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Background: The kidneys are one of the vital organs of our body to excrete metabolic waste products, drugs and chemicals in the form of urine. Objectives: This study was carried out to observe the effect of Vitamin E on gentamicin-induced nephrotoxicity by assessing serum creatinine level in Long Evans rats. Materials and Methods: The experimental study was carried out on 40 Long Evans rats of both sex with the weight ranges from 172-255 gm and the age ranges from 7 to 10 weeks. The rats were divided into four groups- Group A (control) received normal saline, group B, C and D received gentamicin for 6 days, rats of group C received vitamin E capsule for 9 days with gentamicin whereas, group D received vitamin E capsule with gentamicin for total 10 days. Serum creatinine level was measured at the end of experiment. Results: The mean (mean+ SD) serum creatinine levels in group A, B, C and D were 0.98+0.34, 2.36+ 0.44, 1.39+0.18 and 1.30+0.18 respectively. The differences between the groups were highly significant (p0.50). Serum creatinine level on the normal saline control (group A) was within normal limit (0.98mg/dl). Serum creatinine level in gentamicin treated (group B) rats were more in comparison to gentamicin and vitamin E treated rats (group C&D) and pretreatment with longer duration group (group D) showed lower serum creatinine level than the shorter one (group C) though there was no significant difference. Conclusion: Vitamin E treatment showed some protective effects against gentamicin induced nephrotoxicity. The results also indicated that effectiveness of vitamin E depends on a suitable duration of pretreatment for better protection against gentamicin-induced nephrotoxicity. KYAMC Journal Vol. 13, No. 03, October 2022: 149-152

Sulfasalazine (SAS) is a repurposed antitumor drug which inhibits the proliferation and survival of cancer cells by inhibiting the xCT cellular antioxidant system. Recent clinical studies have shown that, due to poor bioavailability, the antitumor effects of SAS monotherapy are minimal. Therefore, we hypothesized that DSF, another repurposed drug that has demonstrated anticancer effects, or its complex with copper (DSF-copper, DSF-Cu) could potentiate the antilung cancer effects of SAS. Exposure of non-small cell lung cancer cells to therapeutically achievable concentrations of SAS-induced low-to-moderate cytotoxic effects (20–40% reduction in cell viability) and, unexpectedly, induced the antioxidant protein NRF2 and its downstream effectors xCT and ALDH1A1. However, combinations of SAS and DSF-Cu, but not SAS and DSF, induced a significantly higher cytotoxic effect (64–88% reduction in cell viability), apoptosis and generation of mitochondrial reactive oxygen species as compared with SAS or DSF-Cu alone. Moreover, DSF-Cu abrogated SAS-induced NRF2, xCT and ALDH1A1 expression. In a mouse model of lung tumor, SAS + DSF-Cu showed a higher efficacy than the individual drugs in reducing the number and size of tumors as well as the incidence and multiplicity of lung adenocarcinoma. Taken together, our findings indicate that the observed antilung cancer effects of SAS plus DSF-Cu are mediated, at least in part, via impairment of reactive oxygen species defense and ­enhancement of oxidative stress and provide evidence for the preventive/therapeutic potential of this combinatorial approach against lung cancer.

Cloud computing has grown as a computing paradigm in the last few years. Due to the explosive increase in the number of cloud services, QoS (quality of service) becomes an important factor in service filtering. Moreover, it becomes a nontrivial problem when comparing the functionality of cloud services with different performance metrics. Therefore, optimal cloud service selection is quite challenging and extremely important for users. In the existing approaches of cloud service selection, the user’s preferences are offered by the user in a quantitative form. With fuzziness and subjectivity, it is a hurdle task for users to express clear preferences. Moreover, many QoS attributes are not independent but interrelated; therefore, the existing weighted summation method cannot accommodate correlations among QoS attributes and produces inaccurate results. To resolve this problem, we propose a cloud service framework that takes the user’s preferences and chooses the optimal cloud service based on the user’s QoS constraints. We propose a cloud service selection algorithm, based on principal component analysis (PCA) and the best-worst method (BWM), which eliminates the correlations between QoS and provides the best cloud services with the best QoS values for users. In the end, a numerical example is shown to validate the effectiveness and feasibility of the proposed methodology.

