Clinical and demographic study of scrub typhus in a tertiary care teaching hospital in Puducherry during 2015-2018

Background: Scrub typhus is a vector borne rickettsial disease commonly found in many parts of India. Scrub typhus can frequently cause complications like pneumonia, acute respiratory distress syndrome (ARDS) and has a mortality rate of 30 to 45% in untreated cases. Diagnosis of scrub typhus is difficult, with serum IgM capture ELISA being the most sensitive test. Present study objectives were to study the clinical and demographic profiles of scrub typhus cases in a tertiary care teaching hospital in the Union Territory of Puducherry, India.Methods: A descriptive study was carried out to analyze clinical and demographic profiles of patients who were positive for IgM antibodies against Orientia tsutsugamushi by scrub typhus IgM ELISA during a three year period (April 2015 to March 2018). Demographic details like age and sex of the patients, clinical signs, symptoms and complication if any were analyzed.Results: A total of 428 patients were found to have been diagnosed with scrub typhus during the study period. Among them, 46% were males and 54% were females. Among all the positive cases, 23.5% were paediatric cases, the second highest group was the 31 to 40 years age group (17.7%). Thirteen percent of positive cases were above 60 years of age. Fever was the most common symptom (92.9%) and eschar was found in 22.9% of patients. The most common complication found in the patients with scrub typhus was acute respiratory distress syndrome (15.9%). Other complications like hepatic dysfunction, pleural effusion and meningoencephalitis were noted.Conclusions: Adequate knowledge about scrub typhus helps in early diagnosis, which facilitates early appropriate antibiotic and supportive therapy, which helps in the recovery of the patient without acquiring complications

Studies on atmospheric gravity wave activity in the troposphere and lower stratosphere over a tropical station at Gadanki

MST radars are powerful tools to study the mesosphere, stratosphere and troposphere and have made considerable contributions to the studies of the dynamics of the upper, middle and lower atmosphere. Atmospheric gravity waves play a significant role in controlling middle and upper atmospheric dynamics. To date, frontal systems, convection, wind shear and topography have been thought to be the sources of gravity waves in the troposphere. All these studies pointed out that it is very essential to understand the generation, propagation and climatology of gravity waves. In this regard, several campaigns using Indian MST Radar observations have been carried out to explore the gravity wave activity over Gadanki in the troposphere and the lower stratosphere. The signatures of the gravity waves in the wind fields have been studied in four seasons viz., summer, monsoon, post-monsoon and winter. The large wind fluctuations were more prominent above 10 km during the summer and monsoon seasons. The wave periods are ranging from 10 min-175 min. The power spectral densities of gravity waves are found to be maximum in the stratospheric region. The vertical wavelength and the propagation direction of gravity waves were determined using hodograph analysis. The results show both down ward and upward propagating waves with a maximum vertical wave length of 3.3 km. The gravity wave associated momentum fluxes show that long period gravity waves carry more momentum flux than the short period waves and this is presented

Use of Surface-Enhanced Laser Desorption/Ionization with Time of Flight (SELDI-TOF) of the Urine in the Assessment of Acute Kidney Injury (AKI)

Background: Urinalysis is an important component in the assessment of acute kidney injury (AKI). Proteonomics is a rapidly developing approach in the analysis of physiological states. Several techniques have been developed to screen for protein populations. In this regard SELDI-TOF is a technique based on mass spectroscopy that is being utilized in proteonomics research. Methods:For this study, clean catch or catheterized urine was collected from normals (n=18) and patients referred to the renal service with AKI. Based upon urine and serum chemistries, clinical parameters, and microscopic urinalysis, the urines were separated into those consistent with prerenal azotemia (n=17) and acute tubular necrosis (ATN) (n=29). Initially, 5 samples each were chosen from the pre-renal and ATN who had no preexisting renal disease. Other etiologies of AKI were not included in this analysis. The urine specimens were diluted 1:5 and deposited onto an H4 ProteinChip array using 50% acetonitrile as the binding buffer. This system captured the greatest spectral range with the SELDI-TOF evaluation (compared to SAX, WCX2, IMAC, and NP1 ProteinChips). Low (250) and high (300) laser intensities were utilized to ionize and desorb the protein molecules; the spectra were collected in a positive ion mode and analyzed with Ciphergen Peaks software (v 3.0). Results: Five peaks with the high laser power were identified as potential candidates to discriminate between AKI due to prerenal or ATN causes. Those urines from the prerenal subjects were associated with detectable masses at 22.6 and 44.8 kilodaltons (KD); whereas subjects with ATN were noted to have urine with substantial masses at 11, 11.7, and 14.6 KD. The intensity of these peaks were then added together and normalized with the individual components of the discriminate peaks representing a percentage of the total. The prerenal and ATN subjects were then randomized in a training set consisting of 23 subjects and a testing set consisting of 23 subjects. Multiple linear regression was performed on the training set, and this allowed for 65% accuracy when applied to the testing set. Feed forward neural networks with hidden neuron layers ranging from 2-10 achieved similar predictive capability on the training set and testing sets. Conclusions: Although the SELDI-TOF methodology may be a useful adjunct in the assessment of AKI and renal disease, we suggest that larger training sets will be necessary to effectively exploit this strategy

