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Tuberculosis (TB) is a contagious disease. More than 2 billion people, equal to one third of the world's population, are infected with TB bacilli, the microbes that cause TB. One in 10 people infected with TB bacilli will become sick with active TB in their lifetime. The purpose of this study was to asses the pattern of TB in our setup and the impact of various factors on the disease spread and control. This is a retrospective study including all cases of tuberculosis diagnosed, referred, treated, and cured from year 2005 to 2009 in Hera General Hospital, Makkah. Of a total of 316 cases, 191 cases were pulmonary and 125 cases were extrapulmonary. Most of the patients were young, with a mean age of 34.44 years and an SD of 17.087. Females of reproductive age outnumbered the males in both pulmonary and extrapulmonary tuberculosis, that is, 57.8% versus 42.2% and 72.4% versus 27.6%. Interestingly, the number of cases showed a sawtooth pattern from year to year. Lymph node tuberculosis was the most common form of extrapulmonary tuberculosis. Only 23% of the cases were smear positive and 20% of the cases were defaulters; only 66% of the cases were declared as cured. Tuberculosis was most common in young adult population, especially the females. Low smear positivity is indicative of less emphasis on sputum testing method due to a cultural custom of not producing sputum especially by females. The year-to-year change of pattern and resurgence of the cases show a need for commitment for directly observed therapy, short course; education; and awareness about the stigmatized disease. Also, a need to assess the impact of pilgrims year-round from all over the world on the spread and perpetuation of this dreaded contagious disease is crucial, which is negligible in the local community.

The adsorption of methyl parathion from aqueous solutions by the low-cost and abundant adsorbent mango kernel was studied in a batch adsorption system. The adsorption was studied as a function of pH, contact time, initial pesticide concentration, adsorbent dose, and temperature. A maximum adsorption of 98% ± 1% was achieved. Physicochemical characterization of the adsorbent was carried out by EDXRF, BET, and CHNS analysis. Freundlich, Langmuir, and Dubinin-Radushkevich isotherms were employed to evaluate the adsorption capacity of the adsorbent. Lagergren, Morris-Weber, and Reichenberg equations were employed to study the kinetics of the adsorption process. Thermodynamic parameters Δ H, Δ S, and Δ G were computed. The developed adsorption method was applied to real environmental samples.

The sorption efficiency of chickpea husk of black gram variety (BGH), for the removal of organophosphorous pesticides (OPPs), i.e. triazophos (TAP) and methyl parathion (MP) from aqueous media has been investigated. Optimization of operating sorption parameters, i.e. particle size, sorbent dose, agitation time, pH, initial concentration of sorbates, and temperature has been studied. The sorption data fitted well to Freundlich, Langmuir and Dubinin–Radushkevich (D–R) sorption isotherms. The maximum sorption capacities of BGH for TAP and MP were calculated to be 3.5 ± 0.45 and 10.6 ± 0.83 mmol g −1 by Freundlich, 0.0077 ± 0.021 and 0.025 ± 0.0094 mmol g −1 by Langmuir and 0.48 ± 0.037 and 0.15 ± 0.077 mmol g −1 by D–R isotherms respectively, employing 0.2 g of sorbent, at pH 6, 90 min agitation time and at 303 K. Application of first order Lagergren and Morris–Weber equations to the kinetic data yielded correlation coefficients, close to unity and showed partial intra-particle diffusion. The negative values of thermodynamic parameters, i.e. Δ H (kJ mol −1 ), Δ S (J mol −1 K −1 ) and Δ G (kJ mol −1 ) indicate the exothermic and spontaneous nature of the sorption process. The sorbed pesticides were recovered by sonication with methanol, making the regeneration and reutilization of the sorbents promising. The investigated sorbent exhibited potential applications in water decontamination, treatments of industrial and agricultural waste waters and thus productively demonstrated viable use of agricultural waste material.

Background: Tuberculosis is a global issue and 2 billion people are infected out of which 1.3 billion come from developing world and tuberculous meningitis (TBM) complicates 1 of every 300 untreated primary tuberculosis infections. Diagnosis is still difficult especially in developing and resource poor countries. We conducted the study to see the clinical profile and the use of available diagnostic tools in the early diagnosis of TBM in our part of the world. Methods: Sixty-eight patients were enrolled and only 38 followed for a period of 3 years from hospitalization to completion of treatment and for sequelae in a tertiary care hospital of Kashmir valley India. Clinical presentation, use of available diagnostic tools, treatment, outcome, and sequelae were studied with the aim to find helpful available tools in early diagnosis and management of TBM. Results: Only 38 patients completed the follow-up and important results were that 29 patients (76.31%) belonged to rural areas, 21 (55.26) were in the age group 20 to 39 years, 60% were females. Relation between stage at presentation, early treatment and outcome, useful laboratory investigations, cerebrospinal fluid (CSF) analysis, computed tomography scan findings, usefulness of serum and CSF enzyme-linked immunoabsorbent assay, most effective treatment regimen, sequelae and mortality were some of the important results obtained. Conclusions: Tuberculous meningitis was found to be more common in female rural population of the valley. Erythrocyte sedimentation rate, CSF analysis, serum and CSF enzyme-linked immunoabsorbent assay, computed tomography scan were the most useful diagnostic tools to support clinical suspicion. Combination 4 drug antitubercular regimen for 12 months was the most effective and steroids improved the outcome in stages II and III of the disease. Mortality was higher in very severe disease, at extremes of age and delay in initiating treatment.