Introduction: Lung cancer is one of the most common malignancies to occur worldwide. Two main subtypes of lung cancer include small cell lung cancer and Non Small Cell Lung Cancer (NSCLC). Patients with advanced stage NSCLC who achieve good response with Tyrosine Kinase Inhibitors (TKI) have been found to have Epidermal Growth Factor Receptor (EGFR) mutation. The first biomarker identified for targeted treatment in lung cancer was EGFR and patients of NSCLC with EGFR mutation have superior survival outcome when treated with targeted therapy as compared to conventional chemotherapy. Aim: To compare the outcome of targeted therapy to mutation to EGFR and conventional therapy in non mutant lung cancer patient of NSCLC. Materials and Methods: The present longitudinal study was conducted in the Department of TB and Respiratory Diseases, Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh, India from July 2017 to November 2019 on a sample size of 80. Patients diagnosed with NSCLC and EGFR mutation status were included in the study. They were started on TKI if tumour was EGFR positive and on conventional chemotherapy (cisplatin plus paclitaxel) if no mutation was detected on histopathology. Among the study group, 35 patients were EGFR positive and started on geftinib (group I), 45 were EGFR negative and received platinum-based chemotherapy (group II). Outcomes were measured in terms of progression-free survival, Overall Survival (OS), and toxicities. Statistical analysis of data was done using Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Among the study group, 35 patients were EGFR positive and started on geftinib (Group I), 45 were EGFR negative and received platinum-based chemotherapy (group II). The mean age of EGFR positive patients was 58.91 years and for EGFR negative patients was 60.11 years. In group I, there was no complete response while 28.5% had partial response, 45.5% had stable disease and 25.7% had progressive disease. In group II, 15.5% patients had complete response, 33.3% had partial response,17.7% had stable disease and 33.3% had progressive disease. Mean progression-free survival in group I (5.65 months) was significantly higher than group II (4.26 months). The mean OS in group I (7.85 months) was slightly higher than group II (6.72 months). Both haematological and non haemaotlogical toxicities were significantly higher in group II. Conclusion: Patients with EGFR positive expression subjected to Gefitinib had significant mean progression-free survival with an acceptable range of non haematological toxicities and no haematological toxicities, as compared to the EGFR negative patients on conventional chemotherapy.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death worldwide. Indacaterol is a new once daily inhaled bronchodilator, recently approved for the treatment of COPD. Once daily dosing is an important step to improve the adherence and compliance of the patients. Methods: Efficacy and Safety of Indacaterol and Tiotropium in Patients of COPD with Stage-2 and Stage-3 GOLD criteria were compared. Total 119 patients were divided into Indacaterol group and Tiotropium group receiving 150 mcg daily of Indacaterol and 18 mcg daily of Tiotropium in each group respectively. Efficacy treatment was determined by assessment of Pulmonary function test (PFT), Symptom score and SGRQ (St. George’s Respiratory Questionnaires) score at day zero (before therapeutic intervention) and at two weeks of interval till 24 weeks. Results: The treatment with inhaled indacaterol 150 mcg once daily and inhaled tiotropium 18 mcg once daily improved spirometric variable, FEV1, decrease in mean Symptoms score and in mean SGRQ in Grade-2 and Grade-3 COPD patients. Conclusion: Indacaterol (150 mcg/day) is non-inferior to tiotropium (18 mcg /day) in efficacy and safety profile of Grade-2 and Grade-3 patients with COPD.

Pancreaticopleural fistula is one of the rarest complication of acute pancreatitis, chronic pancreatitis and pancreatic pseudocyst. Diagnosis requires a high index of clinical suspicion in alcoholic patients presenting with pancreatitis and associated recurrent pleural effusion. Diagnosis is delayed as patients usually present with predominant pulmonary symptoms of dyspnea and chest pain. Hereby authors presented a case, where a 50-year-old chronic alcoholic male presented with chief complains of shortness of breath and chest pain. Based on the chest radiograph, Computed Tomography (CT) scan and pleural fluid analysis diagnosis of pancreaticopleural fistula was made. The patient was managed with intercoastal tube drainage and symptomatic treatment for other complains. Medical management, endoscopic and surgical interventions bring out a good prognosis in pancreaticopleural fistula.

