Utility of Perl's Prussian Blue Stain in Exfoliated Buccal Cells of Thalassemia and Sickle Cell Anemia Patients and Their Correlation With Serum Ferritin Levels.

Introduction Iron is essential for all living beings. Excess iron, on the other hand, is dangerous because it causes the creation of free radicals. As a result, iron absorption is carefully managed to maintain a balance between absorption and iron loss in the body. Due to the lack of particular excretory channels for iron in humans, iron excess in the tissues is common. It can be caused by a number of factors, including increased iron absorption, as seen in hemochromatosis, or frequent parenteral iron treatment, as seen in thalassemia and sickle cell anemia patients (a transfusional overload). Aim The study aims to demonstrate Perl's Prussian blue stain to identify iron overload at a preliminary stage and correlate with serum ferritin levels in patients with thalassemia and sickle cell anemia who frequently receive blood transfusions. Materials and methods The present study comprised 62 confirmed cases of thalassemia and sickle cell anemia patients undergoing repeated blood transfusions of a minimum of 15/more, along with 62 clinically healthy individuals between December 2016 and November 2018. The patients with thalassemia and sickle cell anemia were confirmed by hemoglobin electrophoresis (Bio-Rad D-10, Bio-Rad Laboratories, Inc, California, United States). The buccal smears were obtained from these patients along with the controls, and these slides were stained by Perl's Prussian blue stain and were examined under a light microscope. Results Sixty-two cases and 62 controls were considered in the current investigation. Forty-seven of the 62 people had thalassemia, and 15 had sickle cell anemia. Thirty-nine out of the 47 patients with thalassemia and six of the 15 individuals with sickle cell anemia had positive results for Perl's Prussian blue stain. All patients had elevated blood ferritin levels, with varying ranges associated with positive results for Perl's Prussian blue stain. Conclusion The objective of this study was to demonstrate the utility of oral exfoliative cytology in thalassemia and sickle cell anemia patients who often receive blood transfusions as a screening and diagnostic tool. The exfoliative cytology methods' acceptability and simplicity, along with their correlation with serum ferritin levels and Perl's Prussian blue reaction, make this noninvasive procedure an excellent screening and diagnostic tool for all patients who receive repeated blood transfusions.

Development of a robust real-time synchronized data transmission technique from a Magnetic Observatory to an INTERMAGNET GIN.

This paper presents the step-by-step development and implementation of real-time data transmission from a distant Observatory. Using Python programming language, we have developed an algorithm for automated data transmission of high resolution real-time magnetic data from Choutuppal (CPL) and Hyderabad (HYB), India to INTERMAGNET Edinburgh GIN, with minimal internet services. We have designed a system to transfer the data in a secured and encrypted pattern with SSH keys and save the same dataset in the local server at CSIR-NGRI. Both the Observatories data are transmitted to GIN in real-time with a time frame of less than 300 s. After successfully transmitting real-time 1 min geomagnetic data from CPL and HYB Observatories to Edinburgh GIN, CPL's 1 s real-time data is also initiated and is one of the first Indian observatories to transmit real-time 1 s data to GIN. The details of algorithm development, function libraries and the challenges faced for 1 s and 1 min data transmission at both the Observatories are discussed.

Review of the Role of HER2/neu in Colorectal Carcinomas.

Human epidermal growth factor receptor 2 (HER2/neu) is an oncogenic driver and a proven target for treatment of breast and gastric cancers. The role of HER2/neu and its blockage in various tumors, particularly colorectal adenocarcinoma has been widely explored following the revolutionary impact of anti-HER2/neu therapy in breast and gastric carcinoma patients. This review aimed to highlight the most recent updates on the significance of HER2/neu as a prognostic and predictive factor in these tumors together with its subsequent possible therapeutic indications from preclinical tests and ongoing assessments testing anti-HER2/neu agents in colorectal carcinoma (CRC). In the near future with a growingly tailored therapeutic approach toward cancers, HER2/neu targeted therapeutic strategies may blend into CRC treatment methods.

Biliary Stent Obstruction Leading to Bronchobiliary Fistula: A Rare Case Report.

Bronchobiliary fistula (BBF) is a rare complication encountered by surgeons, most commonly during the follow-up of surgically managed patients with inflammatory, traumatic, or neoplastic pathologies involving the hepatobiliary tree. We present an operated case of liver hydatidosis with biliary stent obstruction with complaints of bitter green colored sputum and upper abdominal pain. The patient underwent an ERCP-guided stent extraction with reinsertion of a common bile duct stent with complete removal after six weeks. Post operatively, the patient is doing well on follow-up. This complication could be prevented by regular follow-up and timely removal of the placed stents, as a prolonged stay of stent insitu could lead to blockage, leading to complications such as bronchobiliary fistula. Thus, it is concluded that judicious follow-up plays a pivotal role, and timely removal of the stents could prevent such avoidable delayed complications.

Concurrent diagnosis of rheumatic mitral stenosis & aortoarteritis: a rare combination.

A 21-year-old lady was initially diagnosed with rheumatic mitral stenosis and then 18 months later with asymptomatic aortoarteritis. She was treated with percutaneous interventions for both problems. This is a very rare combination of conditions, which has previously been reported in a few autopsy specimens. We highlight the importance of thorough echocardiography in the patient and also suggest how future cases could be treated at one catheterisation.

