Geographic information system-based mapping of air pollution & emergency room visits of patients for acute respiratory symptoms in Delhi, India (March 2018-February 2019)

Background & objectives: Studies assessing the spatial and temporal association of ambient air pollution with emergency room visits of patients having acute respiratory symptoms in Delhi are lacking. Therefore, the present study explored the relationship between spatio-temporal variation of particulate matter (PM)2.5 concentrations and air quality index (AQI) with emergency room (ER) visits of patients having acute respiratory symptoms in Delhi using the geographic information system (GIS) approach. Methods: The daily number of ER visits of patients having acute respiratory symptoms (less than or equal to two weeks) was recorded from the ER of four hospitals of Delhi from March 2018 to February 2019. Daily outdoor PM2.5 concentrations and air quality index (AQI) were obtained from the Delhi Pollution Control Committee. Spatial distribution of patients with acute respiratory symptoms visiting ER, PM2.5 concentrations and AQI were mapped for three seasons of Delhi using ArcGIS software. Results: Of the 70,594 patients screened from ER, 18,063 eligible patients were enrolled in the study. Winter days had poor AQI compared to moderate and satisfactory AQI during summer and monsoon days, respectively. None of the days reported good AQI (<50). During winters, an increase in acute respiratory ER visits of patients was associated with higher PM2.5 concentrations in the highly polluted northwest region of Delhi. In contrast, a lower number of acute respiratory ER visits of patients were seen from the ‘moderately polluted’ south-west region of Delhi with relatively lower PM2.5 concentrations. Interpretation & conclusions: Acute respiratory ER visits of patients were related to regional PM2.5 concentrations and AQI that differed during the three seasons of Delhi. The present study providessupport for identifying the hotspots and implementation of focused, intensive decentralized strategies to control ambient air pollution in worst-affected areas, in addition to the general city-wise strategies.

Number Needed To Treat As A Tool For Cost Effectiveness Analysis: A Case Study In Renal Transplantation

Objective: To assess the utility of number needed to treat (NNT) as a tool for cost effectiveness analysis. Methods: Two monoclonal antibodies (MAbs), used for induction therapy viz basiliximab and daclizumab in renal transplantation, were identified. Pivotal placebo controlled clinical trials, mentioned in the innovator package inserts, were compared and analyzed for acute graft rejection and graft survival at 12 mo. NNT viz-a-vis cost was calculated and compared. Results: Daclizumab was comparable to basiliximab for acute graft rejection (NNT 10 vs. 9) but better for graft survival (20 vs. 25) at 12 mo, when used along with triple drug regimen (cyclosporine, azathioprine and corticosteroid). However, considering the cost of regimen for these drugs, in terms of NNT, basiliximab was more cost effective (INR 12,52,044 vs. 28,70,400 for acute rejection and INR 34,77,900 vs. 57,40,800 for graft survival). On the other hand, when these MAbs were used along with dual drug regimen (cyclosporine and corticosteroid), daclizumab was more cost effective for graft survival at 12 mo. The higher cost of daclizumab regimen (INR 2,87,040 vs. 1,39,116 for basiliximab) was offset by its substantially lower NNT (20 vs. 58-75 for one extra graft survival at 12 mo). Conclusion: This study demonstrates the utility of NNT in ascertaining relative effectiveness of treatment modalities that would help to formulate appropriate healthcare policies.

A study to find the various causes for compressive myelopathy

Introduction: Myelopathy was the term that describes any neurologic defect related to the spinal cord. A study was conducted to evaluate various causes of compressive myelopathy and also MR characterization of spinal cord compressive lesions. Materials and Methods: It is a hospital-based cross-sectional study, conducted in the department of radiodiagnosis, GSL Medical College, Rajahmundry from December 2014 to August 2016. All patients referred to the department of radiology with symptoms of compressive myelopathy of the spine were included. Pre-contrast scanning was done using TiWI, T2WI, FLAIR Sagittal, STIR sagittal. A Chi-square test was used to find the statistical significance, P > 0.05 was considered to be statistically significant. Results: During the study period total of 30 participants were included, spinal TB was diagnosed to be the most common cause of myelopathy (13; 43.3%) Extradural myelopathy was diagnosed in 23 (76.6%) participants and intradural in 7 (23.3%) members. Statistically, there was no significant difference between the age and cause for myelopathy and also between the gender. Conclusion: The most common cause of compressive myelopathy was identified to be extradural compression form TB followed by trauma. Spinal TB was the commonest site involved. In spine injury, the common site involved was the thoracic.

An Experimental Study on the Carbon Flux within the Coral Community.

