Exploring the utility of EUS in Budd-Chiari syndrome: a multicenter multiobserver prospective cohort study.

BACKGROUND AND AIMS: The diagnosis of Budd-Chiari syndrome (BCS) is essentially radiologic and is needed to plan appropriate therapy. We therefore conducted this proof of concept study to assess the utility of EUS in assessing the anatomy of BCS. METHODS: This prospective, multicenter, observational study enrolled 50 consecutive patients with a diagnosis of BCS. All patients underwent a detailed EUS examination by 3 independent endosonographers, blinded to the anatomic details of BCS and others' findings. The EUS examination was compared between the endosonographers and with conventional angiography (where available) or magnetic resonance venography (MRV). Outcomes assessed were interobserver agreement, sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy in diagnosing pathologic lesions of BCS. RESULTS: Fifty BCS patients (mean age, 34 years [range, 13-65]) underwent EUS. Results showed good agreement among endosonographers for diagnosing right hepatic vein (κ = .716) and left hepatic vein lesions (κ = .722), moderate agreement for middle hepatic vein lesions (κ = .660), and very good agreement for inferior vena cava (IVC) lesions (κ = .823). EUS demonstrated high sensitivity and positive predictive value, low interobserver variability, and overall diagnostic accuracy for BCS lesions. CONCLUSIONS: EUS is a safe and accurate diagnostic tool for BCS. It can provide accurate mapping of hepatic veins, intrahepatic collaterals, and the IVC.

Plant and yeast consortium for efficient remediation of dyes and effluents: a biochemical and toxicological study.

Textile effluent carries a range of dyes that may be recalcitrant and resistant to biodegradation. A unique consortium of the Fimbristylis dichotoma and Saccharomyces cerevisiae is exploited for the biodegradation of an azo dye Rubine GFL and actual textile effluent. This consortium enhances the rate of biodegradation of Rubine GFL and actual textile effluent with an excellent rate of biodegradation of 92% for Rubine GFL and 68% for actual textile effluent when compared to the individual one within 96 h. Speedy decolorization of Rubine GFL and actual textile effluent was observed due to the induction of oxido-reductive enzymes of the FD-SC consortium. Along with the significant reduction in the values of COD, BOD, ADMI, TSS, and TDS with 70, 64, 65, 41, and 52%, respectively, in experimental sets treated with FD-SC consortium. The biodegradation of Rubine GFL was confirmed with UV-Vis spectroscopy at the preliminary level, and then, metabolites formed after degradation were detected and identified by FTIR, HPLC, and GC-MS techniques. Also, decolorization of the dye was observed in the sections of the root cortex of Fimbristylis dichotoma. The toxicity of dye and metabolites formed after degradation was assessed by seed germination and bacterial count assay, where increased germination % and bacterial count from 31×107CFUs to 92 × 107 CFUs reflect the nontoxic nature of metabolites. Furthermore, the nontoxic nature of metabolites was confirmed by fish toxicity on Cirrhinus mrigala showed normal structures of fish gills and liver in the groups treated with FD-SC consortium proving the better tactic for biodegradation of dyes and textile effluent.

Assessment of Epidemiology and Clinical Profile of Psoriatic Arthritis Patients in India.

BACKGROUND: Psoriasis is an inflammatory skin disease associated with significant comorbidity. However, the characteristics of patients with psoriasis are not well documented in India, and a more detailed understanding is needed to delineate the epidemiologic profile at the regional level for better management of psoriasis. Herein, we reported the clinical profile and demographic pattern of psoriasis to further understand its burden in the Indian setting. METHODS: We conducted a retrospective observational study of patients diagnosed with psoriasis who fulfilled the classification criteria for psoriatic arthritis (CASPAR) criteria. Patients were included from the rheumatology outpatient department of Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute in Mumbai, India. The outcomes included demographic and clinical profiles, patterns of joint involvement, and comorbidities associated with psoriasis. A p-value of <0.05 was considered significant. RESULTS: We enrolled 60 patients, with a mean age of 50.87 years and a higher proportion of females (62%). The majority of patients with less than five joints had associated comorbidities (40 out of 60). Psoriatic arthritis (PsA) occurred in 41 patients [mean ± standard deviation (SD) age of onset-38.88 ± 13.24 years], with the highest occurrence in the 30-50 years (53.3%). The majority of patients with PsA developed it within 2 to ≥5 years of psoriasis occurrence. We did not find any significant correlation between the occurrence of PsA and comorbidities, as well as the duration of PsA and the number of joints (p = 0.152). Pitting and enthesitis were the most common morphological changes noted in almost half of the patients. CONCLUSION: Our study provides an overview of the epidemiologic and clinical characteristics of psoriasis patients in India. These findings could be useful for early diagnosis of PsA and help clinicians in assessing the progression of psoriasis into PsA.