Clinical experience with a shape memory polymer peripheral vascular embolisation plug: a case series.

BACKGROUND: Shape memory polymers are materials that are manufactured in a certain shape, can be stored in a temporary deformed shape, and then return to - or remember - their original shape upon exposure to external stimuli such as temperature and moisture. This property lends itself to application in endovascular medical devices. Peripheral vasculature embolisation devices incorporating this novel technology have become commercially available and this case series, where the data were collected as part of a post market registry, outlines initial clinical experience with these novel devices. RESULTS: Eight cases are described in this series. The disease state/conditions for which embolisation was indicated were right common iliac artery aneurysms (n = 3), a type II endoleak into the thoracic aorta following thoracic endovascular aneurysm repair (n = 1), a left inferior gluteal artery aneurysm (n = 1), left internal iliac artery aneurysms (n = 2), and a case of splenomegaly, where splenectomy was planned after the embolisation procedure (n = 1). Target arteries were 5-10 mm in diameter. In each case, at least one IMPEDE Embolization Plug (IMP-Device) of an appropriate diameter was used. All procedures were technically successful and target vessel thrombosis was achieved in all cases. Follow-up imaging available during the 45-90-day data collection timeframe showed sustained vessel occlusion. This case series includes examples of situations commonly encountered when embolising the peripheral vasculature, namely, the use of one or multiple devices in a single vessel and in combination with the use of other embolic devices (e.g., microcoils, gelatin sponge, and PVA particles) in the same case. There were no adverse events related to the specific use of the device. CONCLUSIONS: This small series illustrates the safety and efficacy of this novel sponge-based embolic device for the embolisation of small and medium sized arteries and further experience will demonstrate the utility of the shape memory polymer devices

Use of Surface-Enhanced Laser Desorption/Ionization with Time of Flight (SELDI-TOF) of the Urine in the Assessment of Acute Kidney Injury (AKI)

Background: Urinalysis is an important component in the assessment of acute kidney injury (AKI). Proteonomics is a rapidly developing approach in the analysis of physiological states. Several techniques have been developed to screen for protein populations. In this regard SELDI-TOF is a technique based on mass spectroscopy that is being utilized in proteonomics research. Methods:For this study, clean catch or catheterized urine was collected from normals (n=18) and patients referred to the renal service with AKI. Based upon urine and serum chemistries, clinical parameters, and microscopic urinalysis, the urines were separated into those consistent with prerenal azotemia (n=17) and acute tubular necrosis (ATN) (n=29). Initially, 5 samples each were chosen from the pre-renal and ATN who had no preexisting renal disease. Other etiologies of AKI were not included in this analysis. The urine specimens were diluted 1:5 and deposited onto an H4 ProteinChip array using 50% acetonitrile as the binding buffer. This system captured the greatest spectral range with the SELDI-TOF evaluation (compared to SAX, WCX2, IMAC, and NP1 ProteinChips). Low (250) and high (300) laser intensities were utilized to ionize and desorb the protein molecules; the spectra were collected in a positive ion mode and analyzed with Ciphergen Peaks software (v 3.0). Results: Five peaks with the high laser power were identified as potential candidates to discriminate between AKI due to prerenal or ATN causes. Those urines from the prerenal subjects were associated with detectable masses at 22.6 and 44.8 kilodaltons (KD); whereas subjects with ATN were noted to have urine with substantial masses at 11, 11.7, and 14.6 KD. The intensity of these peaks were then added together and normalized with the individual components of the discriminate peaks representing a percentage of the total. The prerenal and ATN subjects were then randomized in a training set consisting of 23 subjects and a testing set consisting of 23 subjects. Multiple linear regression was performed on the training set, and this allowed for 65% accuracy when applied to the testing set. Feed forward neural networks with hidden neuron layers ranging from 2-10 achieved similar predictive capability on the training set and testing sets. Conclusions: Although the SELDI-TOF methodology may be a useful adjunct in the assessment of AKI and renal disease, we suggest that larger training sets will be necessary to effectively exploit this strategy

