Complete heart block: an atypical presentation with an atypical diagnosis

Congenital heart block is frequently associated with underlying structural congenital heart disease or connective tissue disorders. Neonatal lupus is considered a form of passively acquired autoimmune disease in which maternal autoantibodies, namely, anti-Ro and anti-La, cross the placenta and injure the previously normal fetal heart. Here, a young female, 30 years of age, who presented with atypical cardiac manifestations, was diagnosed with complete heart block. She was evaluated thoroughly for its etiology, including structural, medication, infective, thyroid and autoimmune panel. Antinuclear antibody (ANA) was positive by immunofluorescence method with 1:160 titre and with fine speckled pattern. Anti-SSA/Ro antibody was positive with a titre of 30.20 units. Anti-Smith antibody was also reported to be positive. On further investigations, her mother also had positive ANA by Immunofluorescence method with a titre of 1:80, with anti dsDNA, anti Ro/SSA, anti La/SSB positivity. The patient was thus diagnosed as a case of lupus causing her to present with complete heart block in adulthood. Patient was managed with TPI followed by PPI and was discharged with no complications. Neonatal lupus can cause heart block of varying degrees that may be noted in utero presenting as congenital heart block. SLE presenting as congenital heart block in young adults is a rare finding. This case report reviews an adult female of SLE presenting to the emergency for the first time with atypical cardiac manifestations and diagnosed as a case of congenital heart block with laboratory investigations revealing lupus as the primary etiology.

A study of growth pattern of school going children of Kolkata, India

Background: In our society only, a few peoples have good physiological status from their childhood. Health status of children and adolescents is important factor for young society. This present study highlights the peoples’ state of health and nutrition. Change in height with respect to age can be seen during puberty and adolescence. Growth can also be dependent upon the geographical regions. Methods: In this study included 230 adolescent students (boys- 146, girls- 84) in the age group of between 12-18 years. So many related growth parameters were measured using by an anthropometric rod, weighing machine, and slide calliper. BMI, p value was obtained by performing t-test at 0.05 level of significance. Statistical software SPSS version 20 was used. Results: Growth parameter was found to be increasing with age and it was more pronounced between 16 and 17 years. Interestingly the increment of all the growth parameter was found to be more in urban and less in rural. Conclusions: The findings of this study showed a progressively increasing of growth-related parameters with ages and the progress vary, indicating a nutritional supplementation are unequal (unequal growth pattern), as it was evident from different growth parameters percentile values of CDC and IAP values. This study will certainly help to create among the children and their parents about the physical growth and health.

Postural strain of spinner and casting workers of a small-scale aluminium utensil making factory

Background: Small scale establishments often neglect the worker safety and comfort which impacts both productivity and workers’ safety. Various studies have been conducted in such small-scale establishments but not much has been done on aluminium utensil manufacturing factories. Spinning and casting are two important processes for manufacturing of aluminium utensils. But not much has been studied to assess the hazards of the involved workers. The present study is an attempt to explore this previously unnoticed area. Methods: The study was conducted in different small scale aluminium utensil factories in West Bengal. Sixteen spinners and seventeen casting workers were evaluated for this study. The analysis of posture was done by rapid upper limb assessment (RULA), rapid entire body assessment (REBA) and Ovako working posture analysis system (OWAS). The body parts discomfort was assessed by using Cornell musculoskeletal discomfort questionnaire and Nordic questionnaire was also used to assess the pain they experience. Results: All the casting workers are experiencing postural load beyond the recommended limit whereas in case of spinner, five workers experienced less postural load due to favorable work conditions. Casting workers mainly suffered from low back, neck, right shoulder pain whereas spinners suffered from wrist and finger pain followed by lower extremity pain. Conclusions: Both group of workers are experiencing postural load and discomfort. In case of casting workers, the prevalence was high and immediate interventions are needed. The discomfort is particularly high during the end of shifts.

Heart rate variability, task load and perceived exertion associated with a long-distance military ski exercise: A pilot study

