Recurrent Left-Sided Hepatic Hydrothorax Leading to Liver-Mediated Dyspnea.

Cirrhosis is a common liver condition caused by several etiologies including alcohol use disorder, infectious hepatitis, and metabolic dysfunction associated with liver disease. Although common symptomatic complications of cirrhosis include malaise, gastrointestinal bleeding, and abdominal distension, shortness of breath is a less common phenomenon that may occur. Hepatic hydrothorax (HH) is an uncommon cause of shortness of breath that is believed to be caused by the accumulation of ascitic fluid in the pleural space. While most cases of HH occur with ascites and the right side, we hereby present a case of a 70-year-old female with left-sided HH without ascites.

Diagnostic Accuracy of Narrow-Band Imaging in Predicting Helicobacter pylori Gastritis in Patients With Dyspepsia.

Background Helicobacter pylori (H. pylori) is one of the most prevalent causes of chronic gastritis that can lead to gastric cancer if left untreated. Currently, endoscopy and histology are the gold standard tests for the diagnosis of H. pylori gastritis. Recently, studies have shown the utility of narrow-band imaging (NBI) in predicting H. pylori gastritis. Therefore, we aimed to determine the diagnostic accuracy of NBI in predicting H. pylori gastritis in patients with dyspepsia. Methodology After obtaining approval from the Ethical Review Committee, Sindh Institute of Urology and Transplantation, this cross-sectional study was conducted in the outpatient Clinic of Hepatogastroenterology of the institute. Inclusion criteria involved all patients of either gender aged 18 to 65 years with dyspeptic symptoms. We excluded patients with a history of proton pump inhibitor use within two weeks before endoscopy, heart failure, previous gastrectomy, portal gastropathy, cirrhosis, use of antiplatelet medications, non-steroidal anti-inflammatory drugs or anticoagulant medication, and hemorrhagic or thrombophilia disorders. Each patient underwent endoscopy-guided NBI studies followed by biopsies from the antrum and body of the stomach. Multivariate logistic regression analysis was performed for the type of NBI pattern predicting H. pylori infection. The diagnostic accuracy was obtained individually for each NBI type and then for the presence of either two or all three NBI types in predicting H. pylori gastritis. Results Out of the total 775 patients enrolled in the study, abnormal NBI patterns were observed in 401 (51.7%) patients. The presence of abnormal NBI antral mucosal pattern on endoscopy was significantly associated with H. pylori infection (p < 0.001) with excellent diagnostic accuracy. Among the three NBI types, individually, NBI type III had excellent specificity and better diagnostic accuracy in predicting H. pylori gastritis than the other two types. Furthermore, the presence of all three abnormal NBI patterns (I+II+III) together was significantly associated with the presence of H. pylori gastritis with a sensitivity of 94.54%, specificity of 86.55%, and diagnostic accuracy of 90.32%. Conclusions NBI on endoscopy shows excellent diagnostic accuracy in identifying H. pylori gastritis in patients with dyspepsia. However, multicenter studies are required not only to validate our results but also to predict the pre-cancerous lesions on NBI in patients with H. pylori gastritis.

Correlation of Model for End Stage Liver Disease (MELD), MELD-Sodium (MELD-Na), and Child-Turcotte-Pugh (CTP) Score With Frailty in Patients With Hepatitis C Virus (HCV) Related Cirrhosis.

