia was the commonest finding (80%).

Right ventricular (RV) strain pattern was present in 68%, S1Q3T3 pattern in 56% and RBBB in 32%. RV dilatation was present in 93% and RV dysfunction in 75%. Thrombus was visualised in the pulmonary artery in 37% and right heart chambers in 12% (714). 26% were classified as high risk, 60% as intermediate risk and 13.4% as low risk acute pulmonary embolism. Overall 50% (92% of high-risk and 41% of intermediate risk) patients received fibrinolytic therapy.

In hospital mortality was 16% (29 patients) of which 72% were from high-risk group. In the high-risk group those who were fibrinolysed had a lower mortality compared to those not lysed. (75% vs 40%). This difference was not observed in the intermediate risk group.

Conclusion

Acute pulmonary embolism is a disease with high in-hospital mortality. Fibrinolytic therapy with streptokinase has a lifesaving potential in high risk patients.

Funding Acknowledgement

Type of funding sources: None.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Outcome of subsequent pregnancy after peripartum cardiomyopathy from a low middle income country- a prospective single center study

Background

Heart failure is the most common complication of women wiht heart disease going through pregnancy. Peripartum cardiomyopathy (PPCMP) is the most common cause of heart failure in pregnancy. PPCMP presents towards the end of pregnancy or in the early months following delivery and has devastating medical, mental and socio-cultural consequences. PPCMP patients may land up with a subsequent pregnancy (SSP) due to cultural and social pressures. Early detection and management with multi-disciplinary approach is crucial.

Purpose

Analysis of clinical course, maternal and fetal outcomes in women with SSP after PPCMP in the index pregnancy (IP).

Methods

Women diagnosed with PPCMP between 2016 to 2019 in a tertiary referral centre in a low and middle income country, who had at least one SSP were included in this prospective analysis. Patients were followed up throughout the pregnancy and for two years after the SSP. Clinical presentation, medication use, echocardiographic data, breast feeding, contraception use, counselling given, maternal and fetal outcome of pregnancy were analyzed.

Results

Fifty-two patients were diagnosed to have PPCMP in our institution from 2016 to 2019. Seven patients had eight singleton SSPS. The mean age of these patients was 25.8±4.2 years.

Index pregnancy details: Five patients had required inotropic support during the IP with two of them requiring ventilatory support. Other two had mild heart failure. Eight index pregnancies resulted in five live births, one neonatal birth, one still birth and one medical termination of pregnancy (MTP). All five women with live births breast fed their children after the IP. Contraception by IUCD was used in four patients. Two women did not accept any means of contraception. All patients had underwent appropriate multidisciplinary counselling about risks of SSP. All except one patient had recovered LV function with LVEF ≥55% within one year of IP. Three patients had stopped anti failure therapy on their own before SSP. The mean duration of anti-failure therapy was 13±5 months.

Subsequent pregnancy details: (Fig. 1) One patient with non-recovered LV function developed HF during the SSP and underwent MTP at 20 weeks. She continues to have LV dysfunction and NYHA III heart failure. Six patients who had recovered LV function, did not suffer any recurrence, one of whom is still in the 34th week of gestation. One of these patients had two SSPs. The first SSP was uneventful without recurrence. She is in the 34th week of her second SSP and is uneventful so far.

Neonatal outcome of the SSPs was good with five live births and one MTP in the 6 completed SSPs.

Conclusion

Baseline LVEF after IP is an important predictor of maternal & fetal outcome outcome. With detailed cardiac evaluation including stress echocardiogram, multidisciplinary counseling and close supervision patients with previous PPCMP patient can be allowed for an SSP with reasonable safety.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Flowchart of SSP outcome in PPCMP

South Indian zebu dwarf cattle show higher natural resistance to tick infestation compared to crossbreds: preliminary observations

The present study aimed to evaluate the influence of various factors on the host resistance of cattle against tick infestation in Kerala State, South India. The number of naturally infested semi-engorged female ticks present on the cattle was counted on a sample cattle population across the four regions of Kerala. Then, the animals were grouped based on the tick count. The chi-square test and Fisher exact test were used to identify the effects of genetic and non-genetic factors on tick burden in cattle. It was found that the Holstein Friesian crossbred and Jersey crossbred cattle had a significantly higher level of tick infestation than the indigenous Vechur breed (Bos indicus). No tick infestation was observed in indigenous Kasaragod Dwarf cattle (B. indicus). Tick infestation was more in heifers and dry animals than lactating animals. However, the sex of the animal and the stage of lactation did not influence the tick load. Tick infestation was also influenced by parity, grazing, and region.