In the present studies chemically and thermally treated watermelon peels (TWMP) have been utilized for the removal of methyl parathion (MP) pesticide from water. The effect of process variables such as pH of solution, shaking speed, shaking time, adsorbent dose, concentration of solution and temperature have been optimized. Maximum adsorption (99 ± 1%) was achieved for (0.38–3.80) × 10−4 mol dm−3 of MP solution, using 0.1 g of adsorbent in 20 ml of solution for 60 min agitation time at pH 6. BET and SEM analysis have been carried out for the characterization of TWMP. Adsorption data has been analyzed by Freundlich, Langmuir and Dubinin–Radushkevich (D–R) adsorption isotherms. Lagergren, Morris–Weber and Reichenberg equations have been used for kinetic studies of adsorption process. Thermodynamic parameters ΔH, ΔS and ΔG have been calculated. Positive value of ΔH and negative value of ΔG show endothermic and spontaneous nature of adsorption respectively. The developed adsorption method has been employed to surface water samples with percent removal 99% ± 1.

Summary Methanolic extracts of rice bran (MRB) were found to be the richest in phenolics than all the other extraction media, i.e. water, 80% methanol, 70% ethanol, diethyl ether. Thermal stability of MRB was determined by evaluating antioxidant activity of heated extracts in linoleic acid system. Cookies were prepared in sunflower oil premixed with MRB at different concentrations, i.e. 500, 1000 and 2000 ppm, and with butylated hydroxytoluene and α-tocopherol at 200 ppm. Oxidative stability of cookies was measured by storing under ambient conditions for an year with periodical analysis after every 2 months. Fatty acid composition was determined by gas–liquid chromatography. A regular decrease in unsaturated fatty acids (USFA) and increase in saturated fatty acids was observed with the increase in storage period; all the stabilised samples showed appreciably less decrease in USFA than that of control sample. Induction period ranged from 14.73 to 31.22 h while control exhibited 7.5 h. Peroxide value, iodine value and free fatty acids were chosen as the parameters for quality evaluation of cookies. Results suggest rice bran to be a potential source of antioxidants for stabilisation of cookies.

Summary Owing to increased concern in a number of diseases associated with low-selenium (Se) foods, the estimation of total Se content (TSC) is the focus of research these days. TSC was determined in fruits, vegetables, meat, milk, poultry, fish and cereals. Hydride generation atomic absorption spectrometric method was employed using the wet digestion method. Different certified reference materials were used for the validation of the method. The lowest Se content was found in plant-based foods, whereas the highest was in fish and appreciable in other animal-based foods. The data was compared with TSC data from other countries. TSC in Pakistani foods was comparable with other countries, with few exceptions. This report may serve as a database for TSC in Pakistani foods.

Pomegranate peels (PP) are underestimated as an agricultural waste. In this work, antioxidant efficacy of PP extracts has been estimated in stabilization of sunflower oil. Methanolic extract was found to be highest in yield, i.e. 29.16% and antioxidant activity 92.69% as compared to other solvents ranging in yield 13.96–21.14% and antioxidant activity 42.11–89.23%. Thermal stability of methanolic extracts was evaluated by heating the extract at 185 °C up to 80 min and evaluating the antioxidant activity of extract for different intervals during storage period and exhibited 66.23% inhibition of peroxidation after 80 min heating time. Methanolic extracts of PP at three concentrations, i.e. 250 (SFO-250), 500 (SFO-500) and 1000 ppm (SFO-1000) were added to preheated RBD sunflower oil. BHT at 200 ppm (SFO-BHT) served as standard besides a control (ctrl). Weight gain (WG), antioxidant activity index (AAI), peroxide value (PV), conjugated dienes (CD), conjugated trienes (CT) and thiobarbituric acid reactive substances (TBARS) were taken as the parameters for evaluation of stabilization efficacy of methanolic extracts of PP. Results from different parameters were in agreement with each other, suggesting higher efficiency of SFO-1000 followed by SFO-BHT, SFO-500, SFO-250 and Ctrl samples, respectively, with the exception of CD; which suggested higher efficiency of SFO-500 over SFO-BHT. Results reveal PP to be a potent antioxidant for the stabilization of sunflower oil.

