18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and 68Ga-prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Imaging in the Evaluation of Rare Entity Adult Embryonal Rhabdomyosarcoma of Prostate.

A 21-year-old male with embryonal rhabdomyosarcoma of the prostate was referred for 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and 68Ga-prostate-specific membrane antigen (PSMA) PET/CT for initial disease staging. The PET scans revealed hypermetabolic and PSMA expressing lobulated mass involving both lobes of the prostate and weakly metabolic and PSMA expressing few bilateral pararectal and external iliac nodes, multiple bilateral lung nodules scattered over the lung parenchyma and multiple bone marrow lesions in both axial and appendicular skeleton. Magnetic resonance imaging prostate showed gross prostatomegaly with large lobulated T2 hyperintense heterogeneously enhancing mass lesion showing restricted diffusion, involving both lobes of the prostate with extraprostatic spread along anterior, posterior, and left lateral margins with evidence of lymph nodal and osseous metastases. The demonstration of increased uptake of 18F-FDG and 68Ga-PSMA in the primary as well as bilateral pararectal and external iliac nodes, multiple bilateral lung nodules, and multiple bone marrow lesions in both axial and appendicular skeleton indicates a potential role of 18F-FDG PET/CT and 68Ga-PSMA PET/CT in disease staging in this rare aggressive tumor of the prostate.

Speckle tracking echocardiography-derived left ventricular global longitudinal strain in ex-thalassaemics.

AIMS: Long term survivors of haematopoietic stem cell transplantation (HSCT) for ß-thalassemia major are designated "ex-thalassaemics". Whether ex-thalassaemics continue to harbour residual myocardial dysfunction and thereby stand the risk of heart failure-related morbidity and mortality is unknown. The aim of this study was to assess the prevalence and predictors of subclinical left ventricular (LV) dysfunction in an apparently normal ex-thalassaemic population. METHODS: We conducted a single centre cross-sectional study among 62 ex-thalassaemic patients, who had undergone HSCT for ß-thalassaemia major at our centre. The primary outcome variable was LV systolic dysfunction, as assessed by 1) LV global longitudinal strain (GLS) derived by 2D speckle tracking echocardiography and 2) LV ejection fraction (EF) derived by 2D Simpsons Biplane method. RESULTS: Among the 62 patients included in the study, 7 [11.3%] were found to have LV systolic dysfunction, all of which were subclinical. Of these, 4 [6.5%] had abnormal GLS and LVEF, 2 [3.2%] had abnormal GLS with normal LVEF, and 1 [1.6%] had abnormal LVEF with low normal mean GLS. There were no statistically significant predictors of LV dysfunction in this cohort. CONCLUSION: There was a high prevalence of subclinical myocardial dysfunction in the ex-thalassaemic population reiterating the need for close follow up of these patients. 2D Speckle tracking echocardiography-derived LV global longitudinal strain is an effective tool in detecting subclinical myocardial dysfunction in this cohort.

Simultaneous conversion of chromium and malachite green coexists in halophilic bacterium Halomonas xianhensis SUR308 isolated from a solar saltern.

Many industries are known to use heavy metals like chromium (Cr) to fix dyes in the fabrication processes and malachite green (MG) as colorant. Alkalinity, elevated temperature, or salinity of the industrial effluents makes conventional physicochemical removal of MG and hexavalent chromium [Cr(VI)] more difficult to apply and demands to perceive potential cost-effective and environment-friendly treatment methods to eliminate or convert them into less toxic compounds. Here, we report simultaneous removal and bioconversion of MG and Cr(VI) by a halophilic biofilm-forming bacterium Halomonas xianhensis SUR308. It can efficiently produce exopolysaccharides as extracellular polymeric substances (EPS) and form biofilm under oxygen limiting condition. The reduction of hexavalent chromium [Cr(VI)] to trivalent chromium [Cr(III)] is about 100%, and 95% after 84 h of growth in shaken and stagnant culture, respectively. The strain completely decolorizes MG after 48 h of growth in shaken culture. Furthermore, we found that strain SUR308 can efficiently detoxify chromium by reduction and degrades MG via producing various intermediate products simultaneously. Most interestingly, such conversions can also take place in alkaline environment and in environment where substantial amount of salt is present. These unique features of strain SUR308 make it suitable for the simultaneous remediation of toxic heavy metals and hazardous dye even from the environment having higher pH and salinity. The detail molecular mechanism of the bioconversion with its application in open environment would be the future research focus for bioprospecting strain SUR308.