Instillation of bradykinin into femoral artery elicits cardiorespiratory reflexes involving perivascular afferents in anesthetized rats

The physiology of baroreceptors and chemoreceptors present in large blood vessels of the heart is well known in the regulation of cardiorespiratory functions. Since large blood vessels and peripheral blood vessels are of the same mesodermal origin, therefore, involvement of the latter in the regulation of cardiorespiratory system is expected. The role of perivascular nerves in mediating cardiorespiratory alterations produced after intra-arterial injection of a nociceptive agent (bradykinin) was examined in urethane-anesthetized male rats. Respiratory frequency, blood pressure, and heart rate were recorded for 30 min after the retrograde injection of bradykinin/saline into the femoral artery. In addition, paw edema was determined and water content was expressed as percentage of wet weight. Injection of bradykinin produced immediate tachypneic, hypotensive and bradycardiac responses of shorter latency (5-8 s) favoring the neural mechanisms involved in it. Injection of equi-volume of saline did not produce any responses and served as time-matched control. Paw edema was observed in the ipsilateral hind limb. Pretreatment with diclofenac sodium significantly attenuated the bradykinin-induced responses and also blocked the paw edema. Ipsilateral femoral and sciatic nerve sectioning attenuated bradykinin-induced responses significantly, indicating the origin of responses from the local vascular bed. Administration of bradykinin in the segment of an artery produced reflex cardiorespiratory changes by stimulating the perivascular nociceptors involving prostaglandins. This is a novel study exhibiting the role of peripheral blood vessels in the regulation of the cardiorespiratory system.

Significant cardiac disease complicating Graves' disease in previously healthy young adults

SUMMARY

Graves' disease is associated with tachydysrythmia, cardiac ischaemia and cardiomyopathy - all uncommon in young adults without previous cardiac disease. We present three young individuals who developed cardiac complications after periods of uncontrolled Graves' disease. Subject 1: A 34-year-old female had severe thyrotoxic symptoms for weeks. Investigations showed fT4: 98.4 (11-25 pmol/L), fT3: 46.9 (3.1-6.8 pmol/L), TSH <0.01 (0.27-4.2 mU/L) and thyrotrophin receptor antibody (TRAb): 34.8 (<0.9 U//l). She had appropriate treatment but several weeks later she became breathless despite improving thyroid function. Echocardiography showed a pericardial effusion of 2.9 cm. She responded well to steroids and NSAIDs but developed active severe Graves' orbitopathy after early total thyroidectomy. Subject 2: A 28-year-old male developed thyrotoxic symptoms (fT4: 38 pmol/L, fT3: 13.9 pmol/L, TSH <0.01 (for over 6 months) and TRAb: 9.3 U/L). One month after starting carbimazole, he developed acute heart failure (HF) due to severe dilated cardiomyopathy - EF 10-15%. He partially recovered after treatment - EF 28% and had early radioiodine treatment. Subject 3: A 42-year-old woman who had been thyrotoxic for several months (fT4: 54.3; fT3 >46.1; TSH <0.01; TRAb: 4.5) developed atrial fibrillation (AF) and heart failure. Echocardiography showed cardiomegaly - EF 29%. She maintains sinus rhythm following early total thyroidectomy (EF 50%). Significant cardiac complications may occur in previously fit young adults, who have had uncontrolled Graves' disease for weeks to months. Cardiac function recovers in the majority, but early definitive treatment should be discussed to avoid Graves' disease relapse and further cardiac decompensation.

LEARNING POINTS

Cardiac complications of Graves' disease are uncommon in young adults without previous cardiac disease. These complications may however occur if Graves' disease had been poorly controlled for several weeks or months prior to presentation. Persistent symptoms after adequate control should alert clinicians to the possibility of cardiac disease. Specific treatment of Graves' disease and appropriate cardiac intervention results in complete recovery in the majority and carries a good prognosis. Early definitive treatment should be offered to them to prevent cardiac decompensation at times of further relapse.

