Mitigating carcinogenic smoke opacity in a light-duty diesel engine by utilizing cyclohexanol, polyethylene glycol, and 2-methoxyethanol.

Diesel fuel reformulation is an attractive method to reduce hazardous smoke emissions because it does not require modifications to the existing engine infrastructure. As the concerns about global warming and air pollution are mounting, high-efficiency diesel engines with low smoke emissions have become more attractive. This study demonstrates that three alcohols, viz. cyclohexanol, polyethylene glycol, and 2-methoxyethanol, can be added to fossil diesel up to 3% by vol. to reduce carcinogenic smoke emissions in a one-cylinder, common rail direct injection (CRDI) diesel engine. The experimental investigations revealed that smoke could be reduced by up to 66.2%, 39.6% and 14% using 3% by vol. addition of cyclohexanol, polyethylene glycol, and 2-methoxyethanol to diesel, respectively, when compared to pure diesel operation. 1% addition by vol. of cyclohexanol and 2-methoxyethanol could reduce NOx and smoke emissions under all load conditions. CO emissions are slightly higher for all alcohol at high load conditions. HC emissions for the test fuels are lower than pure diesel operation at low load conditions, increasing at high loads. These emissions, however, can be reduced by using suitable after-treatment devices.

Efficacy study of non-lanthanide small luminescent molecules as gunshot residue indicators.

The efficiency of using small, non-lanthanide and readily available molecules was tested as luminescent markers for gunshot residue (GSR) analysis. Three luminophores, namely pyrene (Py), fluorescein (Fl) and a Pt-CNN complex (Pt-C) were used in the present study by using their 5 wt% additives to gunpowder filled in a cartridge followed by firing with a 9 mm pistol. The easy visualization of GSR location, collection of GSR samples followed by their identification through various characterization techniques and the possibility of strategically using these markers as a cost-effective alternative compared to any lanthanide material were evaluated through this work. The comparison of physical mixture of marker and gunpowder and surface soaked gunpowder with the same marker (Py) was also evaluated. Spectroscopic (Optical, Luminescence and Raman), Microscopic, Spectrometric (Mass) and thermal analysis (Differential Scanning Calorimetry, DSC) of the marker, gunpowder and GSR residues implies that both the dyes and gunpowder retains their individual properties and those are merely a physical mixture. Overall, the present study clearly demonstrates that these small organic/metal complex based luminophores are cost effective luminescent marker as compared to lanthanide materials for GSR detection / collection and can be strategically use to track the illegal / unauthorized use of gunpowder.

Missed Intracranial Subdural Hematoma in a Case of Spontaneous Subdural Spinal Hematoma: A Rare Case Report and Literature Review.

INTRODUCTION: Idiopathic spontaneous spinal subdural hematoma (ISSSDH) is uncommon in occurrence, and its association with concomitant intracranial subdural hematoma (ISDH) is very exceptional. Lack of recognition of ISDH in a patient with SSDH can lead to unanticipated events. We report a rare case of ISSSDH and unrecognized ISDH and treated surgically with a good outcome. CASE REPORT: A 71-year-old gentleman presented with features of spinal neurogenic claudication of 2 weeks duration and was diagnosed to have ISSSDH of the lumbar spine based on magnetic resonance imaging (MRI). In view of an impending cauda equina syndrome, he underwent an emergency decompression through a laminectomy, durotomy, and clot evacuation from L2 to L5. The next day, he developed sudden-onset hemiparesis and altered sensorium. The computed tomography (CT) scan of the brain demonstrated an ISDH, for which emergency burr hole evacuation was done.The patient improved rapidly after the surgery and regained his normal power, sensorium, and achieved comfortable ambulation within a week. Follow-up CT of the brain and MRI scan of the spine revealed adequate decompression. Since the CT features of ISDH were of acute on chronic nature, we presume that it had existed before the onset of spinal symptoms. CONCLUSION: Through this very rare case, we highlight the importance of screening the brain pre-operatively in patients who present with sub-acute spontaneous spinal SDH.

Retinitis as the presenting feature of subacute sclerosing panencephalitis in an Indian male: A case report.

Measles virus is a rare but important cause for acute retinitis as it can eventually lead to the fulminant complication of SSPE. We report a case of a young Indian male with acute viral retinitis who subsequently developed SSPE. It is of paramount importance to consider measles virus and SSPE as a cause in an immunocompetent young adult with necrotizing viral retinitis.

Diesel reformulation using bio-derived propanol to control toxic emissions from a light-duty agricultural diesel engine.