Background: Tuberculosis (TB) remains a major global health problem. India accounts for the one-fourth of the global TB burden. For resource-limited countries like India having high burden of TB, smear microscopy is the most commonly used method for microbiological diagnosis. Although culture being highly sensitive and specific method, it is time-consuming. Under Revised National TB Control Program (RNTCP), Ziehl–Neelsen (ZN) stain-based microscopy and light-emitting diode-based fluorescent microscopy (LED-FM) are being recommended. Aim: The present study was done to determine the sensitivity and specificity of ZN stain-based microscopy and FM (LED-FM) keeping solid culture as gold standard. Materials and Methods: A total of 1503 sputum samples were collected from suspected cases of pulmonary TB (new or previously treated). They were processed and subjected to ZN (conventional light microscopy), Auramine-O (AO) staining (LED-FM) and solid culture on Lowenstein–Jensen medium for detection of acid-fast bacilli. Positive smears were graded according to RNTCP guidelines. Results: Sensitivity, specificity, positive predictive value, and negative predictive value of ZN staining technique were 84.93%, 95.74%, 96.50%, and 82.16%, respectively, and that of FM was 95.25%, 91.33%, 93.81%, and 93.31%, respectively. Conclusion: LED-FM being more sensitive, especially in detecting the paucibacillary cases and less time-consuming, has advantage over ZN method. Nation-wide implementation will lead to improved diagnosis, thus better control of TB.

Introduction: Pseudomonas aeruginosa (P. aeruginosa) is a usual causative organism of both hospital-acquired pneumonia and community-acquired pneumonia. Although, it is less commonly reported in otherwise healthy hosts, most patients have an identifiable risk factor for disease. These risk factors include those with structural lung abnormalities like bronchiectasis and those with a compromised immune system. With the emergence of multidrug resistant strains of P. aeruginosa, the severity of infection and mortality associated with pneumonia has increased drastically. The insight into the risk factors of Pseudomonas pneumomia helps to suspect and treat the condition at the earliest and thereby reduce the mortality as well as the duration of hospital stay. Aim: To determine various risk factors associated with P. aeruginosa pneumonia. Materials and Methods: An observational cross-sectional study was conducted from November 2018 to November 2020 at Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh, Inida, after obtaining Institutional Ethics Committee (IEC) approval. A total of 89 patients with diagnosis of Pseudomonas pneumonia, defined as the presence of signs and symptoms of pneumonia along with sputum or tracheal culture positive for P. aeruginosa were enrolled in the study. These patients were thoroughly assessed by clinical history, physical examination and relevant investigations to detect any risk factors like age, diabetes, smoking, Chronic Obstructive Pulmonary Disease (COPD), chronic steroid use and prior hospital admission. Data analysis was done using Statistical Package for Social Sciences (SPSS version 22.0). Categorical variables were compared with the Chi-square test. Results: Out of 89 patients with Pseudomonas pneumonia, 77.5% were above 40 years of age, 37.08% were smokers, 25.84% had COPD, 22.47% had bronchiectasis, 31.46% were diabetic, 15.73% were on long term steroid use and 14.61% had history of prior hospital admission. Conclusion: Age, smoking, structural lung diseases like COPD, bronchiectasis, long term steroid use and prior hospital admission are important risk factors for Pseudomonas pneumonia.

Introduction: An upper respiratory tract infection which can be either due to increased airway bacterial load or emergence of new bacterial strain is the most common cause of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). Other factors responsible for exacerbation include viral infections, pollution and other unidentified pathogens. Aim: To evaluate the local pattern of bacterial and fungal isolates from patients diagnosed with AECOPD and forming an antibiogram of the hospital. Materials and Methods: A total of 200 clinically diagnosed cases of AECOPD of age ≥40 years were included in the study. Sputum sample was obtained from the patients and processed according to standard lab procedures. Statistical analysis was done by using Statistical Package for Social Sciences (SPSS) version-20. The test applied in the current study was modified chi-square used for comparison of proportion to analyse statistical significance for antibiotic sensitivity. The p-value