Moringa oleifera pods Lamarck (Drumstick or Horseradish) is a multipurpose medium or small size tree from sub-Himalayan regions of north-west India and indigenous to many parts of Asia, Africa, South America, and in the Pacific and Caribbean Islands. Its pods (MOP) have been employed as an inexpensive and effective sorbent for the removal of organics, i.e., benzene, toluene, ethylbenzene and cumene (BTEC) from aqueous solutions using HPLC method. Effect of different parameters, i.e., sorbent dose 0.05-0.8g, 25cm(-3) agitation time 5-120min, pH 1-10, temperature 283-308K and concentration of sorbate (1.3-13)x10(-3), (1.1-11)x10(-3), (0.9-9)x10(-3), (0.8-8)x10(-3)moldm(-3), on the sorption potential of MOP for BTEC have been investigated. The pore area and average pore diameter of the MOP by BET method using nitrogen as a standard are calculated to be 28.06+/-0.8m(2)g(-1) and 86.2+/-1.3nm respectively. Freundlich, Langumir and Dubinin-Radushkevich (D-R) sorption isotherms were employed to evaluate the sorption capacity of MOP. Sorption capacities of BTEC onto MOP have been found to be 46+/-10, 84+/-9, 101+/-4, 106+/-32mmolg(-1) by Freundlich, 8+/-0.1, 9+/-0.1, 10+/-0.3, 9+/-0.1mmolg(-1) by Langumir and 15+/-1, 21+/-1, 23+/-2, 22+/-3mmolg(-1) by D-R isotherms respectively, from BTEC solutions at 303K. While the mean energy of sorption process 9.6+/-0.3, 9.2+/-0.2, 9.3+/-0.3, 9.5+/-0.4kJmol(-1) for BTEC is calculated by D-R isotherm only. Rate constant of BTEC onto MOP 0.033+/-0.003, 0.030+/-0.002, 0.029+/-0.002, 0.027+/-0.002min(-1) at solution concentration of 1.3x10(-3), 1.1x10(-3), 0.9x10(-3) and 0.8x10(-3)moldm(-3) and at 303K have been calculated by employing Lagergren equation. Thermodynamic parameters DeltaH -8+/-0.4, -10+/-0.6, -11+/-0.7, -11+/-0.7kJmol(-1), DeltaS -22+/-2, -26+/-2, -27+/-2, -29+/-3Jmol(-1)K(-1) and DeltaG(303K) -0.9+/-0.2, -1.9+/-0.2, -2.3+/-0.1 and -2.6+/-0.2kJmol(-1) were also estimated for BTEC respectively at temperatures 283-308K. The negative values of DeltaH, DeltaS and DeltaG suggest exothermic, stable (with no structural changes at solid-liquid interface) and spontaneous nature of sorption process under optimized conditions. MOP has been used extensively to accrue and then to preconcentrate benzene, toluene and ethylbenzene in wastewater sample.

Sorptive potential of selected agricultural waste materials i.e. rice (Oryza sativa) bran (RB), bagasse fly ash (BFA) of sugarcane (Saccharum officinarum), Moringa oleifera pods (MOP) and rice husk (RH) for the removal of methyl parathion pesticide (MP) from surface and ground waters has been investigated. Optimization of operating parameters of sorption process, i.e. sorbent dose, agitation time, pH, initial concentration of sorbate, and temperature have been studied. The sorption data fitted to Freundlich, Langmuir and Dubinin-Radushkevich (D-R) sorption isotherms. The maximum capacities of RB, BFA, MOP and RH for MP were calculated to be 3.6+/-0.8, 5.3+/-1.4, 5.2+/-1.5 and 4.7+/-1.0 mmolg(-1) by Freundlich, 0.39+/-0.009, 0.39+/-0.005, 0.36+/-0.004 and 0.35+/-0.008 mmolg(-1) by Langmuir and 0.9+/-0.08, 1.0+/-0.10, 1.0+/-0.10 and 0.9+/-0.07 mmolg(-1) by D-R isotherms respectively, employing 0.1g of each sorbent, at pH 6, 90 min agitation time and at 303 K. Application of first order Lagergren and Morris-Weber equations to the kinetic data yielded correlation coefficients, close to unity. Thermodynamic parameters of sorption process, i.e. DeltaH, DeltaS and DeltaG were computed and their negative values indicated the exothermic and spontaneous nature of sorption process. The pesticide may be stripped by sonication with methanol, making the regeneration and reutilization of sorbents promising. The sorbents investigated exhibited their potential applications in water decontamination, treatment of industrial and agricultural waste waters.

