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Fine needle aspiration is routinely performed as part of the assessment of thyroid nodules. It is generally regarded as a very safe procedure, though rarely significant bleeding can occur in its aftermath. A 79-year-old female was referred for assessment of an incidental thyroid nodule which had been identified on computed tomography of the chest and extended into the retrosternal space. The patient was referred for fine needle aspiration under ultrasound guidance. Three passes were made with a 25 gauge needle into the nodule; a haemorrhagic aspirate was obtained and sent for cytological examination. Several hours later, the patient developed a cough and progressive breathlessness and died at home before she could be taken to hospital. The key finding from the post-mortem was extensive haemorrhage within the capsule of thyroid. In the absence of another identifiable aetiology, the cause of death was considered to be acute haemorrhage into the thyroid gland. Thyroid fine needle aspiration is generally a safe procedure, but it is important to recognise that, rarely, major complications can occur.

Background: Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion and insulin action or both. T2DM is associated with chronic low grade inflammation, possibly through a pathway involving a cytokine-mediated acute-phase response to infection and other inflammatory processes. authors aim to study C-reactive protein (CRP) which is an acute-phase reactant produced primarily in the liver hepatocytes. Oxidative stress levels in newly diagnosed T2M patients were analysed with respect to malondialdehyde (MDA) and nitric oxide (NO).Methods: Case-control study comprising of aged-sex matched subjects: newly diagnosed T2DM cases (n=30) and controls (n=30). The serum samples of subjects were analysed for levels of MDA by Buege and Aust method, while NO levels by Cortas and Wakid’s kinetic cadmium reduction method using spectrophotometer. CRP levels were analysed by using turbidimetry. Statistical analysis was done using Mini-tab 17 software with 95% confidence interval.Results: Serum levels of MDA, NO and CRP in newly diagnosed T2DM patients were significantly increased as compared to healthy controls.Conclusions: Authors concluded that the oxidative stress and inflammation plays a pivotal role in the aetiology of hyperglycemia in T2DM. Oxidative stress and inflammatory markers might help prognosis of T2DM in hyperglycemic individuals with the help of which precautionary measure can be taken to reduce the rate of disease progression. Treatment involving anti-oxidant and anti-inflammatory medications might help to rescue vital organs from damage.

Background: In recent years, progress in Tuberculosis (TB) control and eradication has been threatened by the emergence of drug resistant strains of Mycobacterium tuberculosis (MTB). Several studies describe micronutrient malnutrition in TB. This study focuses on the effect of drug resistance and disease progression on levels of various vitamins.Methods: The case control study comprised of 50 normal healthy human volunteers (Control), 50 newly diagnosed TB patients (CAT I) and 50 TB patients showing multi drug resistance (MDR). Recruited subjects were of both genders in age group of 18- 60 years and from different socioeconomic status. Blood serum samples analysed for levels of Vitamin A, Vitamin D, Vitamin E, Vitamin C, Vitamin B12 and Folic acid by using Spectrophotometer, ELISA and Chemiluminescence instruments. Statistical evaluation was done for correlation among variables.Results: The levels of vitamins in TB patients were significantly reduced when compared with controls. Also, MDR-TB patients showed severe malnourished state in comparison to those who were newly diagnosed for the disease.Conclusions: There is a need to provide vitamin supplements in proper sufficient dosage with anti-TB drugs during treatment, which will help fight against the disease and ensure rapid recovery of the patients.

Patients coming for atlantoaxial dislocation surgery represent a unique subset of difficult intubation. In addition to having restricted neck movements, excessive movements at the neck joint during intubation must be avoided to avoid further compression. In view of the anticipated difficult intubation, adjuncts or introducers may be required to aid intubation, the most commonly used being bougies. Complications are known to occur with the use of bougies but fortunately the incidences are far and few. The most dreaded of these is pneumothorax, secondary to trauma by the bougie. The use of an adult bougie for pediatric intubations could possibly increase the risk of the same. Here, we report two incidences of pneumothorax after bougie-guided intubation.