INTRODUCTION: The model for end stage liver disease (MELD), model for end stage liver disease-sodium (MELD Na), and Child-Turcotte-Pugh (CTP) score are independent predictors of mortality in cirrhotic patients. Approximately 43% of cirrhotic patients with advanced disease are frail and can have detrimental effects on the disease prognosis and survival including delisting from the transplant list and increased risk of post-transplant complications. Therefore, our aim was to determine the correlation of MELD, MELD-Na, and CTP score with frailty in patients with hepatitis C virus (HCV) related cirrhosis. METHODS:  This cross-sectional study was conducted at the Department of Hepato-gastroenterology, Sindh Institute of Urology and Transplantation from 1st January 2022 to 30th June 2022. All the patients of either gender aged between 18 and 70 years with serological evidence of HCV and features of cirrhosis on ultrasound abdomen were included in the study. Patients with conditions over estimating frailty were excluded from the study. Liver Frailty Index (LFI) was calculated using grip strength measured in kilograms, timed chair stands, and balance testing. CTP and MELD-Na scores for each patient were also recorded. All the data were analyzed using SPSS version 22.0 (IBM Corp., Armonk, NY). The correlation of MELD, MELD-Na, and CTP with LFI was analyzed using the Pearson correlation coefficient and a p-value < 0.05 was considered statistically significant. RESULTS:  A total of 274 patients were included in the study. Out of them, 185 (67.5%) were males. The mean CTP score was 8.1 + 2.1, MELD score of 13.6 + 7.1, MELD-Na score of 15 + 6.6, and LFI of 4.1 + 0.83. LFI was found to be weakly correlated with MELD (r = 0.278) (p < 0.001), MELD-Na score (r = 0.41) (p < 0.001), and CTP score (r = 0.325) (p < 0.001). CONCLUSION:  Weak correlation was noted between LFI, CTP, MELD, and MELD-Na scores in HCV-associated chronic liver disease. Therefore, frailty along with MELD, MELD-Na, and CTP must be assessed before considering the patients for liver transplantation.

Carboxymethyl cellulose coating delays ripening of harvested mango fruits by regulating softening enzymes activities.

The effect of carboxymethyl cellulose [(1%) CMC] was evaluated on mango fruits under storage at 20 ± 1 °C for 20 days. The CMC coating noticeably reduced weight loss and disease incidence. Application of CMC delayed climacteric peak of ethylene and respiration rate with significantly reduced relative ion leakage, malondialdehyde, superoxide anion and hydrogen peroxide content. The treated mangoes showed significantly lower L*, a*, b* and total carotenoids. The CMC treatment reduced the increase in cellulase, pectin methylesterase and polygalacturonase activity that delayed softening of mango fruits. In addition, activities of peroxidase, catalase, ascorbate peroxidase and superoxide dismutase were substantially higher in CMC-treated mango fruits. The treated fruits showed significantly lower soluble solids and higher titratable acidity which thereby reduced the ripening index of mangoes. In conclusion, CMC treatment could be considered a potential pre-storage treatment to delay postharvest ripening and to conserve the eating quality of ambient stored mango fruits.

Effect of gum arabic coating on antioxidative enzyme activities and quality of apricot (Prunus armeniaca L.) fruit during ambient storage.

The effect of gum arabic (GA) coating was studied on apricot fruit at 20 ± 1°C for 8 days. GA coating substantially reduced weight loss, disease incidence, malondialdehyde concentration, and hydrogen peroxide compared to the control. GA coating resulted in significantly higher total phenols, ascorbic acid, and antioxidant activity in contrast to the control. GA coating also suppressed cellulase, pectin methylesterase, and polygalacturonase activity in contrast to the non-coated fruit. In addition, GA-coated apricot fruit had substantially higher catalase, peroxidase, ascorbate peroxidase, and superoxide dismutase enzymes activities in contrast with the control. Similarly, GA coating inhibited soluble solids content increase and inhibited the reduction in titratable acidity in coated fruit. The fruit coated with GA coating also had significantly better sensory and overall eating quality compared to the control apricots. In conclusion, GA could be considered an appropriate edible coating for quality conservation of apricots. PRACTICAL APPLICATIONS: Apricot is a well renowned and nutrients rich fruit. However, apricot has comparatively short shelf life potential due to its susceptibility to rapid senescence and deterioration under ambient conditions. GA is an eco-friendly and biodegradable coating which is considered relatively cheap as compared with other coating types. In our present work, application of gum arabic [GA (10%)] edible coating maintained significantly higher quality of harvested apricot fruit as compared with the control. The outcomes of the present work are of global significance with respect to apricot industry. So, GA coating could be considered an appropriate edible coating for quality conservation of the harvested apricot fruit.

