Clinico-haematological profile of adult pancytopenia patients at a tertiary care institute in South India

Background: Pancytopenia is not a disease by itself; rather it describes simultaneous presence of anemia, leukopenia and thrombocytopenia resulting from a number of disease processes. Varieties of hematological and non-hematological disorders may affect bone marrow either primarily or secondarily, resulting in the manifestation of pancytopenia. The incidence of various hematological disorders causing pancytopenia varies due to geographical distribution and genetic predisposition. This study highlights the spectrum of causes, clinical presentation and bone marrow morphology of pancytopenia.Methods: This prospective observational study was conducted for a period of two years at Al-Ameen Medical College, Bijapur, Bangalore. During this period, fifty patients with a hematological diagnosis of pancytopenia were studied during period in the department of pathology.Results: Among the 50 cases studied, 35 were males and 15 were females. Most of the patients presented with generalized weakness and fever. The commonest physical finding was pallor, followed by splenomegaly and hepatomegaly. Dimorphic anemia was predominant blood picture. Bone marrow study showed 72% hypercellular marrow, 12% normocellular and 16% hypocellular marrow. The commonest cause for pancytopenia was megaloblastic anemia followed by iron deficiency anaemia and malaria.Conclusions: The present study concludes that detailed hematological investigations along with bone marrow examination in pancytopenic patients is helpful to diagnose or rule out the causes of pancytopenia.

Design, Development and Evaluation of Portable Washer for Lotus Rhizomes

629-633The aim of the present study was to design, develop and evaluate a low cost portable washer for Lotus Rhizomes. Different performance parameters and colour values were studied to check the performance of the developed prototype in comparison to the manual washing. The capacity and efficiency of the machine was much higher than the existing manual method of washing. The colour coordinates (L* a* b*) revealed that washing through developed washer makes lotus rhizomes more clean and bright as compared to the  manual washing. Different sanitizers were also tested for shelf life enhancement of lotus rhizomes. Out of all tested sanitizers, the citric acid was found best with regard to shelf life enhancement and cleanliness of lotus rhizomes. The economic analysis reveals that the developed lotus rhizome washer can be beneficial for the people who are directly or indirectly involved in lotus rhizome trade

Pathological Studies on Lung Abscesses in Sheep Slaughtered in Kashmir Valley, India

The present study was conducted in Kashmir valley of India to investigate the prevalence and pathology of lung abscesses in sheep, slaughtered in different organized abattoirs. These abattoirs were visited between January 2010 to February 2011 and a total of 1455 lungs were examined. Out of these 18.9% lungs had abscesses, with higher incidence in young sheep (60%) than in adult ones (40%). Grossly, abscesses were observed in one or more lung lobes and were either single or multiple. In majority of lungs, abscess sizes varied from pea to walnut size, but in some cases large abscesses were also observed. Histopathologically, abscesses were characterized by a central caseo-necrotic core surrounded by pyogenic membrane with infiltration of polymorphonuclear cells and few mononuclear cells and macrophages. Most of the abscesses revealed presence of Gram positive bacterial infection where as chronic abscesses indicated both Gram positive and Gram negative bacterial infection. Fibrous tissue proliferation around the pyogenic membrane of the chronic abscesses was noticed. Disruption and disorientation of elastin fibres was also a prominent feature. Increased concentration of both acid and neutral mucopolysaccharides was observed in and around the lesion. Purulent material of abscesses revealed marked metachromasia. The study revealed that lung abscesses in domestic sheep are highly prevalent in Kashmir valley. Thus, there is a need to introduce appropriate control measures of diseases affecting the lungs to minimize the incidence of lung affections and hence reduce the ensuing economic losses

Spontaneous Rupture of Malarial Spleen: Report of Two Cases

Malaria is endemic in many tropical and subtropical regions of the world, including Saudi Arabia. The infection has serious consequences in those residing in non endemic regions on travelling to endemic areas, due to lack of immunity to the parasite. In this report, we describe the clinical course of two patients who travelled to a malaria endemic area. Both contracted the infection and presented with splenic rupture. They received splenectomy in addition to the appropriate antimalarial medications, with successful outcome

Negative pressure wound therapy: eleven-year experience at a tertiary care hospital

