Asymptomatic Renal Function Abnormalities in Patients having Silicosis

Background: A number of occupational exposures are associated with various types of renal dysfunction. Several studies for many years have drawn attention to renal dysfunction and nephrotoxicity among workers exposed to silica. This study was conducted to evaluate renal dysfunction, if any, among Indian patients having silicosis and its correlation with the duration of exposure to silica dust. Materials and methods: This study includes 52 eligible patients with a history of silica dust exposure and silicosis confirm on radiological examination by the pneumoconiosis board. Investigations like serum creatinine, urinary albumin creatinine ratio, etc. were done. The “modification of diet in renal disease” (MDRD) formula was used to calculate the glomerular filtration rate (GFR). Results: This study showed 53.84% of patients (n = 28) having albuminuria and a mean “urinary albumin to creatinine ratio” (UACR) of 101.88 ± 128.99 mg/gm. Isolated macroalbuminuria was detected in 11.5% of patients (n = 6) while 42.3% of patients (n = 22) presented with microalbuminuria. The mean GFR was 81.94 ± 22.09 mL/min/1.73 m2 among study patients of which four (7.7%) patients had GFR value <60 mL/min/1.73 m2 . We could also identify a significant association between the duration of exposure to silica dust and UACR and GFR (p < 0.01). Conclusion: Albuminuria and reduced estimated GFR in patients with silica dust exposure is not uncommon and reflect early underlying renal dysfunctions. Our study suggests a simple and cost-effective screening strategy for early detection of renal dysfunction among silicosis patients that may be considered as a tool to prevent further renal damage in such patients.

A Rare Case of Salbutamol Induced Tetany Pooja Shukla1*, Mohd Tariq Salman1, R K Dixit2, Shiv Sagar Gupta3, V K Verma1, Ali Ahmad1

A 25-year-old female, housewife, Nonsmoker, with complains of Dysnoea and pain in chest was diagnosed with Bronchial asthma in the Out Patient Department of Pulmonary Medicine of our institute. As per the GINA guidelines she was prescribed nebulization with Salbutamol 5 mg for confirming the diagnosis of bronchial asthma. Within minutes of nebulization she started to have involuntary contraction involving all four limb and developed hand posture associated with tetany. The nebulization was stopped and symptoms were relieved after 15 minutes of the calcium administration. The causal relationship between the suspected drug and the adverse event was assessed to be probable and thus clinicians should always be aware of the possibility of tetany due to salbutamol

A prospective study for comparison of hematological parameters in healthy young adult and elderly age group subjects.

Aims & Objectives: This study of hematological parameters is the object of continuing intensive research of hematopoietic system to the functional integrity in aging. (1) Assessment of Hb, total RBC count in healthy young adult as well as in elderly subject.(2) Assessment of Hct & blood indices (MCV, MCH, MCHC) in healthy young adult as well as in elderly subject.(3) Comparing the values of Hb & total RBC count in healthy young adult with the elderly subject.(4) Comparing the values of Hct & blood indices (MCV, MCH, MCHC) in healthy young adult with the elderly subject.(5) To co-relate the results of present study with findings of other studies. Material & Methods: The hematological indices analysed were Hb, HCT, and Total RBC Count, Blood indices like MCV, MCH & MCHC. Hematological values were measured by the different method in laboratory with the use of standard test reagent. Results: In present study, the result shows that a significant decrease in Hb concentration and RBC count are associated with decrease in Hct, MCH, MCHC and little increase in MCV. Conclusion: In present study, the overall assessment shows that a significant decrease in Hb concentration, reticulocyte count and RBC count are associated with decrease in Hct, MCH, MCHC and little increase in MCV. These results show a significant decrease in haematological parameters in old age and fairly accurate reflection of decreased erythropoietic activity of bone marrow.

A comparative study of reticulocyte count in healthy young adult and elderly age group subjects.

Introduction: Aging process has been viewed as progressive decline in physiological process necessary for maintenance of a constant milieu interior and death as the ultimate failure to sustain homeostasis. Reticulocytes are juvenile red cell. It is flat non-nucleated disc shaped, slightly larger than mature erythrocyte .The number of reticulocyte present in the peripheral blood is a fairly accurate reflection of erythropoitic activity of bonemarrow. Normal values in young adult- 0.5 to 2.5% of total RBC count. The present study was conducted to find out changes in the reticulocyte count in the elderly subject. Aims: to uncover the effect of aging on reticulocyte count. Material and method: 90 subjects were divided into two groups, normal control group (n=30, mean age 35.83yrs) and elderly group (n=60, mean age62.55yrs). Reticulocyte counts were done by new Methylene Blue method. Result & Observations: significant decrease in reticulocyte count was observed in elderly group as compare to normal control group. Conclusion: our data suggests that aging may alter haematological parameters including reticulocyte count.

