The role of the cytopathologist in subtyping and epidermal growth factor receptor testing in non-small cell lung cancer: An institutional experience.

OBJECTIVE: Approximately 10% of non-small-cell lung cancer (NSCLC) remains unclassifiable as NSCLC-not otherwise specified (NOS), after using a panel of immunomarkers. The present study was undertaken to assess sensitivity and specificity of immunomarkers in sub-typing NSCLC on fine needle aspiration cytology (FNAC). Epidermal growth factor receptor (EGFR) mutations were also detected in these samples. METHODS: Sixty cases of NSCLC including 15 squamous cell carcinoma (SCC), 15 adenocarcinomas (ADC) and 30 NSCLC-NOS reported on FNAC were included in the study. A panel of CK7, CK5/6, TTF-1 and p63 was applied in these cases. DNA was extracted from 54 cases including 14 effusion samples, and EGFR mutations were detected. RESULTS: Classic ADC cases (n=15) showed 73.3% TTF-1 positivity and 100% CK7 positivity. Two cases of ADC showed aberrant expression of p63 and 2 cases showed CK5/6 positivity. 80% of classic SCC cases (n=15) showed strong nuclear p63 positivity and 86.6% were positive for CK5/6. TTF-1 was seen exclusively in ADC cases. Immunohistochemistry (IHC) using two immunomarkers (TTF-1 and p63) helped in subtyping 24/30(80%) cases of NSCLC. EGFR mutations were detected in 9/54 (16.7%) cases, and the most common mutation was short in-frame deletion in Exon 19. CONCLUSIONS: More than 90% of NSCLC can be sub-typed on cytology samples with the help of immunochemistry. The sensitivity of TTF-1, p63, CK5/6 and CK7 was 73.3%, 80%, 100% and 100%, respectively. The specificity of TTF-1, p63, CK5/6 and CK7 was 100%, 86.6%, 86.6% and 93.3%, respectively. TTF-1 is highly specific, and almost 80% of NSCLC-NOS cases can be sub-typed using TTF-1 and p63. EGFR mutations can be detected in cytology samples, and 16.7% samples were positive for EGFR mutations.

Assessment of ground and surface water quality along the river Varuna, Varanasi, India.

Multivariate statistical techniques were employed for monitoring of ground-surface water interactions in rivers. The river Varuna is situated in the Indo-Gangetic plain and is a small tributary of river Ganga. The study area was monitored at seven sampling sites for 3 years (2010-12), and eight physio-chemical parameters were taken into account for this study. The data obtained were analysed by multivariate statistical techniques so as to reveal the underlying implicit information regarding proposed interactions for the relevant area. The principal component analysis (PCA) and cluster analysis (CA), and the results of correlations were also studied for all parameters monitored at every site. Methods used in this study are essentially multivariate statistical in nature and facilitate the interpretation of data so as to extract meaningful information from the datasets. The PCA technique was able to compress the data from eight to three parameters and captured about 78.5% of the total variance by performing varimax rotation over the principal components. The varifactors, as yielded from PCA, were treated by CA which grouped them convincingly into three groups having similar characteristics and source of contamination. Moreover, the loading of variables on significant PCs showed correlations between various ground water and surface water (GW-SW) parameters. The correlation coefficients calculated for various physiochemical parameters for ground and surface water established the correlations between them. Thus, this study presents the utility of multivariate statistical techniques for evaluation of the proposed interactions and effective future monitoring of potential sites.

Accumulation of Metals in Soils, Groundwater and Edible Parts of Crops Grown Under Long-Term Irrigation with Sewage Mixed Industrial Effluents.

Farmers in developing countries irrigate crops using raw urban and industrial effluents with consequent risks from metal contamination. Therefore, soils, crops and groundwater from an effluent irrigation use site were assessed for Cd, Cr, Ni and Pb. Total and available contents of metals in soil followed the order Pb>Ni>Cr>Cd. Crops accumulated more Pb, followed by Cd, Ni and Cr. Pb exceeded the permissible limit with wastewater irrigation only, but Cd exceeded the limit even with combined irrigations of wastewater and groundwater. Among crops, sugar beet assimilated highest Cd (3.14 µg g(-1)) and Pb (6.42 µg g(-1)) concentrations. Legumes accumulated more metals than cereals. Long-term use of wastewater and its conjunctive use with groundwater led to toxic accumulations of Cd, Pb, Ni and Cr. Cd with higher availability and mobility indices and lower toxicity limit, posed the maximum risk of food-chain contamination.

Minimally invasive therapy for fetal sacrococcygeal teratoma: case series and systematic review of the literature.

