Cerebrospinal Fluid Lactate in Tubercular Meningitis: Diagnostic or Prognostic Marker?

Introduction/Background: Diagnosis of tubercular meningitis (TBM) continues to be a clinical challenge and available microbiological tests fail to attain the required accuracy standards. As a result, most guidelines for the diagnosis and management of TBM depend on clinical setting, cerebrospinal fluid (CSF) analyses including adenosine deaminase activity (ADA), and imaging to guide decisionmaking. Delay in diagnosis leads to high mortality and morbidity. As there is scarcity of data on CSF lactate in TBM and its role as a diagnostic and prognostic marker, study of CSF Lactate in TBM Patients was undertaken. Methods: In this hospital based cross sectional study all admitted patients of meningo-encephalitis aged more than 15 years who fulfilled the diagnostic criteria for TBM were included. Routine haematological and biochemical investigations were done in all the patients. The CSF analysis was done including all routine microscopic parameters, lactate, Gram's stain, AFB and culture. Patients included were classified as definite, probable, or possible TBM as per WHO diagnostic criteria and were classified into three clinical stages using criteria laid down by the British Medical Research Council. Results: Fifty five patients fulfilling the diagnostic criteria for tubercular meningitis were studied. Most of the patients were in stage II according to severity. An increase in CSF lactate and CSF ADA levels with increase in severity of clinical stage of TBM was observed. Other CSF parameters and imaging were not significantly different in various groups. Conclusion: CSF lactate levels of study patients were higher than normal and showed increasing trend from possible to definite diagnosis of TBM suggesting that CSF lactate could be a predictor of definite diagnostic class of TBM though more studies with large number of patients are needed to prove its utility as prognostic tool.

Uses of local plant biodiversity among the tribal communities of Pangi Valley of District Chamba in cold desert Himalaya, India.

Pangi Valley is the interior most tribal area in Himachal Pradesh of Northwest Himalaya. An ethnobotanical investigation is attempted to highlight the traditional knowledge of medicinal plants being used by the tribes of Pangi Valley. Various localities visited in the valley 2-3 times in a year and ethnobotanical information was collected through interviews with elderly people, women, shepherds, and local vaids during May 2009 to September 2013. This paper documented 67 plant species from 59 genera and 36 families along with their botanical name, local name, family name, habit, medicinal parts used, and traditional usage, including the use of 35 plants with new ethnomedicinal and other use from the study area for the first time. Wild plants represent an important part of their medicinal, dietary, handicraft, fuel wood, veterinary, and fodder components. These tribal inhabitants and migrants depend on the wild plant resources for food, medicines, fuel, fibre, timber, and household articles for their livelihood security. The present study documents and contributes significant ethnobotanical information from the remote high altitude and difficult region of the world, which remains cut off from rest of the world for 6-7 months due to heavy snowfall.

Erratic male meiosis resulting in 2n pollen grain formation in a 4x cytotype (2n = 28) of Ranunculus laetus Wall. ex Royle.

Two accessions were studied for male meiosis in Ranunculus laetus from the cold regions of Northwest Himalayas. One accession showed the presence of 14 bivalents at diakinesis and regular segregation of bivalents at anaphase I which lead to normal tetrad formation with four n microspores and consequently n pollen grains and 100% pollen fertility. Second accession from the same locality revealed the erratic meiosis characterized by the presence of all the 28 chromosomes as univalents in meiocytes at metaphase I. Univalent chromosomes failed to segregate during anaphases and produced restitution nuclei at meiosis I and II. These restitution nuclei resulted into dyads and triads which subsequently produced two types of apparently fertile pollen grains. On the basis of size, the two types of pollen grains were categorized as n (normal reduced) and 2n (unreduced, 1.5-times larger than the n pollen grains). The estimated frequency of 2n pollen grains from dyads and triads (61.59%) was almost the same as that of the observed one (59.90%), which indicated that 2n pollen grains in R. laetus were the result of dyads and triads. The present paper herein may provide an insight into the mechanisms of the formation of various intraspecific polyploids through sexual polyploidization in R. laetus.

Study of skin and mucous membrane disorders among workers engaged in the sodium dichromate manufacturing industry and chrome plating industry.