In the Indian agricultural sector, millions of diesel-driven pump-sets were used for irrigation purposes. These engines produce carcinogenic diesel particulates, toxic nitrogen oxides (NOx), and carbon monoxide (CO) emissions which threaten the livelihood of large population of farmers in India. The present study investigates the use of n-propanol, a less-explored high carbon bio-alcohol that can be produced by sustainable pathways from industrial and crop wastes that has an attractive opportunity for powering stationary diesel engines meant for irrigation and rural electrification. This study evaluates the use of n-propanol addition in fossil diesel by up to 30% by vol. and concurrently reports the effects of exhaust gas recirculation (EGR) on emissions of an agricultural DI diesel engine. Three blends PR10, PR20, and PR30 were prepared by mixing 10, 20, and 30% by vol. of n-propanol with fossil diesel. Results when compared to baseline diesel case indicated that smoke density reduced with increasing n-propanol fraction in the blends. PR10, PR20, and PR30 reduced smoke density by 13.33, 33.33, and 60%, respectively. NOx emissions increased with increasing n-propanol fraction in the blends. Later, three EGR rates (10, 20, and 30%) were employed. At any particular EGR rate, smoke density remained lower with increasing n-propanol content in the blends under increasing EGR rates. NOx reduced gradually with EGR. At 30% EGR, the blends PR10, PR20, and PR30 reduced NOx emissions by 43.04, 37.98, and 34.86%, respectively when compared to baseline diesel. CO emissions remained low but hydrocarbon (HC) emissions were high for n-propanol/diesel blends under EGR. Study confirmed that n-propanol could be used by up to 30% by vol. with diesel and the blends delivered lower soot density, NOx, and CO emissions under EGR.

Management of calcium channel antagonist overdose with hyperinsulinemia-euglycemia therapy: case series and review of the literature.

Calcium channel antagonists (CCAs) are commonly involved in drug overdoses. Standard approaches to the management of CCA overdoses, including fluid resuscitation, gut decontamination, administration of calcium, glucagon, and atropine, as well as supportive care, are often ineffective. We report on two patients who improved after addition of hyperinsulinemia-euglycemia (HIE) therapy. We conclude with a literature review on hyperinsulinemia-euglycemia therapy with an exploration of the physiology behind its potential use.

Escherichia coli septic shock masquerading as ST-segment elevation myocardial infarction.

Elevated cardiac biomarkers in conjunction with electrocardiographic (ECG) changes are valuable in diagnosing acute coronary syndrome (ACS). Elevated troponin I (TnI), while commonly seen in ACS, can also occur in entities such as sepsis and pulmonary thromboembolic disease. Raised TnI levels in patients with sepsis result from various mechanisms, including hypoperfusion or direct extension of infection to cardiac tissue, and can also serve as an important prognostic indicator. Electrocardiographic changes in sepsis are not as well described. Some of the ECG findings associated with septic shock include loss of QRS amplitude, increase in QTc interval, bundle branch blocks, and development of narrowed QRS intervals with deformed, positively deflected J waves (commonly known as Osborn waves). ST-segment elevations in sepsis are rare and have only previously been noted in a handful of case reports involving patients with septic shock. We present a case of a 59-year-old woman with ST-segment elevations and increased levels of cardiac troponin from Escherichia coli septic shock in the setting of normal coronary angiography.

Acute respiratory distress syndrome from chlorine inhalation during a swimming pool accident: a case report and review of the literature.

Chlorine inhalation can result in significant morbidity and mortality. The most common clinical ramification is mucosal irritation. Rarely, depending upon the degree of exposure, patients can develop acute respiratory distress syndrome. Management is usually supportive with an unproven role for inhaled or systemic corticosteroids. A case of a young woman who developed respiratory failure secondary to acute respiratory distress syndrome from accidental exposure to chlorine fumes at a community swimming pool is described. The patient suffered a prolonged hospitalization with the need for mechanical ventilation. Despite limited data to support the decision, the patient was started on treatment with corticosteroids. She recovered completely from her illness and was discharged home without supplemental oxygen. A concise discussion of chlorine inhalation injury and a literature review on the utility of inhaled and/or systemic corticosteroids for this clinical entity is presented.

Ocular manifestations associated with chikungunya.

PURPOSE: To report ocular manifestations associated with chikungunya. DESIGN: Retrospective, nonrandomized, observational case series. PARTICIPANTS: Nine chikungunya patients with ocular involvement. METHODS: All patients with chikungunya infection presenting with ocular complaints from September 2006 to October 2006 were included in the study. The infection was confirmed by demonstration of chikungunya immunoglobulin M antibody in sera of all patients. All patients underwent an ophthalmic examination including fundus photography, fundus fluorescein angiography, confocal microscopy of keratic precipitates, and optical coherence tomography. Positive ocular changes were recorded and tabulated. MAIN OUTCOME MEASURES: Characteristics, frequency, and locations of ocular lesions found in the participants. RESULTS: There were 9 patients with ocular lesions; 1 had nodular episcleritis, 5 presented with acute iridocyclitis, and 3 had retinitis. Four to 12 weeks before the development of ocular manifestations, all of these patients had fever. Although there were no specific changes of iridocyclitis that were diagnostic of the fever, the retinal changes were consistent with viral retinitis. All patients recovered from the infection with relatively good vision. CONCLUSION: It appears that iridocyclitis and retinitis are the most common ocular manifestations associated with chikungunya, with a typically benign clinical course. Less frequent ocular lesions include episcleritis. All the patients responded well to the treatment with preservation of good vision. To the best of our knowledge, similar ocular manifestations associated with chikungunya infection have not been reported. In the differential diagnosis of iridocyclitis and retinitis with features suggestive of a viral infection, the entity of chikungunya-associated ocular changes should be considered in the regions affected by the epidemic.

