Treatment of clinical laboratory sewage using a decentralized treatment unit and risk reduction for its reuse in irrigation using hybrid disinfection.

The disinfection efficacy of standalone chlorine, UV and their combined approach (hybrid) was investigated for the coliform removal in BioKube 1 and 2 treated effluents collected from different environmental settings of clinical and domestic wastes. Chlorine and UV disinfection were applied to BioKube treated wastewater with doses from 0 to 4 mg L-1 and 0-166 mJ cm-2 respectively. Combined disinfection strategies were designed to reduce the dose of chlorine and UV and to exploit the synergistic effect of them. The culturable coliforms were enumerated in treated wastewater sample (control), immediately after (reduction), and 24 h post disinfections (regrowth) using culture media plating and colilert-18 media. Both the BioKube systems (1 and 2) were effective in achieving the strict norms of physicochemical parameters, but not following the coliform counts of treated effluent for reuse in irrigation. A hybrid strategy of chlorine followed by UV was found to be the most effective among various standalone and combination approaches for the removal of coliforms (>4 log ER or <1000 CFU/100 mL) from both the treated effluents. However, coliform present in treated effluent of BioKube 1 were resisting (regrowth) against all kind of applied disinfectants except chlorine followed by UV dose at or more than 0.5 mg L-1 + 41 mJ cm-2. Limited reports are available on hybrid disinfection approaches with decentralized packaged sewage treatment units and this study would help to adopt as an effective tertiary treatment strategy for reuse of treated sewage for irrigation while ensuring public health safety.

Antibiotic resistance genes and bacterial diversity: A comparative molecular study of treated sewage from different origins and their impact on irrigated soils.

Present study aims to investigate how is soil affected following irrigation with treated effluents of different origins by analysing the bacterial diversity, metabolic diversity and antibiotic resistance genes (ARGs). Comparative analysis with previously reported ARGs in effluents was performed to understand the mobility of ARGs from treated wastewater to the irrigated soil with respect to the control soil regimen. Acinetobacter, Burkholderia and Pseudomonas were observed as the most abundant genera in all the samples. The metabolic gene abundance of all the samples suggests a prominent contribution to natural mineral recycling. Most abundant ARGs observed encode resistance for clindamycin, kanamycin A, macrolides, paromomycin, spectinomycin and tetracycline. Treated effluent reuse did not appear to enhance the ARG levels in soils in most cases except for institutional treatment site (M), where the ARGs for aminoglycosides, ß-lactams and sulfonamides were found to be abundantly present in both treated effluent and the irrigated soil. This study finds the importance of wastewater treatment from different origins and the impact of treated wastewater reuse in irrigation. This study also emphasises on the better understanding of ARGs mobility from water to soil.

Central nervous system blast crisis of chronic myeloid leukaemia misdiagnosed as tubercular meningitis.

Chronic Myeloid Leukaemia (CML) presenting with isolated Central Nervous System (CNS) blast crisis is an uncommon entity. A 22-year-old man, diagnosed with chronic phase CML in 2011 and was in haematological and cytogenetic remission until July 2016, had acute onset headache and vomiting with meningeal signs and was admitted elsewhere, investigated by brain imaging and cerebrospinal fluid (CSF) analysis and suspected to have tubercular meningitis, for which steroids and antitubercular medications were started. The patient's sensorium further deteriorated, and Ventriculoperitoneal shunt surgery was done for hydrocephalus by a neurosurgeon. After 2 months of the illness, he was admitted to our hospital with a persistent headache, vomiting and altered sensorium. CSF for cytospin confirmed myeloid blasts. He was still in haematological remission. So, a diagnosis of isolated CNS blast crisis was made. The patient was started on triple intrathecal chemotherapy and cranial radiotherapy. He had improvement with treatment and is still in remission.

A unilateral rectus sternalis muscle: rare but normal anatomical variant of anterior chest wall musculature.

INTRODUCTION: Rectus Sternalis muscle, an uncommon anatomical variant of the chest wall musculature, is regularly present in lower animals and is occasionally detected in humans. Lack of acquaintance of the clinicians with this muscle variant may cause negative changes in prognosis of patient. The anatomical and embryological details of Rectus Sternalis muscle in this article may help clinicians in interventional procedures, in prevention of diagnostic errors and in avoiding complications during any surgery which is done in the pectoral region. MATERIAL AND METHODS: This was a cadaveric study which was conducted as a pilot study, to know the baseline information about the incidence of Rectus Sternalis muscle among cadavers in Indian region. During a period of three years, 30 properly embalmed cadavers of Indian origin were dissected in dissection hall of Anatomy Department, S.M.S. Medical College (Jaipur, Rajasthan) during routine dissections, which is a part of medical education. Dissections of pectoral regions of these 30 cadavers were performed, to know the presence of Rectus Sternalis muscle. Observation and Result: Rectus Sternalis muscle was found only in one cadaver, as a vertical strip of muscle in the anterior chest wall musculature. It was present unilaterally at right-side in anterior chest wall, superficial to pectoralis major muscle. Present study provides the initial estimates towards baseline information about the incidence of Rectus Sternalis, which was 3.3% among the cadavers of Indian origin in this study. CONCLUSION: Rectus Sternalis is a rare but a normal anatomical variant in the anterior chest wall musculature and knowledge on it is important, for interventional and diagnostic procedures which are related to this region.