Sanjeev Kumar Verma

Delta-aminolevulinic acid dehydratase inhibition and oxidative stress in relation to blood lead among urban adolescents

To explore lead-induced oxidative stress among urban adolescents, the present study, the first from India, was designed to determine the proportion of urban adolescents with blood lead > 10 μg/dL and its impact on selected oxidative stress parameters and delta-aminolevulinic acid dehydratase (δ-ALAD) inhibition, which could be used as biomarkers of lead intoxication. A total of 39, urban, male adolescents, drawn from Lucknow and adjoining areas, were recruited to determine lead, d-ALAD, malondialdehyde (MDA) and glutathione (GSH) in blood and catalase (CAT) in RBCs. Mean level of blood lead was 9.96 ± 3.63 μg/dL (4.62 - 18.64); 43% of adolescents crossed the Centre for Disease Control (CDC) intervention level of 10 mg/dL blood lead. On the basis of blood lead levels (BLLs), adolescents were categorized into two groups: Group I and Group II had a blood lead < 10 μg/dL (7.40 ± 1.62) and < 10 μg/dL (13.27 ± 2.67), respectively, with significantly different mean values (P < 0.001). Age, sex, body mass index (BMI), Hb level (malnutrition), and area of living as confounders of lead exposure and toxicity were not statistically different between the two groups. However, d-ALAD activity was significantly lower (P < 0.001), while CAT activity was higher in Group II than in Group I (P < 0.01). MDA level was also significantly higher in Group II compared to Group I (P < 0.001). There were significant negative correlation of BLL with d-ALAD (r = -0.592, P < 0.001), and positive correlations with CAT (r= -0.485, P < 0.01) and MDA (r = -0.717, P < 0.001). Interestingly, d-ALAD, in turn, had significant negative correlations with CAT (r = -0.456, P <0.01) and MDA (r = -0.507, P < 0.01). Results of the present pilot study provide clues to the possible low level of lead-induced oxidative stress in urban adolescents, suggesting that lead-induced d-ALAD inhibition can also be an indicator of oxidative stress. The potential of oxidative stress parameters to be used as biomarkers of lead toxicity warranted further investigation.

Blood lead levels in children of Lucknow, India.

After implementing measures to control lead pollution in many countries, blood lead levels (BLLs) in children have been declined. The phase‐out of leaded petrol began in Lucknow, the capital of most populated state, Uttar Pradesh in India on April 1, 2000. We evaluated the mean BLL and associated risk factors for lead exposure in Lucknow children (3–12 years) after petrol lead phase‐out activity. The mean BLL of the 200 children was 9.3 μg/dL (range: 1.0–27.9 μg/dL). Seventy‐four children (37%) had BLL above the Centre for Disease Control and Preventions (CDC) level of concern (10 μg/dL). When these data were compared with BLLs determined by the George Foundation among the children of Mumbai, Bangalore, Kolkata, Chennai, Hyderabad, and Delhi during the year 1997 when leaded petrol was in use, where 62%, 62%, 87%, 96%, 43%, and 95%, respectively, then exceeded the CDC intervention level. Further, BLL of present study was very close to Mumbai children (age ≤12 years) estimated following the introduction of unleaded petrol, and 33% children had BLL above the CDC concern level with an average 8.4 μg/dL. Low socioeconomic status, proximity of home to traffic density, and mothers illiteracy were the factors associated with elevated BLLs in Lucknow children (P < 0.05). Overall, results indicate a declining trend of BLL in Lucknow children when compared with those reported from other cities of India when leaded petrol was in practice. A national population‐based study is recommended to determine the prevalence of elevated BLLs after the phase‐out of leaded‐petrol. In addition, future studies on other sources of lead exposure in Lucknow are warranted for public health purposes.

Pulmonary tuberculoma and miliary tuberculosis in silicosis.

Tuberculosis is a disease with protean manifestations. We present a case which was initially suspected as bronchogenic carcinoma with lymphangitic carcinomatosis, based on radiological appearance but later diagnosed as pulmonary tuberculoma with military tuberculosis and silicosis after thoracotomy and open lung biopsy. The patient was treated successfully with Antituberculosis Therapy (ATT). Rarity of presentation in form of pulmonary tuberculoma co-existing with histological features of miliary tuberculosis and silicosis, led us to report this case.

A study to compare the diagnostic efficacy of closed pleural biopsy with that of the thoracoscopic guided pleural biopsy in patients of pleural effusion.