Bilateral macular retinitis as the presenting feature of subacute sclerosing panencephalitis.

Two patients presented with retinitis as the initial clinical manifestation of subacute sclerosing panencephalitis (SSPE), a delayed neurologic complication of measles. In one patient, the ocular involvement preceded the neurologic symptoms by 4 weeks and in the other patient by 4 years. The diagnosis of SSPE was suspected when neuropsychiatric manifestations appeared and was confirmed by the typical panencephalitic electroencephalography changes, neuroimaging features of panencephalitis, and high titers of measles antibodies in serum and cerebrospinal fluid. Although SSPE is an untreatable illness, recognition of this unusual presentation is valuable to allow earlier diagnosis and institution of palliative measures.

Neuro-ophthalmic disorders presenting as a diagnostic surprise during pre-LASIK evaluation.

We present 2 cases that came to our institute for refractive surgery and were discovered to have serious systemic conditions requiring immediate intervention. On examination, prolactinoma of the pituitary gland was seen in one patient and multiple sclerosis was diagnosed in the other patient. Prompt treatment of the conditions led to improvement in the neuro-ophthalmic disorders. We recommend a thorough physical evaluation of patients having an ophthalmic examination.

Clinical, anatomic, and electrophysiologic evaluation following intravitreal bevacizumab for macular edema in retinal vein occlusion.

PURPOSE: To investigate clinical, anatomic, and electrophysiologic response after single intravitreal injection of bevacizumab for macular edema attributable to retinal vein occlusion. DESIGN: Prospective nonrandomized, interventional case series. METHODS: Twenty-one patients with macular edema attributable to vein occlusion received intravitreal injection of bevacizumab 1.25 mg. Nine patients had central retinal vein occlusion (CRVO), and 12 patients had branch retinal vein occlusion (BRVO). Complete ophthalmic examination including optical coherence tomography (OCT) was done at baseline and follow-up visits. Fifteen patients underwent fluorescein angiography at baseline. Selected patients underwent electroretinography (ERG) and visual evoked potential (VEP) at baseline and follow-up. Follow-up was for 12 weeks. RESULTS: At baseline, mean visual acuity was 20/381 (median, 20/400) and showed improvement to mean 20/135 (median, 20/60) after one month, (P = .001). At 12 weeks, mean visual acuity was 20/178 (median, 20/80) (P = .001). The mean central retinal thickness (CRT) was 647.81 microm (median, 609.00 microm) at baseline and decreased to mean 293.43 microm (median, 222.00 microm) at one month (P = .001). At 12 weeks, mean CRT was 320.90 mum (median, 280.00 microm) (P = .001). ERG and VEP showed no worsening of the waveforms. There was no significant difference in the visual outcome between the BRVO and CRVO groups. CONCLUSION: Intravitreal injection of bevacizumab appears to result in significant short-term improvement of visual acuity and macular edema secondary to vein occlusion. The present report confirms the previous studies. No ocular toxicity or adverse effects were observed. However, prospective, randomized, controlled long-term studies are required with an adequate number of patients.

Ocular tuberculosis in acquired immunodeficiency syndrome.

PURPOSE: To present the clinical, histopathological, and molecular biologic findings in fifteen cases of ocular tuberculosis (TB) in patients with acquired immune deficiency syndrome (AIDS). DESIGN: Retrospective, observational, noncomparative case series of HIV-infected patients with ophthalmic complaints and/or with advanced disease (CD4+ cell count < 200), seen between the years 1993 to 2005 at tertiary care ophthalmic and AIDS care hospitals. METHODS: Each patient underwent a complete ophthalmic examination and relevant laboratory and radiologic investigations and was treated accordingly. The study was carried out in this cohort to describe the ocular manifestations of TB. The main outcome measures were to describe the clinical course histopathologic and molecular biologic features of ocular lesions attributable to tuberculosis in AIDS patients in our center. RESULTS: Ocular TB was seen in 15 (1.95%) out of 766 consecutive cases of HIV/AIDS. Nineteen eyes of 15 patients were affected. Four cases (26.66%) had bilateral presentation. Presentations of ocular TB included choroidal granulomas in 10 eyes (52.63%), subretinal abscess in seven eyes (36.84%), worsening to panophthalmitis in three eyes, conjunctival tuberculosis, and panophthalmitis each in one eye (5.26%). All cases had evidence of pulmonary tuberculosis. Coexistent central nervous system (CNS) tuberculosis was seen in two cases and one case had abdominal tuberculosis. CD4+ cell counts were done in 14 patients; the count ranged from 14 to 560 cells/microl--mean 160.85 cells/microl. CONCLUSIONS: Ocular TB in AIDS is relatively rare and can occur even at CD4+ cell counts greater than 200 cells/microl. It can have varied presentations with severe sight-threatening complications.