Effect of Oxygen Vacancy on Structural, Optical and Magnetic Behavior of Tin Oxide Nanoparticles

Nanocrystalline SnO2powder has been successfully synthesized by using tin(II) chloride dihydrate (SnCl[Formula: see text]H2O), distilled water and liquid ammonia by the simple chemical co-precipitation method at room temperature using different SnCl[Formula: see text]H2O molar concentration of 0.3[Formula: see text]M, 0.4[Formula: see text]M and 0.5[Formula: see text]M. The structural properties of the prepared SnO2and transition metal doped SnO2nanoparticles has been studied using X-ray diffraction method and scanning electron microscope. The composition of the powders has been analyzed using energy dispersive X-ray analysis. The XRD pattern of the SnO2nanoparticles indicates the formation of single-phase rutile tetragonal structure. The grain size is found to be in the range of 3–7[Formula: see text]nm and is found to increase with increasing SnCl2molar concentration. The absorption spectra revealed that the bandgap decreased from 3.74[Formula: see text]eV to 3.59[Formula: see text]eV with increasing SnCl2molar concentration. The photoluminescence spectra of SnO2nanoparticles showed a visible broad luminescence band in the region of 385–430[Formula: see text]nm. The magnetic studies have been carried out using the hysteresis loop obtained from a vibrating sample magnetometer. The SnO2samples using 0.3 and 0.4 SnCl2molar concentration exhibited ferromagnetic behavior whereas the SnO2sample prepared using 0.5[Formula: see text]M SnCl[Formula: see text]H2O exhibited paramagnetic nature.

Head to head comparison of adverse effects and efficacy between high dose deflazacort and high dose prednisolone in systemic lupus erythematosus: a prospective cohort study

BACKGROUND

Deflazacort (DFZ), an oxazoline derivative of prednisolone (PDN), has a dose equivalence of 1.2:1 (mg) to PDN. No study to date has compared adverse effects and efficacy of high doses of DFZ as against high-dose PDN in systemic lupus erythematosus (SLE).

OBJECTIVES

To compare adverse effects of high dose DFZ and PDN in SLE patients, especially in terms of cushingoid features and gain in body weight, 3 and 6 months after initiation of these agents.

METHODS

In both the steroid arms, the following outcome parameters were assessed at 3 and 6 months: (a) cushingoid features by Cushing's Severity Index (CSI) (b) hirsutism by modified Ferriman Gallwey score (c) weight gain by difference (Δ, delta) of weight (in kilograms).

RESULTS

Patients on PDN had 1.6 kg (3.2%) and 2 kg (5.1%) higher median weight gain as compared to those on DFZ at 3 and 6 months respectively ( p = 0.012 and 0.001). PDN caused 10% and 22.2% higher increment in median hirsutism scores as compared to DFZ at 3 months and 6 months follow-up, respectively ( p = 0.004 and 0.002). PDN caused 100% higher increase in median CSI scores than DFZ at 6 months ( p = 0.03). There was no significant difference by generalized estimation equation between the groups with respect to changes in SLEDAI, renal SLEDAI, anti-dsDNA titres and C3/C4 levels. There were two serious infections (requiring hospitalization/intravenous antibiotics) in the PDN group, while none in the DFZ group.

CONCLUSION

Comparable intake and tapering of high dose DFZ and PDN in active SLE revealed 2-fold less weight gain, 2.5-fold less hirsutism and 1.5-fold lower cushingoid severity index as well as lower glycaemic elevation in the DFZ group as compared to PDN group. Both had similar efficacy.

Dirofilaria repens in scrotum of dogs

Out of 150 apparently healthy male dogs from Kerala, India examined, five revealed single worm in the scrotum. They were found protruding out from beneath the tunica vaginalis when it was incised during the castration operation. Genomic DNA isolated from these worms amplified D. repens specific 246 bp PCR products (KP050552, KP050553). Thickened and enlarged epididymis along with interductal fibrosis, congestion of veins and widening of the cavernous spaces of testes and epididymis were observed in the worm infected dogs. Semeniferous tubules were intact and showed various developmental stages of sperms. The infection resulted in less impact on spermatogenesis.The present communication forms the first report from India on the presence of D. repens in the peritoneal location, which is frequently observed in the subcutaneous locations.

Histoarchitecture of ovary of Haemaphysalis bispinosa during engorgement period

The ovary of Haemaphysalis bispinosa was of panoistic type with asynchronous development of oocytes. The wall of the ovary was composed of a layer of epithelial cells to which the oocytes were attached by means of pedicel cells with elongated nucleus. The oocytes were classified into stages I to V based on morphologic characteristics like size and shape, presence / absence of germ vesicle, cytoplasmic appearance, presence or absence of yolk granules and presence of chorion. Day wise changes were in the form of occurrence of oogonia from partially fed upto day zero of engorgement, presence of all stages of oocytes on day one and two after engorgement and onset of degenerative changes in oocytes from day three onwards. Degeneration was complete on day eight with the appearance of polymorphism, vacuolation, cytoplasmic blebbing and autophagic activity in oocytes.