The flux of carbon within the coralline ecosystem has been a subject of great interest in the recent decades. So far several studies had been conducted to understand actual process of carbon transfer within this system and it is an elusive factor on science because of the complex process. An attempt had been made to delineate the source and sink of carbon within the coral ecosystem by establishing small experimental set up in the present study. For these study, four experimental tanks, each consisted of a different community of coral ecosystem was set up in Pondicherry University, Port Blair, Andaman Islands, India. The Tank A was set up with a most prevalent sponge species Stylissa massa, in this part of the study area, Tank B consisted of sponge Lamellodysidea spp., Tank C consisted of macroalgae community i.e. of Padina spp. of an area of 620 cm2 and Tank D had a soft coral Sarcophyton spp. All these species were collected from Burmanallha, a region characterized by rich species diversity. The results indicated that the algal and sponge community provided carbon to support the growth of coral reefs. Coral utilized this carbon for their growth. It was also observed that fluctuation of environmental and physical parameters induced biological stress within the life forms resulted in the release of excess inorganic carbon to the surrounding water. Whenever, the opportunity were available this carbon was utilized by the system itself and managed full extent without any excess carbon.

Placental mesenchymal dysplasia: A report of two cases with review of literature.

Placental mesenchymal dysplasia (PMD) is a recently recognized, rare placental vascular anomaly characterized by placentomegaly and grape-like vesicles mimicking partial molar pregnancy. It is associated with significant fetal morbidity and mortality. We describe the histologic features of PMD in two different cases with different disease outcomes, one in a preterm intrauterine death (IUD) and another in a live birth. Placental examination in both the cases revealed large placenta with multiple vesicles and mesenchymal dysplasia.

Synthesis and antimicrobial evaluation of some novel sulfur incorporated 7-substituted chromones..

We report herein the design and synthesis of five 2-(phenylthio) methylchromone (4a-d and 5), from 2-bromomethylchromones (3) which were obtained on refluxing 2-methylchromone with N-bromosuccinimide in carbon tetrachloride. The title compounds were characterised by spectral data (IR and NMR). All the compounds have been screened for antimicrobial activity.

Ultrasonographical age estimation from fetal biparietal diameter.

In a wide variety of circumstances of feticide, fetal age determination is important for identification. This is an important identification feature in postmortem cases. There are many different parameters to determine the age from fetus. But actual problem arises, when the body of fetus is either mutilated or decomposed. The data of femur length and other variables at various gestational ages can be used for age estimation of fetus at autopsy. But at time of autopsy each bone may or may not be present for autopsy. So, this study of ultrasonic fetal biparietal diameter was done to collect data, which can be utilized to ascertain the age of fetus in autopsy cases particularly in the Punjab region. This regional data can also be used to determine gestation age, if exact last menstrual period date is not known in antenatal cases of this region or to develop charts for ultrasound dating of pregnancy based on biparietal diameter and, second, to derive reference curves for normal fetal growth based on bi-parietal diameter.

Structure–function–folding relationships and native energy landscape of dynein light chain protein: nuclear magnetic resonance insights.

The detailed characterization of the structure, dynamics and folding process of a protein is crucial for understanding the biological functions it performs. Modern biophysical and nuclear magnetic resonance (NMR) techniques have provided a way to obtain accurate structural and thermodynamic information on various species populated on the energy landscape of a given protein. In this context, we review here the structure–function–folding relationship of an important protein, namely, dynein light chain protein (DLC8). DLC8, the smallest subunit of the dynein motor complex, acts as a cargo adaptor. The protein exists as a dimer under physiological conditions and dissociates into a pure monomer below pH 4. Cargo binding occurs at the dimer interface. Dimer stability and relay of perturbations through the dimer interface are anticipated to be playing crucial roles in the variety of functions the protein performs. NMR investigations have provided great insights into these aspects of DLC8 in recent years.

Glomus tumor of the stomach.

Gastric glomus tumors are rare neoplasms. We report here a case of gastric glomus tumor in a 25-year-old female who presented with exsanguinating gastrointestinal hemorrhage. Clinically and on gross examination, the tumor was suspected to be a gastrointestinal stromal tumor (GIST). Histopathological and immunohistochemical evaluation revealed it to be a glomus tumor.

Measles immunisation coverage in urban slums.