The study was conducted to assess the pattern of inter hospital and inter-departmental consultations for in-patients and to ascertain whether the consultations made were desirable as per our setup in various hospitals of GMC Srinagar and avoid medico legal pitfalls and to conserve resources. All the consultations made from 10.0 am to 4.0 pm from various departments and associated hospitals of GMC Srin agar were recorded and analyzed . The consultations were attended by the consultant in -charge medical casualty. The consultations made from Nov 2, 2011 to Dec 31, 2011 were included in the study. After the first month restraint was shown by a circular from the head of the department of medicine to various departments and hospitals to ensure involvement of senior staff whether a second opinion is desirable and avoid involvement of patient care-givers i.e., attendants in the consultation procedure. Obstetrics and gynecology department had 82% consultations of undesirable nature and less than 10% where those with consultant involvement.

Because of increased safety concerns about synthetic antioxidants, exploitation of cheaper and safer sources of antioxidants based on natural origin is the focus of research nowadays. Rhazya stricta is a medicinally important plant native to South Asia. Extraction of antioxidants was carried out in different solvent systems, i.e., water, 80% methanol, 70% ethanol, and diethyl ether. The methanolic extract exhibited the highest total phenolic content among the extracts; therefore for further studies the methanolic extract was employed. Antioxidant activity measurement in the linoleic acid system, metal chelating activity, reducing power, scavenging effect on 1,1-diphenyl-2-picrylhydrazyl free radical, and superoxide anion radical scavenging activity were taken as the parameters for assessment of antioxidant potential of methanolic extracts. Results were compared with alpha-tocopherol and the synthetic antioxidant butylated hydroxyanisole. The antioxidant potential of methanolic extracts of R. stricta leaves was comparable with previously exploited potent antioxidants and is strongly concentration dependent.

Gastric antral vascular ectasia (GAVE) syndrome is an uncommon but well-described cause of recurrent upper gastrointestinal bleeding or iron deficiency anaemia. Atiology is unknown but several associated diseases have been reported like connective tissue or autoimmune disorders or cirrhosis. Cases have been reported in systemic sclerosis, achlorhydia, atrophic gastritis and chronic renal failure. The most common cause is portal hypertension and portal hypertensive gastropathy. This is especially so after eradication of oesophageal varices by sclerotherapy or banding. Diabetic complications are characterised by microvascular diseases especially in the retina, glomerulus and vasa nervorum. It involves apoptosis and remodelling of endothelial cells. Hyperglycaemia is an essential cause of reactive oxygen species (ROS)-mediated oxidative stress in this complication. Angiopathy of gastric mucosa in diabetes mellitus has not been reported so far in the literature. We are presenting an interesting case of diabetes mellitus with gastric vascular ectasia without evidence of any other systemic illness.

A 78-year-old man presented with a huge abdominal swelling of 3 years duration. The swelling had progressively increased in size, especially over the last year. The patient also gave a history of dysuria and increased frequency of micturation of 8 years duration, which was attributed to prostatism. The patient had been receiving intermittent symptomatic treatment, and had been taking warfarin 3 mg for the last 6 years for paroxysmal atrial fibrillation. Examination revealed a large epigastric hernia (fig 1) with bowel loops as its content. Chest and cardiovascular examination including heart sounds was normal. Digital rectal examination was normal for prostrate, and blood counts, renal and liver function tests …

The majority of patients with primary mediastinal lymphoma are symptomatic at the time of diagnosis and commonly have fever, weight loss and/or night sweats. Symptoms due to compression of adjacent mediastinal structures are infrequent, but may include pain, dyspnoea, stridor, or superior vena cava syndrome. Local infiltration into the chest wall, pleura and pericardium is not uncommon. In the present report, two interesting cases of chest wall swellings that in fact were extensions of primary mediastinal lymphoma are given. Histopathology of the tumour was large B cell lymphoma (CD20+). The first case was in a 23-year-old woman, with dramatic onset but a good outcome. The second was in a 34-year-old Pakistani woman, with insidious onset and poor outcome due to extent and invasion by the tumour. Interesting CT images are presented showing chest wall and left supraclavicular swelling.

Delirium is a cognitive disorder. DSM-IV criteria for delirium must include both acute onset and fluctuating symptoms; disturbance of consciousness (including inattention); at least one of the following: disorganised thinking, disorientation, memory impairment or perceptual disturbance; and evidence of a putative causal medical condition. Traditionally, the course has been described as transient in which recovery is likely to be complete if the underlying aetiological factor is promptly corrected or is self-limited. The most common precipitating causes in elderly include sepsis, dehydration and drugs. Work-up for delirium is limited to septic screening, baseline investigations and imaging. Patients with delirium without focal signs and with either evidence for a medical aetiology of delirium or pre-diagnosed dementia are at a very low risk of having focal lesions in their contrast-enhanced CT or MRI. We are presenting an interesting case of delirium with urosepsis whose imaging revealed milliary brain tuberculomas on contrast-enhanced MRI.