The exaggerated inflammatory response in Behçet's syndrome: identification of dysfunctional post-transcriptional regulation of the IFN-γ/CXCL10 IP-10 pathway

The mechanisms underlying the exaggerated inflammatory response in Behçet's syndrome (BS) remain poorly understood. We investigated the response of CD14(+) blood monocytes to interferon (IFN)-γ, focusing on the chemokine CXCL10. Chemokine synthesis and release were analysed at a protein and mRNA level following stimulation with IFN-γ. Findings in BS patients were compared with 25 healthy controls (HC), 15 rheumatoid arthritis (RA) and 15 systemic lupus erythematosus (SLE) disease control patients. BS monocytes produced significantly more CXCL10 protein than HC monocytes from 2 h following IFN-γ stimulation, despite equivalent quantities of mRNA, suggesting more efficient translation. This was significantly more pronounced in BS with high disease activity and in those with ocular and neurological clinical manifestations. The imbalance between CXCL10 protein and mRNA expression was not observed in either RA or SLE patients, and was not seen with other chemokines studied (CXCL9, CXCL11 and CCL2). Furthermore, BS monocytes treated with an alternative stimulant (LPS) did not show abnormal tumour necrosis factor (TNF)-α release. Sucrose density gradients to segregate monocyte CXCL10 mRNA into free RNA or polysome-associated RNA showed equal proportions in BS and HC samples, suggesting that the difference between BS and HC may be due to reduced negative control of CXCL10 translation in BS at a post-initiation level. We conclude that BS monocytes have dysfunctional post-transcriptional regulation of CXCL10 mRNA, resulting in over-expression of CXCL10 protein upon IFN-γ stimulation. As CXCL10 is a chemokine that recruits mononuclear cells, this abnormality may contribute to the exaggerated inflammatory responses that characterizes BS.

Acaricidal effects of fenvalerate and cypermethrin against Rhipicephalus (Boophilus) annulatus

The acaricidal effects of two most commonly used acaricides viz., fenvalerate and cypermethrin against Rhipicephalus (Boophilus) annulatus were studied using Adult Immersion Test (AIT). The LC50 values observed for fenvalerate and cypermethrin were 1570 ppm and 184 ppm respectively. The death of ticks was not an immediate process. Fenvalerate caused death only after 7 days while cypermethrin after 5 days of treatment. The eggs laid by treated ticks did not hatch at all concentrations tested.

Coronary artery disease in patients undergoing cardiac surgery for non-coronary lesions in a tertiary care centre

Background

The objective of the present study was to determine the prevalence of coronary artery disease (CAD) in patients undergoing surgery for various valvular as well as non-valvular cardiac pathologies.

Methods

Patients with various valvular and non-valvular pathologies were selected. All patients with age ≥40 years and an indication for open heart surgery underwent pre-operative coronary angiogram and were included in the study.

Results

The mean age was 51.5 ± 9.02 years. 178 (59.3%) patients were males and 122 (40.7%) patients were females. Out of 300 patients, 270 (90%) patients had valvular heart disease (VHD) and 30 (10%) patients had non-valvular heart disease. Rheumatic heart disease (RHD), mitral valve prolapse (MVP), degenerative aortic valve disease (DAVD) and bicuspid aortic valve (BAV) was present in 161 (53.7%), 17 (5.7%), 60 (20%) and 32 (10.7%) patients respectively. Overall, 26 (8.7%) patients were found to have significant CAD. CAD was significantly more common in patients with VHD as compared to patients with other etiologies (1 patient, 3.3%, p < 0.05). In the valvular group, DAVD patients had maximum prevalence of CAD (14 patients, 23.4%, p < 0.05). In the group with CAD, the presence of variables such as age >60 years, male sex, typical angina, HT, dyslipidemia and smoking were significantly greater as compared to those with normal coronaries.

Conclusion

The overall prevalence of CAD among patients undergoing non-coronary cardiac surgery is 8.7%. Coronary artery disease is relatively uncommon in patients with rheumatic VHD (4.9%), while its prevalence is highest in DAVD (23.4%).