Background: Management of complicated wounds is a reconstructive challenge. A reconstructive surgeon has to be ready to face new challenges every day. Negative pressure wound therapy has revolutionized the management of complex wounds. We are presenting our experience with this wound care modality in the past 11 years.Methods: It was a prospective study conducted from January 2006 to December 2016 on patients having wounds of varied etiologies, who consented to participate in this study. Custom made low cost NPWT was used till definitive wound closure.Results: A total of 568 patients consented to participate in the study during these 11 years. No major complications were seen. Most of these were males (60.73%) in their 3rd and 4th decade. Trauma was the leading cause of wounds in 38.14%, followed by diabetic foot wounds in 21.5%. Ankle and foot was the most common site of wounds (30.92%) followed by leg (24.01%). A total of 322 small, 218 medium and 97 large size dressings were used. Most of the patients improved with the NPWT.  No major complications were seen.Conclusions: NPWT is safe, effective and has proved to be revolutionary in managing difficult wounds. With the use of customized low cost NPWT the benefit can be extended to underprivileged population in under developed nations too

Reconstruction of soft tissue defects in Fournier’s gangrene at a tertiary care centre

Background: Fournier’s gangrene is an acute and potentially lethal multi-bacterial necrotizing infection that primarily involves the scrotum but may extend beyond its confines to perineum and abdominal wall. The disease may result in sepsis and death if treatment is delayed. Management consists of timely diagnosis, aggressive debridement, broad-spectrum antibiotics followed by reconstruction which still remains a surgical challenge.Methods: It is a prospective study conducted from Jan 2006 to Dec 2015 on 29 patients of Fournier’s gangrene who were referred to the department of Plastic and Reconstructive Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, for reconstruction after initial debridement by general surgeon/urologist. The patient’s age, predisposing factors, site and the size of the defects, reconstructive options used and outcome were evaluated. Assessment of testicular function was done at 6 months by sperm count and morphology.Results: A total of 29 patients of Fournier’s gangrene consisting of 28 males and one female were included in the study. The mean age was 37 years and the most common comorbidity was diabetes mellitus in 18 patients (62%). Wounds were allowed to heal by secondary intension in 8 patients. Scrotal advancement flap was done in seven patients. Split thickness skin grafting (STSG) of extensive wounds was done in 11 patients and testes were placed in medial thigh subcutaneous pocket in one patient. Two elderly diabetic patients succumbed to sepsis and multi organ failure. Overall complication rate was 18.5%.Conclusions: Thorough debridement and early wound cover are essential in the management of Fournier’s gangrene for successful rehabilitation. Various reconstructive options are available with no conclusive evidence to support flap rather than skin graft and most of the procedures result in preservation of testicular function in the long term

Closure of anterior palatal fistula using tongue flap: our experience

Background: Palatal fistula is one of the most common complications following cleft palate repair. It occurs mostly due to tip necrosis of palatal flaps. Small palatal fistulas are usually closed by transposition of adjacent tissues, however these local tissues are not sufficient for the closure of bigger fistulas. The tongue flap serves as a reliable and most easily obtainable local flap for closure of large sized palatal fistulas.Methods: This is a prospective study conducted from Aug 2006 to July 2015 in the department of Plastic & Reconstructive Surgery, SKIMS, Srinagar, Jammu Kashmir, India. A total of 25 patients with large anterior palatal fistula were treated using anteriorly based tongue flap. Patients were selected on the basis of size of fistula (> 1x1 cm), scarred local palatal tissue or history of fistula recurrence after previous attempts of closure using local palatal tissues.Results: In present study 25 patients of palatal fistula were treated using tongue flap. Eighty percent patients were in the age group of 3 to 5 years. Male-to-female ratio was 2:3. The largest dimension of treated fistula was 4x3 cm. There was partial dehiscence of flap suture line in two patients while remnant fistula was observed in three patients. None of our patients had flap necrosis.Conclusions: Tongue flap is an excellent and versatile option for closure of large palatal fistulas with high success rate and least morbidity