Objective: Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis affecting mainly the immune system in humans. This Study determines the malondialdehyde causing oxidation stress and blood levels of superoxide dismutase, catalase act as anti-oxidant. Materials and Methods: Study carried out in normal control subjects (n = 100), different categories of pulmonary in newly sputum culture positive diagnosed category I (n = 100), category II (n = 100), category III (n = 100). Extra pulmonary category I (n = 35) and pulmonary category I before and after six months of directly observed treatment, short course. Results: Malondialdehyde levels were significantly increased in pulmonary and extra pulmonary tuberculosis patients. The activity of superoxide dismutase, and catalase were found to be significantly decreased in subjects of all categories of pulmonary and extra tuberculosis pulmonary. Negative correlation between malondialdehyde content, with superoxide dismutase, and catalase was seen in pulmonary tuberculosis, P < 0.001. Conclusion: Increased defense mechanism was due to increased oxidative stress in tuberculosis. Superoxide dismutase and catalase by scavenging of free oxygen radicals interrupt inflammatory cascades and thereby limit further disease progression. The changes were reversed after six month anti-tubercular treatment in patients with good recovery but increase oxidative stress was not completely reversed.

Background: Oral mucosal lesions are seen commonly in tobacco consumers and some of them are precancerous. Study of various benign oral mucosal lesions has done in tobacco consumers. Comparison of serum Vitamin levels was done in patients with benign oral lesions in tobacco consumers and non- tobacco consumers. Methods: Retrospective study of 100 patients with benign oral lesion with tobacco addiction was done. Control group includes tobacco non-addicts. Detail history regarding tobacco consumption was noted. Tobacco consumption pattern was studied in patients with benign oral lesion. Ear, nose, throat examination was done in detail. Oral lesion was noted. Comparison between serum levels of vitamin A, C and vitamin E in benign oral lesion of patients with tobacco addiction and tobacco non-addicts were included in the study. The results were analysed statistically by student t-test. Results: Patient with tobacco consumption with lime application was more prone to develop benign oral lesions. Gingivitis was most common lesion seen in study population followed by leukoplakia. Serum vitamin A, C and E were significantly decreased in tobacco consumers with benign oral lesions as compared to tobacco non-consumers. Decreased in serum vitamin levels were seen in all benign oral lesions irrespective of its malignant potential. Conclusions: Gingivitis was most common lesion seen in study population followed by leukoplakia. Serum level of non-enzymatic antioxidant vitamin such as vitamin A, C and E gets decreased significantly in all benign oral lesions irrespective of its malignant potential. Serum levels of the antioxidant vitamins indicate need of increased oral intake of these vitamins to protect from damage in all benign oral lesions.

We have enhanced the capability of a microphysical aerosol-chemistry module to simulate the atmospheric aerosol and precursor gases for both tropospheric and stratospheric conditions. Using the Mount Pinatubo eruption (June 1991) as a test case, we evaluate simulated aerosol properties in a composition-climate model against a range of satellite and in-situ observations. Simulations are performed assuming an injection of 20 Tg SO2 at 19–27 km in tropical latitudes, without any radiative feedback from the simulated aerosol. In both quiescent and volcanically perturbed conditions, simulated aerosol properties in the lower stratosphere show reasonable agreement with the observations. The model captures the observed timing of the maximum aerosol optical depth (AOD) and its decay timescale in both tropics and Northern Hemisphere (NH) mid-latitudes. There is also good qualitative agreement with the observations in terms of spatial and temporal variation of the aerosol effective radius (Reff), which peaks 6–8 months after the eruption. However, the model shows significant biases against some observational data sets. Simulated AOD and Surface Area Density (SAD) in the tropics are substantially higher than the gap-filled satellite data products during the first 6 months after the eruption. The model shows consistently weaker enhancement in Reff compared to satellite and in-situ measurements. Simulated aerosol particle size distribution is also compared to NH mid-latitude in-situ balloon sounding measurements of size-resolved number concentrations. Before the eruption, the model captures the observed profiles of lower stratospheric particle number concentrations with radii larger than 5, 150 and 250 nm (N5, N150 and N250) very well. However, in the first 6 months after the eruption, the model shows high bias in N5 concentrations in the lower stratosphere, suggesting too strong nucleation. Following particle growth via condensation and coagulation, this bias in the finest particles propagates into a factor 2 high bias in N150. Our comparison suggests that new particle formation in the initial phase of large eruptions, and subsequent particle growth to optically-active sizes, might be playing an important role in determining the magnitude of the climate impacts from volcanoes like Pinatubo.