Pirfenidone has been approved for the treatment of idiopathic pulmonary fibrosis due to its anti-fibrotic activity. It has been shown to have anti-inflammatory and antioxidant properties apart from being an anti-fibrotic agent. Cytokine storm, severe inflammation and oxidative stress leading to acute respiratory distress syndrome and multiorgan failure are factors causing mortality in patients of COVID-19. This article reports two cases of 35 years and 60-year-old male patients of COVID-19, those were diagnosed by real time Polymerase Chain Reaction (PCR) using nasopharyngeal samples. They were started on pirfenidone 400 mg BD, later increased to 600 mg TDS along with empirical antibiotics, dexamethasone, supplemental oxygen and non-invasive ventilator support. Both the patients improved and were discharged. Both the patients were followed by telemedicine after one week, did not require oxygen at rest and were comfortable at rest in contrast to earlier complaints. Thus, the authors conclude that pirfenidone can be a possible cure for COVID-19 patients, larger trials are required to confirm its efficacy.

Pulmonary involvement is common in patients with systemic sclerosis. The most common underlying histology is Non Specific Interstitial Pneumonia (NSIP). Disrupted immunity from the disease or associated medication may render such patients prone to develop tuberculosis infection. A 55-year-old female patient presented with chief complaints of shortness of breath from past five years which was gradually progressive, cough initially dry later with minimal expectoration, low grade fever from past two months. She also gave history of bluish discolouration of fingers tips on exposure to cold water. On examination there was restrictive mouth opening, thickened skin over hands, forearm, face, neck and trunk on pinching. Sclerodactyly was present with clubbing grade 2. On auscultation bilateral fine crepts were present. Serum ANA was highly raised and Scl 70 was positive. PFT was suggestive of restrictive ventilatory abnormality. Sputum smear for AFB was found to be positive. HRCT thorax was suggestive of NSIP. Patient was put on antituberculer treatment under DOTS category 1; nifedipine, pentoxyphylline and nitroglycerine gel was started for raynauds phenomenon. Chemotherapy for systemic sclerosis was given with cyclophosphamide infusion in six cycles every four weeks.

Introduction: Pleural effusions are one of the most common entities encountered by pulmonologists worldwide which have a very long list of causes. Initial workup of these patients begins with a chest X-ray and percutaneous or Ultrasound (USG) guided thoracocentesis followed by biochemical and cytological evaluation of the fluid to ascertain the cause of effusion. A 20 to 25% of cases remain undiagnosed even after thoracocentesis and closed pleural biopsy. Medical Thoracoscopy is emerging as a safe diagnostic procedure in these patients. Aim: To detect the diagnostic yield of medical thoracoscopy in cases of undiagnosed exudative lymphocytic pleural effusion and to study the complications associated with it. Materials and Methods: This was a prospective observational study, carried out in the Department of Pulmonary Medicine, JN Medical College and hospital, Aligarh Muslim University (AMU), Aligarh, Uttar Pradesh, India, from August 2016 to August 2018. Undiagnosed exudative pleural effusion was defined as pleural effusion with Adenosine Deaminase (ADA) levels less than 70 IU/L and negative pleural fluid cytology for malignancy. Thoracoscopic examination of the pleural space using flexi-rigid thoracoscopy was done and biopsy was taken from suspected areas and the tissue obtained, was send for histopathological examination. The results were presented as mean±SD (Standard Deviation) or percentage. Differences in categorical data were compared using the chi-square test or the Fisher-exact test. A p-value of

Unilateral hyperlucency of the lung is not an uncommon finding which arises from a variety of conditions, like technical, congenital and acquired. Here, the author presents a case of diaphragmatic hernia which presented as unilateral hyperlucency on chest radiography. A 45-year-old female, presented with complaint of shortness of breath for 2-3 years, increased since 15 days and pain in abdomen for 2-3 years. She consulted a doctor where a chest X-ray was done and was advised Intercostal tube insertion with the diagnosis of left-sided pneumothorax and was referred to us for further management. Instead of her vitals were stable on examination. On auscultation, breath sounds were of decreased intensity. A chest X-ray was then done which showed unilateral hyperlucency of the left side with the presence of air fluid level. The CECT thorax showed a large diaphragmatic hernia through which the large intestine and stomach were occupying the left hemithorax. Therefore, a thorough evaluation should be done before reaching a definitive diagnosis in such patients.