A cross-sectional, community-based study was conducted in 32 slums of Udaipur city to assess the prevalence of missed opportunities for measles immunization, reason for their occurrence and potential impact of avoiding them on measles immunization coverage. Two hundred and sixty-five children, between the age of 9 and 24 months were enlisted for the study, using a practical cluster sampling method. Immunization status of the children, visits to health facilities after 9 months of age and reasons for non-immunization were noted. Missed opportunities for measles immunization was defined as any visit by an eligible child to a health facility, which did not result in his/her vaccination. Measles immunization coverage amongst the study population was 50.61%. The prevalence of missed opportunities for measles immunization was 14.3%. Not offering measles immunization at curative visits (86.9%) was the major reason for missing opportunities. Avoiding all missed opportunities could have increased the measles immunization coverage to 64.9%.

Inter-relationship of zinc levels in serum and semen in oligospermic infertile patients and fertile males.

Infertility is a problem affecting 10-12% of couples. Zinc is necessary for growth, sexual maturation and reproduction. Semen analysis is helpful in ascertaining the evidence of spermatogenesis, sperm transport, sperm quantity and quality and also provides clue to the functioning of the accessory glands i.e. seminal vesicles and prostate. The present study was conducted in 50 oligospermic infertile males and control group consisting of 25 normospermic known fertile males. Semen and Serum samples were obtained from each case in study as well as control group. Semen and serum were processed by wet ash method. The seminal and serum zinc levels of each case in study and control group were estimated. Statistically, serum zinc and semen zinc levels were significantly lower in infertile patients than fertile males. A significant correlation was observed between serum and semen zinc levels in study group.

Postal follow up of patients with epilepsy.

BACKGROUND. Epilepsy services in India are mostly located in urban areas and are often overcrowded. It is difficult, therefore, to organize long term management programmes. We report our experience at a tertiary referral centre on follow up of patients with epilepsy through regular postal review. METHODS. One hundred consecutive patients with epilepsy (63 men, 37 women, mean age 17 years) who had only seizures were followed up by post using a questionnaire, instead of reviewing them in a clinic. The safety, utility and efficiency of this system were evaluated. RESULTS. Sixty patients had generalized seizures, 30 had complex partial seizures and 10 had other types of seizures. The indication for shifting to postal review was good control of seizures in 87 cases and economic reasons in the remaining. Postal review constituted 60% of the total follow up period in 55 cases. Sixty-six patients could be maintained on postal review which was suspended or discontinued in 34 patients. Of these 34, 16 were returned to it after being seen in the clinic on a further occasion. Poor control of seizures, fresh medical or social problems, lack of confidence or a combination of these were the reasons for discontinuing the postal review. The economic benefit to a patient by way of savings in travel, incidental expenses and lost wages was estimated to be Rs 750 per annum. The work load in the epilepsy clinic was decreased by 40%. No serious medical problems or mortality were reported in the study population. CONCLUSION. Systematic postal review is a cost-effective alternative to clinic review in the long term follow up of a certain group of patients with epilepsy.

Mycotic aneurysms of the intracranial vessels.

The salient clinical and pathological features are reported of Aspergillus cerebral aneurysms in four young women who had undergone intra-abdominal surgery under spinal anaesthesia and developed clinical features of meningitis 7-16 days postoperatively. The circle of Willis showed ruptured aneurysm in the basilar artery and its branches. The role of iatrogenic factors in the pathogenesis of Aspergillus cerebral aneurysms is highlighted.

Necrotizing myelopathy--a report of two cases with review of literature.

Necrotizing myelopathy is an uncommon neurological disorder. Till 1991, only 31 cases have been described in the literature. In this report, clinical and neuropathological features in two patients with necrotizing myelopathy are described. The precise aetiological agent in first patient was undetermined, However in the second patient there was serological evidence, suggestive of Herpes simplex virus infection.

Diagnosis of tuberculous meningitis by enzyme-linked immuno-sorbent assay (ELISA), using an affinity chromatography purified mycobacterial antigen.

Using an immunoabsorbent affinity chromatography, a mycobacterial antigen was isolated from culture filtrate of H37Ra Mycobacterium tuberculosis (MTB). The immunoabsorbents were prepared by coupling cynogen bromide-activated Sepharose-4B with human IgG antibody to MTB. Cerebrospinal fluids (CSF) from 10 culture positive, 30 culture negative patients with tuberculous meningitis (TBM) were assayed, for IgG antibody to this mycobacterial antigen by ELISA. CSFs from 50 patients with non-tuberculous neurological diseases were selected as control group. At a selected 'cut off' titre of 1:80, 21 out of 30 CSFs from culture negative patients gave positive results. No false negative result was observed in CSF from 10 culture positive patients with TBM. No false positive results were recorded in CSFs of 50 patients with non-tuberculous neurological diseases. Technical aspects involved in the isolation of this myobacterial antigen and its potential applications in the laboratory diagnosis of TBM have been emphasised in this study.