The most common cause of upper gastrointestinal bleeding in patients with systemic rheumatic diseases is non-steroidal drug use; this is the case with COX-2 inhibitors, especially when used concomitantly with corticosteroids. Bleeding from varices is unusual in the absence of liver disease. We present an interesting case of a patient with systemic lupus erythematosus, rheumatoid arthritis and polymyositis overlap syndrome with recurrent upper gastrointestinal bleeds from isolated fundal gastric varices and a normal liver.

An 82-year-old woman presented with a 9-month history of progressive headache and swelling of the left side of head. The patient experienced deterioration in their consciousness level and was brought into hospital. Examination revealed a localised swelling of the left of the skull of bony consistency with a smooth surface. The patient was confused; vitals were stable and the patient had papilloedema. The rest of the systemic examination was normal other than a scar on the neck, which on further questioning was found to be due to …

We report a unique case of a 26-year-old female patient with systemic lupus erythematosus (SLE), who had been treated with hydroxychloroquine 400 mg/day from the age of 11 years, who presented with congestive cardiac failure. She was treated for heart failure with diuretics and angiotensin converting enzyme (ACE) inhibitors, but deteriorated and was readmitted, this time with the additional finding of pericardial effusion and painful left breast swelling. Echocardiography revealed dilated cardiac chambers with thin wall and septum and minimal pericardial effusion (figs 1 …

Sheehan’s syndrome, first described in 1937, is characterised by postpartum haemorrhage, pituitary necrosis, lactational failure and hypopitutarism. Presentation is variable and late presentations are not unusual due to partial ischaemic injury of the pituitary and gradual loss of endocrine function. A history of postpartum haemorrhage is usual but in some cases it is not elicited. Presentations such as malaise, fatigue, hypoglycaemia, decline in cognition, hyponatraemia, pancytopoenia, osteoporosis, secondary infertility, confusion and coma have all been reported. Two interesting cases of Sheehan’s syndrome are presented that were diagnosed in the eighth decade; one due to atypical presentation of recurrent hyponatraemia and confusion, another from hypoglycaemic coma and symptoms of malaise and lethargy.

Actinomycosis is an infectious disease caused by anaerobic gram-positive, non-spore forming bacteria of the genus Actinomyces that affects the oropharynx, digestive tract, and genitalia. Thoracic actinomycosis may affect the respiratory tract and the pleura, even extending to the chest wall. Pulmonary actinomycosis occurs in immunocompetent persons during the fourth and fifth decades of life, with greater prevalence in men, and is generally due to Actinomyces israelii or A meyeri. It is frequently misdiagnosed as primary or metastatic lung cancer or conventional lung infections (eg, tuberculosis). The accepted predisposing factors for bronchopulmonary actinomycosis are poor dental hygiene, alcoholism and various chronic debilitating diseases, hiatus hernia, and gastro-oesophageal reflux. We report an interesting case of pulmonary actinomycosis presenting with haemoptysis, associated with achlasia cardia, and treated as tuberculosis.

Catastrophic antiphospholipid syndrome (APS) is caused by thrombotic vascular occlusions that affect both small and large vessels, producing ischaemia in the affected organs. The "catastrophic" variant of the antiphospholipid syndrome (cAPS) develops over a short period of time. Although patients with cAPS represent

Toxic epidermal necrolysis (TEN) is a rare but life threatening skin disease that is most commonly drug induced. The exact pathogenesis of TEN is still unknown and many drugs, including prednisolone, cyclosporin and intravenous immunoglobulin (IVIG), have been used in an attempt to halt the disease process. The use of IVIG in particular is controversial. Recently, the US Food and Drug Administration (FDA) has made a labelling change to the drug information for carbamazepine. Owing to recent data implicating the HLA allele B*1502 as a marker for carbamazepine induced Stevens–Johnson syndrome and TEN in Han Chinese, the FDA recommends genotyping all Asians for the allele. We present an interesting case of carbamazepine induced TEN which was confused with oral thrush, had no skin lesions on presentation, and had an excellent response to a 5 day course of methylprednisolone and high dose IVIG in combination.