Cardiac uptake patterns in routine 18F-FDG PET-CT scans: A pictorial review.

Broad variability of 18F-Fluoro-2-deoxyglucose (FDG) uptake is noted in myocardium while performing FDG PET-CT scans for viability, infection, or oncologic purposes. While most of the uptakes are considered non-specific, presence of underlying cardiac disease is seldom encountered. With this presentation, our intent is to pictorially highlight the variable FDG uptake patterns associated with the normal variations, benign, and malignant disease.

Synthesis and anticancer evaluation of furfurylidene 4-piperidone analogs.

Recently different series of compounds have been designed that utilize the 1,5-diaryl-3-oxo-1,4-pentadinenyl pharmacophore for the development of novel cytotoxic and anticancer agents. These compounds interact with cellular thiols and thiols are not part of nucleic acids. Hence, these compounds are free from the problem of mutagenicity and carcinogenicity. The Claisen-Schmidt reaction is used for synthesizing furfurylidene analogs in a basic medium. The title compounds were prepared by reacting furfurylidenes with aryl sulfonyl, benzoyl, acroylyl, or acetyl chloride. The resulting synthesized compounds were screened for their in vitro cytotoxic properties by MTT and SRB assays against leukemic and colon cancer cell lines. Acute toxicity was determined by OECD-423 guidelines. The in vivo anticancer activities were evaluated against Ehrlich ascites carcinoma (EAC)-bearing Swiss albino mice. The MTT assay showed that compounds 2d and 3d have significant cytotoxicity against the Molt-4 human cell line as compared to the standard, 5-fluorouracil. In addition, the SRB assay indicated that the compounds 2, 2a, 2d, and 3d showed equipotent cytotoxicity against human leukemia cell lines as compared to the standard, doxorubicin. Compounds 2a and 2d showed significant anticancer activity against EAC in Swiss albino mice. This study revealed the potential of these molecules for further development as anticancer agents.

Potential Role of Bone Scintigraphy in the Diagnosis of Calciphylaxis.

Nonosseous abnormalities are often seen on bone scans and can be related to a wide variety of pathology ranging across vascular, infection, and inflammatory etiology. Diffuse soft tissue radiotracer uptake on bone scans is typically attributed to renal or metabolic derangements. Calciphylaxis is the deposition of calcium in small blood vessels, skin, and other organs leading to vascular obstruction and skin necrosis. It is a rare disorder with unknown pathophysiology. Diagnosis of calciphylaxis is challenging and requires an interdisciplinary approach including clinical findings, laboratory results, medical imaging, and skin biopsy. An early diagnosis is important as the disease is associated with high morbidity and mortality. The purpose of this review article is to highlight the role of bone scintigraphy in the evaluation of calciphylaxis and to correlate the findings with other imaging modalities and histopathology.

In situ treatment of real textile effluent in constructed furrows using consortium of Canna indica and Saccharomyces cerevisiae and subsequent biochemical and toxicity evaluation.