OBJECTIVES: Skiing is practiced by the security forces posted at mountain areas for patrolling, securing borders, taking up rescue missions and sometimes as recreational activities. A study was planned to assess physiological and mental stress of a military ski activity through the measurement of heart rate (HR) variability, task load and perceived exertion. MATERIALS AND METHODS: Eleven healthy Indian soldiers, trained with skiing techniques, participated in a 15 km skiing with 22 kg equipment at a predetermined snowy mountainous track. Pre- and post-exercise HR and HR variability (HRV) were recorded (bio-harness, Zephyr, USA) and questionnaires, namely NASA task load index (NASA-TLX) and Borg’s rating of perceived exertion (RPE) scale, were filled after exercise. Time and frequency domain parameters such as HR, variations between successive RR intervals (RMSSD), standard deviation of RR (SDNN) and percentage value of NN50 (pNN50), low- and high-frequency bands (LF and HF %) and LF/HF ratio were derived using Kubios software. Student’s t (paired) test was applied to compare pre- and post-exercise HRV parameters and Pearson’s correlation was applied to observe interdependencies between HRV and subjective scores. RESULTS: The findings depicted increase in post-exercise HR and decrease in overall HRV (both significant). Besides this, there was an increase in LF (significant) and LF/HF ratio (insignificant). Such response shows sympathetic dominance over parasympathetic domain of autonomic nervous system. The physical and mental stress experienced during the exercise was also expressed through high physical demand (79 out of 100) and high overall task load (total score – 77 out of 100) of the NASA-TLX and a moderately heavy RPE score (14 out of 20). CONCLUSION: The pre- and post-exercise differences in physiological variables ensured the presence of physical stress along with dominance of sympathetic nervous system. Overall task load was depicted with high subjective ratings. Carrying out skiing task in an environment infested with cold, wind chill, moderate hypoxia at a snowy and mountainous track possibly has induced the observed physiological and mental stress to the participants. Such findings are important to understand exact requirements of the mountain warfare events carried out by the forces.

Iron-Chelating Property of Phytic Acid in Thalassaemia: An In vitro Study.

Aims: The aim of this study is to report an oral iron chelator phytic acid (PA), on blood samples from different types of thalassaemic patients of various age groups and physical conditions. Study Design: The In vitro iron chelating effect was evaluated by ferritin assay using ELISA. Methodology: Blood from the iron-overloaded 30 Thalassaemic patients of different age groups, body weights and heights were collected and the serum was separated. Patients without any history of blood transfusion and chelation therapy were taken as control group. The ELISA based ferritin assay was performed with standard phytic acid (40% water solution, Fluka), using Desferrioxamine (DFO) as control (0.5g Deferoxamine mesylate USP, Novartis, USA). The serum ferritin levels were recorded in two different conditions (treated with DFO and PA) at different time intervals (10, 30 and 60 min) by measuring absorbance at 450 nm. Results: The Kolmogorov-Smirnov test of patient samples in two different conditions showed that the ferritin concentration, treated by DFO and PA, was significantly decrease in PA treated group compared to DFO, when used in equivalent concentrations, at intervals of 10 min (P=0.760),30 min (P=0.537) and 60 min (P=0.055). Conclusion: The common iron chelators DFO or Deferiprone used as monotherapy may lead to transient and incomplete removal of iron, while PA showed a more complete and sustained removal of ferritin due to specific chemical binding at a wider pH range. However, further trial is required to establish its maintenance dose, comparative efficacy and mechanism of action.

Hairy cell leukemia: Clinical, pathological and ultrastructural findings in Asian-Indians.

Background: Hairy-cell leukemia (HCL), lymphoproliferative disease of older age, is characterized by projections from surface of abnormal cells. Aim: The aim was to study the clinical presentation and ultrastructural changes in hairy cells (HCs) following cladribine treatment. Settings and Design: Clinical presentation, peripheral smear, bone marrow aspiration and biopsy of HCL cases diagnosed over a period of three years were reviewed. Materials and Methods: Consecutive HCL cases in Hematology clinic of a tertiary care center were enrolled. Tartarate-resistant acid phosphatase (TRAP) test was done to detect HCs and electron microscopy was done to demonstrate initial ultrastructural changes and alterations following cladribine therapy. Results: Fifteen cases of HCL, aged 32-57 years (median 47 years) were studied. The clinical presentation included splenomegaly in 15 (100%), fever in 10 (67%), hepatomegaly and pain abdomen in eight (53%), fatigue in nine (60 %) cases. The commonest laboratory features were monocytopenia in 13 (87%), neutropenia in 12 (80%), anemia in 10 (67 %) and pancytopenia in nine (60%). All patients showed symptomatic improvement on cladribine therapy. Electron microscopy after treatment (three months) showed loss of the finger like projections, characteristic bald lymphocytes, loss of ribosomal lamellar complexes, as well as decrease in mitochondria and vacuoles. Conclusions: Indian patients with HCL are younger. Cladribine is an effective therapy for these patients and leads to complete response in most of the patients. There is a significant improvement in the ultrastructural features following cladribine therapy.

Serological aspects of Dengue fever and its correlation with clinical features in a recent febrile outbreak.