A pregnant 28-year-old woman presented in the 34th week of gestation for a disproportionate increase in her abdominal size as compared to her previous pregnancy. The patient’s antenatal check-up was regular and routine antenatal screening for hepatitis and toxoplasmosis, rubella, cytomegalovirus and herpes (TORCH) were negative. There was no Rh/ABO blood type incompatibility. The patient denied any febrile illness in the past 8 months. Examination revealed a distended abdomen with multiple fetal parts and ultrasonography confirmed a twin pregnancy, with one of the fetuses having marked ascites (fig 1) with radiological features of meconium peritonitis. The patient was hospitalised and a paediatric surgeon was informed. After induction of labour, twins of gestational age 34 weeks were delivered. Figure 1 Prenatal ultrasound showing fetal ascites. Fetus 1 was a normal boy, weight 2 …

A 68-year-old Saudi man (non-smoker, non-diabetic, with an insignificant past medical history) presented with complaints of dysphagia of 2 weeks’ duration and haematemesis of 1 day duration. The patient’s examination was unremarkable and investigations revealed a haemoglobin of 14 g % with normal serum chemistry and cell counts. The patient was treated with pantoprazole 40 mg twice daily. An osophagogastroduodenoscopy was done which revealed diffuse oesophageal candidiasis (fig 1). In view …

Biosorption of divalent metal ions, i.e. Pb(II), Cd(II), Zn(II) and Cu(II) onto rice husk activated (RHA) is investigated over pH range (1–10) via batch adsorption technique. The chemical and thermal activation of rice husk with 0.1 M HNO 3 and 1 M K 2 CO 3 at 473 K enhanced the removal efficiency of RHA (35 ± 2.1–99 ± 0.5%, 33 ± 1.2–97 ± 0.6%, 32 ± 1.3–96 ± 0.8% and 28 ± 1.8–95 ± 0.9% before and after treatment, respectively). The surface area analysis of RHA by BET (Brunauer, Emmett and Teller) nitrogen adsorption method provided pore area and average pore diameter to be 542 ± 2.3 m 2 g −1 and 1076 ± 5.6 nm respectively. SEM and FTIR analyses of RHA were carried out to determine the surface morphology and functional groups involved in metal binding mechanism, respectively. The adsorption equilibrium was well described by Freundlich, Langmuir and Dubinin–Radushkevish (D–R) isotherm models by employing (4.8–48, 8.9–89, 15.3–153 and 15.7–157) × 10 −5 M solution concentrations of sorbates, respectively, at equilibrium time of 20 min at pH 6 and onto 0.2 g of sorbent. The kinetics of mass transfer and intra-particle diffusion for metal ions sorption onto RHA were studied with Lagergren and Morris–Weber kinetic models. The numerical values of thermodynamic parameters indicated the exothermic nature, spontaneity and feasibility of the sorption process. The desorption study of metal components from RHA surface was carried out with 0.1 M HCl. The sorption mechanism developed illustrates the strong interactions of sorbates with the active sites of the sorbent coupled with efficient and environmentally clean exploitation of rice waste product.

The removal of selected pesticides such as carbofuran (CF) and methyl parathion (MP) using low-cost abundant sorbent chestnut shells from aqueous solutions has been investigated in the present study. The sorption parameters, i.e., contact time, pH, initial pesticide solution concentration and temperature have been studied. Maximum percent sorption (99+/-1%) was achieved for (0.38-3.80) x10(-4) and (0.45-4.5) x10(-4) mol dm(-3) of MP and CF pesticide solutions respectively, using 0.4 g of sorbent in 100 ml of solution for 30 min agitation time at pH 6. The Freundlich, Langmuir and Dubinin-Radushkevich (D-R) models have been applied, and their constants for methyl parathion and carbofuran, sorption intensity 1/n (0.55+/-0.02 and 0.54+/-0.04), multilayer sorption capacity C(m) (28.3+/-0.5 and 16.4+/-0.7) x10(-3) mol l(1-1/n)dm(3/n)g(-1), monolayer sorption capacity Q (22.5+/-0.5 and 10.8+/-0.3) x10(-6) mo lg(-1), binding energy, b (2.9+/-0.2 and 5.2+/-0.5) x10(4) dm(3)mol(-1), and sorption energy E (11.2+/-0.1 and 11.5+/-0.2 kJ mol(-1)) have been evaluated respectively. Lagergren, Morris-Weber and Reichenberg equations were employed to study kinetics of sorption process. Thermodynamic parameters DeltaH (-5.09+/-0.1 and 22.8+/-0.4 kJ mol(-1)), DeltaS (-4.33+/-0.0003 and 0.09+/-0.001 kJ mol(-1)K(-1)) and DeltaG((303K)) (-2.9 and -3.8 kJ mol(-1)) have been calculated for methyl parathion and carbofuran, respectively. The developed sorption procedure has been employed to environmental samples.