Electrocardiographic lead reversals.

Misplacement of cables during the recording of a 12-lead electrocardiogram [ECG] poses a non-negligible risk of creating panic and confusion at the bedside in daily clinical practice. Clinical awareness about the manifestations of commonly encountered electrode misplacements is imperative for avoiding misdiagnosis. A basic understanding of the electrophysiology behind these anomalous ECG tracings is likely to aid in prompt suspicion, accurate detection, and appropriate rectification in most cases. We discuss the abnormalities produced on 12-lead ECG tracings by the misplacement of electrode cables, with a focus on the clinical implications of the same. We suggest a mnemonic - 'SPIRAL' - as a quick screening criterion to detect commonly encountered lead reversals.

Medical and economic burden of delirium on hospitalization outcomes of acute respiratory failure: A retrospective national cohort.

Although delirium in patients with acute respiratory failure (ARF) may evolve in any hospital setting, previous studies on the impact of delirium on ARF were restricted to those in the intensive care unit (ICU). The data about the impact of delirium on ARF hospitalizations outside of the ICU is limited. Therefore, we conducted the first national study to examine the effect-magnitude of delirium on ARF in all hospital settings, that is, in the ICU as well as on the general medical floor. We searched the 2016 and 2017 National Inpatient Sample databases for ARF hospitalizations and created "Delirium" and "No delirium" groups. The outcomes of interest were mortality, endotracheal intubation, length of stay (LOS), and hospitalization costs. We also aimed to explore any potential demographic, racial, or healthcare disparities that may be associated with the diagnosis of delirium among ARF patients. Multivariable logistic regression was used to control for demographics and comorbidities. Delirium was present in 12.7% of the sample. Racial disparities among African Americans were also significant. Delirious patients had more comorbidities, higher mortality, and intubation rates (17.5% and 9.2% vs 10.6% and 6.1% in the "No delirium" group [P < .001], respectively). Delirious patients had a longer LOS and higher hospitalization costs (5.9 days and $15,395 USD vs 3.7 days and $9393 USD in "No delirium" [P < .001], respectively). Delirium was associated with worse mortality (adjusted odds ratio 1.49, confidence interval [CI] = 1.41, 1.57), higher intubation rates (adjusted odds ratio 1.46, CI = 1.36, 1.56), prolonged LOS (adjusted mean ratio 1.40, CI = 1.37, 1.42), and increased hospitalization costs (adjusted mean ratio 1.49, CI = 1.46, 1.52). A racial disparity in the diagnosis of delirium among African Americans hospitalized with ARF was noted in our sample. Patients in small, non-teaching hospitals were diagnosed with delirium less frequently compared to large, urban, teaching centers. Delirium predicts worse mortality and morbidity for ARF patients, regardless of bed placement and severity of the respiratory failure.

Atrial depolarization abnormalities in pulmonary sarcoidosis.