Emerging contaminants removals like dyes and heavy metals from the textile effluent have an immense challenge. The present study focuses on the biotransformation and detoxification of dyes and in situ textile effluent treatment by plants and microbes efficiently. A mixed consortium of perennial herbaceous plant Canna indica and fungi Saccharomyces cerevisiae showed decolorization of di-azo dye Congo red (CR, 100 mg/L) up to 97% within 72 h. Root tissues and Saccharomyces cerevisiae cells revealed induction of various dye-degrading oxidoreductase enzymes such as lignin peroxidase, laccase, veratryl alcohol oxidase and azo reductase during CR decolorization. Chlorophyll a, Chlorophyll b and carotenoid pigments were notably elevated in the leaves of a plant during the treatment. Phytotransformation of CR into its metabolic constituents was detected by using several analytical techniques, including FTIR, HPLC, and GC-MS and its non-toxic nature was confirmed by cyto-toxicological evaluation on Allium cepa and on freshwater bivalves. Mix consortium of plant Canna indica and fungi Saccharomyces cerevisiae efficiently treated textile wastewater (500 L) and reduced ADMI, COD, BOD, TSS and TDS (74, 68, 68, 78, and 66%) within 96 h. In situ textile wastewater treatment for in furrows constructed and planted with Canna indica, Saccharomyces cerevisiae and consortium-CS within 4 days reveals reduced ADMI, COD, BOD, TDS and TSS (74, 73, 75, 78, and 77%). Comprehensive observations recommend this is an intelligent tactic to exploit this consortium in the furrows for textile wastewater treatment.

Substitution controlled aryne insertion: synthesis of diarylmethane/chromones.

Aryne insertion reaction with 2-aroyl malonates/cyanoesters lead to the formation of diarylmethane or chromones depending on the substitution on the aryne ring. The presence of an electronegative atom at the ortho position of arynes generates chromones, whereas other arynes lead to the formation of diarylmethanes, via a cascade double aryne insertion.

When to Discharge a Patient After Endoscopy: A Narrative Review.

Video endoscopy is an important modality for the diagnosis and treatment of various gastrointestinal diseases. Most endoscopic procedures are performed as outpatient basis, sometimes requiring sedation and deeper levels of anesthesia. Moreover, advances in endoscopic techniques have allowed invasion into the third space and the performance of technically difficult procedures that require the utmost precision. Hence, formulating strategies for the discharge of patients requiring endoscopy is clinically and legally challenging. In this review, we have discussed the various criteria and scores for the discharge of patients who have undergone endoscopic procedures with and without anesthesia.

Graves' disease: A rare fate of Hashimoto's thyroiditis.

Hashimoto's thyroiditis is a known autoimmune disorder that leads to chronic inflammation of the thyroid gland, with a gradual decline in function and eventual hypothyroidism. Conversion of Hashimoto's thyroiditis to Graves' disease is unusual clinically and has been occasionally reported in the literature. Awareness of such a rare phenomenon is important for the physicians evaluating patients with autoimmune thyroid disorders. Close investigation of the patient's symptoms and biochemical status is crucial in the implementation of appropriate treatment.

A rare case of ruptured intracranial aneurysm arising from the retro-mastoid branch of the occipital artery.

BACKGROUND: Aneurysms of the occipital artery (OA) are rare, with few cases published in the literature. The pathophysiology is unknown, and the presentation is variable. We present a case of a ruptured intracranial aneurysm arising from a branch of the OA. CASE DESCRIPTION: A 36-year-old male with a history of ankylosing spondylitis presented with altered mental status after an assaulted. On examination, he was intubated, with a Glasgow coma scale of 9, and imaging of the head and neck revealed a subdural hematoma of the posterior fossa and the cervical spine. The patient underwent suboccipital craniectomy and C1-5 laminectomy with the evacuation of the subdural hematoma. Postoperative cerebral angiography showed an intracranial aneurysm arising from the retromastoid branch of the OA on the left side. Furthermore, the parent vessel of the aneurysm supplied the left lower half of the cerebellar hemisphere. The aneurysm and the parent vessel were embolized using platinum coils. The patient tolerated the procedure well, and magnetic resonance imaging of the brain showed a minor left-sided cerebellar infarct, which was asymptomatic. The patient was discharged home with a modified Rankin scale of 2. There were no outpatient follow-up data available because the patient lost to follow-up. CONCLUSION: Intracranial OA aneurysms are extremely rare with no clear consensus concerning the management of these aneurysms. They can be treated using endovascular and or open surgical techniques depending on the aneurysm characteristics, patient condition, rupture status, and others.