Asthma is coined as a chronic inflammatory disorder and disarrays of the airways and respiratory tract which manifests as recurrent episodes of wheezing, breathlessness, chest tightness, and cough. The World Health Organization recognizes asthma as a major health problem. Although asthma can occur at any age, children and young adults are the age groups which are affected more commonly.The objective of this study is to find the prevalence of bronchial asthma in school-going children (6-16 years) and its associated factors.A cross-sectional study among the school-going children in the age group of 6-16 years was done in the field practice areas of urban health and training center and rural health and training center of the Department of Community Medicine, JNMCH, A. M. U., Aligarh, U.P. the study done for a period of one year. The validated questionnaire (International Study on Allergy and Asthma in Childhood) was used. The sample size was taken as 902. The data were entered and analyzed in the SPSS statistical software version 20.0. Chi-square was used.The prevalence of asthma among the study population was found to be 26.9%. Family history of smoking and history of allergy in an individual came out to be a significant factor associated with asthma. The association is also significant between asthma and the diet of an individual.Asthma among school children is a public health problem in urban and rural areas. There was a rising pattern in the prevalence of asthma at national and subnational levels.

Background: Acute lymphoblastic leukaemia (ALL) is a common malignancy in children which may cause significant nutritional problem as well as micronutrient deficiency like zinc. These deficiencies ultimately affect the outcome of the patient.Objective: The present study was done to identify the relationship of height, weight and serum zinc with acute lymphocytic leukemia in pediatric patients.Methods: This observational study was carried out in the Department of Pediatric Haematology and Oncology, Dhaka Medical College Hospital, Dhaka over a period of one year from July 2013 to June 2014. All children ranging from 1-10 years with newly diagnosed acute lymphocytic leukaemia were enrolled as case. An equal number of healthy children of similar age and sex were also included as control. The outcome measures were weight for height (wasting) and height for age (stunting) in children 5 or below 5 years of age and BMI in children > 5 years of age. The serum zinc level was also studied as a measure of micronutrient status.Result: Majority (80%) of the cases and 60% of the controls were 5 or < 5 years old. The mean ages of the children of cases and controls were almost similar (4.2 ± 2.3 vs. 4.8 ± 1.8 years, p >0.05). The groups were significantly different in terms of sex with male children being more prone to develop leukaemia than the females (p

Introduction: The role of vitamin D in bone homeostasis is well known but nowadays, its role in various essential body processes including prevention of various infective and chronic illnesses like Tuberculosis (TB), by facilitating adaptive and innate immunity in lungs and peripheral blood, is being a matter of debate. Low levels have been associated with respiratory tract infections like TB. Present study aimed to evaluate the level of vitamin D in tubercular patients. Aim: To determine serum vitamin D level in patients with TB and compare it with controls. To compare serum vitamin D level among different types of TB, including Pulmonary TB (PTB), tubercular lymphadenitis and tubercular pleural effusion. Materials and Methods: The present study was a single centre cross-sectional study done during the study period from September 2013 to September 2016 at a tertiary care centre of Uttar Pradesh, India. Total 216 subjects aged between 21 and 60 years were included randomly out of which 113 patients were cases and 103 were controls. Cases of TB were confirmed by sputum Acid Fast Bacilli (AFB) staining, sputum and pleural fluid cytology, Adenosine Deaminase (ADA) of pleural fluid and Fine Needle Aspiration Cytology (FNAC) of lymph nodes. Controls were healthy subjects. Total serum vitamin D levels were measured by Diasorin competitive Radioimmunoassay (RIA) (Autoimmune Diagnostika, GmbH, Strasburg, Germany). Results: The mean serum vitamin D level for patients with TB was 22.4±8.5 ng/mL. Among controls, it was 30.5±8.6 ng/mL (p