OBJECTIVE: Large solid sacrococcygeal teratomas (SCT) can cause high-output cardiac failure and fetal or neonatal death. The aim of this study was to describe the outcomes of minimally invasive antenatal procedures for the treatment of fetal SCT. METHODS: A case review was performed of five fetuses with a large SCT treated antenatally using minimally invasive techniques, and a systematic literature review on fetal therapy for solid SCTs was carried out. RESULTS: Five women were referred between 17 + 5 and 26 + 4 weeks' gestation for a large fetal SCT with evidence of fetal cardiac failure. Vascular flow to the tumors was interrupted by fetoscopic laser ablation (n = 1), radiofrequency ablation (RFA; n = 2) or interstitial laser ablation ± vascular coiling (n = 2). There were two intrauterine fetal deaths. The other three cases resulted in preterm labor within 10 days of surgery. One neonate died. Two survived without procedure-related complications but had long-term morbidity related to prematurity. The systematic literature review revealed 16 SCTs treated minimally invasively for (early) hydrops. Including our cases, six of 20 hydropic fetuses survived after minimally invasive therapy (30%). Survival after RFA or interstitial laser ablation was 45% (5/11). Of 12 fetuses treated for SCT without obvious hydrops and for which perinatal survival data were available, eight (67%) survived. Mean gestational age at delivery after minimally invasive therapy was 29.7 ± 4.0 weeks. Survival after open fetal surgery in hydropic fetuses was 6/11 (55%), with a mean gestational age at delivery of 29.8 ± 2.9 weeks. CONCLUSIONS: Fetal therapy can potentially improve perinatal outcomes for hydropic fetuses with a solid SCT, but is often complicated by intrauterine death and preterm birth.

Dynamics of nitrogen mineralization and fine root decomposition in sub-tropical Shorea robusta Gaertner f. forests of Central Himalaya, India.

This study aimed to examine the effects of spatial and temporal variability in edaphic, and climatic attributeson soil net nitrogen mineralization rate, and to understand the pattern of fine root decomposition of dominant and co-dominant tree species, and its influence on the nutrient cycling in forest ecosystems. Study was carried out at four different sites in sub-tropical forest ecosystems of Shorea robusta, in foothills of Central Himalayan region, India. Co-dominant tree species at four sites were Mallotus philippensis (site A), Glochidion velutinum (site B), Holarrhena pubescens (site C), and Tectona grandis (site D). Buried bag technique was used for nitrogen mineralization, while fine root decomposition was determined using fine root mesh bags. Seasonal variation, soil depth, soil characteristics, and site variability, all significantly (p < 0.05) affected nitrogen mineralization rates. Fine root decomposition was significantly affected by nutrient concentration of fine roots. Total mineral nitrogen was maximum at site D (16.24 ± 0.96 µg g-1 soil), while minimum at site C (10.10 ± 0.84 µg g-1 soil). Maximum nitrogen mineralization (13.18 ± 0.18 µg g-1 month-1) was recorded during summer season at site D, while the minimum nitrogen mineralization (3.20 ± 0.46 µg g-1 month-1) was recorded during rainy season at site C. Inorganic-N and net nitrogen mineralization was relatively higher in 0-20 cm soil layer than 20-40 cm and 40-60 cm soil layer. The fine roots showed 70.61-74.82 % weight loss on completion of 365 days of decomposition process. Maximum fine root decomposition was observed in the G. velutinum, and minimum in T. grandis. A significant positive correlation (p < 0.05) was observed between root nitrogen and carbon content, and decomposition rates per month. This study concluded that the spatial and temporal variability in soil nitrogen mineralization rates and fine root decomposition optimises nutrient cycling in forest ecosystems, which can contribute to the development of sustainable forest management practices.

Minimally invasive fetal therapy for hydropic lung masses: three different approaches and review of the literature.

OBJECTIVE: To report three different antenatal therapeutic approaches for fetal lung masses associated with hydrops. METHODS: Three prospectively followed cases are described, and all 30 previously published minimally invasive cases of fetal therapy for hydropic lung masses are reviewed. RESULTS: Three hydropic fetuses with large intrathoracic lung masses presented at 17, 25 and 21 weeks of gestation, respectively. An aortic feeding vessel was identified in each case and thus a bronchopulmonary sequestration (BPS) was suspected. Under ultrasound guidance, the feeding vessel was successfully occluded with interstitial laser (Case 1), radiofrequency ablation (RFA) (Case 2) and thrombogenic coil embolization (Case 3). Complete (Cases 1 and 2) or partial (Case 3) resolution of the lung mass and hydrops was observed. A healthy infant was born at term after laser therapy (Case 1), and the involved lung lobe was resected on day 2 of postnatal life. In Case 2, hydrops resolved completely following RFA, but an iatrogenic congenital diaphragmatic hernia and abdominal wall defect became apparent 4 weeks later. The neonate died from sepsis following spontaneous preterm labor at 33 weeks. In Case 3, despite technical success in complete vascular occlusion with coils, a stillbirth ensued 2 days after embolization. CONCLUSIONS: The prognosis of large microcystic or echogenic fetal chest masses associated with hydrops is dismal. This has prompted attempts at treatment by open fetal surgery, with mixed results, high risk of premature labor and consequences for future pregnancies. We have demonstrated the possibility of improved outcome following ultrasound-guided laser ablation of the systemic arterial supply. Despite technical success, RFA and coil embolization led to procedure-related complications and need further evaluation.

