Bronchiolitis obliterans as a long-term sequela of Stevens-Johnson syndrome and toxic epidermal necrolysis in children.

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are characterized by widespread skin and mucosal blistering and necrosis. The triggers and long-term sequelae in children may differ from those reported for adults. Bronchiolitis obliterans (BO) is an uncommon complication, with only 15 previously reported cases, but can lead to significant long-term morbidity, requiring lung transplantation in some cases. We report three children with nondrug-related SJS (n = 1) and TEN (n = 2) who developed BO. Two were treated with intravenous immunoglobulin therapy (2-2.4 g/kg) and all three survived. We highlight salient learning points from our cases and potential pitfalls in diagnosis of BO, including delayed onset, and we also review the literature.

Variation of Stable Carbon and Nitrogen Isotopic Composition of PM10 at Urban Sites of Indo Gangetic Plain (IGP) of India.

This paper presents the variation of elemental concentrations of total carbon (TC), total nitrogen (TN) and isotopic ratios of δ13C and δ15N along with δ13OC and OC of PM10 mass over Delhi, Varanasi and Kolkata of the Indo Gangetic Plain (IGP), India. For Delhi, the average concentrations of TC and TN of PM10 were 53.0±33.6 and 14.9±10.8 µg m(-3), whereas δ13C and δ15N of PM10 were -25.5±0.5 and 9.6±2.8‰, respectively. For Varanasi, the average values of δ13C and δ15N of PM10 were -25.4±0.8 and 6.8±2.4‰, respectively. For Kolkata, TC and TN values for PM10 ranged from 9.1-98.2 to 1.4-25.9 µg m(-3), respectively with average values of 32.6±24.9 and 9.3±8.2 µg m(-3), respectively. The average concentrations of δ13C and δ15N were -26.0±0.4 and 7.4±2.7‰, respectively over Kolkata with ranges of -26.6 to -24.9‰ and 2.8±11.5‰, respectively. The isotopic analysis revealed that biomass burning, vehicular emission and secondary inorganic aerosols were likely sources of PM10 mass over IGP, India.

Dissolved methane in Indian freshwater reservoirs.

Emission of methane (CH4), a potent greenhouse gas, from tropical reservoirs is of interest because such reservoirs experience conducive conditions for CH4 production through anaerobic microbial activities. It has been suggested that Indian reservoirs have the potential to emit as much as 33.5 MT of CH4 per annum to the atmosphere. However, this estimate is based on assumptions rather than actual measurements. We present here the first data on dissolved CH4 concentrations from eight freshwater reservoirs in India, most of which experience seasonal anaerobic conditions and CH4 buildup in the hypolimnia. However, strong stratification prevents the CH4-rich subsurface layers to ventilate CH4 directly to the atmosphere, and surface water CH4 concentrations in these reservoirs are generally quite low (0.0028-0.305 µM). Moreover, only in two small reservoirs substantial CH4 accumulation occurred at depths shallower than the level where water is used for power generation and irrigation, and in the only case where measurements were made in the outflowing water, CH4 concentrations were quite low. In conjunction with short periods of CH4 accumulation and generally lower concentrations than previously assumed, our study implies that CH4 emission from Indian reservoirs has been greatly overestimated.

Antimicrobial susceptibility, risk factors and prevalence of bla cefotaximase, temoneira, and sulfhydryl variable genes among Escherichia coli in community-acquired pediatric urinary tract infection.

INTRODUCTION: The emergence of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli has become an important challenge among pediatric patients with community-acquired urinary tract infection (UTI). OBJECTIVES: The aim of this study was to assess the antimicrobial susceptibility patterns, associated risk factors and to survey the frequency of bla cefotaximase (CTX-M), bla temoneira (TEM), and bla sulfhydryl variable (SHV) genotypes in ESBL-producing E. coli isolated from children with community-acquired UTI. METHODS: This was a prospective study conducted from November 2012 to March 2016 in a tertiary care center. E. coli isolated in urine cultures from children aged ≤18 years was identified and confirmed for ESBL production. ESBL-positive strains were screened for ESBL encoding genes. Chi-square test and Fisher's exact test were used to compare the difference in antibiotic susceptibility with respect to ESBL positive and negative, and binary logistic regression was used to identify the risk factors associated with ESBL production. RESULTS: Among 523 E. coli isolates, 196 (37.5%) were ESBL positive, >90% were resistant to cephalosporins, and 56% were resistant to fluoroquinolones. Least resistance was observed for imipenem, netilmicin, and nitrofurantoin (2%, 8.6%, 15.3%). Association between ESBL production and drug resistance was significant for ceftazidime (P < 0.001), cefixime (P < 0.001), cefotaxime (P = 0.010), ceftazidime-clavulanic acid (P < 0.001), levofloxacin (P = 0.037), and gentamicin (P = 0.047) compared to non-ESBL E. coli. CTX-M gene was the most prevalent (87.5%), followed by TEM (68.4%) and SHV (3.1%). Previous history of UTI and intake of antibiotics were the common risk factors. CONCLUSION: ESBL-producing E. coli from community-acquired pediatric UTI carries more than one type of beta-lactamase coding genes correlating their increased antibiotic resistance. Aggressive infection control policy, routine screening for detecting ESBL isolates in clinical samples, and antimicrobial stewardship are the keys to prevent their dissemination in community settings.

