Uranium distribution in groundwater and assessment of age dependent radiation dose in Amritsar, Gurdaspur and Pathankot districts of Punjab, India.

A comprehensive study of seasonal variation of uranium distribution in groundwater of Amritsar, Gurdaspur and Pathankot districts of Punjab, India and assessment of associated radiological risks, chemical risks and effective radiation dose for different age groups, was conducted to determine its health impact on humans residing in these regions. Physicochemical parameters such as pH, EC, TDS, total hardness and contents of various anions such as carbonates/bicarbonates, chlorides, fluorides, nitrates, sulphates and phosphates in groundwater were also analysed to determine correlation between groundwater chemistry and uranium distribution. The average values of uranium concentration in ground water samples of Amritsar, Gurdaspur and Pathankot districts were found to be 8.6 µg L-1, 4.3 µg L-1 and 3.0 µg L-1, respectively, in pre-monsoon and 8.8 µg L-1, 4.9 µg L-1 and 3.4 µg L-1, respectively, in post-monsoon. The uranium concentration in majority of the ground water samples was found to be below the permissible limit of 30 µg L-1 recommended by World Health Organization (WHO, 2011). In all three districts, TDS, EC and bicarbonates were found to have positive correlation with observed uranium contents in both seasons. The annual effective dose due to ingestion of uranium through drinking water was found to be less than the prescribed limit of 100 µSv y-1 given by WHO (2004). Radiological and chemical toxicity risk assessment of uranium in groundwater was also carried out and found to be within the permissible values of 1.67 × 10-4 and 4.53 µg kg-1 day-1 respectively, recommended by Atomic Energy Regulatory Board (AERB, 2004).

Clinical and laboratory factors associated with mortality in dengue.

Dengue is endemic in more than 100 countries, giving rise to an increased number of deaths in the last five years in the South-East Asian region. We report our findings from a retrospective study of adults admitted with confirmed dengue at our institution. We studied the clinical and laboratory parameters associated with mortality in these patients. Of the 172 hospitalised patients studied, 156 (90.69 %) recovered while 16 (9.3%) died. Univariate analysis showed altered sensorium on presentation, lower haemoglobin and haematocrit levels, higher serum creatinine, higher serum transaminase and lower serum albumin levels to be significantly associated with mortality in dengue. Further, using stepwise multivariate logistic regression, altered sensorium ( P = 0.006) and hypoalbuminemia ( P = 0.013) were identified as independent predictors of mortality in dengue. Identification of these parameters early in the course of disease should prompt intensification of treatment in dengue cases.

An unusual case of reversible mild cognitive impairment.

Mild cognitive impairment (MCI) is cognitive dysfunction greater than expected for age and education in either a single cognitive domain or in multiple domains without impairment of activities of daily living. The present case report describes the case of an elderly male patient of 71 years who presented with MCI and was Venereal Disease Research Laboratory test reactive in serum. This was confirmed by Treponema pallidum Hemagglutination Assay. After a complete course of antibiotic therapy, his memory complaints disappeared completely. Though syphilis is termed as reversible dementia; to the best of our knowledge, this is the first case of MCI with reactive syphilis serology who responded to antimicrobial therapy.

Ludwig's angina by Salmonella Typhi: a clinical dilemma.

Salmonella Typhi has rarely been associated with focal abscesses; and in literature, there is no evidence of its association with abscesses in the neck spaces. Ability of Salmonella Typhi to invade and localise in the neck spaces not only poses a diagnostic challenge but also underscores the necessity to understand the mechanisms that facilitate Salmonella Typhi to establish infections at sites completely non-traditional to the organism.

Primary tubercular chest wall abscess in a young immunocompetent male.