Background: The diagnostic approach to exudative pleural effusion remains an underappreciated aspect of modern thoracic medicine. 15-20% of the pleural effusions remain undiagnosed. The most efficient approach to pleural exudates remains uncertain and controversial particularly if acquisition of pleural tissue is required. The clinician needs to consider various factors when confronted with the choice between closed pleural biopsy (CPB) and thoracoscopy. Hence this study was planned to compare the diagnostic efficacy of CPB and Thoracoscopic pleural biopsy (TPB). Materials and Methods: This was a prospective interventional study in patients of exudative pleural effusion. CPB was performed by Cope′s biopsy needle. Then inspection of the pleural cavity was performed by single port rigid thoracoscope (KARL, STORZ TELECAM DX II 20 2330 20) with viewing angle of zero (0) degrees and biopsy taken from the diseased or unhealthy parietal pleura. Accordingly we compared the results of CPB and TPB. Results: 46 Patients underwent this study. In all 46 patients both CPB and TPB were performed.TPB was diagnostic in 36 cases (78.2%) while CPB was diagnostic only in 10 cases i.e. 21.7%. 10 (21,7%) cases remained undiagnosed. On thoracoscopic examination 30 patients were having nodularity, 25 (54.3%) were having adhesions and 20 (43.5%) were having hyperemia. 79.3% of the patients with nodularity turned out to be malignant and 71.4% of patients with adhesions and hyperemia tubercular. Conclusions: TPB has much greater diagnostic efficacy than CPB.

Tuberculous otitis media with postaural abscess and submandibular lymphadenopathy

We are reporting a case of right-sided tuberculous otitis media with postaural abscess and multiple submandibular lymphadenopathy which has been reported very infrequently. A high level of suspicion by the treating physician is mandatory to avoid long delay in diagnosis and increased complications in the modern chemotherapy era.

Duplex Ultrasound-guided Direct Percutaneous Management of Pseudoaneurysm of Branch of Segmental Renal Artery: Technique and Its Outcome

OBJECTIVE To describe the role of duplex ultrasound imaging (DUI) in prompt diagnosis of pseudoaneurysm (PSA) of a branch of the segmental renal artery (b-SRA) and to evaluate outcomes of DUI directed percutaneous embolization. MATERIALS AND METHODS Forty-five patients were referred to us for the management of intractable renal hematuria. A total of 20 cases (44.44%) had developed PSA after nephrolithotomy, 12 cases (12.66%) had developed PSA after guided renal biopsies, 6 cases (13.33%) had developed PSA following road side trauma, and 2 cases (4.44%) of the tuberous sclerosis complex had developed PSA. Three cases (6.66%) of arteriovenous and 2 cases (4.44%) of arteriocalyceal fistulae had been excluded from the study. DUI-guided direct percutaneous management (DPM) was done as a 4-step process. First is the identification of PSA sac in the neck and offending b-SRA. Second is the puncture of PSA sac with 18 g puncture needle under DUI. Subsequently, manual injection of temporary embolic agent was done followed by N-butyl cyanoacrylate glue. Thrombosis of the PSA sac was confirmed by absent flow on DUI. RESULTS Forty cases of b-SRA were managed successfully in a single session and followed up by clinical findings, DUI, and computed tomography angiography. There was no need for the second session of DPM, transarterial embolization, or surgery in this cohort. Twelve cases (30%) had developed a mild fever and were managed conservatively. All 40 cases had no evidence of renal hematuria after follow-up of 3 months. CONCLUSION DUI-guided DPM is a safe, feasible, cost-effective, and nephron-sparing promising alternative to TAE or surgery for management of PSA of b-SRA.

Alveolar microlithiasis: A rare cause of breathlessness since childhood

Pulmonary alveolar microlithiasis (PAM) is an uncommon chronic disease characterized by calcifications within the alveoli and a paucity of symptoms in contrast to the imaging findings. It occurs sporadically and it is regarded as an autossomal recessive lung disease. The pathogenesis of PAM has yet to be elucidated. The disorder has a protracted course and there is no treatment available. We report a case of 21 years-old male who presented to us with complaint of exertional breathlessness since childhood. Diagnosis of pulmonary alveolar microlithiasis was made on the basis of clinical features and laboratory findings.

Tuberculosis: oral alveolus and pulmonary alveoli coexisting.

Tuberculosis of the oral cavity is uncommon in this antibiotic era. We report a case of a long standing non-healing ulcer of the right upper maxillogingival sulcus, found to be tuberculosis of a rather unusual site in the oral cavity, the alveolus.

Rare vascular anomaly mimicking bronchogenic carcinoma

We report a case of anomalous left pulmonary artery (pulmonary artery sling) detected incidentally on computed tomography thorax. This was carried out to rule out bronchogenic carcinoma in a patient of chronic obstructive pulmonary disease who presented with streaking. He was a chronic smoker having bilateral hilar prominence on chest radiograph.

Pulmonary lymphangioleiomyomatosis (PLAM)

Pulmonary lymphangioleiomyomatosis (PLAM) is a rare idiopathic, progressive multisystem disorder that predominantly affects women of childbearing age. Here is a report of pulmonary lymphangioleiomyomatosis in 28 years old female who presented with intial complaints of breathlessness, dry cough and chest pain for 2 years.