Effect of dust load on the leaf attributes of the tree species growing along the roadside.

Dust is considered as one of the most widespread air pollutants. The objective of the study was to analyse the effect of dust load (DL) on the leaf attributes of the four tree species planted along the roadside at a low pollution Banaras Hindu University (BHU) campus and a highly polluted industrial area (Chunar, Mirzapur) of India. The studied leaf attributes were: leaf area, specific leaf area (SLA), relative water content (RWC), leaf nitrogen content (LNC), leaf phosphorus content (LPC), chlorophyll content (Chl), maximum stomatal conductance (Gs(max)), maximum photosynthetic rate (A (max)) and intrinsic water-use efficiency (WUEi). Results showed significant effect of sites and species for DL and the leaf attributes. Average DL across the four tree species was greater at Chunar, whereas, the average values of leaf attributes were greater at the BHU campus. Maximum DL was observed for Tectona grandis at Chunar site and minimum for Syzygium cumini at BHU campus. Across the two sites, maximum value of SLA, Chl and Gs(max) were exhibited by S. cumini, whereas, the greatest value of RWC, LNC, LPC, A (max) and WUEi were observed in Anthocephalus cadamba. A. cadamba and S. cumini exhibited 28 and 27 times more dust accumulation, respectively, at the most polluted Chunar site as compared to the BHU campus. They also exhibited less reduction in A (max) due to dust deposition as compared to the other two species. Therefore, both these species may be promoted for plantation along the roadside of the sites having greater dust deposition.

End of life issues in the intensive care units.

A structured discussion of End-of-Life (EOL) issues is a relatively new phenomenon in India. Personal beliefs, cultural and religious influences, peer, family and societal pressures affect EOL decisions. Indian law does not provide sanction to contentious issues such as do-not-resuscitate (DNR) orders, living wills, and euthanasia. Finally, published data on EOL decisions in Indian ICUs is lacking. What is needed is a prospective determination of which patients will benefit from aggressive management and life-support. A consensus regarding the concept of Medical Futility is necessary to give impetus to further discussion on more advanced policies including ideas such as Managed Care to restrict unnecessary health care costs, euthanasia, the principle of withhold and/or withdraw, ethical and moral guidelines that would govern decisions regarding futile treatment, informed consent to EOL decisions and do-not-resuscitate orders. This review examines the above concepts as practiced worldwide and looks at some landmark judgments that have shaped current Indian policy, as well as raising talking points for possible legislative intervention in the field.

Incidence of healthcare associated infection in the surgical ICU of a tertiary care hospital.

BACKGROUND: Healthcare associated infections (HAI) have taken on a new dimension with outbreaks of increasingly resistant organisms becoming common. Protocol-based infection control practices in the intensive care unit (ICU) are extremely important. Moreover, baseline information of the incidence of HAI helps in planning-specific interventions at infection control. METHODS: This hospital-based observational study was carried out from Dec 2009 to May 2010 in the 10-bedded surgical intensive care unit of a tertiary care hospital. CDC HAI definitions were used to diagnose HAI. RESULTS: A total of 293 patients were admitted in the ICU. 204 of these were included in the study. 36 of these patients developed HAI with a frequency of 17.6%. The incidence rate (IR) of catheter-related blood stream infections (CRBSI) was 16/1000 Central Venous Catheter (CVC) days [95% C.I. 9-26]. Catheter-associated urinary tract infections (CAUTI) 9/1000 urinary catheter days [95% C.I. 4-18] and ventilator-associated pneumonias (VAP) 32/1000 ventilator days [95% confidence interval 22-45]. CONCLUSION: The HAI rates in our ICU are less than other hospitals in developing countries. The incidence of VAP is comparable to other studies. Institution of an independent formal infection control monitoring and surveillance team to monitor & undertake infection control practices is an inescapable need in service hospitals.