18F-FDG PET/CT Appearance of Plugoma.

Postsurgical anatomic alterations and placement of prosthetic materials may cause misdiagnosis, leading to unnecessary patient work-up. Reading physicians must be aware of common and uncommon postoperative imaging appearances and their pitfalls. In this case report, we present the appearance of a postsurgical hernia repair plug on PET/CT, also called plugoma or meshoma.

Synthesis of 2-Amino-2'-hydroxy-1,1'-biaryls via Cascade Benzannulation and C-N Bond Cleavage Sequence.

A serendipitous synthesis of N-substituted 2-amino-2'-hydroxy-1,1'-biaryls through an aryne annulation with indolyl ß-ketonitrile/ester in a cascade manner is demonstrated. The reaction sequence involves benzyne-mediated [2 + 2] Stoltz-type cycloaddition-cleavage and intramolecular Michael addition followed by C-N bond cleavage under transition-metal-free reaction conditions. Interestingly, while [4 + 2] Diels-Alder reaction is a possible pathway, no traces of the regioisomer was isolated.

FNAC of lymph nodes in HIV positive patients-a diagnostic boon.

OBJECTIVES: The goal of this study is to examine the fine-needle aspiration cytology (FNAC) features of lymph node lesions in human immunodeficiency virus (HIV)-positive patients and to evaluate the role of FNAC in diagnosis. This study also aims to analyze the cytological patterns and available clinicopathological parameters of FNAC. MATERIALS AND METHODS: This study was carried out in the Department of Pathology at Government Medical College Miraj and P.V.P.G.H. Sangli from August 2012 to July 2014. FNAC was conducted for all HIV-positive patients with lymphadenopathy referred into this department. A total 70 lymph nodes were aspirated from different sites in 60 HIV-positive cases. RESULTS: The mean age of presentation was 32.4 years with a male predominance (66.7%). The cervical lymph node was the most commonly involved site (70%). The most common lesion was tuberculous lymphadenitis (66.66%) followed by reactive lymphadenitis (13.33%). The most common staining pattern in acid fast bacilli (AFB)-positive tuberculous lymphadenitis was grade 1 (87.88%). The overall AFB positivity in tuberculous lymphadenitis in the present study was 82.5%. The most common cytological pattern was caseous necrosis with epithelioid cell granulomas (60%). The mean CD4 count showed an inverse relationship with increasing grade of AFB positivity. The mean CD4 count was lowest in caseous necrosis-only pattern (330.2 cells/µL). All the cases were consistent with HIV type A lymphadenopathy. Two cases of malignancy was also seen. CONCLUSIONS: FNAC is a rapid and cheap procedure that can help in establishing the diagnosis in a large number of cases. It also helps in segregating the lesions that need further evaluation. Comparison of lymph node lesions with CD4 counts, AFB grading, and hematological alterations reflects immunity, stage of disease, and disease activity, thus aiding in better treatment.

A pure primary transitional cell carcinoma of the ovary: A rare case report with literature review.

Primary transitional cell carcinoma (TCC) of the ovary is a rare and recently recognized subtype of ovarian surface epithelial-stromal cancer. Pure forms of the TCC ovary account for only 1% of surface epithelial carcinomas. The clinical presentation is indistinguishable from other types of ovarian cancers. They have a favorable response to chemotherapy than other surface epithelial cancers. We report a case of 55-year-old woman who presented with a hard mass in the abdomen. Computed tomography-diagnosed it as a carcinoma of the ovary. Tumor was immunoreactive with Wilms' tumor protein-1 and nonreactive with cytokeratin 7 (CK7) and CK20. Histopathology diagnosis of primary TCC of the ovary was made. These tumors are needed to be differentiated from metastatic TCC from other sites and undifferentiated carcinomas of ovaries. Clinical features and immunohistochemistry are helpful. Surgical resection is the primary therapeutic approach followed by standardized chemotherapy.