BACKGROUND: Cardiac sarcoidosis, often manifested as sudden death, can be the first manifestation of sarcoidosis. Since 12-lead electrocardiogram (ECG) is recommended as an initial screening tool for cardiac sarcoidosis, the recognition of subtle abnormalities assumes utmost significance. The objective of this study was to identify the electrocardiographic abnormalities in patients with pulmonary sarcoidosis. RESULTS: A detailed analysis of 12-lead ECGs obtained from sixty patients with histopathologically proven pulmonary sarcoidosis and no overt cardiac involvement was done. The findings were compared with those of an age-matched control group. Varying degrees of intraventricular conduction defects were common in the study group [67%], as well as the control group [57%] [P = 0.23]. There was a higher prevalence of biphasic P wave [P = 0.003] and bifid P wave [P = 0.029] in lead III and rsr' in lead aVF [P = 0.03] in the study group as compared to the control group. CONCLUSIONS: Our study demonstrates a greater prevalence of subtle ECG abnormalities in patients with pulmonary sarcoidosis as compared to patients with other forms of pulmonary disease. Atrial depolarization abnormalities were commoner in patients with pulmonary sarcoidosis.

Enhanced production of poly(3-hydroxybutyrate-co-3-hydroxyvalerate) copolymer by endophytic Bacillus cereus RCL 02 utilizing sugarcane molasses as sole source of carbon: a statistical optimization approach.

Polymers of biological origin have become a topic of interest due to growing concerns about the environmental impact of the disposal of plastics. In recent years, the production of ecobenign microbial polymer polyhydroxyalkanoates (PHAs) using inexpensive and renewable resources has gained significant interest as these compounds are highly biodegradable, biocompatible, and sustainable. This study used leaf endophytic isolate Bacillus cereus RCL 02, obtained from the oil-yielding plant Ricinus communis L., to achieve statistical optimization of culture variables for the enhanced production of PHAs utilizing sugarcane molasses as the sole carbon source. A three-level and four-factor Box-Behnken design of response surface methodology was implemented to optimize the process variables, namely molasses (carbon substrate), ammonium sulfate (nitrogen source), initial pH, and incubation period, for improved biomass formation and PHA production. The highest growth (14.8 g/l) and PHA production (85.2%, dry cell weight) by the isolate were observed with 47 g/l molasses, 3 g/l ammonium sulfate, an initial pH of 6.7, and 62 h of incubation. Statistical optimization of the process allowed achieving a 1.6-fold increase in the PHA yield (7.8-12.6 g/l) compared with the conventional single-factor system of analysis. The biopolymer thus produced was confirmed as a copolymer of 3-hydroxybutyrate and 3-hydroxyvalerate [P(3HB-co-3HV)] using 1H nuclear magnetic resonance spectroscopic analysis and was found to contain 7.8 mol% 3-hydroxyvalerate. These findings clearly indicate the efficacy of the B. cereus RCL 02 isolate in the biotransformation of raw sugarcane molasses to P(3HV-co-3HV), without the need for supplementation with high-cost precursors.

Production and characterization of a bioactive extracellular homopolysaccharide produced by Haloferax sp. BKW301.

The production of extracellular polysaccharides (EPS) by haloarchaeal members, with novel and unusual physicochemical properties, is of special importance and has the potential for extensive biotechnological exploitation. An extremely halophilic archaeon, Haloferax sp. BKW301 (GenBank Accession No. KT240044) isolated from a solar saltern of Baksal, West Bengal, India has been optimized for the production of EPS under batch culture. It produced a considerable amount (5.95 g/L) of EPS in the medium for halophiles with 15% NaCl, 3% glucose, 0.5% yeast extract, and 6% inoculum under shake flask culture at 120 rpm. The purified EPS, a homopolymer of galactose as revealed by chromatographic methods and Fourier-transform infrared spectroscopy, is noncrystalline (CIxrd , 0.82), amorphous, and could emulsify hydrocarbons like kerosene, petrol, xylene, and so forth. Moreover, the polymer is highly thermostable (up to 420°C) and displayed pseudoplastic rheology. Biologically, the EPS was able to scavenge DPPH (2,2-diphenyl-1-picrylhydrazyl) radical efficiently and inhibit the proliferation of the Huh-7 cell line at an IC50 value of 6.25 µg/ml with a Hill coefficient of 0.844. Large-scale production of this thermostable, pseudoplastic homopolysaccharide, therefore, could find suitable applications in industry and biotechnology.