United States rural residence is associated with increased acute maternal end-organ injury or mortality after birth: a retrospective multi-state analysis, 2007-2018.

BACKGROUND: Geographic-based healthcare determinants and choice of anesthesia have been shown to be associated with maternal morbidity and mortality. We explored whether differences in maternal outcomes based on maternal residence, and anesthesia type for cesarean and vaginal birth, exist. METHODS: This study was a retrospective multi-state analysis; patient residence was the predictor variable of interest and a composite binary measure of maternal end-organ injury or inpatient mortality was the primary outcome. Our secondary outcomes included a binary measure of anesthesia type for cesarean birth (general vs. neuraxial [NA]) and NA analgesia for vaginal birth (no NA vs. NA). Our predictor variable of interest was patient residency (reference category central metropolitan areas of >1 million population), fringe large metropolitan county, medium metropolitan, small metropolitan, micropolitan, and non-metropolitan or micropolitan county. RESULTS: Women residing in micropolitan (OR 1.17; 95% CI 1.09 to 1.27) and non-metropolitan or micropolitan counties (OR 1.14; 95% CI 1.04 to 1.24) had the highest adjusted increased odds of adverse maternal outcomes. Those residing in suburban, medium, and small metropolitan areas underwent general anesthesia less often during cesarean births than those residing in urban areas. Patients residing in micropolitan rural (OR 2.07; 95% CI 2.02 to 2.12) and non-metropolitan or micropolitan (2.25; 95% CI 2.16 to 2.34) counties underwent vaginal births without NA analgesia more than twice as often as those residing in urban areas. CONCLUSIONS: Rural-urban disparities in maternal end-organ damage and mortality exist and anesthesia choice may play an important role in these disparate outcomes.

Biomass estimation of dry tropical woody species at juvenile stage.

Accurate characterization of biomass in different forest components is important to estimate their contribution to total carbon stock. Due to lack of allometric equations for biomass estimation of woody species at juvenile stage, the carbon stored in this forest component is ignored. We harvested 47 woody species at juvenile stage in a dry tropical forest and developed regression models for the estimation of above-ground biomass (AGB). The models including wood-specific gravity (ρ) exhibited higher R(2) than those without ρ. The model consisting of ρ, stem diameter (D), and height (H) not only exhibited the highest R(2) value but also had the lowest standard error of estimate. We suggest that ρ-based regression model is a viable option for nondestructive estimation of biomass of forest trees at juvenile stage.

Contamination of ground water as a consequence of land disposal of dye waste mixed sewage effluents: a case study of Panipat district of Haryana, India.

Spatial samples of surface and ground water collected from land disposal site of dye waste mixed sewage effluents at Binjhole, in Haryana, India were analyzed to evaluate its effect on quality of pond, hand pumps and ground waters for human health and irrigation purposes. It was found that average COD and TDS of dye houses discharge (310 and 3,920 mg/L) and treated sewage (428 and 1,470 mg/L) on mixing acquired the values of 245 and 1,780 mg/L and only Pb (0.24 microg/L) was above the permissible limit for irrigation purpose. Disposal of this mixed water to village pond changes the COD and TDS to 428 and 1,470 mg/L, respectively. COD and TDS of hand pump water samples were 264 and 1,190 mg/L, where as in tube well water these values were 151 and 900 mg/L. Though the ground water contamination seemed to decrease with the increasing distance from the pond but COD, TDS and BOD values continued to be quite high in water samples drawn from the hand pumps up to a distance of 500 m from pond. However, the major cause of the concern in these waters was Pb (0.11-0.45 ppm). Crops grown with this water shows accumulation of heavy metals like Pb,Cd, Fe, Mn, Ni, Cu, and Zn but in few crops they (Zn, Pb and Cd) exceed the safe limits. Regular consumption of these crop products may lead heavy metal toxicity. It was concluded from this study that the deep seepage of effluents led to deterioration of ground water quality for drinking purposes and the well waters rendered unfit for irrigation purposes within a span of 2 years. This warrants appropriate disposal measures for sewage and dye industry effluents in order to prevent deterioration of ground water and health of human and animals.

Fluid Therapy in Trauma.

Advances in shock resuscitation have occurred as a result of various military conflicts. Primary objective of trauma care is to minimize or reverse shock, avoiding the lethal triad of hypothermia, acidosis, and coagulopathy. The concept of Damage Control Resuscitation has evolved along with "damage control surgery" which includes hypotensive and haemostatic resuscitation, where small aliquots of fluid are infused, with hypovolaemia and hypotension tolerated as a necessary evil until definitive haemorrhage control can be achieved. In the initial stages of trauma resuscitation the precise fluid, crystalloid or colloid, used is probably not important as long as an appropriate volume is given. Haemostatic resuscitation includes early use of fresh frozen plasma in a 1:1 ratio with packed red cells with emphasis on whole blood, frequent cryo precipitates and platelets and the use of recombinant Factor VII for control of bleeding.