In this paper, we present a description of the tropospheric chemistry component of the UK Chemistry and Aerosols (UKCA) model which has been coupled to the Met Office Hadley Centre's HadGEM family of climate models. We assess the model's transport and scavenging processes, in particular focussing on convective transport, boundary layer mixing, wet scavenging and inter-hemispheric exchange. Simulations with UKCA of the short-lived radon tracer suggest that modelled distributions are comparable to those of other models and the comparison with observations indicate that apart from a few locations, boundary layer mixing and convective transport are effective in the model as a means of vertically re-distributing surface emissions of radon. Comparisons of modelled lead tracer concentrations with observations suggest that UKCA captures surface concentrations in both hemispheres very well although there is a tendency to underestimate the observed geographical and interannual variability in the Northern Hemisphere. In particular, UKCA replicates the shape and absolute concentrations of observed lead profiles, a key test in the evaluation of a model's wet scavenging scheme. The timescale for inter-hemispheric transport, calculated in the model using a simple krypton tracer experiment, does appear to be long relative to other models and could indicate deficiencies in tropical deep convection and/or insufficient boundary layer mixing. We also describe the main components of the tropospheric chemistry and evaluate it against observations and other tropospheric chemistry models. In particular, from a climate forcing perspective, present-day observed surface methane concentrations and tropospheric ozone concentrations are reproduced very well by the model, thereby making it suitable for long centennial integrations as well as studies of biogeochemical feedbacks. Results from both historical and future simulations with UKCA tropospheric chemistry are presented. Future projections of tropospheric ozone vary with the Representative Concentration Pathway (RCP). In RCP2.6, for example, tropospheric ozone increases up to 2010 and then declines by 13% of its year-2000 global mean by the end of the century. In RCP8.5, tropospheric ozone continues to steadily rise throughout the 21st century, with methane being the main driving factor. Finally, we highlight aspects of the UKCA model which are undergoing and/or have undergone recent developments and are suitable for inclusion in a next-generation Earth System Model.

Background: This study determines the protein carbonyls which cause cellular damage and glutathione, glutathione peroxidase, glutathione reductase act as antioxidants. Materials and Methods: This study was carried out in different categories of pulmonary and extra pulmonary tuberculosis cases of newly sputum culture positive diagnosed pulmonary categorie I (n=100), extra pulmonary patients categorie (n=35) before and after the DOTS treatment of 6 months, categorie II (n=100), categorie III (n=100) and in normal control subjects (n=100). Results: The serum protein carbonyl levels were significantly increased in the pulmonary and extra pulmonary tuberculosis patients. The activities of blood glutathione, glutathione per­ oxidase, and glutathione reductase were found to be significantly decreased in subjects of all the categories of pulmonary and extra pulmonary tuberculosis. A negative correlation between the carbonyl protein content and glutathione, glutathione peroxidase, and glutathione reductase was seen in pulmonary tuberculosis, p

Atmospheric chemistry is driven by photolytic reactions, making their modelling a crucial component of atmospheric models. We describe the implementation and validation of Fast-JX, a state of the art model of interactive photolysis, into the MetUM chemistry climate model. This allows for interactive photolysis frequencies to be calculated in the troposphere and augments the calculation of the frequencies in the stratosphere by accounting for clouds and aerosols in addition to ozone. In order to demonstrate the effectiveness of this new photolysis scheme we employ new methods of validating the model, including techniques for sampling the model to compare to flight track and satellite data.