Lawsozaheer, a new chromone produced by an endophytic fungus Paecilomyces variotii isolated from Lawsonia Alba Lam. inhibits the growth of Staphylococcus aureus.

One new chromone, lawsozaheer (1), and five known compounds 4-(2-hydroxyethyl) phenol (2), viriditoxin (3), stigmasta-4,6,8(14),22-tetraen-3-one (4), ß-sitosterol (5) and stigmasterol (6) were isolated from the fungal broth of Paecilomyces variotii. Their structures were elucidated using spectroscopic data. The configuration of 1 was determined by Horeau's method. The broth extract and compound 1 showed highly selective activity against Staphylococcus aureus (NCTC 6571) bacterium with 83.19 and 84.26% inhibition respectively at 150 µg/mL, comparing well with that of standard drug ofloxacin (87.013% inhibition at 100 µg/mL). Broth extract also showed 75, and 40% inhibition of Candida albicans and Fusarium lini, respectively.

Antiproliferative Activity and Characterization of Metabolites of Aspergillus nidulans: An Endophytic Fungus from Nyctanthes arbor-tristis Linn. Against Three Human Cancer Cell Lines.

BACKGROUND: Endophytic fungi are receiving attention as sources of structurally novel bioactive secondary metabolites towards drug discovery from natural products. This study reports the isolation and characterization of secondary metabolites from an endophytic fungus Aspergillus nidulans, associated with Nyctanthes arbor-tristis Linn., a plant which has a traditional use to cure many ailments including cancer. OBJECTIVE: The objective of this study was to evaluate the antiproliferative activity of the metabolites of A. nidulans from N. arbor-tristis on three human cancer cell lines, lung (NCI-H460), breast (MCF-7) and uterine cervix (HeLa), and carry out their characterization. METHODS: The extracts of the endophytic fungus cultured on potato dextrose agar were subjected to various chromatographic techniques. Structures of pure compounds were determined using spectroscopic techniques. The non-polar constituents were analyzed by GC-MS. Antiproliferative activity was determined by sulforhodamine B (SRB) assay. RESULTS: The extracts and fractions showed moderate to good growth inhibition of the aforementioned human cancer cell lines. The broth extract was most potent (IC50 = 10 ± 3.1 µg/mL and LC50= 95 ± 3.9) against HeLa whereas petroleum ether insoluble fraction of mycelium was most active against NCI-H460 and MCF-7 (IC50 = 10 ± 2.1 µg/mL and 18 ± 3.1 µg/mL respectively). GC-MS led to identify 12 compounds in mycelium and 19 compounds in broth. Four pure compounds were isolated and characterized one compound 5, 10-dihydrophenazine-1-carboxylic acid (1) from broth and three 1-hydroxy-3-methylxanthone (2), ergosterol (3) and sterigmatocystin (4) from mycelium. 1 has not been reported earlier as a plant/fungal metabolite while 2-4 are new from this source. Sterigmatocystin exhibited growth inhibitory effect (IC50 = 50 ± 2.5 µM/mL) against only MCF-7 cell line whereas other compounds had IC50 > 100. CONCLUSIONS: In this paper, the cytotoxicity of mycelium and broth constituents of endophytic fungus Aspergillus nidulans from Nyctanthes arbor-tristis is reported for the first time. The study shows that fungus Aspergillus nidulans from Nyctanthes arbor-tristis is capable of producing biologically active natural compounds and provides a scientific rationale for further chemical investigations of endophyte-producing natural products.

Effect of seed pelleting with biocontrol agents on growth and colonisation of roots of mungbean by root-infecting fungi.