Chest wall tuberculosis is a rare entity especially in an immunocompetent patient. Infection may result from direct inoculation of the organisms or hematogenous spread from some underlying pathology. Infected lymph nodes may also transfer the bacilli through lymphatic route. Chest wall tuberculosis may resemble a pyogenic abscess or tumour and entertaining the possibility of tubercular etiology remains a clinical challenge unless there are compelling reasons of suspicion. In tuberculosis endemic countries like India, all the abscesses indolent to routine treatment need investigation to rule out mycobacterial causes. We present here a case of chest wall tuberculosis where infection was localized to skin only and, in the absence of any evidence of specific site, it appears to be a case of primary involvement.

Tubercular liver abscess: a distinct entity not to be missed.

BACKGROUND: Liver abscess is fairly common in developing countries and its incidence is ever-rising. Though amoebic and pyogenic liver abscesses form majority of cases in our country, tubercular liver abscess (TLA) should also be considered as differential diagnosis. AIMS: To study the clinical and imaging profile of tubercular liver abscess while establishing its increased incidence. METHODS: A prospective observational study was carried out on 72 indoor cases of liver abscess, presenting to Department of Medicine, from November 2011 to February 2013. All cases were subjected to abscess tap and tapped abscess was sent for microbiological examination. RESULTS: Though amoebic liver abscess was most common type diagnosed, five cases came out to be tubercular (AFB positive). Mean age of TLA patients was 28.4 years (all males). All cases were sub-acute in presentation. Splenomegaly and ascites were noted in 60% and 40% cases respectively. ESR was raised in 80% cases with mean value of 52.8 mm at first hour. Haemoglobin was low in 80% cases. Serum Alkaline phosphatise (ALP) was raised in all cases, mean value being 1034.4 U/L. On ultrasonography, all abscesses were < 5 centimetres in size, most commonly involving seventh segment. They were multiple in numbers in 60% cases. All cases responded well to anti-tubercular treatment. CONCLUSIONS: Tubercular liver abscess has increased in incidence, and in majority of cases in our study, they were incidentally found with no associated foci of infection in lung or gastrointestinal tract. So, keeping high index of suspicion, TLA should be considered in all patients with subacute presentation and associated anaemia, splenomegaly or ascites. Also, TLA is associated with raised ESR and comparatively higher levels of ALP in serum. They are more commonly multiple in number on ultrasonography.

Clinical, laboratory, and management profile in patients of liver abscess from northern India.

Objective. To describe the clinical profile, microbiological aetiologies, and management outcomes in patients with liver abscess. Methods. A cross-sectional study was conducted from May, 2011, to April, 2013, on 200 consecutive liver abscess patients at PGIMER and Dr. RML Hospital, New Delhi. History, examination, and laboratory investigations were recorded. Ultrasound guided aspiration was done and samples were investigated. Chi-square test and multivariate regression analysis were performed to test association. Results. The mean age of patients was 41.13 years. Majority of them were from lower socioeconomic class (67.5%) and alcoholic (72%). The abscesses were predominantly in right lobe (71%) and solitary (65%). Etiology of abscess was 69% amoebic, 18% pyogenic, 7.5% tubercular, 4% mixed, and 1.5% fungal. Percutaneous needle aspiration was done in 79%, pigtail drainage in 17%, and surgical intervention for rupture in 4% patients. Mortality was 2.5%, all reported in surgical group. Solitary abscesses were amoebic and tubercular whereas multiple abscesses were pyogenic (P = 0.001). Right lobe was predominantly involved in amoebic and pyogenic abscesses while in tubercular abscesses left lobe involvement was predominant (P = 0.001). Conclusions. The commonest presentation was young male, alcoholic of low socioeconomic class having right lobe solitary amoebic liver abscess. Appropriate use of minimally invasive drainage techniques reduces mortality.

Case of sparganosis: a diagnostic dilemma.

Sparganosis, also known as larval diphyllobothriasis, is a rare disease of humans as man is not a natural host in the life cycle of Spirometra spp. Diagnosis of the latter is difficult as it mimics other conditions that commonly cause subcutaneous or visceral fluid collection. Clinical diagnosis of this particular case was also erroneously labelled as tuberculosis but later labelled as a case of sparganosis. To the best of our knowledge, this is the first case from India where a sparganum-like parasite was isolated in drain fluid from the perinephric area.