The sorption efficiency of indigenous rice (Oryza sativa) bran for the removal of organics, that is, benzene, toluene, ethylbenzene, and cumene (BTEC), from aqueous solutions has been studied. The sorption of BTEC by rice bran is observed over a wide pH range of 1-10, indicating its high applicability to remove these organics from various industrial effluents. Rice bran effectively adsorbs BTEC of 10 microg mL(-1) sorbate concentration from water at temperatures of 283-323 +/- 2 K. The effect of pH, agitation time between solid and liquid phases, sorbent dose, its particle size, and temperature on the sorption of BTEC onto rice bran has been studied. The pore area and average pore diameter of rice bran by BET method are found to be 19 +/- 0.7 m(2) g(-1) and 52.8 +/- 1.3 nm. The rice bran exhibits appreciable sorption of the order of 85 +/- 3.5, 91 +/- 1.8, 94 +/- 1.4, and 96 +/- 1.2% for 10 microg mL(-1) concentration of benzene, toluene, ethylbenzene, and cumene, respectively, in 60 min of agitation time using 0.1 g of rice bran at pH 6 and 303 K. The sorption data follow Freundlich, Langmuir, and Dubinin-Radushkevich (D-R) models. Sorption capacities have been computed for BTEC by Freundlich (32 +/- 3, 61 +/- 14, 123 +/- 28, and 142 +/- 37 m mol g(-1)), Langmuir (6.6 +/- 0.1, 7.5 +/- 0.13, 9.5 +/- 0.22, and 9.4 +/- 0.18 m mol g(-1)), and D-R isotherms (11 +/- 0.5, 16 +/- 1.3, 30 +/- 2.2, and 33 +/- 2.5 m mol g(-1)), respectively. The Lagergren equation is employed for the kinetics of the sorption of BTEC onto rice bran and first-order rate constants (0.03 +/- 0.002, 0.04 +/- 0.003, 0.04 +/- 0.003, and 0.05 +/- 0.004 min(-1)) have been computed for BTEC at their concentration of 100 mug mL(-1) at 303 K. Studies on the variation of sorption with temperatures (283-323 K) at 100 mug mL(-1) sorbate concentration gave thermodynamic constants DeltaH (kJ mol(-1)), DeltaG (kJ mol(-1)), and DeltaS (J mol(-1) K(-1)). The results indicate that the sorption of organics onto rice bran is exothermic and spontaneous in nature under the optimized experimental conditions selected. This sorbent has been used successfully to accumulate and then to determine benzene, toluene, and ethylbenzene in wastewater sample.

The sorption potential of chemically and thermally treated rice husk (RHT) for the removal of 2,4-dichlorophenol (DCP) from aqueous solutions has been investigated. Sorption of DCP by rice husk was observed over a wide pH range of 1-10. The effect of contact time between liquid and solid phases, sorbent dose, pH, concentration of sorbate and temperature on the sorption of DCP onto rice husk has been studied. The pore area and average pore diameter of RHT by BET method are calculated to be 17+/-0.6 m2g-1 and 51.3+/-1.5 nm, respectively. Maximum sorption (98+/-1.2%) was achieved for RHT from 6.1x10(-5) moldm(-3) of sorbate solution using 0.1g of rice husk for 10 min agitation time at pH 6 and 303K, which is comparable to activated carbon commercial (ACC) 96.6+/-1.2%, but significantly higher than chemically treated rice husk (RHCT) 65+/-1.6% and rice husk untreated (RHUT) 41+/-2.3%. The sorption data obtained at optimized conditions was subjected to Freundlich, Langmuir and Dubinin-Radushkevich (D-R) isotherms. Sorption intensity 1/n (0.31+/-0.01) and sorption capacity multilayer C(m) (12.0+/-1.6 mmolg(-1)) have been evaluated using Freundlich sorption isotherm, whereas the values of sorption capacity monolayer Q (0.96+/-0.03 mmolg(-1)) and binding energy, b, (4.5+/-1.0)x10(4)dm(3)mol(-1) have been estimated by Langmuir isotherm. The Langmuir constant, b, was also used to calculate the dimensionless factor, R(L), in the concentration range (0.6-6.1)x10(-4) moldm(-3), suggesting greater sorption at low concentration. D-R sorption isotherm was employed to calculate sorption capacity X(m) (2.5+/-0.07 mmolg(-1)) and sorption energy E (14.7+/-0.13 kJmol(-1)). Lagergren and Morris-Weber equations were employed to study kinetics of sorption process using 0.2g of RHT, 25 cm(3) of 0.61x10(-4)moldm(-3) sorbate concentration at pH 6, giving values of first-order rate constant, k, and rate constant of intraparticle transport, R(id), (0.48+/-0.04 min(-1) and 6.8+/-0.8 nmolg(-1)min(-1/2), respectively) at 0.61x10(-4)moldm(-3) solution concentration of DCP, 0.1g RHT, pH 6 and 2-10min of agitation time. For thermodynamic studies, sorption potential was examined over temperature range 283-323 K by employing 6.1x10(-4)moldm(-3) solution concentration of DCP, 0.1g RHT at pH 6 and 10 min of agitation time and values of DeltaH (-25+/-1 kJmol(-1)), DeltaS (-61+/-4 Jmol(-1)K(-1)) and DeltaG(303K) (-7.1+/-0.09 kJmol(-1)) were computed. The negative values of enthalpy, entropy, and free energy suggest that the sorption is exothermic, stable, and spontaneous in nature.