BACKGROUND: Mungbean (Vigna radiata (L.) Wilczek) is a leguminous pulse crop that is a major source of proteins, vitamins and minerals. Root-infecting fungi produce severe plant diseases like root rot, charcoal rot, damping-off and stem rot. The soil-borne pathogens can be controlled by chemicals, but these chemicals have several negative effects. Use of microbial antagonist such as fungi and bacteria is a safe, effective and eco-friendly method for the control of many soil-borne pathogens. Biological control agents promote plant growth and develop disease resistance. Application of bacteria and fungi as seed dressing suppressed the root-infecting fungi on leguminous crops. RESULTS: Seeds of mungbean were pelleted with different biocontrol agents to determine their effect on plant growth and colonisation of roots by root-infecting fungi, viz. Fusarium solani, Macrophomina phaseolina, Pythium aphanidermatum, Rhizoctonia solani and Sclerotium rolfsii. Treatment of mungbean seeds with fungal antagonists showed more shoot and root length as compared to bacterial antagonists, whereas seed treated with bacterial antagonists showed maximum shoot and root weight. Trichoderma harzianum and Bacillus subtilis were the best among all the biocontrol agents since they provided the highest plant growth and greater reduction in root colonisation by all root-infecting fungi. Bacillus cereus, Trichoderma virens, Pseudomonas fluorescens and Micrococcus varians were also effective against root-infecting fungi but to a lesser extent. T. harzianum, T. virens, B. subtilis and P. fluorescens were found to be best among all biocontrol agents. CONCLUSION: The root-infecting fungi can be controlled by pelleting seeds with biocontrol agents as it is safe and effective method. Additionally, plant growth was promoted more by this method. © 2015 Society of Chemical Industry.

Comparison between Double J (DJ) Ureteral Stenting and Percutaneous Nephrostomy (PCN) in Obstructive Uropathy.

OBJECTIVE: To compare the complications rate of percutaneous nephrostomy and double J ureteral stenting in the management of obstructive uropathy. METHODOLOGY: Total number of 300 patients of age 20-80 years who underwent JJ stenting or percutaneous nephrostomy for obstructive uropathy were included in this study. Patients were divided in two groups i.e. A & B. In group A, 100 patients who underwent double J ureteral stenting while in group B, 200 patients who underwent percutaneous nephrostomy tube insertion were included. The stent was inserted retrograde by using cystoscope, under mild sedation or local anesthesia. While the percutaneous nephrostomy was done under ultrasound guidance by using local anesthetic agent. Complications were noted in immediate post-operative period and on follow up. RESULTS: Majority of the patients were between 36 to 50 years of age with male to female ratio was 2.6:1. The most common cause of obstructive uropathy was stone disease i.e. renal, ureteric or both. Post DJ stent, complications like painful trigon irritation, septicemia, haematuria and stent encrustation were seen in 12.0%, 7.0%, 10.0% and 5.0% patients respectively. On the other hand, post-PCN septicemia, bleeding and tube dislodgment or blockage was seen in 3.5%, 4.5% and 4.5% respectively. In this study, overall success rate for double J stenting was up to 83.0% and for percutaneous nephrostomy (PCN) was 92.0% (p<0.0001). CONCLUSION: Percutaneous nephrostomy is a safe and better method of temporary urinary diversion than double J stenting for management of obstructive uropathy with lower incidence of complications.

Robotic-assisted radical cystectomy.

OBJECTIVE: To evaluate the emerging role of robotic-assisted radical cystectomy (RARC) in the management of bladder cancer. METHODS: Review of the published literature on robotic-assisted radical cystectomy, including data from our cystectomy series of 30 patients. RESULTS: Nearly 150 procedures have been performed worldwide. The benefits of robotic-assisted operations are similar to those of laparoscopically-performed procedures. RARC appears to be technically safe, oncologically and functionally equivalent to open (ORC) and laparoscopic radical cystectomy (LRC). However, RARC offers superior ergonomics and better vision. These benefits come at extra initial capital expenditure and subsequent higher maintenance costs. CONCLUSION: With the rapid spread of robotics, it is likely that RARC will become the standard of care in units with access to the technology.

Injection sclerotherapy for haemorrhoids causing adult respiratory distress syndrome.

A young lady with first-degree haemorrhoids was administered injection sclerotherapy with 5% phenol in almond oil. Soon after the injection, she developed syncope and later signs and symptoms of acute respiratory distress syndrome (ARDS). She was kept on ventilatory support for 4 days, made a smooth recovery and was successfully weaned off from the ventilator.

