CT for Evaluation of Hemoptysis.

Hemoptysis, which is defined as expectoration of blood from the alveoli or airways of the lower respiratory tract, is an alarming clinical symptom with an extensive differential diagnosis. CT has emerged as an important noninvasive tool in the evaluation of patients with hemoptysis, and the authors present a systematic but flexible approach to CT interpretation. The first step in this approach involves identifying findings of parenchymal and airway hemorrhage. The second step is aimed at determining the mechanism of hemoptysis and whether a specific vascular supply can be implicated. Hemoptysis can have primary vascular and secondary vascular causes. Primary vascular mechanisms include chronic systemic vascular hypertrophy, focally damaged vessels, a dysplastic lung parenchyma with systemic arterial supply, arteriovenous malformations and fistulas, and bleeding at the capillary level. Evaluating vascular mechanisms of hemoptysis at CT also entails determining if a specific vascular source can be implicated. Although the bronchial arteries are responsible for most cases of hemoptysis, nonbronchial systemic arteries and the pulmonary arteries are important potential sources of hemoptysis that must be recognized. Secondary vascular mechanisms of hemoptysis include processes that directly destroy the lung parenchyma and processes that directly invade the airway. Understanding and employing this approach allow the diagnostic radiologist to interpret CT examinations accurately in patients with hemoptysis and provide information that is best suited to directing subsequent treatment. ©RSNA, 2021.

Allergic Bronchopulmonary Mycosis due to fungi other than Aspergillus.

Summary: Allergic bronchopulmonary mycosis (ABPM) is a clinical syndrome associated with immune sensitivity to various fungi that colonize the airways. Early diagnosis and treatment with systemic corticosteroids is the key in preventing the progression of the disease to irreversible lung fibrosis. Although Aspergillus has progressively gained recognition as a causative agent in past few decades, other fungi, that have been reported to cause ABPM, are not yet widely evaluated. We studied hundred and two patients with asthma for occurrence of ABPM. Patients were tested for cutaneous hypersensitivity and serum precipitin to 12 common fungal antigens. The positive cases were further evaluated for ABPM using standard criteria. Out of 102 asthma patients screened, 18 patients had either skin prick test (SPT) and/or serum precipitin positive. While 14 patients were SPT positive for one or more fungal antigen, two patients were serum precipitin positive for one or more fungi. Two patients had both serum precipitin positive as well as SPT positive. Six (5.8%) patients were diagnosed as ABPM as they fulfilled the criteria. Three of these were because of Aspergillus sp. Two were because of fungi other than Aspergillus namely Schizophyllum and Curvularia. One patient had ABPM because of both Aspergillus and Curvularia. In our study absolute eosinophil count (AEC), total IgE, serum precipitin and SPT had sensitivity of 100%, 100% 50% and 83.3% respectively for diagnosing ABPM. The specificity of these tests was 44.79%, 64.58% 98.96% and 88.54% respectively. Specfic IgE was positive in 50% of patients with either serum precipitin or SPT positivity. SPT or serum precipitin followed by specific IgE had sensitivity of 100% and specificity of 96.88% for diagnosing ABPM. SPT alone followed by Specific IgE had a sensitivity of 83.33% and specificity of 96.88% for diagnosing ABPM. We found that fungi other than Aspergillus such as schizophyllum, and curvularia, can be implicated in ABPM. Multiple fungal agents may be responsible for ABPM in an individual. There is a subset of patients of BA who have fungal sensitization but do not fulfil the criteria for ABPM. SPT was the single most sensitive and specific test, AEC >350 and total IgE more than 417IU were most sensitive tests and SPT followed by specific IgE was most effective strategy for diagnosing ABPM.

Genetic polymorphisms in KCNJ11 (E23K, rs5219) and SDF-1ß (G801A, rs1801157) genes are associated with the risk of type 2 diabetes mellitus.