The study was done to assess correlation between serology and clinical features of Dengue fever at Burdwan Medical College, where after clinical examination, blood samples were processed by E.I.A. Of 139 cases, mostly between 1 to 20 years, Male-Female ratio was 80:59. Bleeding manifestation was observed only in 3 cases, and Lymphadenopathy, Myocarditis were uncommon features. Few patients have biphasic temperature. Fever and severity of symptoms did not have correlation. Patients' blood was examined for Dengue viruses, with only 44.6% positivity. Correlation exists between illness duration and antibody titer. [r = 0.41; (P < 0.01)]. Fever other, than Dengue also exhibited similar symptoms, but optical density in EIA test was less. As high fever with similar symptoms may be due to causes other than Dengue, thorough search for other viral infection namely Chikungunya should be done in endemic areas also.

In vitro Antioxidant Activities of the Fractions of Coccina Grandis L. Leaf Extract

The present study was aimed at investigating the antioxidant activities of the various fractions of the hydromethanolic extract of the leaves of Coccinia grandis L. Voigt. (Cucurbitaceae). The antioxidant activities of the fractions have been evaluated by using nine in vitro assays and were compared to standard antioxidants such as ascorbic acid; a-tocopherol; curcumin and butylated hydroxyl toluene (BHT). All the fractions showed effective Hdonor activity; reducing power; free radical scavenging activity; metal chelating ability and inhibition of Beta-carotene bleaching. None of the fractions exerted an obvious pro-oxidant activity. The antioxidant property depends upon concentration and increased with increasing amount of the fractions. The free radical scavenging and antioxidant activities may be attributed to the presence of phenolic and flavonoid compounds present in the fractions. The results obtained in the present study indicate that the leaves of C. grandis are a potential source of natural antioxidant

Angiogenesis in myelodysplastic syndromes (MDS) in Indian patients.

Angiogenesis plays an important role in the pathogenesis of haematological neoplasms and may be correlated with the prognosis. We recently evaluated the microvessel densities in trephine biopsy sections of seventeen patients of myelodysplastic syndromes (MDS). Of the 17 cases, 2 were RAEB-t, 3 were RAEB, one was RARS and 11 were of the subtype RA (FAB subtyping). The microvessel counts were measured in the bone marrow biopsy sections by immunohistochemical staining, using CD34 reactive monoclonal antibodies. MVD was significantly higher in the cases of RAEB and RAEB-t as compared to the cases of RA. The average MVD per x400 in the cases of RA was 5.7 +/- 4.7 with a median value of 4.65 (range 19) whereas it was 45.4 +/- 10.0 and 44.0 (range 27.3) respectively in RAEB and RAEB-t (p <.001), the 95% confidence interval being (2.94, 8.5) and (36.6, 54.3), for the two groups respectively. This finding may imply that subtypes of MDS with a higher tendency for converting to acute leukaemia are associated with increased angiogenesis as compared to other subtypes where the risk of progression to acute leukaemia is much lower.

Disseminated Langerhans cell histiocytosis-an interesting case report with concise review of literature.

A 2-year-old boy presented with fever, recurrent infections and multiple skin lesions. He had anemia, eczematous skin lesions, cervical lymph node enlargement, hepatomegaly and lytic lesions on skull x-ray. The skin infiltrates were CD 68, CD 1a positive and S100 positive. He was diagnosed as disseminated langerhans cell histiocytosis. The occurrence of histiocytosis is reviewed and possible treatment is discussed.

Comparative evaluation of whole blood D-dimer test to plasma D-dimer test for diagnosis of disseminated intravascular coagulation.

Three rapid D-dimer test methods were compared for the diagnosis of acute disseminated intravascular coagulation (DIC). These were (a) SimpliRED, an autologous red cell agglutination assay. (b) DIMERTEST latex agglutination assay, containing monoclonal antibody DD-3B6/22(6), and (c) D-DI latex agglutination assay containing mouse anti-human D-dimer monoclonal antibodies. The D-DI latex method having higher sensitivity (100%) and specificity (81%) in clinically acute DIC was postulated as the gold standard and compared with the other two methods. The results suggest that D-DI latex agglutination assay containing mouse anti-human D-Dimer monoclonal antibodies are the better assay methods amongst all the three kits analyzed. It is advisable to look for the nature of the antibody used to coat the latex particles in plasma based kits. In emergency setting RBC kits may be of some use as rapid diagnosis is advantageous.

Needle necropsy in AIDS.

