Improved detection of sinusoidal obstructive syndrome using pediatric-AYA diagnostic criteria and severity grading.

New diagnostic criteria and severity grading for sinusoidal obstructive syndrome (SOS) among pediatric and adolescent young adult (AYA) patients have been recently endorsed by international consensus. The extent to which these have been adopted in the US remains unclear. We sought to assess the potential impact via retrospective application of these criteria among patients treated at a large academic center in the United States. This is a single center retrospective study of pediatric-AYA patients who underwent hematopoietic cell transplantation (HCT) between July 2009 and 2019. The incidence of SOS was assessed using historic Baltimore and Seattle diagnostic criteria and compared with more recent guidelines (pEBMT) as proposed by the Paediatric Diseases Working Party of the European Society for Blood and Marrow Transplantation. Among 226 patients, application of the pEBMT diagnostic criteria was associated with a higher incidence (15.9%) and earlier time to diagnosis of SOS (by 2.5-3 days) compared with the modified Seattle (12.3%), and Baltimore (6.6%) criteria, respectively. The pEBMT criteria were sensitive and highly specific. Refractory thrombocytopenia was present in 75% of patients at diagnosis. Approximately 61% of patients with SOS were anicteric at diagnosis, though the majority (94.4%) developed hyperbilirubinemia as SOS progressed over a median time of 4 (1-57) days. Application of pEBMT criteria may have resulted in earlier indication for definitive treatment by 3 days. Timely diagnosis and administration of definitive treatment of SOS has been associated with improved outcomes. Prospective studies may better characterize the risk factors and natural course of SOS using pEBMT criteria.

Demonstration of acid and water recovery systems: Applicability and operational challenges in Indian metal finishing SMEs.

Diffusion dialysis, acid retardation and nanofiltration plants were acquired from Europe and demonstrated in several Indian metal finishing companies over a three year period. These companies are primarily small and medium enterprises (SMEs). Free acid recovery rate from spent pickling baths using diffusion dialysis and retardation was in the range of 78-86% and 30-70% respectively. With nanofiltration, 80% recovery rate of rinse water was obtained. The demonstrations created awareness among the metal finishing companies to reuse resources (acid/water) from the effluent streams. However, lack of efficient oil separators, reliable chemical analysis and trained personnel as well as high investment cost limit the application of these technologies. Local manufacturing, plant customization and centralized treatment are likely to encourage the uptake of such technologies in the Indian metal finishing sector.

PBOX-15, a novel microtubule targeting agent, induces apoptosis, upregulates death receptors, and potentiates TRAIL-mediated apoptosis in multiple myeloma cells.

BACKGROUND: In recent years, much progress has been made in the treatment of multiple myeloma. However, a major limitation of existing chemotherapeutic drugs is the eventual emergence of resistance; hence, the development of novel agents with new mechanisms of action is pertinent. Here, we describe the activity and mechanism of action of pyrrolo-1,5-benzoxazepine-15 (PBOX-15), a novel microtubule-targeting agent, in multiple myeloma cells. METHODS: The anti-myeloma activity of PBOX-15 was assessed using NCI-H929, KMS11, RPMI8226, and U266 cell lines, and primary myeloma cells. Cell cycle distribution, apoptosis, cytochrome c release, and mitochondrial inner membrane depolarisation were analysed by flow cytometry; gene expression analysis was carried out using TaqMan Low Density Arrays; and expression of caspase-8 and Bcl-2 family of proteins was assessed by western blot analysis. RESULTS: Pyrrolo-1,5-benzoxazepine-15 induced apoptosis in ex vivo myeloma cells and in myeloma cell lines. Death receptor genes were upregulated in both NCI-H929 and U266 cell lines, which displayed the highest and lowest apoptotic responses, respectively, following treatment with PBOX-15. The largest increase was detected for the death receptor 5 (DR5) gene, and cotreatment of both cell lines with tumour necrosis factor-related apoptosis-inducing ligand (TRAIL), the DR5 ligand, potentiated the apoptotic response. In NCI-H929 cells, PBOX-15-induced apoptosis was shown to be caspase-8 dependent, with independent activation of extrinsic and intrinsic apoptotic pathways. A caspase-8-dependent decrease in expression of Bim(EL) preceded downregulation of other Bcl-2 proteins (Bid, Bcl-2, Mcl-1) in PBOX-15-treated NCI-H929 cells. CONCLUSION: PBOX-15 induces apoptosis and potentiates TRAIL-induced cell death in multiple myeloma cells. Thus, PBOX-15 represents a promising agent, with a distinct mechanism of action, for the treatment of this malignancy.