Background Type 2 diabetes mellitus (T2DM) is a global major health problem resulting from interaction of environmental and genetic factors, examples of the latter being KCNJ11 (coding for part of the ATP-sensitive potassium channel) and SDF-1ß (coding for chemokine CXCL12). Our case-control study was conducted to assess whether recessive, dominant or additive genotype model associations of KCNJ11 (E23K, rs5219) and SDF-1ß (G801A, rs1801157) were more strongly linked to type 2 diabetes. Subjects & Methods Genetic polymorphism analysis was performed by polymerase chain reaction-restriction fragment length polymorphism. Alleles and genotype frequencies between 200 cases and 200 controls were determined and compared. Results The dominant (EE v EK + KK, p = 0.022) and additive (EK v EE + KK, p = 0.021) models, but not the recessive model (KK v EE + EK, p = 0.727) of KCNJ11 were linked to diabetes. Similarly, the dominant (GG v GA + AA, p < 0.001) and additive (AG v GG + AA, p=<0.001) models, but not the recessive model (AA v AG + GG, p = 0.430) of SDF-1ß were linked to diabetes. The A allele (p = 0.006) of SDF-1ß was protective against the risk of T2DM. Conclusion Both dominant and additive models in both KCNJ11 (E23K, rs5219) and SDF-1ß (G801A, rs1801157) genetic polymorphisms are significantly associated with type 2 diabetes.

Effect of seaweeds occurring at Karachi coast on mosquito larvae and liver function in rats.

Seaweeds have been consumed as human food from thousands of years. In this study ethanol extract of 16 different seaweeds were tested for mosquito larvicidal activity against 4th instar larvae of Aedes aegyptii. The ethanol extracts of Padina pavonia and Sargassum ilicifolium caused 50% mortality at 1200ppm concentration. However other seaweeds Halimeda tuna, Ulva lactuca (Chlorophyta), Dictyota dichotoma var intricata, Jolyna laminariodes, Sargassum binderi (Phaeophyta), Melanothamnus afaqhusainii and Solieria robusta (Rhodophyta) showed LC50 at ≈1500 ppm concentration. The n-hexane fraction of Padina pavonia was most potent and produced lethality at minimum concentration (LC50 at 250ppm).The effect of ethanol and water extracts of S. binderii was also examined on liver function of healthy rats. The ethanol extract of Sargassum binderi given orally to rats @ 200mg/kg for 14 days slightly increased the concentration of liver enzymes (ALT, AST, ALP and LDH) and urea level as compared with normal control rats, but did not increase bilirubin, glucose, triglycerides, cholesterol and creatinine. Whereas water extract of S. binderi affected ALT while other biochemical parameters were near normal or slightly decreased as compared to normal control.

Identification of FUS p.R377W in essential tremor.

BACKGROUND AND PURPOSE: Exome sequencing analysis has recently identified a nonsense mutation in fused in sarcoma (FUS) segregating with essential tremor (ET) within a large French-Canadian family. Further characterization of FUS resulted in the identification of additional mutations in ET patients; however, their pathogenicity still remains to be confirmed. The role of FUS in an independent cohort of ET patients from Canada was evaluated. METHODS: The entire coding sequence of FUS in 217 patients diagnosed with ET was analyzed and two missense variants in 219 healthy controls were genotyped by Sanger sequencing. RESULTS: Sequencing of FUS identified a previously reported non-pathogenic mutation p.G174_G175del in one ET patient and two healthy controls, and a novel p.R377W in one patient with family history of disease. This mutation is highly conserved and strongly predicted to be damaging by in silico analysis. CONCLUSION: This study has identified a novel FUS p.R377W substitution in ET patients. Additional genotyping studies in a large number of ET patients and controls are necessary to conclusively define its pathogenicity.

Don't skip a beat! Critical findings in imaging studies performed in adults with congenital heart disease.

With ongoing advances in both medical and surgical management, the population of adults with congenital heart disease (CHD) continues to grow each year and has surpassed the number of pediatric cases. These adult patients will present to adult emergency departments with increasing frequency. Adults with CHD are at increased risk of developing not only cardiovascular complications, such as aortic dissection and thromboemboli, but also abdominopelvic and neurologic processes at younger ages. These individuals are also more likely to develop less urgent but clinically significant complications including end-organ dysfunction, baffle leaks, or bleeding collateral vessels. Ultimately, imaging can play a critical role in determining the triage, diagnosis, and management of adult CHD patients. To accomplish this goal, radiologists must be able to distinguish acute and chronic complications of treated CHD from benign processes, including expected post-surgical changes or imaging artifacts. Radiologists also need to be familiar with the various long-term risks and complications associated with both treated and untreated forms of CHD, particularly those in adults with complex lesions.

Characterization of diamond and organic scintillation detectors utilizing radiation sources for continuous plasma operation.