Seroprevalence of bluetongue among domestic ruminants in Northern Kerala, India

The objective of the present study is to assess the seroprevalence of bluetongue (BT) among domestic ruminants of Northern Kerala. Sera samples from cattle (82), goat (40) and sheep (50) collected from districts of Wayanad, Kozhikode and Palakkad respectively were tested using competitive enzyme linked immune-sorbent assay (cELISA). Out of the 172 samples tested, the overall BT seroprevalence was 9.3%. There is an increase in prevalence from previous reports which may indicate possible outbreaks in future.

Acaricidal activity of alkaloid fractions of Leucas indica Spreng against Rhipicephalus (Boophilus) annulatus tick

The acaricidal activity from alkaloid and non-alkaloid fractions of Leucas indica were studied against Rhipicephalus (Boophilus) annulatus tick using adult immersion test under laboratory conditions. For this purpose, the engorged female R.(B.) annulatus tick were exposed to two fold serial dilutions of alkaloid extract (50 mg/ml, 25 mg/ml, 12.5 mg/ml, 6 mg/ml and 3 mg/ml) using 'dipping method' in vitro. The efficacy was assessed by measuring the percentage of adult mortality, inhibition of fecundity and hatching rate. The alkaloid fraction of the extract produced concentration dependent delayed adult tick mortality. The extract at a concentration of 50 mg/ml demonstrated 66.67 per cent mortality and 55.16 per cent inhibition of fecundity. Nicotine was identified as one of the compounds of alkaloid fraction. However, it did not reveal any acaricidal activity when tested in vitro at concentrations ranging from 62.5-1000 μg/mL. Hence, the acaricidal action of L. indica is not due to nicotine. Non alkaloid fraction also did not reveal any acaricidal effects against R. (B.) annulatus tick.

Phylogenetic analysis of bovine Theileria spp. isolated in south India

The objective of the present study is to determine the phylogenetic position of the Theileria organisms in blood of cattle of southern India using molecular tools. Theileria annulata (Namakkal isolate, Tamil Nadu) and three Theileria field isolates (free of T. annulata) from Wayanad, Kerala (Wayanad 1, 2, 3) were used. The small subunit ribosomal RNA (SSU rRNA) and major piroplasm surface protein (MPSP) gene products were cloned, sequenced and the phylogenetic tree constructed. SSU rRNA gene of Wayanad 1 isolate (JQ706077) revealed maximum identity with Theileria velifera or Theileria cervi. The phylogenetic tree constructed based on SSU rRNA genes revealed that Wayanad 1 isolate belonged to a new type which share common ancestor with all the other theilerial species while Wayanad 2 and 3 isolates (JX294459, JX294460) were close to types A and C respectively. Based on MPSP gene sequences, Wayanad 2 and 3 (JQ706078, JX648208) isolates belonged to Type 1 and 3 (Chitose) respectively. When, the previously reported MPSP type 7 is also considered from the same study area, Theileria orientalis types 1, 3 and 7 are observed in south India. SSU rRNA sequence of South Indian T. annulata (JX294461) showed a maximum identity with Asian isolates while the Tams1 merozoite surface antigen (MSA) gene (JX648210) showed maximum identity with north Indian isolate.

Acaricidal effect of Cassia fistula Linn. leaf ethanolic extract against Rhipicephlaus (Boophilus) annulatus

The present study evaluates the acaricidal properties of crude ethanolic extract of Cassia fistula leaves for controlling Rhipicephalus (Boophilus) annulatus based on adult immersion test (AIT). The percentage of adult mortality, inhibition of fecundity and hatching of ova laid were studied at different concentrations of the extract ranging from 50 to 100 mg / ml. The results were compared using one-way ANOVA. The extract produced complete inhibition of hatching of eggs at concentrations above 80 mg / ml of the extract. Mortality of adult engorged female ticks and inhibition of fecundity were concentration dependent. The LC50 value of extract against R. (B.) annulatus was 97.1 mg / ml.

Bovine carriers of Anaplasma marginale and Anaplasma bovis in South India

Carriers of bovine anaplasmosis in Northern Kerala, South India were detected using conventional microscopical and molecular techniques. PCR-RFLP and nested PCR techniques were used for detection of Anaplasma marginale and Anaplasma bovis respectively and the PCR products were confirmed by sequencing. Out of 150 samples tested, 25 were detected positive for A. marginale and five for A. bovis based on molecular tests. The inclusion bodies of A. marginale could be detected by microscopy in two blood smears after staining by giemsa while acridine orange staining detected three smears positive. The data clearly suggest the higher sensitivity of molecular techniques for diagnosis of these diseases.