The value of autopsy in understanding the natural course of any disease is beyond any argument. The reluctance of pathologists to perform autopsy in HIV infected cadavers is justified due to the risks involved to the prosector and the morgue attendants. A relative low risk needle necropsy protocol is proposed using fine needle aspiration cytology, tru-cut biopsies and microbiological examination. Diagnosis could be offered in all the forty-four needle necropsies performed. Disseminated tuberculosis in 18/44 (40.9%) cases, disseminated cryptococcosis in 12/44 (27.2%) cases, poly-microbial infections in 27.2% cases and non-Hodgkin's lymphoma in 9% cases were detected in the study. Infectious agents like Histoplasma capsulatum, Isospora belli, tachyzoites of Toxoplasma gondii, Candida sp and Cryptococcus sp could be demonstrated in the samples obtained in the study. Lack of material for study of gross pathology, inaccessibility of deep-seated lesions and risk of needle stick injury to the prosector though low are the limitations of this procedure.

Reproductive health needs and care seeking behaviour of pavement dwellers of Calcutta.

An unabated growth of street dwellers in the city of Calcutta is reported to be due to twin reasons like, migration of rural poor people as well as uncontrolled fertility among these poor settlers of the city. A community-based study on reproductive health, fertility and related care seeking behaviour was studied among a sample of women of child bearing age living on streets of Calcutta. Besides, the quite common conditions like leucorrhoea (28.5%), menstrual irregularities (12.3%), infertility (2.5%) and STDs (1.3%) were also reported. But most of these illnesses (three-fourth) were uncared for, and the remaining one-fourth sought treatment from govemment institutions, private agencies or even from untrained practitioners (quacks). The reproductive behaviour of street dwelling women was characterised by early marriage, teenage pregnancies, and scarce use of contraceptives (32%) as well as frequent abortions (2.8%). Very few pregnant women received adequate antenatal care (3.8%). Coverage of tetanus toxoid immunisation (68.5%) and proper iron and folic acid supplementation (16.7%) were also poor. Whereas, antenatal care was received mostly from government health institutions (71%), home delivery (ie, on street) was a common practice and conducted mostly by untrained birth attendants (51.8%).

Nutritional status of pavement dweller children of Calcutta City.

Pavement dwelling is likely to aggravate malnutrition among its residents due to extreme poverty, lack of dwelling and access to food and their exposure to polluted environment. Paucity of information about nutritional status of street children compared to that among urban slum dwellers, squatters or rural/tribal population is quite evident. The present study revealed the magnitude of Protein Energy Malnutrition (PEM) and few associated factors among a sample of 435 underfives belonging to pavement dweller families and selected randomly from clusters of such families, from each of the five geographical sectors of Calcutta city. Overall prevalence of PEM was found almost similar (about 70%) to that among other 'urban poor' children viz. slum dwellers etc., but about 16% of them were found severely undernourished (Grade III & V of IAP classification of PEM). About 35% and 70% of street dweller children had wasting and stunting respectively. Severe PEM (Grade III & IV) was more prevalent among 12-23 months old, girl child, those belonged to illiterate parents and housewife mothers rather than wage earners. It also did increase with increase of birth rate of decrease of birth interval.

Effects of plant extract Centella asiatica (Linn.) on cold restraint stress ulcer in rats.

Extract of C. asiatica (Linn.) inhibited significantly gastric ulceration induced by cold and restraint stress (CRS) in Charles-Foster rats, Antiulcer activity of plant extract was compared with famotidine (H2-antagonist) and sodium valproate (anti-epileptic). Plant extract, formotidine and sodium valproate showed a dose dependent reduction of gastric ulceration. Plant extract increased brain GABA level which was also dose dependent. Pretreatment with bicuculline methiodide (specific GABAA-antagonist) at the dose level of 0.5 mg/kg im, reversed the antiulcerogenic activity of both plant extract and sodium valproate. Bicuculline as such did not induce gastric ulceration in normal rat.

Antimicrobial activities of mycotoxin MT81 and its structural derivatives.

Antimicrobial activities of mycotoxin MT81 and its acetylated, benzoylated and acetic acid derivatives were determined by zone inhibition method. MT81, acetylated MT81 and acetic acid MT81 exhibited sensitivity (31.25, 62.50, 62.50 micrograms/ml respectively) to all the test bacteria. Benzoylated-MT81 did not exhibit any activity even up to 1000 mcg/ml. MT81, its acetylated and acetic acid derivatives exhibited antifungal activity up to 62.5 micrograms/ml and 125.0 micrograms/ml respectively against test yeasts and other fungi. Benzoylated MT81 also exhibited antifungal activity but the degree was comparatively less.