There are 700,000 people in the UK living with Dementia (Knapp etal, Dementia UK: The full Report Alzheimer’s Society2007). This has prompted the government to publish the first National Dementia Strategy which has made dementia a national priority. Dementia has a huge impact on physical, psychological and social aspects of care and also poses ethical challenges. One major ethical challenge which looms large, is the difficulty faced by clinicians in disclosing the diagnosis of dementia. The National Dementia strategy acknowledges this. 61% General practitioners routinely withhold diagnosis (Vassilas C& Donaldson J, 1998) and 60% Old Age Psychiatrists do not always disclose diagnosis as 20% do not see any benefit (Downs et al, 2002). This is similar to disclosure practices with cancer patients in the 1960’s whereby 90% of physicians did not disclose the diagnosis of cancer to their patients (Oken etal 1961). This however saw a fundamental shift in the seventies when only 10% of physicians withheld the diagnosis of cancer (Novack etal, 1979). This may be related to new cancer medications and patient rights. There are many reasons for not disclosing a diagnosis of dementia. Physicians fear causing harm to their patients. (Pinner G& Bouman W, 2002). Some medical practitioners find it hard to share a diagnosis of dementia( Illife,S etal,03) and others report explaining a diagnosis of dementia is more difficult than for other diseases( Glosser etal,1985). This can lead to variability in diagnostic disclosure which I will address here. Since the last decade great progress has been made in identifying biomarkers and molecular changes in the brain associated with Alzheimer’s disease. With various disease modifying medications like Bapineuzumab in phase III trials showing promising results, diagnostic disclosure is finding itself in the limelight for ethical and scientific reasons.

Time and motion studies have been used to analyze performance and improve outcomes. This prospective study evaluated a typical operating day at a surgical facility in the United Kingdom by recording admitting time into the hospital, entrance and exit times from theatre, and length of surgical time. The same surgical team performed 10 breast augmentations in less than 10 hr, with a mean preparation time of 9 min 20 s and a mean surgical time (from incision to closure) of 32 min. The mean exit time was 6 min 15 s, with a mean changing time between patients of about 24 min (median = 21 min). No adverse patient complications were reported.

Helicobacter pylori are considered the most common human pathogen colonizing gastric mucosa. Gastritis with or without H. pylori infection is associated with increase in levels of homocysteine and high-sensitivity C-reactive protein (hs-CRP) but a more pronounced increase is noted in gastritis with H. pylori infection. Increasing level of homocysteine, due to decreased absorption of vitamin B12 and folic acid, together with increased CRP levels in gastritis with H. pylori infection may be the earliest event in the process of atherosclerosis and plaque formation. Retrospective study conducted at tertiary care hospital in Mumbai by Department of Biochemistry in association with Department of Surgery. Eighty patients who underwent gastroscopy in view of gastritis were subjected to rapid urease test for diagnosis of H. pylori infection. Vitamin B12, folic acid, homocysteine and hs-CRP were analyzed using chemiluminescence immuno assay. Student’s t-test, Pearson’s correlation and linear regression used for statistical analysis. Patients with H. pylori gastritis had significantly lower levels of vitamin B12 (271.6 ± 101.3 vs. 390.6 ± 176.7 pg/mL; P = 0.0005), as well as higher levels of homocysteine (17.4 ± 7.4 vs. 13.8 ± 7.8 mmol/L; P = 0.037) and hs-CRP (2.5 ± 2.9 vs. 1.2 ± 1.1 mg/L; P = 0.017), than in patients without H. pylori gastritis. However, folic acid showed (8.9 ± 3.2 vs. 10.0 ± 3.6 ng/mL; P = 0.171) no significant difference. Elevated homocysteine and hs-CRP in H. pylori gastritis may independently induce endothelial dysfunction, leading to cardiovascular pathology.

By aiming to relieve pain from removing blisters in partial thickness burn, we tested whether the application of a sterile lubricant (KY-Jelly®) on blisters and the use of a sterile razor to remove their roof can reduce algesia in humans, compared to a conventional method. A prospective randomized controlled designed study was performed on 20 patients. A visual pain scale was used by patients to evaluate pain experienced.