Autologous platelet gel and its clinical application.

Platelets are attracted to a wound or injury site stimulating the clotting and healing cascades. Degranulated platelets release numerous substances including proteins known as growth factors. Growth factors signal undifferentiated stem cells to the site, promote cell mitosis, and stimulate osteogenesis and angiogenesis. Cytokines, which attract neutrophils, are also released from platelet granules. Concentrating platelets 4x to 5x the baseline level accelerates the healing process. When platelet rich plasma is mixed with an activator, a platelet gel will form. Clinical applications of platelet gel are numerous. Some benefits include a marked decrease in post-surgical swelling and bruising, reduction in surgical site pain, elimination of drains, and acceleration of bone growth and soft tissue healing. Scientific publications support that autologous biomaterial accelerates the healing process.

Aging and its theories.

Several factors (the lengthening of the average and, to a lesser extent, of the maximum human life span; the increase in percentage of elderly in the population and in the proportion of the national expenditure utilized by the elderly) have stimulated and continue to expand the study of aging. Recently, the view of aging as an extremely complex multifactorial process has replaced the earlier search for a distinct cause such as a single gene or the decline of a key body system. This mini review keeps in mind the multiplicity of mechanisms regulating aging; examines them at the molecular, cellular, and systemic levels; and explores the possibility of interactions at these three levels. The heterogeneity of the aging phenotype among individuals of the same species and differences in longevity among species underline the contribution of both genetic and environmental factors in shaping the life span. In this mini review, several theories are identified only briefly; a few (evolutionary, gene regulation, cellular senescence, free radical, and neuro-endocrineimmuno theories) are discussed in more detail, at molecular, cellular, and systemic levels.

Allergic bronchopulmonary aspergillosis presenting with cavitary lesion and simulating a lung abscess.

A case of allergic bronchopulmonary aspergillosis (ABPA) is being described in a 52-year-old female patient who presented with a cavitary lesion on skiagram chest and simulating a lung abscess. Patient responded with the oral corticosteroid therapy with complete resolution of the initial radiographic abnormality. Despite various radiological presentations described in the literature, a lung abscess like presentation in ABPA is very rare and significant, because an early and correct diagnosis by the clinicians will help in early management of these cases to prevent the development of end-stage pulmonary fibrosis.

Immune haemolymph proteins in response to bacterial infection and identification of a putative bacteria binding protein in malaria vector Anopheles stephensi.

Induction of haemolymph proteins in mosquito A. stephensi due to wounding or bacterial infection (E. coli) was analyzed using SDS-PAGE. Wounding response of pupa revealed subsequent induction of two polypeptides (21 and 74 kDa). Two other polypeptides (44 and 57 kDa) were induced commonly in both pupa and adult female haemolymph upon bacterial infection. In vitro binding assay revealed identification of 44 kDa, a putative bacterial binding protein, a more relevant protein for further elucidation of molecular mechanism involved in host parasite interactions.

Nifedipine potentiates gabapentin antinociception in rats.

To evaluate the involvement of Ca++ channels in Gabapentin antinociception. In healthy male albino rats formalin (50 microliters, 5%) was injected at the planter surface of the paw. Pain score was calculated. Antinociceptive effect of (10, 30 mg/kg) gabapentin and (3, 10 mg/kg) nifedipine alone and on co-administration of sub analgesic doses was studied 30 minutes after formalin injection and reduction in pain scores was calculated. Gabapentin (30 mg/kg) and nifedipine (10 mg/kg) reduced the pain score in formalin injected rats. Gabapentin (10 mg/kg) and nifedipine (3 mg/kg) given alone did not modify pain score, however, on co-administration they significantly reduced the pain score. Study provides evidence of involvement of Ca++ channels in gabapentin antinociception.

Pharmacokinetics of ciprofloxacin in patients with liver cirrhosis.