Spatial variations of DMS, DMSP and phytoplankton in the Bay of Bengal during the summer monsoon 2001.

Data on the distribution of dimethylsulphide (DMS) and dimethylsulphoniopropionate (DMSP) in relation to phytoplankton abundance in different oceanic environments is important to understand the biogeochemistry of DMS, which plays an important role in the radiation balance of the earth. During the summer monsoon of 2001 measurements were made for DMS and DMSPt (total DMSP) together with related biological parameters in the Bay of Bengal. Both DMS and DMSPt were restricted to the upper 40 m of the water column. Diatoms accounted for more than 95% of the phytoplankton and were the major contributors to the DMS and DMSPt pool. The mean concentration of DMS in the upper 40 m was observed to be around 1.8+/-1.9 nM in the study area, while DMSPt concentrations varied between 0.7 nM and 40.2 nM with a mean of 10.4+/-8.2 nM. The observed lower DMSPt in the northern Bay in spite of higher mean primary productivity, chlorophyll a and phytoplankton cell counts seemed to result from grazing. Though salinity divides the Bay into different biogeochemical provinces there is no relation between salinity and DMS or DMSPt. On the other hand DMS was linearly related to chlorophyll a:phaeopigments ratio. The results suggest the need for deeper insight into the role of diatoms in the biogeochemical cycling of DMS.

Acoustic realignment of nematic liquid crystals.

In a nematic liquid-crystal cell, the molecules can be realigned by an ultrasonic wave, leading to a change in the optical transmission through the cell. We present a model for this acousto-optic effect, and show that the magnitude of this effect is controlled by a director-density coupling. We then measure the optical transmission as a function of acoustic intensity for three liquid-crystal materials, and confirm that the data fit the functional form of the theoretical prediction. This fit gives the value of the director-density coupling, which varies greatly from material to material.

Temporal variations in dimethylsulphoniopropionate and dimethyl sulphide in the Zuari estuary, Goa (India).

Despite tropical estuarine systems representing important sites for active biogeochemical processes, studies on dimethyl sulphide (DMS) in these systems are sparse. Here we report on DMS and dimethylsulphoniopropionate (DMSP) variability in relation to physicochemical and biological parameters for a period of 14 months in a tropical estuarine environment. DMS and DMSP showed high temporal variations with maximal concentrations during the southwest monsoon coinciding with a dinoflagellate bloom. Dinoflagellates appear to be the major contributors to the DMSP pool. Average DMS and DMSP concentrations (surface and bottom) suggested that much of the DMSP produced is converted to forms other than DMS. Surface DMS varied between 0.3 and 15.4 nmol dm(-3) while DMSP ranged from 0.8 to 419.5 nmol dm(-3). The DMS flux was 0.03-1.9 microM m(-2) d(-1) (average=0.6 microM m(-2) d(-1)) during the study period, that concurs well with the values reported for temperate estuaries.

Single-dose oral treatment of vaginal trichomoniasis with tinidazole and metronidazole.

Sixty cases of trichomonal vaginitis were randomly allocated to treatment with tinidazole or metronidazole, both administered as a 2 g single dose. One patient on tinidazole did not complete her follow-up. Parasitological cure was obtained in all patients in both the treatment groups. A satisfactory clinical response was obtained in all 29 patients on tinidazole, and in 27 out of 30 (90%) on metronidazole. Complete relief of sumptoms was obtained in 62% (18/29) and 13% (4/30) of patients ontinidazole and metronidazole, respectively (p less than 0.01). Ten patients on tinidazole and 24 on metronidazole manifested side-effects. The frequency and severity of side-effects were much more in the metronidazole group (p less than 0.01). Tinidazole has distinct advantages over metronidazole in the one-dose treatment of trichomonal vaginitis.

Calcified hypernephroma. A case report.

Pattern of classification in an renal neoplasm is variable. If calcium is located nonperipherally (within the mass) it is more likely to be a renal cell carcinoma. But peripheral calcification does not rule out malignancy.

Polyradiculopathy in a patient of systemic lupus erythematosus.

The relationship of the neurological manifestations to the lupus disease process is not always clear. We present a case of systemic lupus erythematosus (SLE) with subacute onset muscle weakness, which was due to polyradiculopathy, a rarely described neurological manifestation of SLE.

Seasonal variation in the incidence of hyponatremia.