This paper provides a comprehensive study of neutron calibration methodologies, specifically highlighting the capabilities for n-γ discrimination in diamond and EJ-309, and stilbene scintillation detectors. The calibration process detailed in this study includes pulse height analysis and pulse shape discrimination, relying on the analysis of charge deposition resulting from both γ and neutron interactions. Utilizing 60Co and 252Cf radiation sources, the energy spectra of these sources are obtained. The characterized detectors were used in ST40 experiments and allowed acquiring neutron signal during a plasma shot with good agreement among diamond and scintillation detectors. Then, the diamond detector was cross-calibrated against indium activation foils placed at the same location in proximity to the ST40 during plasma shots: both detectors measured a neutron flux of ≈106 cm-2 s-1 at ≈1 m distance from the tokamak center, and the discrepancy between the diamond detector and the activation foils is ≈25%.

Estimation of production cross-sections, transmutation and gas generation from radionuclides (A ∼50-60) in fusion environment.

Degradation of material properties under neutron irradiation generates a requirement for studying effects on materials in a fusion environment and optimizing radiation-resistant materials for future applications. In the present work, the durability of stainless steel (SS) alloy used in ITER-like fusion devices is studied. We have predicted the amount of radionuclides produced in the material upon neutron irradiation at various locations is determined using the ACTYS, neutron activation code, for a typical one-dimensional geometry of ITER-like fusion reactor. The ACTYS code is further used to determine the gas production from 55Fe, 59Ni, and other long-lived radionuclides in the material. To further stress the importance of gas production in fusion materials, a comparative study of gas production cross-sections as given in various standard data libraries is examined using TALYS-1.8 and is presented in the paper.

In vitro and in vivo anthelmintic response of the seeds of Amomum subulatum roxb and Vitex negundo.

The current study was designed to check the anthelmintic activities of some local plants. Seeds of Amomum (A.) subulatum and Vitex (V.) negundo in different solvents were subjected to in vitro (adult motility assay; AMA and egg hatch assay; EHA) and in vivo (faecal egg count reduction test; FECRT) anthelmintic activity testing protocols using Haemonchus (H.) contortus as an experimental model. The results of AMA, EHA, and FECRT were statistically analysed through linear regression and Duncan multiple range test. In AMA test, at 50 mg mL-1 concentration, the percent mortality of H. contortus was higher in A. subulatum than V. negundo, whereas, in EHA test, A. subulatum was proven better ovicidal (LC50=14.2 µg mL-1) than V. negundo (LC50= 65.7405 µg mL-1). The FECRT also indicated the better efficacy of A. subulatum than V. negundo against natural infection of gastrointestinal (GI) parasites. The crude powder of plants used in this study showed 29.6% to 57.7% anthelmintic. The reduction rate was found higher for A. subulatum (3 g kg-1) as compared to V. negundo (7 g kg-1). Reagrding efficacy analysis of solvents used for plants extract, ethyl acetate and chloroform were found better in increasing ovicidal activity in adult worms (in vitro testing), whereas, the crude aqueous methanol was found better than the crude powders in in vivo testing. It will be beneficial to document the indigenous knowledge to standard scientific procedures for their validation. This study will help to motivate the farmers to make a better choice of cultivation of the indigenous plants because of their varying efficacies as an alternative preventive approach against the GI parasitic infections.

Formulation and evaluation of verapamil hydrochloride loaded solid lipid microparticles.

The present study aimed to produce verapamil hydrochloride-loaded solid lipid microparticles (SLM) by the w/o/w emulsion solvent evaporation technique, using diethyl ether as solvent phase, glyceryl monostearate as biodegradable polymer and Span 60 as surfactant. SLM of spherical shape were prepared by simple dilution of the emulsion with water. To increase the lipid load the process was conducted at 50 degrees C, and in order to reach sub-micron size, a high-shear homogenizer was used. The encapsulation efficiency of prepared SLM reached 74.29 +/- 0.76%. Particle size (98.55 +/- 1.42 microm), surface morphology (spherical) and drug loading efficiency (18.57 +/- 1.25% w/w) were investigated. And optimization of drug polymer ratio (3:1), nature and concentration of emulsion stabilizer in the external aqueous (0.1%), phase viscosity of external aqueous phase (0.5%), volume of external aqueous phase and stirring rate (1000 rpm) were detected. Analysis of microsphere content after processing showed that verapamil did not undergo any chemical modification within the micro-particles. The in-vitro release of verapamil from the microparticles was very low and an initial burst effect of 17% of the dose was observed. The slow release may help to avoid a high frequency of administration. The prepared solid lipid microparticles appear to have interesting perspectives as delivery systems for the oral administration of verapamil hydrochloride with improved half-life, improved bioavailability, and minimized local and systemic gastrointestinal disturbances of the drug.