In vitro evaluation of acaricidal activity of fipronil against Haemaphysalis bispinosa based on adult immersion test

Fipronil is a phenylpyrazole family insecticide which mainly affects the nervous system of insects. In the present study, the in vitro acaricidal effects of the compound against the widely prevalent multihost tick, Haemaphysalis bispinosa was assessed. The lowest concentration at which complete adult tick mortality was observed was at 25 ppm while complete absence of egg mass observed at 10 ppm. Hundred per cent inhibition of fecundity was observed at 1 ppm while complete blocking of hatching of the laid ova was observed even at 500 ppb.

Effects of solvents and surfactants against Haemaphysalis bispinosa

As per the report published by FAO (2004), the tick population in India has developed resistance against all the available acaricides. Hence, newer methods of control including potential herbal agents are required to reduce the problems caused by the ticks. Most of the herbal extracts or their fractions are dissolved in polar or non-polar solvents or detergents before tested for acaricidal activity and these diluents should be of little acaricidal activity. In the present study, adult immersion test (AIT) was carried out on adult engorged female Haemaphysalis bispinosa ticks to detect the acaricidal activity of different solvents viz., nbutanol, glycerol, acetone, ethanol, methanol and surfactants (at 1 per cent dilution) like dimethyl sulphoxide (DMSO), tween 20 and triton X- 100. The study revealed that methanol was the least toxic solvent while tween 20 (1 per cent) was the least toxic detergent against H. bispinosa.

Haemoprotozoa of cattle in Northern Kerala, India

A cross-sectional study was conducted using 150 blood samples collected from apparently normal / healthy crossbred cattle of Northern Kerala, South India, for detection of haemoprotozoan infections using staining techniques (Giemsa and Acridine Orange) and specific PCR. Theileria like piroplasms and Babesia bigemina were the only protozoan organisms detected in blood smears. Polymerase chain reaction using specific primers revealed amplification of products specific for Trypanosoma evansi (34.6%), Theileria sp. other than T. annulata (16%) and B. bigemina (0.6%). The higher prevalence rate of Trypanosoma evansi indicated that the subclinical parasitism can be due to higher prevalence of tabanid flies. The study also revealed the presence of a theilerial piroplasm other than T. annulata in North Kerala, which needs further investigation.

Prevalence of Linguatula serrata in domestic ruminants in South India

Linguatula serrata Frohlich, 1789 is an aberrant endoparasite of occasional zoonotic importance in humans. We report the prevalence of encapsulated nymphal stages of L. serrata in domestic ruminants surveyed in Wayanad, located in Kerala State, South India. Large and small intestine mesentery were examined from 100 goats, cattle and buffaloes each revealing an infection prevalence of 21, 19, and 8%, respectively. The prevalence of L. serrata infection among ruminants is higher than previous reports from India and indicates a strong focus of infection in herbivorous domesticated mammals of South India. The potential importance of these findings to human health is discussed.

Visceral schistosomiasis among domestic ruminants slaughtered in Wayanad, South India

This short communication reports the prevalence of visceral schistosomiasis by worm counts from the mesentery of domestic ruminants of the hilly district of Wayanad, located in Kerala, one of the states in South India. We found 57.3, 50, and 4.7% of cattle, buffaloes and goats, respectively, had visceral schistosomiasis upon slaughter at a municipal slaughter house in Kalpetta. Our findings show that the prevalence of Schistosoma spindale infection is very high in Wayanad in comparison to previous reports from this and neighboring countries.

Bile duct brushings cytology ? improving sensitivity of diagnosis using the ThinPrep�technique: a review of 113 cases

OBJECTIVE

Common bile duct (CBD) brushings have been recognized as a technique of moderate sensitivity and high specificity in identifying carcinoma of the ampulla and pancreatico-biliary regions. This study evaluated the increase in sensitivity of this technique using the ThinPrep technique of specimen preparation when compared with conventional cytology smears.

METHODS

A total of 113 bile duct brushings were included in the study (38 conventional smears and 75 slides prepared using the ThinPrep technique). All slides were reviewed by one cytologist. Five categories of reporting were used: inadequate, negative, atypia, suspicious and malignant.

RESULTS

The inadequate category of reporting disappeared in the ThinPrep group with improved specimen fixation and preparation and hence reduced artefact. Sensitivity of diagnosis of malignancy increased from 39% in conventional smears to 53% in the ThinPrep group. Specificity, positive and negative predictive values and accuracy were 100%, 100%, 60% and 68% for conventional smears and were 100%, 100%, 60% and 72%, respectively, for ThinPrep specimens.