Worldwide, the case-fatality rate of smear-positive pulmonary tuberculosis among persons on treatment is 3.8%. We assessed the case-fatality rate among such patients in Baltimore between January 1993 and June 1998. Tuberculosis incidence was17/100 000 population, and 99% of patients received directly observed therapy. Of 174 patients, 42 (24%) died on treatment. Patients who died were older (mean age 62 vs. 47 years; P0.001) and were more likely to have underlying medical conditions. In multivariate analyses, older age, diabetes mellitus, and renal failure were independently associated with an increased risk of death. With effective control, tuberculosis may become concentrated in older persons with chronic diseases and be associated with high case-fatality rates. In such settings, acceptable treatment success rates may need to be revised.

The prevalence of the C677T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene in Asian Indians from India was determined and the association of the mutant allele with coronary artery disease (CAD) was evaluated in a case-control study. The case group consisted of 251 patients with CAD; 195 male and 56 female aged from 29 to 82 years (mean age +/- SD, 57.5 +/- 10.6 years). The control group consisted of 216 apparently healthy individuals without evidence of CAD; 161 male and 55 female aged from 30 to 83 years (mean age +/- SD, 54.9 +/- 10.4 years). All the patients were assessed by coronary angiography. While 33 patients had normal coronaries, 23, 25 and 39 patients had single-vessel, two-vessel and triple-vessel disease, respectively. Eighty-three patients (33%) had suffered myocardial infarction less than a year to five years earlier. The C677T polymorphism in the MTHFR gene was assessed. While 31% of the controls and 38% of the patients had the heterozygous genotype, 2% of the control group and none of the patients had the mutant homozygous genotype. The overall 'T' allelic frequencies were comparable in control and patient groups (0.18 and 0.19, respectively), but the association of the sum of heterozygous and homozygous genotypes with CAD (1, 2 or 3-vessel disease) was statistically significant for females only [Odds ratio (95% confidence intervals), 2.8 (1.1-6.9), p = 0.023]. No association was found between genotype distribution and previous myocardial infarction or severity of atherosclerosis.

This paper has beenretracted.Vinayak W Patil1, Mukund B Tayade2, Sangeeta A Pingale1, Shubhangi M Dalvi1, Rajesh B Rajekar1, Hemkant M Deshmukh1, Shital D Patil1, Rajeev Singhai11Department of Biochemistry, 2Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, IndiaBackground: Combination chemotherapy is highly effective in locally advanced breast cancer. A negative expression of biomarker p53 indicates a higher chance of responding to this regimen. Patients' p53 status may be used as a biological cancer marker to identify those who would benefit from more aggressive treatments.Aims: The role of p53 in modulating apoptosis has suggested that it may affect the efficacy of anticancer agents. p53 alterations in 80 patients with locally advanced breast cancer IIIB undergoing neoadjuvant chemotherapy were prospectively evaluated.Materials and methods: Patients received three cycles of paclitaxel (175 mg/m2) and doxorubicin (60 mg/m2) every 21 days. Tumor sections were analyzed before treatment for altered patterns of p53 expression, using immunohistochemistry and DNA sequencing.Results: An overall response rate of 83.5% was obtained, including 15.1% complete pathological responses. The regimen was well tolerated with 17.7% grade 2/3 nausea and 12.8% grade 3/4 leukopenia. There was a statistically significant correlation between response and expression of p53. Of 25 patients who obtained a complete clinical response, only two were classified as p53-positive (P = 0.004, χ2). Of 11 patients who obtained a complete pathological remission, one was positive (P = 0.099, χ2).Conclusion: Immunohistochemical (IHC) analysis has been shown to be a prognostic factor for patients with breast cancer in India. Paclitaxel is one of the most promising anticancer agents for the therapy of breast cancer, where it has also shown activity in tumors resistant to doxorubicin.Keywords: breast cancer, doxorubicin, p53, paclitaxel, cancer tissue biomarkers, neoadjuvant chemotherapy, immunohistochemistry, infiltrating duct cancer