Two stage flexor tendon reconstruction in hand: our experience

Background: Flexor tendon injuries in the digital flexor sheath area (zone II) are the most difficult to treat and remain a focus of both clinical attention and basic investigations. This prospective study was designed to evaluate the results of staged zone II flexor tendon repair.Methods: Seventy digits in thirty five patients were treated by Two Stage flexor tendon reconstruction and followed for an average of one and a half year. The procedure included placing a silicone catheter (cut to desire size) as an active implant and reconstruction of A2, A4 or both pulleys if damaged in first stage. During the second stage (performed three to eight months later), tendon graft replaced the silicone catheter in the pseudo sheath formed around the catheter. The proximal end of the transplanted tendon was fixed with flexor digitorum profundus tendon of respective finger using the Pulvertaft method, and the distal end of the graft was fixedwith the distal stump of respective flexor digitorum profundus tendon. Early controlled motion protocol was instituted in all cases.Results: As per Buck Gramcko scale total active motion obtained was Excellent in 70%, Good in 20%, Fair in 7.1%, and Poor in 2.9% of patients.Conclusions: Flexor tendon reconstruction using two stage tendon reconstructions is an effective way to restore digital tendon function in delayed zone II flexor tendon injuries

Impact of Sensor Networks on Aquatic Biodiversity in Wetland: An Innovative Approach

Aquatic biodiversity is in the central field of environmental conservation issues in a wetland. Yet it determinately faced aquatic conservation authorities the loss of biodiversity as a very important global issue for several years due to misuse wireless sensor technology. The study attempts to re-look at the sensor networks that affect the aquatic biodiversity within and around the Tanguar Haor- wetland study at Sunamganj district in Bangladesh. Key aquatic conservation tools provided at the Tanguar Haor and its challenges with gaps in policies for wetland management practices are highlighted. The study shows the aquatic biodiversity-related rules and regulations amended were apex in Bangladesh from 2010 to 2018. The study represents the impact of processed sensor networks on aquatic biodiversity in a wetland to be compared to larger, medium, and smaller animals in a bright, dark and optimum environment, facilitating the design and misuse of wireless sensor networks within GPS locations. Approximately 64% of the respondents agreed on the development of aquatic biodiversity for managing the wetland at Sunamganj with secure peripheral sensor networks. The research also found that the Tanguar Haor is at risk due to misuse of wireless sensor networks compared to other wetlands in the Sylhet Division. Scientific knowledge is indispensable in wetland resource management but it poorly identified such knowledge while various performances are still below par. The research is unique and represents the innovative idea to improve the existing wetland policy linking with the appropriateness for the Ramsar Wetland Conservation Strateg

Transcription factor AP-1 in esophageal squamous cell carcinoma: Alterations in activity and expression during Human Papillomavirus infection

<p>Abstract</p> <p>Background</p> <p>Esophageal squamous cell carcinoma (ESCC) is a leading cause of cancer-related deaths in Jammu and Kashmir (J&K) region of India. A substantial proportion of esophageal carcinoma is associated with infection of high-risk HPV type 16 and HPV18, the oncogenic expression of which is controlled by host cell transcription factor Activator Protein-1 (AP-1). We, therefore, have investigated the role of DNA binding and expression pattern of AP-1 in esophageal cancer with or without HPV infection.</p> <p>Methods</p> <p>Seventy five histopathologically-confirmed esophageal cancer and an equal number of corresponding adjacent normal tissue biopsies from Kashmir were analyzed for HPV infection, DNA binding activity and expression of AP-1 family of proteins by PCR, gel shift assay and immunoblotting respectively.</p> <p>Results</p> <p>A high DNA binding activity and elevated expression of AP-1 proteins were observed in esophageal cancer, which differed between HPV positive (19%) and HPV negative (81%) carcinomas. While JunB, c-Fos and Fra-1 were the major contributors to AP-1 binding activity in HPV negative cases, Fra-1 was completely absent in HPV16 positive cancers. Comparison of AP-1 family proteins demonstrated high expression of JunD and c-Fos in HPV positive tumors, but interestingly, Fra-1 expression was extremely low or nil in these tumor tissues.</p> <p>Conclusion</p> <p>Differential AP-1 binding activity and expression of its specific proteins between HPV - positive and HPV - negative cases indicate that AP-1 may play an important role during HPV-induced esophageal carcinogenesis.</p