CONCLUSIONS

ThinPrep technique was associated with increased sensitivity of diagnosis, in part due to improved specimen fixation and reduced artefact. Cytology of bile duct brushings is an important diagnostic tool for sites from which it can be difficult to obtain a histology biopsy. It may therefore provide the only opportunity for tissue diagnosis of carcinoma from these sites, hence the importance of optimizing sensitivity.

An unreported complication of acute pancreatitis

Acute pancreatitis constitutes 3% of all admissions with abdominal pain. There are reports of osteal fat necrosis leading to periosteal reactions and osteolytic lesions following severe pancreatitis, particularly in long bones. A 54-year-old man was admitted to our hospital with acute pancretitis, who later developed spinal discitis secondary to necrotizing pancreatitis. He was treated conservatively with antibiotics and after a month he recovered completely without any neurological deficit. This case is reported for its unusual and unreported spinal complications after acute pancreatitis.

Slide Enzyme-Linked Immunosorbent Assay for the Diagnosis of Babesia bigemina Infection in Bovines

A slide enzyme-linked immunosorbent assay (SELISA) for the diagnosis of Babesia bigemina infection in cattle was standardized. Acetone-fixed whole Babesia bigemina-infected erythrocytes on micro-slides were immunoreacted with bovine serum samples followed by antibovine horseradish peroxidase conjugate and developed using diaminobenzidine tetrahydrochloride as a substrate. The positive immunoreactivity (staining pattern) was visualized in the form of dark brown piroplasms. Using the laboratory-standardized SELISA with a sensitivity of 94.4%, the seroprevalence of babesiosis was studied in cattle from two endemic areas of the disease. In comparison to IFAT, SELISA detected higher number of serum samples positive for bovine babesiosis.

Serotonin turnover in different duration of sleep recovery in discrete regions of young rat brain after 24 h REM sleep deprivation

Sleep plays an important role in restorative function and serotonin (5-hydroxytryptamine: 5HT) equally plays important roles in sleep. Though various studies have revealed the roles of 5HT in sleep/wake cycle, the mechanism involved is yet unclear. In the present study we investigated alteration of the 5HT turnover in various regions of the young rat brains after 24 hours (h) REM sleep (sREM) deprivation to elucidate the roles of 5HT in sleep restoration function in the these regions. The 5HT turnover was evaluated by the ratio of 5-hydroxyindole acetic acid against 5HT. The sREM deprivation was performed by the inverted flowerpot technique. The 5HT turnover showed significant alteration in the all regions of the brain examined after 24h sREM deprivation, particular depending on the brain region. These results revealed that sREM modulates the 5HT turnover in the brain with region specificity and this may be one of the restorative functions of sleep indicating that sREM is regionally generated.

Plumbago zeylanica action on blood coagulation profile with and without blood volume reduction

Plumbago zeylanica (PZ) is extensively used in Indian systems of medicine for its medicinal properties. The structure of its active principle is similar to that of vitamin K. Its effect on blood coagulation profile after chronic administration has not been reported so far. The PZ extract (2 mg/kg body weight) and napthoquinone (2 mg/kg body weight) given to individual groups were screened for its effect on bleeding time (BT), clotting time (CT), prothrombin time (PT), platelet count and platelet adhesion in albino rats after 1-day, 15-day and 31-day treatment. There was no change in the platelet count in the treated groups when compared to the control levels. But the platelet adhesion was significantly decreased after PZ and also napthaquinone-treated animals in both with and without blood volume reduction after 15th as well as 31st day. Since the napthoquinone-treated group also showed similar response the changes observed after PZ treatment may be due to this component. Even at a lower dosage level (2 mg/kg body weight), the chronic PZ administration prolongs the bleeding time by altering platelet adhesiveness and the coagulation.

Serotonin turnover in discrete regions of young rat brain after 24 h REM sleep deprivation

The present study has attempted to elucidate the alteration of serotonin turnover after 24 h REM sleep deprivation in different regions in brain of young rat. Sleep deprivation was induced by the inverted flower pot technique. Results of this study show increased serotonin turnover after 24 h REM sleep deprivation in all the brain regions except in the hypothalamus. The decreased 5-HT ratio shows increased serotonin in the hypothalamus after 24 h sleep deprivation. This study indicates increased activity of serotonergic neurons in the hypothalamus after 24 h sleep deprivation. This also indicates that the hypothalamus plays a role in the immediate compensatory mechanism during 24 h REM sleep deprivation in young rats.