Giant ruptured sinus of Valsalva aneurysm: diagnosis on echocardiography.

A giant ruptured sinus of Valsalva aneurysm was diagnosed on transthoracic and subsequent transesophageal echocardiography, in a 45-year-old man who presented with gradual onset shortness of breath. Although the initial presentation was insidious, he later rapidly deteriorated. We discuss the unusual clinical course in a patient with such a large aneurysm and discuss the likely reasons.

Giant single left coronary artery with right ventricular fistula diagnosed in early childhood.

We present an unusual case of an 18-month-old boy, who presented with dyspnea and recurrent respiratory tract infections. Echocardiography and subsequent angiography were suggestive of a fistula from a coronary artery to the right ventricle. Finally, only on table could the actual diagnosis of a single left coronary artery with right ventricular fistula be made. Surgical treatment was successfully performed with off-pump ligation and the patient was well with no residual fistula on echocardiogram when seen at 3 month follow-up.

Clinical presentation and investigation findings in cardiac myxomas: new insights from the developing world.

BACKGROUND: Cardiac myxomas are an uncommon condition and most of the available information on their clinical features comes from smaller series of patients from developed countries. Our aim was to quantify and correlate the clinical and investigation findings in cardiac myxomas in a developing country and compare them with existing data. METHODS: A retrospective study of case notes, electrocardiograms, and x-rays of 171 patients treated for cardiac myxoma from February 1992 to October 2006 at a large charitable institution in South India was conducted. Frequency of different clinical findings and relationships between these findings, age, sex, tumor location, and size were calculated. RESULTS: The mean age at presentation was 37.1 years. Dyspnea was the most common symptom. Embolism was found in 9% of patients and systemic symptoms in 20% of patients. Auscultation abnormalities were present in 89% of patients, including a tumor plop in 50%. Left atrial enlargement was the most common electrocardiographic abnormality (35%), whereas cardiomegaly was the most common chest x-ray finding (55%). Raised erythrocyte sedimentation rate was found in 75% and anemia in 45% of patients. Female patients and patients with right atrial myxomas more commonly had systemic symptoms. Tumor size correlated with electrocardiographic and x-ray abnormalities. CONCLUSIONS: Cardiac myxomas present at a younger age in developing countries. Almost all patients were symptomatic because they presented for medical care at an advanced stage of disease. Certain clinical manifestations depend on site and size of the tumor as well as age of the patient. A high index of suspicion is necessary for making an early diagnosis.

Ruptured sinus of valsalva: unexpected finding in a patient diagnosed with ventricular septal defect with aortic regurgitation.

Ruptured sinus of Valsalva aneurysm is an uncommon condition which has a good prognosis if surgically corrected. However, sometimes making the diagnosis on echocardiography and even cardiac catheterization can be difficult. We describe a case which was diagnosed as ventricular septal defect with aortic regurgitation but, on the table, was found to be a ruptured sinus of Valsalva aneurysm.

Mixed supra- and infradiaphragmatic totally anomalous pulmonary venous connection in an adolescent.

An unusual type of mixed totally anomalous pulmonary venous drainage in an 11-year-old boy was diagnosed on angiography. The left-side veins drained via a vertical vein into the portal venous system, while the right-side veins drained high into the superior vena cava. Surgical correction of this abnormality was successfully performed.

Aortopulmonary window in adults: diagnosis and treatment of late-presenting patients.

OBJECTIVES: Aortopulmonary window is an uncommon condition, particularly so in adulthood because it is usually fatal in infancy or childhood if untreated. Very few cases of those who have survived to adulthood and been operated on successfully have been described. Our study aimed to provide clinical, investigative, surgical, and outcome details of such patients. DESIGN AND SETTING: Retrospective study of consecutive adult patients with aortopulmonary window treated at a tertiary charitable cardiovascular institute in South India between 1996 and 2006. RESULTS: Six adult patients successfully underwent aortopulmonary window closure. Five of the six patients had been correctly diagnosed on echocardiography, while one was only diagnosed after cardiac catheterization for unexplained pulmonary arterial hypertension. Four of the patients had large defects with severe pulmonary arterial hypertension, with pulmonary vascular resistance index (PVRI) ranging from 5.2 to 15.9 at baseline. All showed significant reversibility with oxygen administration, with PVRI on oxygen falling to between 0.6 and 2.2. These patients successfully underwent cardiopulmonary bypass. The other two patients with small lesions underwent ligation off-pump. There was no early or late mortality among these patients. All were in New York Heart Association class I, on follow-up ranging from 3 months to 8 years. CONCLUSIONS: Aortopulmonary window may rarely present in adulthood. The diagnosis can usually be made by careful echocardiography alone. Even in the presence of severe pulmonary arterial hypertension, if a significant reversibility in pulmonary vascular resistance can be demonstrated with oxygen, the condition can be successfully corrected with good long-term outcomes.

Imaging features of aorto-right atrial tunnel: a report of two cases.

Aorto-right atrial tunnel is a rare congenital anomaly with very few cases described in the literature. It has been classified into anterior and posterior types and we present two operated cases, one of each type. The radiologic, echocardiographic, and angiographic features of the condition are highlighted.