AIM: To study the seasonal variation in the incidence of hyponatremia and to correlate it with the rainfall pattern. METHOD: Retrospective analysis of patients having serum sodium of less than 120 meq/L was done during the 24 months from March, 1995. Patients with fever, renal failure, cardiac failure, cirrhosis, hyperlipidemia, hyperproteinemia, patients taking diuretics and postoperative patients were also excluded. Average inpatient number and rainfall for each month was noted. Daily incidence of hyponatremia was expressed as percentage of total inpatients for each day and was compared with the rainfall. RESULTS: A total of 353 patients had hyponatremia during the two years from March, 1995; 174 cases during the first year and 179 during the second year. Average inpatient strength was 302.17 +/- 21.41 during the first year and 313.67 +/- 12.94 during the next year. The incidence of hyponatremia was 0.24 +/- 0.096% between June and August and 0.1 +/- 0.04% between December and February (95% confidence interval 0.045-0.235, p < 0.01). Statistically significant correlation was observed between rainfall pattern and hyponatremia, r = 0.711, 95% confidence interval 0.478-0.913, p = 0.01 during 95-96 and r = 0.825, 95% confidence interval 0.478-0.949, p < 0.001, during 96-97. CONCLUSION: Incidence of hyponatremia is higher during the peak southwest monsoon season with similar pattern for the study period of two years. Humidity and temperature may have important role in the manifestation of hyponatremia.

Blood sugar profile in diabetics receiving plain insulin.

Blood sugar profile was studied by checking multiple plasma venous samples at 1/2 hr interval after porcine plain insulin. Mean blood sugar was the highest (198.8 +/- 24.6 mg%) at 1 1/2 hrs and the lowest (86.3 +/- 18.4) at 4 1/2 hrs after breakfast. 52% of the patients had hypoglycemias between 4 and 5 hrs. It is recommended that pre-lunch blood sugar be checked in those receiving plain insulin.

Distribution of malarial parasites: effect of gender of construction workers.

The city of Mangalore in South India was having increasing number of malaria cases from 1990. Concerned over the import of cases through migrant construction workers, a screening was done among them using clinical and parasitological methods. This demonstrated 6.28% slide positivity rate with statistically insignificant difference in prevalence of infection between males and females. There were many asymptomatic individuals reporting positive only on peripheral smear examination. Yet, clinical symptoms like fever were found to have good predictive value on logistic regression. It was more so with the P. falciparum which is a relatively new entrant to Mangalore.

The influence of kinesiophobia on trunk muscle voluntary responses with pre-programmed reactions during perturbation in patients with chronic low back pain.

The purpose of this study was to examine the relation between fear of movement and perturbation induced electromyographic global trunk muscle voluntary responses with pre-programmed reactions among persons with chronic low back pain (CLBP). CLBP subjects (n = 25) were challenged to unexpected and expected perturbations on stable and unstable surfaces. 'Tampa scale for kinesiophobia - Adjusted version-13' was used to measure kinesiophobia. Regression analysis revealed significant negative correlation between kinesiophobia scores and voluntary responses of rectus abdominis (RA) for unexpected perturbations on stable (r = -0.69, 95% of CI: -0.85 to -0.40, p < 0.000, r(2) = 0.41) and unstable surfaces (r = -0.47, 95% of CI: -0.72 to -0.09, p < 0.018, r(2) = 0.29). The activity of erector spinae was not influenced by most of testing conditions in the study except task on unstable surface for expected perturbation (r = -0.593, 95% of CI: -0.8 to -0.25, p = 0.002, r(2) = 0.15). RA activity and kinesiophobia score of the CLBP population was significantly inversely associated during anteriorly directed unexpected perturbations. In our study, the significant association between fear of movement and the trunk muscle responses was differentially influenced by expected and unexpected postural demands.

The magnitude of pre-programmed reaction dysfunction in back pain patients: experimental pilot electromyography study.

BACKGROUND: Preprogrammed reactions (PPR) appear at a latency of higher than 40 ms, but before the voluntary muscle responds (approximately 120 ms) to postural perturbations. OBJECTIVE: To examine the difference in magnitude of preprogrammed reactions in patients with chronic low back pain (CLBP) and without low back pain. METHODS: we analyzed electromyographic Root Mean Square (RMS) amplitudes of asymptomatic (n=25) and CLBP patients (n=25) on stable and unstable surfaces during expected and unexpected perturbations for rectus abdominus and erector spinae muscles. The mean PPR and PPR-combined voluntary response RMS amplitudes (VRPPR) were compared between the two groups. To find the presence of PPR in LBP patients, a criteria was set that the obtained PPR RMS amplitude value should exceed 60% mean reflex RMS amplitude that occur within 50 ms after perturbation. RESULTS: Fleiss' kappa revealed a good agreement (kappa = 0.7 to 0.9) among raters for absence of PPR in patients with CLBP and presence of PPR in asymptomatic population. The two way ANOVA revealed significantly different mean PPR and VRPPR RMS amplitudes between asymptomatic and LBP population for rectus abdominus and erector spinae muscles (p<0.05). CONCLUSION: PPR responses were found absent (<60% of Mean Reflex RMS) in patients with CLBP. Further, patients with CLBP demonstrated lower PPR amplitudes with higher peak voluntary responses compared to asymptomatic population, indicating difficulties in presetting of voluntary responses for regaining postural stability after perturbation.