BACKGROUND: Bacterial infections are common in patients with cirrhosis of liver and are frequently treated with ciprofloxacin. Literature on pharmacokinetics of ciprofloxacin in patients with cirrhosis of the liver is scanty. The present study compared the pharmacokinetics of ciprofloxacin in cirrhotic patients with that in healthy volunteers. METHODS: In 20 patients with cirrhosis of liver (all Child-Pugh class B) and 10 healthy volunteers, plasma levels of ciprofloxacin were measured using high-performance liquid chromatography at several time points after a 500-mg oral dose. Various pharmacokinetic parameters were calculated. RESULTS: No significant differences were observed in maximum plasma levels reached (mean [SD] 2.6 [0.6] vs 2.6 [1.3] microg/ml), time taken for maximum plasma levels to be reached (1.3 [0.6] vs 1.5 [0.9] h), t1/2a (0.7 [0.3] vs 0.4 [0.9] h), elimination half-life (3.6 [1.2] vs 3.2 [1.8] h), and area under the curve (19.3 [3.8] vs 21.9 [4.5] microg/mL x h) in healthy volunteers and cirrhotic patients, respectively. CONCLUSIONS: Pharmacokinetics of ciprofloxacin is unaltered in patients with liver cirrhosis. Ciprofloxacin can be safely administered in the usual doses in such patients.

Effect of anxiolytics on blood sugar level in rabbits.

Anxiety disorders are more prevalent not only in normal individuals but also in diabetes mellitus. Diazepam, a benzodiazepine, and buspirone, an azaspirodecanedione, are the most often prescribed anxiolytics. Present study was aimed to investigate the effect of diazepam and buspirone on the blood sugar levels in rabbits. Buspirone (0.5 mg/kg/day p.o.) and diazepam (0.6 mg/kg/day p.o.) did not affect the glucose levels in rabbits even after one month of treatment. Present findings suggest that these two anxiolytics have minimal effect on blood sugar control.

Primary tuberculosis of soft palate.

Primary tuberculosis of upper respiratory tract including oral cavity is a rare disease. One such unusual case is reported.

Comparative study of visceral and parietal pleural biopsy in the etiological diagnosis of pleural diseases.

OBJECTIVE: The present study was planned to evaluate the efficacy and diagnostic reliability of conoctional parietal pleural biopsy to a technique of visceral pleural biopsy. METHOD: Study comprises of 54 diagnosed cases of pleural effusion and after establishing the clinical diagnosis for probable etiological causes. Then parietal pleural biopsy using absents punch biopsy needle and vesceral pleural biopsy using Prabhudesai et al technique was taken in all these patients. Size of the tissue yield; percentage of biopsies; diagnostic yield and sensitivity for these two techniques were compared. RESULTS: A definitive etiological diagnosis could be reached in 52 out of 54 patients on the basis of pleural biopsy (33 tuberculous, 16 malignant and 3 pyogenic), 23 (69.7%) tuberculous effusion patients were diagnosis by visceral pleural biopsy and 14 (42.4%) by parietal pleural biopsy out of 33 diagnosed tuberculous effusion cases. While for the 16 malignant effusions the visceral pleural biopsy showed suggestive histological change in 13 (81.25%) patients and the parietal pleural biopsy in seven (43.8%) with five (31.25%) of these patients being positive by both. All three pyogenic effusions showed only nonspecific inflammatory change in both pleurae. CONCLUSION: The mean size of biopsy sample obtained with modified Prabhudesai et al technique was significantly larger than that of the parietal pleural biopsy with Abrams punch (4.85 mm2 V/s 2.5 mm2 with P < 0.01). Adequate pleural tissue was identifiable in 94.4% and 90.7% of cases, respectively. The modified Prabhudesai et al technique proved to be effective safe and easily learnt. Visceral pleural sampling using this technique is a definite superior addition to the present diagnostic armamentarium of an idiopathic pleural effusion and its routine application together with parietal pleural biopsy will help to establish a definitive diagnosis in majority of patients with idiopathic pleural effusions.

Development of pleural effusion in patients during anti-tuberculous chemotherapy: analysis of twenty-nine cases with review of literature.

Twenty-nine cases of tuberculosis developing pleural effusion (PE) during antituberculous chemotherapy (ATT) were analysed for clinical presentation and management outcome. Sixteen (55%) patients had pulmonary tuberculosis alone while rest had associated or isolated extrapulmonary tuberculosis. Thirteen (44.8%) patients developed PE during the 5th-8th week of chemotherapy and nine (31%) during 9th-12th week. Eighteen (62%) patients were on either HRZE or HRE while five (17.2%) were on SHRZ regimen before developing PE. All cases had exudative PE. Pleural fluid centrifuge was smear positive for AFB in two (6.8%) cases and culture positive for Mycobacterium tuberculosis in four (13.7%) cases. Pleural biopsy sections were negative for either AFB or tuberculous histology in 15 out of the 24 biopsies done. Twenty-four (82.7%) patients showed good response on the same ATT without modification. Development of PE during successful ATT seems to be an extension of paradoxical events having an immunological basis, which does not necessarily require any modification in chemotherapy.