A pharmacovigilance study in medicine department of tertiary care hospital in chhattisgarh (jagdalpur), India.

The aim of the present study was to observe adverse drug reactions (ADRs) with respect to polypharmacy at tertiary care centre at Bastar, Jagdalpur (Government Medical College, Jagdalpur). A prospective, observational evaluation of the ADRs conducted over a period of 6 months in Department of Medicine in Government Medical College, Jagdalpur. During the study period, a total of about 4850 patients visited the OPD and inpatient ward of medicine department, and 154 ADRs events were reported. Out of 154 reports that were identified, a higher percentage of ADRs in females (51.29%) was observed as compared to males (48.7%). Of the 154 ADRs, 76 (49.35%) were found to be mild, 55 moderate (35.71%), and 23 severe (14.93%). A total of 99 (64.28%) ADRs were observed in patients receiving four or more medications concurrently. Conversely 55 (35.71%) ADRs were detected in patients using three or less medicines. The largest number of reports was associated with antimicrobial therapy (28.57%), followed by antihypertensive (24.02%) and antidiabetics (14.28%). Among the affected organ systems, gastrointestinal ADRs constituted a major component (39.61%) followed by skin reactions (28.57%). On causality assessment, nearly 36.36% ADRs were considered as probable, 31.16% possible, and 9.74% could not be categorized and were placed under unassessable. Expected, limited ADR are permissible in normal clinical setting, but the present study focuses on the result showing increased and amplified ADR associated with the polypharmacy practices, which may be curtailed with rational drug prescribing habit.

Severe Evans syndrome with multi-system involvement is a distinct immunodeficiency disorder.

A female infant who presented with autoimmune hemolytic anemia and thrombocytopenia subsequently developed hepatic, dermatologic, renal, pulmonary, gastrointestinal, endocrine, and nervous system involvement. Prolonged and intensive treatment with prednisone, IVIG, mycophenolate mofetil, and anti-CD20 and anti-CD52 antibodies was necessary to control the symptoms. Laboratory evaluation showed normal lymphocyte subsets and function. There was normal Foxp3 and CD25 expression, no increased CD4(-)CD8(-) T-cell population, and the AIRE and Fas genes were without mutations. These features place the patient at the most severe portion of the Evans syndrome spectrum, and suggest that this case may represent a rare, new immunodeficiency disorder.

Efficient water use in industries: cases from the Indian agro-based pulp and paper mills.

Agro-based pulp and paper mills in India are one of the most polluting industries; in addition, they are high consumers of raw water. Growing scarcity of high quality freshwater as well as stringent regulatory standards is compelling these units to explore appropriate water management options. Based on data obtained through a questionnaire survey and plant visits, this work provides an overview of the water use and effluent treatment status in Indian agro-residue and recycled pulp and paper mills. The challenges faced by this sector are reviewed and practices adopted by progressive units to minimize freshwater use are illustrated through case studies.

Emergency cardiopulmonary bypass for impassable airway.

INTRODUCTION: Some medical emergencies need compromised airway management as the first measure. Most of these cases are first seen by an ENT surgeon, whose proper evaluation and timely intervention can prove decisive. Knowledge of alternatives for airway management can prove life-saving, although these may require the active involvement of other specialities. CASE REPORTS: Two patients, a 27-year-old man and a 31-year-old woman, presented in respiratory distress with cyanosis. Each had a pedunculated mass in the lower trachea above the carina, with about 90 per cent tracheal lumen obstruction. They were managed successfully with femorofemoral cardiopulmonary bypass and restoration of airway. CONCLUSION: Femorofemoral cardiopulmonary bypass can be a relatively safe option which gains time for airway management in such conditions. Knowledge of this procedure among ENT surgeons can lead to timely intervention, in properly selected cases, which can save valuable time.

Novel substituted naphthalen-1-yl-methanone derivatives as anti-hyperglycemic agents.

A series of aminoalkoxy phenyl-substituted naphthalene-1-yl-methanone was synthesized and tested for its anti-hyperglycemic activity in SLM and STZ-S rat models. Some compounds (3b, 4c and 4h) of the series were showing significant anti-hyperglycemic activity in male Sprague-Dawley rats in sucrose-loaded model (SLM) as well as in streptozotocin-induced model (STZ-S). Active compounds were also evaluated for relative binding affinity against glucagon receptor.