Astrophysical Constraints on Modifying Gravity at Large Distances

Recently, several interesting proposals were made modifying the law of gravity on large scales, within a sensible relativistic formulation. This allows a precise formulation of the idea that such a modification might account for galaxy rotation curves, instead of the usual interpretation of these curves as evidence for dark matter. We here summarize several observational constraints which any such modification must satisfy, and which we believe make more challenging any interpretation of galaxy rotation curves in terms of new gravitational physics.Comment: References added, submitted to Classical & Quantum Gravit

Randomised Controlled Trial of Particles Used in Uterine fibRoid Embolisation (PURE): Non-Spherical Polyvinyl Alcohol Versus Calibrated Microspheres.

PURPOSE: The PURE study is a randomised controlled trial (RCT) comparing the clinical and MRI outcomes of patients treated with non-spherical polyvinyl alcohol, ns-PVA (Contour PVA-Boston Scientific-355-500 & 500-700 microns) versus calibrated hydrogel microspheres (Embozene-Varian Inc-700 & 900 microns) for symptomatic uterine fibroids. MATERIALS AND METHODS: Prospective, ethically approved non-sponsored RCT in 84 patients in a single UK tertiary IR unit, ISRCTN registry trial number ISRCTN18191539 in 2013 and 2014. All patients with symptomatic fibroid disease were eligible. UAE followed a standardised protocol with UFS-QOL and contrast-enhanced MRI before and 6 months post UAE. Outcome measures included: (1) Uterine Fibroid Symptom and Quality of Life questionnaire (UFS-QOL). (2) Percentage total and dominant fibroid infarction. (3) Uterine and dominant fibroid volume reduction. (4) Volume of embolics. RESULTS: Sixty-three patients completed the QOL follow-up (33 ns-PVA vs 30 Embozenes), the groups were equivalent at baseline. Patients were followed up for 6 months following UAE. There was no significant difference in symptom scores or HR-QOL between ns-PVA and Embozenes, p = 0.67 and 0.21, respectively. 92.7% of patients treated with ns-PVA achieved > 90% dominant fibroid infarction versus 61.8% treated with Embozenes (p = 0.0016). 66% of patients treated with ns = PVA achieved > 90% total fibroid percentage infarction compared with 35% in the Embozene group (p = 0.011). The mean vials/syringes used were 5.2 with Embozenes versus 4.1 using PVA (p = 0.08). CONCLUSION: The PURE study informs IRs regarding the efficacy of embolic agents in UAE, with superior fibroid infarction on MRI using ns-PVA versus Embozenes however no significant difference in clinical outcomes at 6 months after UAE

Predicting the Fibroid-Migratory Impact of UAE: Role of Pre-embolization MRI Characteristics.

AIM: To investigate potential factors on MR imaging that could be used to predict migration of uterine fibroids post-UAE. METHODS AND MATERIALS: We retrospectively reviewed patients referred for UAE having pre-procedural and 6 months post-procedural MRI, at a tertiary centre, over a 1-year period. Pre- and post-UAE images were reviewed in 64 women by two radiologists to identify the sub-type, dimensions, and infarction rate of each dominant fibroid. The shortest distance between the fibroid and the endometrial wall was measured to determine intramural fibroid movement. Paired sample T tests and two-sample T tests were used to compare between pre- and post-embolization variations and between migrated and non-migrated intramural fibroids, respectively. After preliminary results suggested potential predictors of intramural fibroids migration, we tested our findings against the non-dominant intramural fibroids in the same patients. RESULTS: Review of images revealed 35 dominant intramural fibroids, of which eight migrated to become submucosal fibroids, while five were either partially or completely expelled. These 13 migrated fibroids had a shorter pre-procedural minimum endometrial distance (range 1-2.4 mm) and greater maximum fibroid diameter (range 5.1-18.1 cm), when compared to non-migrating fibroids. On image reassessment, the migrated non-dominant intramural fibroids had a minimum endometrial distance and maximum fibroid diameter within the same range. CONCLUSION: Intramural fibroids with a minimum endometrial distance less than 2.4 mm and a maximum fibroid diameter greater than 5.1 cm have a high likelihood of migrating towards the endometrial cavity after UAE