Characterization of heterogeneity in Ty1-copia GROUP retrotransposons in chickpea (Cicer arietinum L.).

Retrotransposons represent a major fraction of the plant genome and play a significant role in the molecular evolution through sequence re-organization. In order to access the diversity in Ty1-copia group of retrotransposons in chickpea, reverse transcriptase (RT) conserved domain specific primers were selected to amplify RT conserved sequences. Thirty-six amplified fragments were cloned and characterized. On the basis of deduced amino acid homology among them, these sequences were grouped into five families. These sequence families showed from 34 to 81% inter-family homology at the amino acid level. Although these sequences belong to a highly conserved region no two sequences were identical. The results show that there is a high degree of heterogeneity among the Ty1-copia group of retroelements in chickpea. The genomic Southern hybridization with one of the reverse transcriptase sequences as a probe shows the presence of a large population of the Ty1-copia group of retrotransposons in chickpea.

Isolation and characterization of stress induced Ty1-copia like retrotransposable elements in chickpea (Cicer arietinum L.).

Almost all active plant retroelements are known to be induced by various biotic and abiotic stresses. Here, we show the presence of transcriptionally active Ty1-copia like retroelements in chickpea and their induction in response to abiotic stress. Eight Ty1-copia retrotransposon like mRNA sequences were reverse transcribed, amplified, cloned and characterized from stressed plants. These mRNA sequences were not detected in chickpea plants grown under normal conditions. Basing on the similarity analysis, these RT transcript sequences were classified into three families. It is proposed that all sequences except CARE7 might be transcript sequences of functional retrotransposons. The mRNA sequence CARE3 shows 99% nucleotide identity to a genomic Ty1-copia like sequence present in the Genbank with accession no. AJ535883.

Gallbladder Scalloping, Mammillated Caudate Lobe, and Inferior Vena Cava Scalloping: Three Novel Ultrasound Signs of Cirrhosis.

PURPOSE: We aimed to present three new ultrasound signs-gallbladder scalloping, mammillated caudate lobe, and inferior vena cava scalloping-and determine their accuracy in diagnosing liver cirrhosis. MATERIALS AND METHODS: A total of 201 consecutive patients with a history of chronic liver disease who had undergone ultrasound imaging and liver biopsy were identified. A senior ultrasound radiologist blindly reviewed the ultrasound examinations. Specificity, sensitivity, positive predictive value, and negative predictive value of diagnosing cirrhosis were calculated for all evaluated ultrasound signs and selected combinations of signs, using the liver biopsy results as the reference standard. RESULTS: Of the 201 patients, 152 (76%) had either pathology-proven cirrhosis or significant fibrosis. Caudate lobe hypertrophy was the most specific (88%) and most positive predictor (90%) for cirrhosis, whereas mammillated caudate lobe was the most sensitive (78%). Inferior vena cava scalloping was the most specific (78%) of the three proposed ultrasound signs. When signs were combined, the presence of either gallbladder scalloping or liver surface nodularity was highly sensitive for cirrhosis (87%), whereas the presence of either gallbladder scalloping or inferior vena cava scalloping with caudate lobe hypertrophy was highly specific (93%). CONCLUSIONS: Gallbladder scalloping, mammillated caudate lobe, and inferior vena cava scalloping are three novel signs that improve the accuracy of ultrasound in diagnosing cirrhosis.

A comparison between a conventional and a fiberoptic flow-directed thermal dilution pulmonary artery catheter in critically ill patients.

Invasive hemodynamic monitoring is frequently required in the management of patients in intensive care units. A fiberoptic flow-directed thermal dilution pulmonary artery catheter capable of continuously monitoring the mixed venous saturation, while more expensive than a conventional pulmonary artery catheter, theoretically could result in better patient care, and might be cost-effective if it resulted either in fewer blood tests being ordered or in less time in the intensive care unit. To test this hypothesis, we designed a randomized trial in our Medical Intensive Care Unit to compare a standard pulmonary artery catheter with a fiberoptic catheter. Twenty-six patients received a standard catheter and 25 patients received the fiberoptic catheter. There were no statistical differences between the groups in age, time in the intensive care unit, number of tests ordered, hours of mechanical ventilator therapy, hours of vasoactive drug therapy, or mortality rate. The only statistically significant differences between the groups were that (1) the fiberoptic catheter required a longer insertion time and (2) there were more technical problems in consistently obtaining the wedge pressure in the patients with the fiberoptic catheters. We conclude that routine substitution of a fiberoptic catheter for the standard pulmonary artery catheter is not indicated.