An unusual case of neonatal anuria.

Neonatal anuria is not an uncommon problem in neonates. Here, we report an unusual case of neonatal anuria due to renal tubular dysgenesis, secondary to the use of angiotensin converting enzyme inhibitor (ACEI) during pregnancy. ACEI remains one of the most commonly used antihypertensive drug at present. A greater awareness needs to be created in the medical fraternity especially among pediatricians, gynecologists and internists that ACE inhibitors should not be prescribed during any trimester of pregnancy.

Performance of Uscana mukerjii (Mani) for the control of Callosobruchus maculatus (Fab.) and allied bruchid species.

Investigations have been carried out on the relative preference of U. mukerjii to four common species viz., C. maculatus, C. analis, C. chinensis and Zabrotes subfasciatus of store bruchids. Results show correspondence between the acceptance/contact ratio and the total number of eggs laid by the parasitoid for Callosobruchus species. U. mukerjii shows maximum preference on C. maculatus followed by C. analis, C. chinensis and Z. subfasciatus in the decreasing order. Z. subfasciatus has been the least preferred host having 2-3% parasitization in choice situation. Percentage emergence of the adults and females differ insignificantly from each other in Callosobruchus species. In no choice experiments, U. mukerjii laid sufficient number of eggs in the eggs of C. chinensis and Z. subfasciatus but less number of eggs in a choice situation due to competition with the preferred host. As is evident, U. mukerjii gives the first preference to primary host C. maculatus. Moreover, the congeneric species i.e C. analis and C. chinensis are given more preference than Z. subfasciatus.

Preconcentration of lead with Amberlite XAD-2 and Amberlite XAD-7 based chelating resins for its determination by flame atomic absorption spectrometry.

Four chelating matrices prepared by coupling Amberlite XAD-2 with chromotropic acid (AXAD-2-CA or 1), pyrocatechol (AXAD-2-PC or 2) and thiosalicylic acid (AXAD-2-TSA or 3) through azo spacer and impregnation of Amberlite XAD-7 with xylenol orange (AXAD-7-XO or 4) have been studied for enrichment of lead(II). All the four resins quantitatively sorb Pb(II) at pH 3.0-8.0 when the flow rate is maintained between 2 and 10 mlmin(-1). HNO(3) (0.5-4.0 M) instantaneously elutes Pb(II) from all the four chelating resins. The sorption capacity is in the range 16.0-186.0 mumolg(-1) and loading half time (t(1/2)) between 3.2 and 15.5 min. The tolerance limits of electrolytes (NaCl, NaBr, NaNO(3), Na(2)SO(4), Na(3)PO(4)) and cations (Ca and Mg) are reported. Phosphate interferes in the sorption with 3 and 4. The limit of detection and limit of quantification have been found to be in the ranges 2.44-7.87 and 2.76-8.64 ngml(-1), respectively. Lead has been determined in river (RSD approximately 2.6-12.8%) and tap (RSD approximately 1.8-7.2%) water samples.

Synthesis, characterization and applications of pyrocatechol modified amberlite XAD-2 resin for preconcentration and determination of metal ions in water samples by flame atomic absorption spectrometry (FAAS).

A new chelating resin is prepared by coupling Amberlite XAD-2 with pyrocatechol through an azo spacer, characterized (by elemental analysis, IR and TGA) and studied for preconcentrating Cd(II), Co(II), Cu(II), Fe(III), Ni(II) and Zn(II) using flame atomic absorption spectrometry (FAAS) for metal monitoring. The sorption is quantitative in the pH range 3.0-6.5, whereas quantitative desorption occurs instantaneously with 2 M HCl or HNO(3) The sorption capacity has been found to be in the range 0.023-0.092 mmol g(-1) of resin. The loading half time (t(1/2)) is 1.4, 4.8, 1.6, 3.2, 2.3 and 1.8 min, respectively for Cd, Co, Cu, Fe, Ni and Zn. The tolerance limits of electrolytes NaCl, NaBr, NaNO(3), Na(2)SO(4) and Na(3)PO(4) in the sorption of all the six metal ions (0.2 mug ml(-1)) are reported. The Mg(II) and Ca(II) are tolerable with each of them (0.2 mug ml(-1)) up to a concentration level of 0.01-1.0 M. The enrichment factor has been found to be 200 except for Fe and Cu for which the values are 80 and 100, respectively. The lowest concentration of metal ion for quantitative recovery is 5, 10, 20, 25, 10 and 10 mug l(-1) for Cd, Co, Cu, Fe, Ni and Zn, respectively. The simultaneous determination of all these metal ions is possible and the method has been applied to determine all the six metal ions in tap and river water samples (RSD