Percutaneous ultrasound-guided stenting of the atrial septum in fetal sheep.

OBJECTIVES: Hypoplastic left heart syndrome (HLHS) with a restricitive foramen ovale is associated with high mortality related to fetal left atrial hypertension. Fetal atrial balloon septoplasty has largely failed to achieve adequate decompression due to the small size of the holes produced. We attempted to produce larger atrial communications by stenting the atrial septum in fetal sheep using a minimally invasive technique. METHODS: We used a percutaneous, ultrasound-guided transpulmonary or transhepatic approach to attempt deployment of coronary stents (2-5 mm in diameter and 13-23 mm in length) in the atrial septum primum of 10 normal fetal sheep. RESULTS: Coronary stents were deployed in eight of the 10 fetal sheep (119-139 days' gestation). The transhepatic route was unsuccessful (n = 2). Transpulmonary implantation was only possible in prone fetuses, so three initially supine fetuses underwent external version. Small coronary stents (2.0-2.5 mm in diameter) were deployed rapidly without complication via an 18G needle (n = 4). Larger coronary stents (5 mm in diameter) were delivered through a 4F sheath, but a right pleural effusion occurred in three of the four cases, related to inferior vena cava injury by the balloon. One stent dislodged from a floppy septum. Another was partially occluded within a week by endocardial cells. CONCLUSIONS: Percutaneous ultrasound-guided deployment of coronary stents into the septum primum is feasible without laparotomy or uterine exteriorization in fetal sheep. Partial luminal occlusion by rapid proliferation of endocardial cells is a concern.

Extraction of cadmium and tolerance of three annual cut flowers on Cd-contaminated soils.

To evaluate the production potential and Cd removal by three flower crops, viz.: marigold (Tagetes erecta), chrysanthemum (Chrysanthemum indicum) and gladiolus (Gladiolus grandiflorus), an experiment was conducted on differentially contaminated soils (DTPA-Cd 0.6-68.4 mg kg(-1)). Biotoxicity of Cd lead to reductions in growth and flower yield of marigold at DTPA-Cd >or= 7.9 mg kg(-1) soil, while the productivity of chrysanthemum and gladiolus was sustained up to 21.2 mg kg(-1). DTPA-Cd for 50% yield reduction (C(50)) was 85, 106 and 215 mg kg(-1) soil for marigold, chrysanthemum and gladiolus, respectively, that indicates a better Cd-tolerance in gladiolus. The uptake of Cd increased with contents in soils and the maximum accumulation occurred in leaves. Among the economic parts, gladiolus spikes accumulated the highest Cd (7.2) followed by flowers of marigold (6.5) and chrysanthemum (4.0 mg kg(-1)). But, because of higher biomass, the total Cd removal was the maximum with chrysanthemum (8.3) followed by gladiolus (6.0) and the minimum (2.6 mg m(-2)) with marigold. Gladiolus with highest tolerance and Cd-content in saleable part holds potential to clean up the moderately contaminated soils.

Preventive and protective effects of wild basil in ethanol-induced liver toxicity in rats.

In the present study, preventive and protective effects of Ocimum gratissimum in ethanol-induced hepatotoxicity are assessed in albino rats. A methanol extract of O. gratissimum leaves is prepared, with a yield of 3.5% (w/w) of the dry weight of leaves. Graded doses of the extract (10, 20, 40 and 80 mg/kg body weight), together with ethanol (5 gm/kg body weight) are administered orally to experimental groups for 30 days. Normal control rats receive distilled water only, while rats in an alcohol control group (AC) receive ethanol only for 30 days. O. gratissimum reduced the level of thiobarbituric acid reactive substance in all experimental groups (E1-E4). Alanine transaminase and aspartate transaminase levels fell in all experimental groups (E1-E4), but this reduction was significant only in groups E3 and E4 (P < 0.05), indicating inhibition of lipid peroxidation by free radicals generated after ethanol metabolism. Levels of antioxidants also increased. Ascorbic acid and glutathione levels increased in all experimental groups (E1-E4; P < 0.05 and P < 0.01, respectively). A significant increase in catalase (P < 0.05) was noted only in group E4, although an upward trend was noted in all experimental groups. This study shows that O. gratissimum prevents free radical damage to the liver and thus protects the organ from oxidative stress.