Phytochemical studies on the seed extract of Piper nigrum Linn.

The petroleum ether extract of dried ground seeds of Piper nigrum Linn. and some column fractions of this extract were subjected to GC and GC-MS analysis, resulting in the identification of fourteen compounds (1-14) by using NIST Mass spectral search program 1998 and the Kovat's retention indices. Ten of the compounds (1, 2, 4-12) are reported for the first time from this plant. All the fractions showed insecticidal activity against the fourth instar larvae of Aedes aegypti and against the fourth instar larvae of Anopheles stephensi Liston, determined by the WHO method.

Nephropathy in Indian patients with non-insulin-dependent diabetes in the young.

In 85 patients diagnosed as having non-insulin-dependent diabetes in the young (NIDDY), 6 were found to have nephropathy. The duration of diabetes ranged from 2 to 17 yr; 5 of the 6 patients had retinopathy as evidenced by fluoroscein angiography (3 with proliferative changes). All 6 patients had a 24-h urinary protein excretion greater than 0.5 g and a glomerular filtration rate less than 80 ml/min. Serum beta 2-microglobulin levels were increased in all 6 patients, while only 3 had increased serum creatinine levels.

Acute insulin response to glucagon, tolbutamide, and glucose in non-insulin-dependent diabetes of the young.

Acute insulin release in response to maximal intravenous doses of glucose (0.5 g/kg), tolbutamide (1 g), and glucagon (1 mg) was studied in 10 subjects with non-insulin-dependent diabetes of the young (NIDDY) and 10 age-, sex-, and weight-matched controls. Diabetic subjects had attenuated insulinemic responses to all three stimuli, in comparison with control subjects. However, insulin responses to glucagon and tolbutamide were higher than those obtained with intravenous glucose. This study demonstrates that the pancreatic beta-cell is more responsive to nonglucose secretagogues than to glucose stimuli in individuals with NIDDY.

Pituitary function in Sheehan's syndrome.

The responses of plasma prolactin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and thyroid-stimulating hormone were measured in ten women with Sheehan's syndrome after intravenous administration of the appropriate releasing hormones. Growth hormone and cortisol responses to insulin-induced hypoglycemia were also measured. It was found that two patients were biochemically borderline euthyroid and eight were probably hypothyroid in the face of thyroid-stimulating hormone values in the reference range; in two patients thyroid-stimulating hormone response to thyrotropin-releasing hormone was appropriate. In no patient were the minimum prolactin levels achieved, in response to thyroid-releasing hormone as established in reference subjects. Growth hormone response to hypoglycemia was inadequate in all patients and only one patient achieved reference range values of cortisol during hypoglycemia. In six patients fasting LH and FSH were in the reference range and the response to gonadotropin-releasing hormone was adequate and appropriate in eight patients. In light of these findings it is suggested that prolactin response to thyrotropin-releasing hormone administration would be a reliable and simple screening procedure for suspected Sheehan's syndrome.

Effect of air pollution on peri-urban agriculture: a case study.

Peri-urban agriculture is vital for the urban populations of many developing countries. Increases in both industrialization and urbanization, and associated air pollution threaten urban food production and its quality. Six hour mean concentrations were monitored for SO(2), NO(2) and O(3) and plant responses were measured in terms of physiological characteristics, pigment, biomass and yield. Parameter reductions in mung bean (Vigna radiata), palak (Beta vulgaris), wheat (Triticum aestivum) and mustard (Brassica compestris) grown within the urban fringes of Varanasi, India correlated directly with the gaseous pollutants levels. The magnitude of response involved all three gaseous pollutants at peri-urban sites; O(3) had more influence at a rural site. The study concluded that air pollution in Varanasi could negatively influence crop yield.

Prolactin secretion in Sheehan's syndrome. Responses to thyrotropin-releasing hormone and metoclopramide.

The prolactin response to thyrotropin-releasing hormone (TRH) and metoclopramide was studied in 16 patients with Sheehan's syndrome and 16 matched controls in the follicular phase. Metoclopramide resulted in a greater prolactin response than TRH did in the controls. However, both stimuli failed to evoke any appreciable prolactin response in the patients with Sheehan's syndrome. Since metoclopramide is generally free of side effects and far cheaper than TRH, we recommend the prolactin response to metoclopramide as the preferred screening test in the diagnosis of Sheehan's syndrome.