Introduction: Tuberculosis (TB) remains a significant public health problem with an estimated onethird of the world’s population being infected. Cytokines play a major role in protection against Mycobacterium tuberculosis infection and regulate the immune responses at cellular level. Most studies on cytokines during TB are from ‘in vitro’-stimulated lymphoid cells with few reports on in vivo plasma levels. This study was aimed to evaluate the levels of TNF-α & IL4 in new, underOriginal Research Article Fatima et al.; BMRJ, 7(4): 159-166, 2015; Article no.BMRJ.2015.107 160 treatment (UT) and multidrug resistant (MDR) pulmonary and extra-pulmonary cases. Methodology: The study was conducted at the Department Of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India. Levels of TNF-α and IL-4 were measured in 76 serum samples from TB patients by ELISA kit (Diaclone France) along with 10 BCG vaccinated control. A complete clinical, radiological & treatment data was collected on questionnaire forms of each patients. Results: TNF-α levels were elevated in new (P 0.05). TNF-α and IL-4 levels showed no significant variations according to site of involvement in pulmonary vs. extra-pulmonary TB cases. Conclusion: An understanding of the development of this response may lead to insight into pathogenesis and novel therapies for TB.

Introduction: Nosocomial infections have been considered as a major health problem causing incremental morbidity, mortality and costs of therapy. Aim: This retrospective study was initiated with aim to analyse the comparative efficacy of a novel Antibiotic Adjuvant Entity (AAE), a combination of ceftriaxone + sulbactam + disodium edetate and meropenem in combination with colistin, for the management of Multi Drug Resistant (MDR) nosocomial Gramnegative bacterial infections. Materials and Methods: Case history sheets of patients with documented MDR nosocomial Gram-negative infections who received either AAE or meropenem in combination with colistin for management of infections over a period of 3 years (November 2012 – October 2015) were included in the study. Data related to clinical management, demographics, vital signs and laboratory parameters along with prior antibiotic therapy, dose and clinical outcomes were evaluated thoroughly to analyse the clinical benefits of this new AAE+ colistin therapy for management of MDR nosocomial infections. Results: Out of 115 patients short listed for the study, 52 patients had received AAE + colistin therapy and 63 patients have received meropenem + colistin. AAE + colistin therapy resulted in significantly higher efficacy (86.53%) as compared to meropenem + colistin (63.49%). A rising trend in clinical cure rates was observed in AAE based combination therapy in contrast to the decreasing trend in meropenem based combination therapy. A progressive decline in clinical cure rates was observed in meropenem treated group over a period of 3 years due to rising carbapenemases and multiple resistance by pathogens, where as AAE maintained the same efficacy. Conclusion: The AAE + colistin therapy has shown better bacteriological and clinical efficacy as compared to meropenem + colistin in the management of various nosocomial MDR Gramnegative infections. A significant number of meropenem failure patients responded to the AAE therapy highlighting the new hope to spare carbapenems.

Human DNA ligase1 (hLig1) is the major replicative enzyme in proliferating mammalian cells that join Okazaki fragments of the lagging strand during DNA replication. Interruptions in the process of ligation cause DNA damage to accumulate, resulting in cytotoxicity and cell death. In the present study we demonstrate that pyrrolo[1,4] benzodiazepine (PBD) derivatives exhibit anticancer properties by targeting the nick sealing activity of hLig1 as opposed to the DNA interaction activity known for such compounds. Our in silico and in vitro assays demonstrate the binding of these molecules with amino acid residues present in the DNA binding domain (DBD) of the hLig1 enzyme. Two of these hLig1 inhibitors S010–015 and S010–018 demonstrated selective cytotoxicity against DLD-1 (colon cancer) and HepG2 (hepatic cancer) cells in a dose dependant manner. The molecules also reduced cell viability and colony formation at concentrations of ⩽20 μM in DLD-1 and HepG2 cells and induced apoptotic cell death. In yet another significant finding, the molecules reduced the migration of cancer cells in wound healing experiments, indicating their anti-metastatic property. In summary, we report the anticancer activity of PBD derivatives against DLD-1 and HepG2 cells and propose a new molecular target for their activity.