Amberlite XAD-7 impregnated with Xylenol Orange: a chelating collector for preconcentration of Cd(II), Co(II), Cu(II), Ni(II), Zn(II) and Fe(III) ions prior to their determination by flame AAS.

A new chelating resin, Xylenol Orange coated Amberlite XAD-7, was prepared and used for preconcentration of Cd(II), Co(II), Cu(II), Fe(III), Ni(II) and Zn(II) prior to their determination by flame atomic absorption spectrophotometry. The optimum pH values for quantitative sorption of Cd(II), Co(II), Cu(II), Fe(III), Ni(II) and Zn(II) are 4.5-5.0, 4.5, 4.0-5.0, 4.0, 5.0 and 5.0-7.0, respectively, and their desorptions by 2 mol L(-1) HCl are instantaneous. The sorption capacity of the resin has been found to be 2.0, 2.6, 1.6, 1.6, 2.6 and 1.8 mg g(-1) of resin for Cd, Co, Cu, Fe, Ni and Zn, respectively. The tolerance limits of electrolytes, NaCl, NaF, NaI, NaNO3, Na2SO4 and of cations, Mg2+ and Ca2+ in the sorption of the six metal ions are reported. The preconcentration factor was between 50 and 200. The t1/2 values for sorption are found to be 5.3, 2.9, 3.2, 3.3, 2.5 and 2.6 min for the six metals, respectively. The recoveries are between 96.0 and 100.0% for the different metals at preconcentration limits between 10 to 40 ng mL(-1). The preconcentration method has been applied to determine the six metal ions in river water samples after destroying the organic matter (if present in very large amount) with concentrated nitric acid (RSD < or = 8%, except for Cd for which it is upto 12.6%) and cobalt content of vitamin tablets with RSD of approximately 3.0%.

Thiosalicylic acid-immobilized Amberlite XAD-2: metal sorption behaviour and applications in estimation of metal ions by flame atomic absorption spectrometry.

Thiosalicylic acid (TSA)-modified Amberlite XAD-2 (AXAD-2) was synthesized by coupling TSA with the support matrix AXAD-2 through an azo spacer. The resulting chelating resin was characterized by elemental analyses, thermogravimetric analysis (TGA) and infrared spectra. The newly designed resin quantitatively sorbs CdII, CoII, CuII, FeIII, NiII and ZnII at pH 3.5-7.0 when the flow rate is maintained between 2 and 4 ml min-1. The HCl or HNO3 (2 mol l-1) instantaneously elutes all the metal ions. The sorption capacity is 197.5, 106.9, 214.0, 66.2, 309.9 and 47.4 mumol g-1 of the resin for cadmium, cobalt, copper, iron, nickel and zinc, respectively, whereas their preconcentration factor is between 180-400. The breakthrough volume of HCl or HNO3 for elution of these metal ions was found to be 4-8 ml. The limit of detection (LOD) for CdII, CoII, CuII, FeIII, NiII and ZnII was 0.48, 0.20, 4.05, 0.98, 1.28 and 3.94 micrograms l-1, respectively, and the limit of quantification (LOQ) was found to be 0.51, 0.29, 4.49, 1.43, 1.58 and 4.46 micrograms l-1, respectively. The loading half time, t1/2, for the cations was found to be less than 2.0 min, except for nickel for which the value was 13.1 min. The determination of each of these six cations is possible in the presence of other five, if their concentration is up to 4 times. All six metals were determined in river water (RSD approximately 0.7-7.7%) and tap water samples (RSD approximately 0.3-5.7%). The estimation of Co was made in the samples of multivitamin tablets (RSD < 2.3%). The results agree with those quoted by manufacturers.

Inadvertent cannulation of the left internal thoracic vein during central vein catheter insertion.

The left internal thoracic vein was accidentally cannulated during an attempt to establish central vein catheterization through left internal jugular vein. The surgeon found this during left internal mammary artery dissection and it needed to be repositioned.