Geophysical characterization of Saraswati River palaeochannel in parts of Yamuna Nagar and Kurukshetra districts of Haryana, India.

Palaeochannels are remnants of rivers or stream channels filled with younger sediments over the period of time. In ancient times, these rivers/channels were thriving in phenomenal conditions, but due to frequent tectonic activities, they lost the direction of their original path and were gradually either lost or buried under thick beds of younger alluvium. Palaeochannels act as reservoirs for fresh groundwater since they are made up of coarser sediments and were formerly flowing rivers. Depending on the groundwater regime and local topography, these could either be saturated or dry. The palaeochannels have high groundwater potential if saturated. These are ideal sites for artificial groundwater recharge, if dry. The identification of palaeochannels becomes quite challenging if they are buried under thick deposits of finer younger sediments. In the present study, an attempt has been made to characterize the Saraswati River Palaeochannel in parts of Yamuna Nagar and Kurukshetra districts of Haryana by using surface and subsurface geophysical methods. Till date, the palaeochannels in this area were mainly discerned on the basis of remote sensing only; therefore, geophysical characterization of these palaeochannels has been attempted in this study. In surface geophysical methods, electrical resistivity surveys, especially gradient resistivity profiling (GRP) and vertical electrical sounding (VES), were conducted in the study area, while electrical and natural gamma logging was used as subsurface geophysical approaches to identify the coarser sands of buried palaeochannels. The main objective of the study was to characterize the Saraswati River palaeochannel and analyze the quality of the groundwater stored in the palaeochannel in the study area. The findings were compared with the well-log data and were found in good agreement.

Plasmablastic transformation of chronic lymphocytic leukemia: a review of literature and report on 2 cases.

Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is the most common leukemia in adults in Western countries. Transformation of CLL/SLL to plasmablastic lymphoma (PBL) is exceedingly rare and often has an extremely poor response to treatment. A thorough molecular workup may help in determining clonality-relatedness and prognosis. We describe two cases of CLL/SLL that transformed into PBL, with an extensive molecular workup in one case, and a review of the literature.

An Automated Pipeline for Differential Cell Counts on Whole-Slide Bone Marrow Aspirate Smears.

The pathologic diagnosis of bone marrow disorders relies in part on the microscopic analysis of bone marrow aspirate (BMA) smears and the manual counting of marrow nucleated cells to obtain a differential cell count (DCC). This manual process has significant limitations, including the analysis of only a small subset of optimal slide areas and nucleated cells, as well as interobserver variability due to differences in cell selection and classification. To address these shortcomings, we developed an automated machine learning-based pipeline for obtaining 11-component DCCs on whole-slide BMAs. This pipeline uses a sequential process of identifying optimal BMA regions with high proportions of marrow nucleated cells, detecting individual cells within these optimal areas, and classifying these cells into 1 of 11 DCC components. Convolutional neural network models were trained on 396,048 BMA region, 28,914 cell boundary, and 1,510,976 cell class images from manual annotations. The resulting automated pipeline produced 11-component DCCs that demonstrated a high statistical and diagnostic concordance with manual DCCs among a heterogeneous group of testing BMA slides with varying pathologies and cellularities. Additionally, we demonstrated that an automated analysis can reduce the intraslide variance in DCCs by analyzing the whole slide and marrow nucleated cells within all optimal regions. Finally, the pipeline outputs of region classification, cell detection, and cell classification can be visualized using whole-slide image analysis software. This study demonstrates the feasibility of a fully automated pipeline for generating DCCs on scanned whole-slide BMA images, with the potential for improving the current standard of practice for utilizing BMA smears in the laboratory analysis of hematologic disorders.

Comparison of Rates of Fast and Catastrophic Visual Field Loss in Three Glaucoma Subtypes.

Purpose: To compare the distribution of visual field progression rates in three subgroups of glaucoma, being primary angle-closure glaucoma (PACG), POAG, and juvenile open-angle glaucoma (JOAG). Methods: We assessed glaucoma patients treated in an Indian tertiary care setting with at least four visual field assessments. We determined rates from a single eye of each of 525 patients using linear regression of the summary index mean deviation (MD) over time. The main outcome measures were the proportions of fast (<-1.0 to -2.0 dB/y) and catastrophic (<-2 dB/y) visual field progression. Bootstrapped 95% CIs allowed comparison with published data from a large clinical cohort in Canada. Results: The combined proportion of fast and catastrophic progressors in our cohort was less than half that in the Canada dataset (2.3% vs. 5.8%), despite median progression rates differing by only 0.03 dB/y. PACG, POAG, and JOAG represented 45%, 32%, and 12% of our cohort, respectively. Baseline MD values were similarly distributed between these subtypes. All subtypes showed a similar shaped distribution for progression rates, with median progression rates of -0.03, -0.05, and 0.02 dB/y for PACG, POAG, and JOAG, respectively. Combined proportions of fast and catastrophic progression rates did not significantly differ between subtypes. Conclusions: Differences in fast and catastrophic visual field progression can exist despite only small changes in median progression rates, highlighting the importance of considering the full shape of the progression rate distribution when comparing the risk of devastating visual field loss.

