NCCP-ICS joint consensus-based clinical practice guidelines on medical thoracoscopy

ABSTRACT

Medical Thoracoscopy (MT) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. The aim of the study was to provide evidence-based information regarding all aspects of MT, both as a diagnostic tool and therapeutic aid for pulmonologists across India. The consensus-based guidelines were formulated based on a multistep process using a set of 31 questions. A systematic search of published randomized controlled clinical trials, open labelled studies, case reports and guidelines from electronic databases, like PubMed, EmBase and Cochrane, was performed. The modified grade system was used (1, 2, 3 or usual practice point) to classify the quality of available evidence. Then, a multitude of factors were taken into account, such as volume of evidence, applicability and practicality for implementation to the target population and then strength of recommendation was finalized. MT helps to improve diagnosis and patient management, with reduced risk of post procedure complications. Trainees should perform at least 20 medical thoracoscopy procedures. The diagnostic yield of both rigid and semirigid techniques is comparable. Sterile-graded talc is the ideal agent for chemical pleurodesis. The consensus statement will help pulmonologists to adopt best evidence-based practices during MT for diagnostic and therapeutic purposes.

Primary Low-Grade Fibromyxoid Sarcoma of Kidney-an Extremely Rare Entity

Renal LGFMS is an extremely rare tumor. So far, only four cases have been reported in literature. LGFMS are indolent tumor with distinctive histopathological features with potential for late recurrences and metastasis. The diagnosis is made on histopathological examination and supported by immunohistochemical analysis. A 35-year-old young male was presented with flank pain and lump and diagnosed as low-grade fibromyxoid sarcoma after surgery on immunohistochemical analysis. This is the fifth case of renal LGFMS and we presented the review of literature. Radical surgery remains the primary treatment modality. Long follow-up is mandatory.

Procamallanus spiculogubernaculus Agarwal, 1958 (Nematoda: Camallanidae) from Stinging catfish, Heteropneustes fossilis in India: morphological characterization and molecular data

The nematode, Procamallanus spiculogubernaculus Agarwal, 1958 was found from the Stinging catfish, Heteropneustes fossilis (Bloch, 1794) from Ghazipur, Delhi, India. Morphological characterization, including scanning electron microscope observation supplemented with DNA sequences is provided. Specimens recently found are characterized by the presence of an unlined buccal capsule having a small basal ring, esophagus muscular and glandular, vulva position is slightly post-equatorial, tail conical, long, and ending in three digit-like processes, phasmids present at about mid-length and cloaca located at the posterior end. In this study the species P. spiculogubernaculus is validated on the basis of molecular data after 47 years from its original description. In the scanning electron microscope examination, the topology of mouth and sensory pits in anterior portion, while the phasmids and digit like processes in posterior portion is clearly observed. Molecular data of the 18S ribosomal RNA and mitochondrial cytochrome c oxidase subunit 1 (cox1) gene were analyzed. Molecular phylogenetic analyses supported the validity of Procamallanus spiculogubernaculus and confirmed the paraphyletic status of the members of Procamallanus, Spirocamallanus, Camallanus and Paracamallanus. Taxonomic status of members of the family Camallanidae are briefly discussed along with the results of the systematic evaluation of P. spiculogubernaculus based on molecular data.

Liquid crystal mediated interactions between nanoparticles in a nematic phase

A continuum theory is used to study the interactions between nanoparticles suspended in nematic liquid crystals. The free energy functional that describes the system is minimized using an Euler-Lagrange approach and an unsymmetric radial basis function method. It is shown that nanoparticle liquid-crystal mediated interactions can be controlled over a large range of magnitudes through changes of the anchoring energy and the particle diameter. The results presented in this work serve to reconcile past discrepancies between theoretical predictions and experimental observations, and suggest intriguing possibilities for directed nanoparticle self-assembly in liquid crystalline media.

Unilateral anomalous antebrachial vasculature--a clinico-embryological insight

OBJECTIVES

An important and frequently reported arterial variant of the upper extremity is the superficial ulnar artery (SUA). Although SUA is not an uncommon variation, its presence should be detected timely as any surgical procedure in this region could put this unnaturally present superficial vessel to risk. Therefore, we sought to report this anomaly relating to the brachial arterial branching pattern.

MATERIALS AND METHODS

Through the course of a usual instructive gross anatomy class an arterial variant of the brachial artery was noted. A scrupulous dissection was carried out and the specimen photographed.

RESULTS

The present study reports the unilateral presence of abnormal branching pattern and disposition of antebrachial blood vessels. The brachial artery is seen to branch off into superficial ulnar artery (SUA) and usual radial artery. Interestingly, common interosseous artery (CIA) springs from the radial artery instead of the ulnar artery which is the usual case.

CONCLUSIONS

Simple procedures such as venepuncture and intra arterial injections may become cumbersome and complication prone. The study is a humble attempt to caution the radiologists before interpreting angiographic films and the surgeons before performing reconstructions in this region.