Female genital TB and HIV co-infection.

HIV-induced immunosuppression paves the way for several infections, tuberculosis being very common in our country. Female genital tuberculosis (FGTB), presenting as menstrual irregularities, is a diagnostic challenge in an adolescent female when these may be considered normal. The present case is of a young female who presented with menstrual irregularities, diagnosed subsequently as a case of genital tuberculosis. Microbiological relapse after anti-tubercular treatment of six months caused suspicion of a co-existing immunodeficiency and investigations revealed HIV co-infection; thus emphasizing the need of HIV testing in all patients of tuberculosis for timely diagnosis and treatment support thereafter.

Recent outbreak of meningococcal meningitis--a microbiological study with brief review of literature.

Meningococcal disease presents in various clinical forms, most common being meningitis and meningococcemia. A spurt of meningococcal cases was seen in medicine and pediatric wards of Dr. Ram Manohar Lohia Hospital during the recent outbreak from Dec 2005 - June 2006. These had presented either with the classical features of acute purulent meningitis or as fever with rash. The patients were investigated microbiologically for the causative organism which was identified as Neisseria meningitidis in 257 out of 531 cases (48.39%). The classic finding of gram negative diplococci on gram stain remained the mainstay of diagnosis. N. meningitidis isolates from culture were sensitive to all commonly used antibiotics.

A mercury(II) ion-selective electrode based on neutral salicylaldehyde thiosemicarbazone.

A new ion-selective PVC membrane electrode based on salicylaldehyde thiosemicarbazone as an ionophore is developed successfully as sensor for mercury(II) ions. The electrode shows excellent potentiometric response characteristics and displays a linear log[Hg(2+)] versus EMF response over a wide concentration range of 1.778x10(-6)-1.0x10(-1) M with Nernstian slope of 29 mV per decade with the detection limit of 1.0x10(-6) M. The response time of the electrode is less than 30 s and the membrane electrode operates well in the pH range of 1.0-3.0. The lifetime of the sensor is about 2 months. The electrode shows better selectivity towards Hg(2+) ions in comparison with the alkali, alkaline and some heavy metal ions; most of these metal ions do not show significant interference (K(Pot)(Hg,)(M) values of the order of 10(-3)-10(-4)). The present sensor showed comparable or even better performance vis-à-vis similar PVC based ion-selective electrodes reported in literature. The sensor was also applied as an indicator electrode for potentiometric titration of Hg(2+)ions with I(-) and Cr(2)O(7)(2-).

Determination of metals of toxicological significance in sewage irrigated vegetables by using atomic absorption spectrometry and anodic stripping voltammetry.

Soil and vegetable samples drawn from the fields being irrigated by the city sewage have been analysed for some toxic metals namely copper, iron, cadmium, lead and chromium using atomic absorption spectrometry and anodic stripping voltammetry. It has been found that these vegetables contain an appreciable amount of these metals per unit dry mass, which the general public is ingesting everyday. It is further seen from the differential results that the fields being irrigated with the sewage water for the last so many years till date as compared to the ones, irrigation of which was replaced with the tubewell water some ten years ago, that the content of toxic metals is much larger in the former case. The results and the gravity of the situation is discussed.

Cesium ion selective electrode based on calix[4]crown ether-ester.

The potentiometric response characteristics of cesium ion selective PVC membrane electrode employing calix[4]crown ether-ester as an ionophore were investigated. The electrode exhibit a good response for cesium ion over wide concentration range of 5.0x10(-6)-1.0x10(-1) M with a Nernstian slope of 59 mV per decade. The detection limit of electrode is 5.0x10(-6) M. The electrode was found to have selectivity for cesium ion over alkali, alkaline and transition metals. The response time of the electrode is less than 20 s and can be used for more than 4 months without observing any divergence in potentiometric response. The electrode response was stable over wide pH range.

Silver(I) ion-selective membrane based on Schiff base-p-tert-butylcalix[4]arene.