Biogenic amine changes in brain regions and attenuating action of Ocimum sanctumin noise exposure

Broadband white noise exposure (100 dB) in wistar strain male albino rats significantly increased the levels of dopamine (DA), serotonin (5-HT) and 5-HT turnover in many of the discrete brain regions (cerebral cortex, cerebellum, hypothalamus, hippocampus, pons-medulla and corpus striatum) during sub-chronic noise exposure (4 h daily for 15 days). In acute (4 h for 1 day) and chronic noise exposures (4 h daily for 30 days) the levels were significantly altered only in certain regions. The turnover study of serotonin clearly indicates that neurotransmitter level alone cannot be an indicator, as in some brain regions the rate of synthesis matched with the degradation in order to maintain the normal levels. The intraperitoneal administration of 70% ethanolic extract of Ocimum sanctum(OS) at the dosage of 100 mg/kg body weight to animals subjected to noise exposure has prevented the noise induced increase in neurotransmitter levels without affecting the normal levels. This indicates that OS can be a probable herbal remedy for noise induced biogenic amine alterations.

Effect of noise stress on free radical scavenging enzymes in brain

The levels of free radical scavenging enzymes in six discrete brain regions (cerebral cortex, cerebellum, midbrain, pons medulla, hippocampus and hypothalamus), after exposure to three different durations of noise stress (broadband white noise, 100dB, 4h/day, in acute: 1 day, sub acute: 15 days and chronic stress: 30 days) was studied in Wister strain male albino rats. Acute noise stress significantly increases the levels of superoxide dismutase (SOD: EC 1.15.1.1), catalase (EC 1.11.1.6), glutathione peroxidase (GPx: EC 1.11.1.9), oxidized glutathione (GSSG) and lipid peroxidation (LPO) and decreases the levels of reduced glutathione (GSH), GSH/GSSG ratio and protein thiols. The free radical scavenging enzymes levels, in sub acute and chronic noise stress also showed marked deviation in certain regions from the controls within the study duration. The results indicate that adaptation to noise stress does not occur immediately in all the brain regions. The noise induced alterations in free radicals may be assumed to serve as a linkage between the environmental noise and the manifestation of multifactorial diseases attributed to noise exposure. Moreover the quantification of the health effects of noise by the alterations in free radicals seems inappropriate in chronic noise stress.

Outcome of a conservative surgical policy for differentiated thyroid cancer: a prospective population-based cohort study

Background

The extent of surgery and the requirement for routine total thyroidectomy in patients with papillary or follicular differentiated thyroid cancer (DTC) is contentious. It is desirable to strike a balance between achieving cure and local disease control and avoidable surgical morbidity. Routine total thyroidectomy increases the rate of permanent hypoparathyroidism and may not improve cure or local recurrence rates in patients categorized at low risk. An ongoing prospective study of the outcome of a conservative surgical policy based on an unselected population from the north east of Scotland is reported.

Methods

With few exceptions, all patients with thyroid cancer in north-east Scotland are treated in a specialist unit. Data are recorded prospectively and all patients are reviewed at a dedicated thyroid clinic or by postal review if they leave the area. The mortality, morbidity (including recurrent laryngeal nerve and parathyroid function), recurrence and reoperation rates, and administration of radioactive iodine are recorded. The population of this region is very stable and follow-up is complete in over 97 per cent of patients. The surgical policy is to remove all macroscopic disease from the neck at the first operation and reserve total thyroidectomy for patients with bilateral disease or who are considered at high risk and likely to require postoperative radioactive iodine therapy.

Results

During the period 1977–1996, 238 patients with thyroid cancer were treated of whom 193 (81 per cent) had DTC. Some 148 (77 per cent) of the DTCs were categorized ‘low risk’. Fifty-five (28 per cent) of the 193 patients underwent total or near-total thyroidectomy. The majority of patients (75 per cent low risk; 59 per cent high risk) underwent lobectomy. Seven patients (five low risk; two high risk) have required subsequent completion total thyroidectomy, usually for a rising thyroglobulin level, only three of whom had evidence of DTC in the resected lobe. The mortality rate from DTC was 13 and 1 per cent in high- and low-risk patients respectively. Four (2 per cent) of the 193 patients developed postoperative hypoparathyroidism.

Conclusion

This prospective study suggests that appropriate selection of patients for total thyroidectomy in an endocrine surgical unit is associated with a low mortality rate and little requirement for completion total thyroidectomy. Routine total thyroidectomy is not necessary.