Apparent diffusion coefficient with higher b-value correlates better with viable cell count quantified from the cavity of brain abscess

BACKGROUND AND PURPOSE

DWI by using higher b-values provides tissue diffusivity with less T2 shinethrough effect. VCD in the abscess cavity correlates with ADC values. The purpose of this study was to investigate which b-value-derived ADC correlates better with VCD.

MATERIALS AND METHODS

Thirty patients with brain abscess underwent conventional MR imaging and DWI with b = 1000, 2000, and 3000 s/mm(2) on a 3T MR imaging scanner. ADC values were quantified by placing regions of interest inside the abscess cavity in all sections where the lesion was apparent on coregistered ADC maps derived from different b-values. VCD was measured on pus aspirated.

RESULTS

An increase in b-value was associated with a decrease in ADC values in normal parenchyma as well as in the abscess cavity. The most significant negative correlation of VCD was observed with b = 3000 s/mm(2) (r = -0.98, P = .01).

CONCLUSIONS

VCD in the abscess cavity can be best assessed at b = 3000 s/mm(2) secondary to the reduction in the T2 shinethrough effect. DWI with b = 3000 s/mm(2) is of promising value in the assessment of the therapeutic response of brain abscess.

Synthesis of new chalcone derivatives containing acridinyl moiety with potential antimalarial activity

A series of novel chalcones bearing acridine moiety attached to the amino group in their ring A have been synthesized through noncatalyzed nucleophilic aromatic substitution reaction between various 3'-aminochalcone or 4'-aminochalcones and 9-chloroacridine. The synthesized chalcone derivatives have been characterized and screened for in vitro antimalarial activity against Plasmodium falciparum NF-54. All the chalcones showed complete inhibition at concentration of 10 microg/mL and above while three compounds showed significant inhibition at concentration of 2 microg/mL. The three most active chalcone derivatives were screened for in vivo activity as well, but no significant inhibition in parasitaemia was observed when given intraperitoneally to Plasmodium yoelii infected mice model.

Synthesis and antimicrobial evaluation of new chalcones containing piperazine or 2,5-dichlorothiophene moiety

Two new series of chalcones have been synthesized by reacting 1-(4-piperazin-1-yl-phenyl)ethanone and 1-(2,5-dichloro-3-thienyl)-1-ethanone with different substituted benzaldehydes in turn by Claisen-Schmidt condensation. The compounds have been characterized by IR, (1)H NMR spectral and microanalysis data. All the synthesized compounds have been evaluated for antimicrobial activity. Some of these derivatives are potentially active against Gram-positive bacteria, Staphylococcus aureus and Escherichia coli while the most potent compound (1) in this study showed MIC(50) value of 2.22 microg/mL against Candida albicans.

Complete ureteral avulsion

Complete avulsion of the ureter is one of the most serious complications of ureteroscopy. It requires open or laparoscopic intervention for repair. This case report emphasizes its management and presents recommendations for prevention in current urological practice.

Protrusion of bladder mucosa in exstrophy mimicking cloacal exstrophy

An interesting case of bladder exstrophy with protrusion of bladder mucosa mimicking cloacal exstrophy is reported. The child presented with continuous leakage of urine and swelling in the lower abdomen since birth. Before the operation, this was considered to be a variant of cloacal exstrophy.

Platelet transfusion practice during dengue fever epidemic

Blood components especially platelet concentrates due to their short shelf life are frequently in limited supply. Appropriate use of blood components is required to ensure their availability for needy patients as well as to avoid the unnecessary risk of transfusion-transmitted diseases. Medical audit of blood transfusion practice, which forms an important part of quality assurance programme in a transfusion centre, can provide grounds for improvement in transfusion medicine practice. During the epidemic of dengue fever in Oct., 1996, 1837 patients were admitted as dengue haemorrhagic fever in a teaching hospital in Delhi. Two hundred and eight patients (11.3%) were given platelet transfusions. Retrospective analysis of these platelet transfusions was done. It was observed that in only 52 (25%) out of 208 patients the information on platelet counts was provided. History of active bleeding was obtained only in 65 (31.2%) patients. About 35% patients received unnecessary prophylactic transfusions and during 89% of the transfusion episodes inappropriate dose of platelet concentrate was given. Information regarding post-transfusion recovery could be obtained in only 16.5% of transfusion episodes. The study emphasises the need for development of specific guidelines for transfusion of blood components, constant interaction and co-ordination amongst clinicians and transfusion centre for implementation of these guidelines, and a regular medical audit to review the optimal utilisation of blood components.