EDITOR—The paper by English et al confirms a view that serial photography does not alter the final diagnosis of a skin lesion1; a suspicious lesion that remains will require a biopsy to confirm the pathological diagnosis. With serial photography it is difficult to obtain a standard image. The ambient …

Quantifying forcings from anthropogenic perturbations to the Earth system (ES) is important for understanding changes in climate since the pre-industrial (PI) period. Here, we quantify and analyse a wide range of present-day (PD) anthropogenic effective radiative forcings (ERFs) with the UK's Earth System Model (ESM), UKESM1, following the protocols defined by the Radiative Forcing Model Intercomparison Project (RFMIP) and the Aerosol and Chemistry Model Intercomparison Project (AerChemMIP). In particular, quantifying ERFs that include rapid adjustments within a full ESM enables the role of various chemistry–aerosol–cloud interactions to be investigated. Global mean ERFs for the PD (year 2014) relative to the PI (year 1850) period for carbon dioxide (CO2), nitrous oxide (N2O), ozone-depleting substances (ODSs), and methane (CH4) are 1.89 ± 0.04, 0.25 ± 0.04, −0.18 ± 0.04, and 0.97 ± 0.04 W m−2, respectively. The total greenhouse gas (GHG) ERF is 2.92 ± 0.04 W m−2. UKESM1 has an aerosol ERF of −1.09 ± 0.04 W m−2. A relatively strong negative forcing from aerosol–cloud interactions (ACI) and a small negative instantaneous forcing from aerosol–radiation interactions (ARI) from sulfate and organic carbon (OC) are partially offset by a substantial forcing from black carbon (BC) absorption. Internal mixing and chemical interactions imply that neither the forcing from ARI nor ACI is linear, making the aerosol ERF less than the sum of the individual speciated aerosol ERFs. Ozone (O3) precursor gases consisting of volatile organic compounds (VOCs), carbon monoxide (CO), and nitrogen oxides (NOx), but excluding CH4, exert a positive radiative forcing due to increases in O3. However, they also lead to oxidant changes, which in turn cause an indirect aerosol ERF. The net effect is that the ERF from PD–PI changes in NOx emissions is negligible at 0.03 ± 0.04 W m−2, while the ERF from changes in VOC and CO emissions is 0.33 ± 0.04 W m−2. Together, aerosol and O3 precursors (called near-term climate forcers (NTCFs) in the context of AerChemMIP) exert an ERF of −1.03 ± 0.04 W m−2, mainly due to changes in the cloud radiative effect (CRE). There is also a negative ERF from land use change (−0.17 ± 0.04 W m−2). When adjusted from year 1850 to 1700, it is more negative than the range of previous estimates, and is most likely due to too strong an albedo response. In combination, the net anthropogenic ERF (1.76 ± 0.04 W m−2) is consistent with other estimates. By including interactions between GHGs, stratospheric and tropospheric O3, aerosols, and clouds, this work demonstrates the importance of ES interactions when quantifying ERFs. It also suggests that rapid adjustments need to include chemical as well as physical adjustments to fully account for complex ES interactions.

Tigemonam, a new monobactam with excellent activity against gram-negative bacteria, was evaluated for in vivo efficacy and absorption after oral administration to laboratory animals. Tigemonam is absorbed when administered orally to mice and dogs. In a variety of gram-negative systemic infections in mice, orally administered tigemonam was efficacious in all infections studied. Comparison drugs such as amoxicillin, cephalexin, and cefaclor were less efficacious, especially in infections caused by beta-lactamase-producing organisms. In localized infections, tigemonam also demonstrated excellent in vivo activity. In acute pyelonephritis in mice caused by Escherichia coli or Proteus sp., tigemonam was very effective. In a rat lung model with Klebsiella pneumoniae, tigemonam was active with a median effective dose of 46 mg/kg compared with 160 mg/kg for cefaclor and over 200 mg/kg for amoxicillin. Tigemonam was well absorbed in laboratory animals and with its excellent gram-negative spectrum of activity should prove of value in oral antibiotic therapy in humans.