BACKGROUND: Inhalation of dusts and fumes arising during the manufacture of sodium dichromate from chrome ore, chromic acid mist emitted during electroplating, and skin contact with chromate produce hazards to workers. OBJECTIVES: (1) To elucidate the prevalence of skin and mucous membrane disorders among the workers engaged in the sodium dichromate manufacturing industry and chrome plating industry. (2) To know the relationship of prevalence with the duration of exposure to chrome mist, dust, and fumes. SETTINGS AND DESIGN: A cross-sectional study was conducted among all the workers engaged in sodium dichromate manufacturing and chrome plating from several industries situated near the Delhi-Haryana border in the districts of Faridabad and Sonepat of Haryana, India from January 01, 2014 to December 31, 2014. MATERIALS AND METHODS: All the workers available from the concerned industries for the study were interviewed and medically examined after obtaining their informed consent. A total of 130 workers comprising 66 workers from the sodium dichromate manufacturing industry and 64 workers from the chrome plating industry were examined on a pretested schedule. STATISTICAL ANALYSIS: Descriptive statistical methods (proportions, relative risk, and Chi-square test of significance with P value analyzed using Epi Info version 7). RESULTS: All the workers were found to be males and of the adult age group. Out of the total examined, 69.69% and 56.22% of the workers had disorders of the nasal mucous membrane in the sodium dichromate manufacturing industry and the chrome plating industry, respectively. 42.42% and 28.22% of the workers had perforation of the nasal septum in the sodium dichromate manufacturing industry and chrome plating industry, respectively. 6.06% and 3.12% workers had skin ulcers in the sodium dichromate manufacturing industry and chrome plating industry, respectively. Nasal irritation and rhinorrhea were the most commonly found symptoms in both the processes. 48.48% and 90.52% of the workers were using hand gloves in the sodium dichromate manufacturing and chrome plating industry, respectively. Only 27.27% and 37.50% of the workers were using masks in the sodium dichromate manufacturing industry and chrome plating industry, respectively. No worker was using protective clothing or barrier cream in the sodium dichromate manufacturing industry. 40.65% and 12.50% workers were using protective clothing and barrier cream in the chrome plating industry. CONCLUSION: Workers engaged in sodium dichromate manufacturing and chrome plating are at a great risk of skin and mucous membrane disorders including chrome holes and nasal septum perforation. Protective measures and awareness of the management and workers about the exposure hazards and safeguarding against them will be useful public measures to prevent these occupational hazards among workers engaged in these processes.

Chromosome numbers, characterization of chromosomal pairing during meiosis, origin and natural propagation in polyploid cytotypes (4x, 5x and 6x) of Agrimonia eupatoria L. (Rosaceae) in northwest Himalayas (India).

Despite the presence of intraspecific polyploidy (2x, 4x, 5x and 6x) in Agrimonia eupatoria, origin of these cytotypes has never been addressed adequately. The aim of the present study was to record the original chromosome counts and characterize chromosomal pairing during meiosis and microsporogenesis in the 5x cytotype, and discussing the hypothesis regarding the possible origin of polyploid cytotypes (4x, 5x and 6x) in the species. The geographical distribution pattern of cytotypes in the Indian Himalayas and elsewhere has also been analyzed. The present meiotic analysis revealed three chromosomes counts, the tetraploid (2n = 4x = 56), the pentaploid (2n = 5x = 70) and the hexaploid (2n = 6x = 84) cytotypes based on x = 14. Meiotic course was perfectly normal in the 4x and 6x cytotypes resulting into high pollen fertility (94-100 %). Meiotic course in the imbalanced 5x cytotype has been found to be irregular characterized by the presence of high frequency of univalents at diakinesis and metaphase-I. Abnormal meiotic course contributed towards high pollen sterility (74-88 %). Even the apparently fertile/stained pollen grains were of irregular shape and of heterogeneous sizes. Meiotic behaviour of the 5x cytotype is like typical of allopolyploid. Individuals of 5x cytotype did not produce seeds and propagate vegetatively (root suckers) while 4x and 6x cytotypes exploited sexual (seeds) as well as vegetative means for propagation. Chromosomal pairing in pentaploid cytotype is like typical of an allopolyploid and we assume that it might have originated owing to natural inter-cytotype hybridization between 4x and 6x cytotypes in a mixed population. Analysis of geographical distribution pattern of cytotypes shows that Indian Himalayas represent the most cytotype-diverse region for A. eupatoria with the existence of all the four cytotypes (2x, 4x, 5x, 6x). This shows the dynamic nature of the species at chromosomal level in this part of the world.

Male meiosis, morphometric analysis and distribution pattern of 2× and 4× cytotypes of Ranunculus hirtellus Royle, 1834 (Ranunculaceae) from the cold regions of northwest Himalayas (India).

In this study, we examined the chromosome number, detailed male meiosis, microsporogenesis, pollen fertility and morphological features and distribution of 2× and 4× cytotypes of Ranunculus hirtellus Royle, 1834. The majority of the populations scored now from cold regions of the northwest Himalayas showed tetraploid (n=16) meiotic chromosome count and one of the populations studied from the Manimahesh hills existed at diploid level (n=8). The individuals of diploid cytotype exhibited perfectly normal meiotic course resulting in 100% pollen fertility and pollen grains of uniform sizes. On the other hand, the plants of the tetraploid cytotype from all the populations in spite of showing normal bivalent formation and equal distribution to the opposite poles at anaphases showed various meiotic abnormalities. The most prominent among these meiotic abnormalities was the cytomixis which involved inter PMC (pollen mother cell) chromatin material transfer at different stages of meiosis-I. The phenomenon of cytomixis induced various meiotic abnormalities which include chromatin stickiness, pycnotic chromatin, laggards and chromatin bridges, out of plate bivalents at metaphase-I, disoriented chromatin material at anaphase/telophase and micronuclei. Consequently, these populations exhibited varying percentages of pollen sterility (24 - 77 %) and pollen grains of heterogeneous sizes. Analysis of various morphometric features including the stomata in 2× and 4× cytotypes showed that increase in ploidy level in the species is correlated with gigantism of vegetative and floral characters and the two cytotypes can be distinguished from each other on the basis of morphological characters. The distribution patterns of the 2× and 4× cytotypes now detected and 2×, 3×, 4× cytotypes detected earlier by workers from other regions of the Indian Himalayas have also been discussed.