Increased TGF-beta and decreased oncogene expression by omega-3 fatty acids in the spleen delays onset of autoimmune disease in B/W mice

This study was designed to investigate the mechanisms by which marine lipids rich in long chain omega-3 fatty acids inhibit autoimmune disease and prolong the survival rate in female (NZB/NZW) F1 (B/W) mice, an animal model for human SLE. Nutritionally adequate semipurified diets containing at 10% either corn oil (CO) or fish oil (FO) were fed from 1 mo of age and were monitored for proteinuria and survival. Proteinuria was detected earlier and became progressively severe in CO-fed mice. The average life span was significantly shortened by the CO diet (266.7 days +/- 12.5), whereas FO extended the survival significantly (402.1 days +/- 26.1; p < 0.001). A cross-sectional study at 6.5 mo of age revealed an increased proliferative response to T cell mitogens including bacterial superantigens and decreased serum anti-dsDNA Ab titers in the FO group compared with the CO group. Furthermore, splenocytes from the FO group when stimulated with Con A had higher IL-2 and lower IL-4 production similar to that of young (3.5 mo) mice. Flow cytometric analyses of splenocytes revealed lower Ig+, higher lymphocyte endothelial cell adhesion molecule-1, and lower Pgp-1+ cells within CD4+ and CD8+ subsets in FO-fed mice. Also, elevated IL-2 and IL-4 and significantly higher TGF-beta 1 and lower c-myc and c-ras mRNA expression and higher TGF-beta 1 and significantly lower c-Myc and c-Ha-Ras proteins were detected in spleens of FO-fed mice. Fatty acid analysis revealed significantly higher linoleic (18:2 omega-6) and arachidonic (20:4 omega-6) acid levels in splenocytes of the CO-fed group and higher eicosapentaenoic (20:5 omega-3) and docosahexanoic (22:6 omega-3) acid levels in the FO-fed group, indicating that changes in membrane fatty acid composition may contribute to the altered immune function and gene expression during the development of murine SLE.

Increased TGF-beta and decreased oncogene expression by omega-3 fatty acids in the spleen delays onset of autoimmune disease in B/W mice

This study was designed to investigate the mechanisms by which marine lipids rich in long chain omega-3 fatty acids inhibit autoimmune disease and prolong the survival rate in female (NZB/NZW) F1 (B/W) mice, an animal model for human SLE. Nutritionally adequate semipurified diets containing at 10% either corn oil (CO) or fish oil (FO) were fed from 1 mo of age and were monitored for proteinuria and survival. Proteinuria was detected earlier and became progressively severe in CO-fed mice. The average life span was significantly shortened by the CO diet (266.7 days +/- 12.5), whereas FO extended the survival significantly (402.1 days +/- 26.1; p &lt; 0.001). A cross-sectional study at 6.5 mo of age revealed an increased proliferative response to T cell mitogens including bacterial superantigens and decreased serum anti-dsDNA Ab titers in the FO group compared with the CO group. Furthermore, splenocytes from the FO group when stimulated with Con A had higher IL-2 and lower IL-4 production similar to that of young (3.5 mo) mice. Flow cytometric analyses of splenocytes revealed lower Ig+, higher lymphocyte endothelial cell adhesion molecule-1, and lower Pgp-1+ cells within CD4+ and CD8+ subsets in FO-fed mice. Also, elevated IL-2 and IL-4 and significantly higher TGF-beta 1 and lower c-myc and c-ras mRNA expression and higher TGF-beta 1 and significantly lower c-Myc and c-Ha-Ras proteins were detected in spleens of FO-fed mice. Fatty acid analysis revealed significantly higher linoleic (18:2 omega-6) and arachidonic (20:4 omega-6) acid levels in splenocytes of the CO-fed group and higher eicosapentaenoic (20:5 omega-3) and docosahexanoic (22:6 omega-3) acid levels in the FO-fed group, indicating that changes in membrane fatty acid composition may contribute to the altered immune function and gene expression during the development of murine SLE.

Potential of diet therapy on murine AIDS

Recently, a murine retrovirus (LpBM5 MuLV), which induces immunodeficiency syndrome in mice, termed MAIDS, has been found to have several features similar to those seen in human acquired immunodeficiency syndrome (AIDS). The present study was undertaken to compare the effects of 40% energy restriction (R) and/or ad libitum (AL) diets with vegetable [corn oil, (CO) (n-6)] or marine oil [menhaden fish oil (FO), (n-3)] as a source of dietary fats on the immune function and survival rate of C57BL/6 mice injected with the LpBM5 MuLV virus. Weanling mice were fed, throughout the study, either a 5% CO-, 5% CO(R)-, 20% CO- or 20% FO-based diet and 8 wk later the mice were injected with the LpBM5 MuLV (5 x 10(5) plaque-forming units). The results revealed a significantly prolonged postinjected survival rate in the mice fed 20% FO and 5% CO(R) diets [5% CO = 131 +/- 7 d; 5% CO(R) = 161 +/- 13 d; 20% CO = 125 +/- 6 d; 20% FO = 164 +/- 14 d]. Immunological studies conducted 4 wk after injection revealed decline in both interleukin-2 production and proliferative response to mitogens in spleen cells of mice in all four dietary groups. However, this decline was less apparent in mice fed 5% CO(R) and 20% FO diets.(ABSTRACT TRUNCATED AT 250 WORDS)