Electrocardiographic Predictors of Mortality in Acute Anterior Wall Myocardial Infarction With Right Bundle Branch Block and Right Precordial Q-Waves (qRBBB).

BACKGROUND: Published data on the clinical, electrocardiographic, and angiographic profile of acute anterior-wall ST-elevation myocardial infarction (STEMI) with right bundle branch block with q in leads V1, V2 (qRBBB) are scarce. The aim of this study was to estimate the incidence of short-term mortality and in-hospital complications in acute qRBBB STEMI and identify the electrocardiographic (ECG) predictors of a poor outcome. METHODS: We conducted a single-centre retrospective study among the patients with acute anterior-wall STEMI and qRBBB pattern on ECG. All relevant clinical and treatment data were collected from the electronic medical records. All the ECGs taken during the index hospitalization were subjected to detailed analysis. RESULTS: Among the 272 qRBBB patients included in the study, 64% had thrombolysis in myocardial infarction (TIMI) risk score of ≥6, and 41% were in Killip class III or IV at the time of presentation. The in-hospital mortality rate was 42.6%. There was a high incidence of ventricular tachyarrhythmias (12%), complete heart block (13%), heart failure (69%), and cardiogenic shock (52%). Extreme deviation of mean QRS axis to the right (180 to 269 degrees) in the baseline ECG was associated with high in-hospital mortality (odds ratio: 13.43; 95% confidence interval: 1.48-122.03; P = 0.021). CONCLUSIONS: Acute qRBBB myocardial infarction is a sinister form of acute coronary syndrome that entails high in-hospital mortality and morbidity, necessitating early recognition and prompt institution of reperfusion therapy. Extreme deviation of QRS axis to the right (180 to 269 degrees) is a significant electrocardiographic predictor of in-hospital mortality.

Effects of heat stroke on surface ECG: a study on clinical outcomes.

AIMS: Classic heat stroke is associated with high in-hospital mortality and morbidity. The relation between the ECG findings in heat stroke and the clinical outcomes of these patients has not been studied. The aim of this study was to describe the electrocardiographic features in patients with classic heat stroke and to determine if there is any correlation of ECG findings with in-hospital outcomes. METHODS: We performed a retrospective study on 50 patients with classic heat stroke during summer months of 2016-2018. All 12-lead electrocardiographic recordings obtained from these patients were subjected to in-depth analysis. Statistical analysis was done to determine the correlation of electrocardiographic findings with in-hospital outcomes. RESULTS: 37 patients were in sinus rhythm, while supraventricular arrhythmias including atrial fibrillation (n=6), ectopic atrial tachycardia (n=4) and atrial flutter (n=2) were observed in the rest. There was a high prevalence of QTc prolongation, low voltage P waves, conduction defects like incomplete right bundle branch block and repolarisation abnormalities. The ratio of QRS voltage in the limb leads to that in precordial leads was ≤0.5 in nearly three-fourths of the patients. Among the observed electrocardiographic features, low P-wave voltage (<0.01 mV) in lead II was found to have statistically significant correlation with adverse in-hospital outcome (OR 8.93, p=0.04), after adjustment for clinical covariates. CONCLUSION: There was high incidence of atrial arrhythmias in patients with classic heat stroke. A low P-wave voltage (<0.01 mV) in lead II was predictive of adverse in-hospital outcome in this cohort of patients.

Congenital methaemoglobinaemia diagnosed in an adolescent boy.