A PVC membrane electrode for silver(I) ion based on Schiff base-p-tert-butylcalix[4]arene is reported. The electrode works well over a wide range of concentration (1.0 x 10(-5)-1.0 x 10(-1) mol dm-3) with a Nernstian slope of 59.7 mV per decade. The electrode shows a fast response time of 20 s and operates in the pH range 1.0-5.6. The sensor can be used for more than 6 months without any divergence in the potential. The selectivity of the electrode was studied and it was found that the electrode exhibits good selectivity for silver ion over some alkali, alkaline earth and transition metal ions. The silver ion-selective electrode was used as an indicator electrode for the potentiometric titration of silver ion in solution using a standard solution of sodium chloride; a sharp potential change occurs at the end-point. The applicability of the sensor to silver(I) ion measurement in water samples spiked with silver nitrate is illustrated.

Silver(I) ion selective PVC membrane based on bis-pyridine tetramide macrocycle.

A PVC membrane based on bis-pyridine tetramide macrocycle exhibits a good response for silver ion over a wide concentration range (1.0x10(-1)-4.0x10(-5) mol l(-1)). The electrode has a relatively fast response time and can be used for more than 5 months without observing any divergence. High selectivity for Ag(+) ions over that of Na(+), K(+), Ca(2+), Sr(2+), Pb(2+) and Hg(2+) have been observed.

Assembly mechanism of Dictyostelium myosin II: regulation by K+, Mg2+, and actin filaments.

Regulated assembly of myosin II in Dictyostelium discoideum amoebae partially controls the orderly formation of contractile structures during cytokinesis and cell migration. Kinetic and structural analyses show that Dictyostelium myosin II assembles by a sequential process of slow nucleation and controlled growth that differs in rate and mechanism from other conventional myosins. Nuclei form by an ordered progression from myosin monomers to parallel dimers to 0.43 microns long antiparallel tetramers. Lateral addition of dimers to bipolar tetramers completes the assembly of short (0.45 microns) blunt-ended thick filaments. Myosin heads are not staggered along the length of tapered thick filaments as in skeletal muscle, nor are bipolar minifilaments formed as in Acanthamoeba. The overall assembly reaction incorporating both nucleation and growth could be kinetically characterized by a second-order rate constant (kobs,N+G) of 1.85 x 10(4) M-1 s-1. Individual rate constants obtained for nucleation, kobs,N = 4.5 x 10(3) M-1 s-1, and growth, kobs,G = 2.5 x 10(4) M-1 s-1, showed Dictyostelium myosin II to be the slowest assembling myosin analyzed to date. Nucleation and growth stages were independently regulated by Mg2+, K+, and actin filaments. Increasing concentrations of K+ from 50 to 150 mM specifically inhibited lateral growth of dimers off nuclei. Intracellular concentrations of Mg2+ (1 mM) accelerated nucleation but maintained distinct nucleation and growth phase kinetics. Networks of actin filaments also accelerated the nucleation stage of assembly, mechanistically accounting for spontaneous formation of actomyosin contractile fibers via myosin assembly (Mahajan et al., 1989). The distinct assembly mechanism and regulation utilized by Dictyostelium myosin II demonstrates that myosins from smooth muscle, striated muscle, and two types of amoebae form unique thick filaments by different pathways.

Actinomycotic brain abscess : report of two cases.

Actinomycotic brain abscesses constituted 1 per cent of all brain abscesses treated in last eleven years. Computed tomographic finding of an irregular (nodular) thick unit or multilocular peripheral rim enhancing lesion were of some help in suspecting actinomycotic aetiology. The diagnosis was confirmed by bacteriological studies. A combined medical and surgical treatment produced excellent results.

Collet-Sicard syndrome after closed head injury.

A case is reported of basilar fracture of the occipital bone passing through the left occipital condyle, ascending the clivus anteriorly, with marked medial displacement of the bony fragment. The injury produced ipsilateral palsies of nerves IX through XII (Collet-Sicard syndrome). A CT scan accurately delineated the extent of the fracture. Partial neurological recovery ensued following surgery.