Primary non-Hodgkin's lymphoma of vagina associated with pregnancy.

We report a case of non-Hodgkin's lymphoma (NHL) in 23 years old, 36 weeks pregnant female, who presented with a swelling in the vagina. Biopsy of the lesion led to profuse haemorrhage and emergency caesarean-section along with bilateral ligation of internal iliac arteries were required. Recovery was smooth and she was discharged from the hospital on the 5th postoperative day. Histopathology revealed non-Hodgkin's lymphoma, diffuse large B cell type (DLBCL). Further treatment by medical oncologist led to complete resolution of the tumour at three months.

Hernia uterine inguinale.

A case of hernia uterine inguinale (HUI) is reported in a middle aged man, who had presented with an inguinal hernia. On exploration, a uterus with cervix, fallopian tubes and ovotestes were detected and confirmed on histopathology. Chromosomal analysis revealed 46 XY.

A huge malignant triton tumour.

A 45 years old man presented with progressively increasing abdominal mass of two years duration. The mass had rapidly increased in size in the past five months. The patient was emaciated, with a grossly protuberant abdomen. The biopsy revealed fibrosarcoma. Extirpation of the tumour was contemplated. A huge 82 x 53 x 32 cm retroperitoneal mass was removed and the histopathology confirmed it as malignant triton tumour.

Massive splenic hydatid cyst.

Hydatid disease can involve any organ of the body and a high suspicion of this disease is justified in endemic regions. A case of massive splenic hydatid cyst with hepatic hydatidosis presented with 5 years history of abdominal distension with discomfort is reported. Clinically she had massive splenomegaly with hepatomegaly. Laboratory and radiological findings were diagnostic of hydatid disease of the liver and spleen. Peroperatively huge (35 x 20 cm) splenic hydatid cyst with two liver cysts was seen. Splenectomy was performed and hepatic lesions were subjected to endocystectomy with capsulorrhaphy.

Male pseudohermaphroditism.

An unusual case of a 40-year-old infertile male is presented. On examination he had cryptorchidism with other normal secondary sexual characters. Ultrasonography and computerized tomography raised the suspicion of tumour in the right abdominal testis. On exploration, a uterus with cervix, fallopian tubes and abdominal testes were detected. This was confirmed histopathologically. Chromosomal analysis revealed 46XY.

Follicular carcinoma thyroid in Pendred syndrome.

Pendred syndrome is a rare inherited disorder of bilateral sensorineural deafness with goitre. Presence of follicular carcinoma thyroid makes it even rarer. A case of a young girl is described with the features of Pendred syndrome and euthyroid state. Follicular carcinoma of thyroid was detected on histopathology requiring re-tailoring of the management.

Management of vascular trauma.

OBJECTIVE: To characterize the vascular injuries, their management and the results. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of General Surgery, Combined Military Hospital, Kharian Cantonment, between October 2000 and October 2003. SUBJECTS AND METHODS: Cases of vascular injuries received at the hospital amongst the total of 3134 trauma patients were evaluated. Thirty six cases with 41 vascular lesions were evaluated, excluding the three primary amputations. Vascular injuries were then characterized by age, gender, site, mechanism, associated injuries, need and type of surgery. RESULTS: Penetrating trauma accounted for 94.4% of all vascular admissions. Five percent of the vascular injuries developed complications. Surgical intervention was required in all cases (100%). Reverse saphenous vein graft was used in 82.9%. The injured veins were mostly ligated except one, which was managed by saphenous vein graft. The average time lapsed between injury and intervention of patients ranged between 2 to 18 hours. No mortality or secondary haemorrhage was documented. CONCLUSION: Vascular trauma represents a small percentage of all trauma admissions. It has a high morbidity and most require surgical intervention. The operative intervention rates are higher in patients with vascular injuries than in the general trauma population but with prompt surgery, the chances of limb salvage increases and the overall complication rate reduces.