Peptic ulcer perforation and haemorrhage is not unusual as a complication of peptic ulcer disease. In the older patientspresentation can be dramatic and atypical. The authors are presenting a case of duodenal ulcer perforation and haemorrhage which was misdiagnosed as a gastric malignancy and thus failure to have Helicobacter pylori eradication, recurrence with complication and hesitancy in surgical intervention due to initial label of malignancy.

Dengue viral infections are one of the most important mosquito borne diseases in the world. The dengue virus is a single stranded RNA virus belonging to the Flaviviridae family. There are four serotypes (DEN 1–4) classified according to biological and immunological criteria. Patients may be asymptomatic or their condition may give rise to undifferentiated fever, dengue fever, dengue haemorrhagic fever (DHF), or dengue shock syndrome. Annually, 100 million cases of dengue fever and half a million cases of DHF occur worldwide and 2.5 billion people are at risk. At present, dengue is endemic in 112 countries. Early recognition and prompt initiation of appropriate treatment are vital if disease related morbidity and mortality are to be limited. We present an interesting case of dengue fever with headache, skin rash and abnormal behaviour who had a massive intracranial haemorrhage with fatal outcome.

A 41-year-old man with family history of diabetes mellitus was referred from a primary health centre with a 20-year history of insulin-dependent diabetes mellitus, a 4-year history of hypertension controlled with captopril and a 6-month history of small nodular lesions on both elbows. The patient was on simvastatin 20 mg/day for dyslipidaemia. The lesions progressively increased in size. The dermatologist decided to start treatment with intralesional corticosteroids as a treatment for keloids (fig 1) and took a biopsy. Examination of the patient revealed an adult male with multiple nodular lesions on his arms, elbows and back with long hypertrophied irregular, branching keloid-like lesions on his elbows and multiple nodular lesions on his back (fig 2). Blood pressure was 150/90 mm Hg in a sitting position. Full blood counts were normal. Fasting blood glucose was 11.7 mmol/l (normal 3.6–5.8 mmol/l), triglycerides 146 mmol/l (normal 0.6–1.7 mmol/l), serum total cholesterol 17.7 mmol/l (normal 0.8 mmol/l for males). Serum uric acid level and liver enzymes were normal. The patient had no evidence of neuropathy but had early retinopathy and microalbuminuria of 0.45 g/24 h. The patient was started on enlapril 10 mg/day, gemfibrozil 1.2 g/day, simvastatin 80 mg/day and the insulin dosage was adjusted to 60 units/day (Mixtard 30/70). Two weeks later the patient’s fasting lipid profile revealed triglycerides 4.0 mmol/l, cholesterol 4.2 mmol/l, low density lipoprotein 5.3 mmol/l and high density lipoprotein 0.8 mmol/l. Fasting blood sugar was 6.7 mmol/l, but liver and muscle enzymes were almost twofold increased (normal range for aspartate aminotransferase 10–45 U/l, alanine aminotransferase 10–50 U/l, lactate dehydrogenase 200–260 U/l, creatine phosphokinase 55–170 U/l). Blood pressure was 120/80 mm Hg. The skin lesions were diagnosed as eruptive xanthomas with spontaneous Koebner phenomenon and biopsy of one of the lesions was consistent with keloid and areas of lipid laden cells (fig 3). The patient is being regularly followed up. Liver enzymes and muscle enzymes returned to normal levels within 1 month and now 6 months after aggressive treatment for dyslipidaemia, the lesions seem to have regressed in size. We report this interesting second case of type 1 diabetes mellitus, hypertension, hypertriglyceridaemia type V and eruptive xanthomas with spontaneous Koebner phenomenon. Figure 1 Eruptive xanthomas as popular lesions with early koebnerisation and keloid formation. Figure 2 Eruptive xanthomas on the back of the patient. Figure 3 Biopsy of lesion showing scarring of keloid and lipid laden macrophages (H&E). Eruptive xanthomas have been well reported in patients with diabetes mellitus and hypertriglyceridaemia.1 The Koebner phenomenon, which is well described for diseases such as psoriasis,2 has been reported in a single case report of eruptive xanthomas in hypertriglyceridaemia,3 but the management is that of diabetes mellitus and dyslipidaemia. LEARNING POINTS Patients with eruptive xanthomas must be evaluated for metabolic disorders. Treatment must be directed to underlying dyslipidaemia. The Koebner phenomenon is not unique to diseases reported in the literature; our case is the second found in hypertriglyceridaemia. An interesting and unique image of eruptive xanthomas is presented. High dose statins and fibrates in combination may be well tolerated by some patient populations.