A 14-year-old boy of Asian origin presented with a history of bluish discolouration of the finger and toenail bed with associated mild fatiguability on exertion since early childhood. Clinical examination revealed bilaterally symmetric uniform central cyanosis with no associated clubbing. Cardiovascular and respiratory system examination was normal. Pulse oximetry revealed an oxygen saturation of 87% in all four limbs. Transthoracic and transoesophageal echocardiography showed no evidence of shunt lesions. In view of the past diagnosis of pulmonary arteriovenous fistulae made at 4 years of age, a repeat cardiac catheterisation study was done, which revealed no shunt at any level. Interestingly, arterial oxygen tension of the chocolate-brown blood was normal in all the samples, suggesting the possibility of methaemoglobinaemia. Co-oximetry revealed methaemoglobin levels of 36%, confirming the diagnosis. Secondary causes were ruled out. The family was counselled about the hereditary nature of the condition.

Cardiac involvement in beta-thalassaemia: current treatment strategies.

Despite the advances in the management of thalassemia major, heart disease remains the leading cause of mortality in patients afflicted with this disorder. Cardiac involvement in thalassemia encompasses a spectrum of disorders including myocardial dysfunction, arrhythmias, pulmonary hypertension, and peripheral vascular disease. Although cardiac siderosis (accumulation of iron in cardiac myocytes) as a consequence of repeated blood transfusions is deemed to be the main etiologic factor for myocardial dysfunction in transfusion-dependent patients, the significance of other pathophysiologic mechanisms is being increasingly recognized especially in non-transfusion dependent patients. Management of cardiac complications in thalassemia major hinges on the treatment of the underlying pathophysiology, which often is unmitigated iron overload. The prevalence and predictors of cardiac complications in 'ex-thalassaemics' [thalassaemic patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) is unknown at present. In this review, we look at the pathogenesis of cardiac involvement in patients with beta-thalassemia major, the advances in the management of these patients and the future prospects.

Devil is in the detail.

A 15-year-old girl of Asian origin, hailing from a rural agrarian background, presented with history of multiple episodes of dizziness for 3 years. The episodes were precipitated mostly by emotional and/or physical stress and relieved on lying down, with a few episodes culminating in transient loss of consciousness. As preliminary cardiac and neurological evaluation were normal, she was being treated by the primary physician as a case of probable psychogenic syncope, supported by the consistent association of the episodes with emotional stress. A detailed review of family history revealed that the premature demise of the patient's siblings which were attributed to snakebite and head trauma by the family could have been in reality sudden cardiac deaths. Treadmill test revealed exercise-induced polymorphic ventricular tachycardia confirmatory for the diagnosis of catecholaminergic polymorphic ventricular tachycardia. She was initiated on beta-blocker therapy to which she showed remarkable response.

Development of active packaging material based on cellulose acetate butyrate/polyethylene glycol/aryl ammonium cation modified clay.

Active packaging is one of the interesting concepts in food industry which extend the shelf-life of the food products. The purpose of this work was to develop nontoxic antimicrobial nanocomposite films. Benzyltrimethylammonium chloride modified montmorillonite (BMMT) were used as nano-filler and the prepared BMMT was characterized using Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and thermogravimetric analysis. Polyethylene glycol (PEG) plasticized cellulose acetate butyrate (CAB) films with different ratios of PEG and CAB was prepared and it was found that the 20 wt% PEG in CAB matrix (CBP20) gave optimal results in terms of mechanical properties. BMMT was mixed with CBP20 in different proportions to prepare nanocomposites. 3 wt% BMMT loaded nanocomposite gave best in terms of the barrier and mechanical properties. The storage modulus, thermal stability, glass transition, and melting temperature of the nanocomposites increased with the loading of 1, 3, and 5 wt% of BMMT. Furthermore, these nanocomposites showed nontoxic and antimicrobial behavior.

Left ventricular global longitudinal strain following revascularization in acute ST elevation myocardial infarction - A comparison of primary angioplasty and Streptokinase-based pharmacoinvasive strategy.