Disaster management in flash floods in leh (ladakh): a case study.

BACKGROUND: On August 6, 2010, in the dark of the midnight, there were flash floods due to cloud burst in Leh in Ladakh region of North India. It rained 14 inches in 2 hours, causing loss of human life and destruction. The civil hospital of Leh was badly damaged and rendered dysfunctional. Search and rescue operations were launched by the Indian Army immediately after the disaster. The injured and the dead were shifted to Army Hospital, Leh, and mass casualty management was started by the army doctors while relief work was mounted by the army and civil administration. OBJECTIVE: The present study was done to document disaster management strategies and approaches and to assesses the impact of flash floods on human lives, health hazards, and future implications of a natural disaster. MATERIALS AND METHODS: The approach used was both quantitative as well as qualitative. It included data collection from the primary sources of the district collectorate, interviews with the district civil administration, health officials, and army officials who organized rescue operations, restoration of communication and transport, mass casualty management, and informal discussions with local residents. RESULTS: 234 persons died and over 800 were reported missing. Almost half of the people who died were local residents (49.6%) and foreigners (10.2%). Age-wise analysis of the deaths shows that the majority of deaths were reported in the age group of 25-50 years, accounting for 44.4% of deaths, followed by the 11-25-year age group with 22.2% deaths. The gender analysis showed that 61.5% were males and 38.5% were females. A further analysis showed that more females died in the age groups <10 years and ≥50 years. CONCLUSIONS: Disaster preparedness is critical, particularly in natural disasters. The Army's immediate search, rescue, and relief operations and mass casualty management effectively and efficiently mitigated the impact of flash floods, and restored normal life.

D-dimer in the diagnostic workup of suspected pulmonary thrombo-embolism at high altitude.

BACKGROUND: Pulmonary thrombo-embolism (PTE) is relatively common in high altitude areas where radiological diagnostic facilities are usually not available. So this study was undertaken to use the results of D-dimer assay to determine the need for imaging studies in patients suspected of having PTE at high altitude. METHODS: A total of 101 patients at an altitude of > 3,000 m suspected of having PTE were evacuated. D-dimer and imaging studies were carried out to confirm the diagnosis. RESULTS: A total of 101 patients suspected of having PTE underwent D-dimer level estimation and imaging studies for PTE. Sixty-eight of these had negative findings) on D-dimer assay. All these patients with negative findings on D-dimer assay had negative findings on pulmonary imaging studies also. So this test is very sensitive with very high negative predictive value (NPV). Whereas, 17 out of 33 patients positive for D-dimer, had positive findings on imaging studies, indicating a relatively less specific test. CONCLUSION: Clinical assessment in combination with D-dimer assay can be used for timely differentiation of PTE from other conditions such as high altitude pulmonary oedema (HAPO) especially at isolated high altitude areas/military posts, so that patients could be evacuated as early as possible by fastest means to save the precious lives and in hospital settings this test identifies patients to whom anticoagulant therapy should not be given or patients who should not be subjected to invasive imaging tests.

Retinal vein occlusion in high altitude.

Staying at high altitude has been reported to be associated with thrombosis in lowlanders. We report 3 cases of retinal vein occlusion in high altitude. Two were males 31 and 37 years of age, who developed nonischemic central retinal vein occlusion while staying at high altitude. The former developed central retinal vein occlusion after 90 days at 6309 m, while the latter was affected at an altitude of 3353 m where he had been for the past 1 year and had recurrence of central retinal vein occlusion in the other eye on re-entry to the same altitude. The third case is that of a 40-year-old female who developed inferotemporal branch retinal vein occlusion on the second day after entry into high altitude (3353 m) by air, while ascending further in a vehicle at an altitude of approximately 4572 m. All three did not have any systemic disease and showed complete recovery on descent to a lower altitude.