OBJECTIVE: Tenecteplase-based pharmacoinvasive percutaneous coronary intervention (PCI) has been shown to yield outcomes comparable to primary PCI in the setting of acute ST elevation myocardial infarction (STEMI). This study was designed to compare the efficacy of pharmacoinvasive PCI following successful thrombolysis with Streptokinase versus primary PCI in patients with STEMI. METHODOLOGY: We conducted a prospective single center observational study in 120 patients with STEMI who underwent primary PCI (n=60) and Streptokinase-based pharmacoinvasive PCI (n=60). Patients with Killips class 3 or 4 at presentation, and those with evidence of failed fibrinolysis were excluded. The primary outcome was LV systolic function after angioplasty, as assessed by 2D global longitudinal strain (GLS) using speckle tracking echocardiography (STE), as well as 2D LVEF using Simpson's biplane method. RESULTS: LV systolic function after PCI was significantly lower in the pharmacoinvasive arm as compared to the primary PCI arm, both by 2D STE (GLS: -9% vs -11%; p=0.03) and 2D Simpson's biplane method (LVEF: 40.7% vs 45.1%; p=0.02). TIMI flow in the culprit vessel prior to angioplasty was better in the pharmacoinvasive arm indicating successful thrombolysis, whereas post angioplasty flow was not different. There was no in-hospital mortality in either group. There was a trend toward increased incidence of acute kidney injury in the pharmacoinvasive arm. CONCLUSION: LV systolic function is significantly better after primary angioplasty as compared to pharmacoinvasive PCI following successful thrombolysis with Streptokinase.

Optimization of factors influencing exopolysaccharide production by Halomonas xianhensis SUR308 under batch culture.

A moderately halophilic bacterium, Halomonas xianhensis SUR308 (GenBank Accession No. KJ933394) was isolated from multi-pond solar salterns of Odisha, India. Exopolysaccharide (EPS) production by this strain in malt extract yeast extract (MY) medium has been optimized under batch culture system. Among the different media tested, MY medium showed an EPS production of 2.55 g/L, which increased to 2.85 g/L under optimized aeration. An initial pH of 7.5 and incubation temperature of 32 °C were found to be most suitable for EPS production by the isolate under aerobic condition. An EPS production of 3.85 g/L was achieved when the growth medium was supplemented with 2.5% NaCl. Glucose was the most favourable carbon source for EPS production and maximum production (5.70 g/L) was recorded with 3% glucose. However, growth as well as production of EPS was remarkably affected when the growth medium was supplemented with hydrocarbons as sole source of carbon. Among different nitrogen sources, casein hydrolysate at 0.5% level was proved to be the best for EPS production and an initial inoculum dose of 7% (v/v) enhanced the EPS production to 7.78 g/L, while the divalent metal ions were in general toxic to growth and EPS production, EPS synthesis by SUR308 was enhanced with Cr (VI) supplementation.

Endophytic bacteria with plant growth promoting abilities from Ophioglossum reticulatum L.

Endophytic bacteria colonizing the internal tissues of plants are known to improve plant growth by a wide variety of mechanisms. This study envisages the isolation and evaluation of plant growth promoting attributes of bacterial endophytes in perennial fern Ophioglossum reticulatum L. A total of 20 phenotypically distinguishable bacterial endophytes were isolated from surface sterilized leaf lamina, petiole, rhizome and spike of O. reticulatum L. The Shannon-Weaver diversity index showed that the rhizome (1.54) harbor more diverse types of endophytic bacteria than in its petiole, leaf lamina and spike. The isolated endophytes were characterized on the basis of micromorphological and physio-biochemical characters and tentatively assigned to the genus Bacillus, Pseudomonas and Staphylococcus. The isolates showed distinct variations in their enzymatic activities, sugar fermentation and antibiotic sensitivity profile. A number of endophytic isolates showed plant growth promoting activities like production of indole-3-acetic acid (IAA) and siderophore, growth in nitrogen-free medium and solubilization of phosphate. Time course of growth and IAA production by the potent isolate Bacillus OPR 7 have been determined. Exploitation of such plant growth promoting endophytes appears to be one of the best options in increasing biomass yield and improving plant fitness and productivity.