Myelomatous pleural effusion is a very rare presentation of multiple myeloma. A 65-year-old male patient presented to us with complaints of dyspnea and left-sided chest pain. His contrast enhanced computed tomography of the thorax showed left-sided pleural effusion with multiple pleural nodules. His pleural fluid cytology shows malignant plasma cells with eccentric nuclei and cart wheel chromatin and a few cells showing binucleation and multinucleation suggestive of plasma cell myeloma. His pleural fluid and serum electrophoresis showed a distinct band in the gamma globulin region (M-spike). On immunofixation of pleural fluid and serum, immunoglobulin G lambda light chain band was detected. Bone marrow aspiration showed sheets of malignant plasma cells with large and binucleated cells suggestive of multiple myeloma. The patient was diagnosed with multiple myeloma presenting as myelomatous pleural effusion. Intercostal tube drainage and then pleurodesis with talc was performed.

Context: Recurrent pneumothorax is common in cavitory pulmonary tuberculosis, but it is extremely rare in miliary tuberculosis. Case Report: A 25 year old female patient presented to us with the complains of shortness of breath since 3 days. She was also having fever and cough since 3 months. Chest roentgenogram (PA view) on admission showed a left sided pneumothorax with miliary mottling. An intercostals tube drainage was done on the left side resulting in relief of symptoms. Two days post intercostals tube drainage chest X ray (PA view) showed complete resolution of pneumothorax, and intercostals tube was removed. Patient was discharged on antitubercular drugs. After 1 month patient again presented to us with severe breathlessness, on repeat chest X ray pneumothorax again developed on left side, urgent intercostals tube drainage was done, and patient relieved immediately. Patient was kept in the hospital for 12 days and, and was discharged after intercostals tube removal. Conclusion: If a patient of miliary tuberculosis presents with shortness of breath diagnosis of pneumothorax should be considered.

Dopaminergic neurotransmission has been investigated extensively, yet direct optical probing of dopamine has not been possible in live cells. Here we image intracellular dopamine with sub-micrometer three-dimensional resolution by harnessing its intrinsic mid-ultraviolet (UV) autofluorescence. Two-photon excitation with visible light (540 nm) in conjunction with a non-epifluorescent detection scheme is used to circumvent the UV toxicity and the UV transmission problems. The method is established by imaging dopamine in a dopaminergic cell line and in control cells (glia), and is validated by mass spectrometry. We further show that individual dopamine vesicles/vesicular clusters can be imaged in cultured rat brain slices, thereby providing a direct visualization of the intracellular events preceding dopamine release induced by depolarization or amphetamine exposure. Our technique opens up a previously inaccessible mid-ultraviolet spectral regime (excitation ~270 nm, emission320 nm) for label-free imaging of native molecules in live tissue.

Introduction: Mycobacterium tuberculosis (Mtb) infects one third of the world population. Despite advance in therapy, tuberculosis (TB) remains responsible for 2-3 million deaths annually. During TB, cytokines play a role in host defense. Many cytokines are produced during TB with a predominance of Th1 cytokines during the early stage and Th2 cytokines in the later stages of the infection. The present study aims to screen tumor necrosis factor-alpha (TNF-α), interferon gamma (IFN-γ), interleukin (IL)-12p70, IL-4, IL-6, and IL-1β among TB patients and controls. Materials and Methods: The study was conducted at the Department Of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India. Different cytokine levels were measured in 65 samples of TB patients of whom 30 (46.1%) were new TB cases and 35 (53.8%) were suspected multidrug-resistant (MDR)-TB cases along with 15 bacille Calmette-Guerin (BCG) vaccinated healthy controls by enzyme-linked immunosorbent assay (ELISA) (Diaclone, France). Complete clinical, radiological, and treatment data were collected. Informed consent was taken from all subjects. Study was approved by the Institutional Bioethical Committee, Jawahar Lal Nehru Medical College. Statistical analysis had been performed by using Sigma plot (10.0). Results: The serum concentration of TNF-α, IFN-γ, IL-12p 70 , IL-1β, and IL-6 in patients with active TB and MDR-TB was elevated than in patients after anti-TB treatment (P < 0.001), in contacts (P < 0.001) and in controls (P < 0.001). It was found that IL-6 seems critical in resistance to TB. IL-4 concentration increased only in MDR-TB patients (P < 0.001) as compared to controls. All these cytokines showed no significant variations according to the site of involvement in pulmonary versus extrapulmonary TB cases. Conclusions: Measuring the serum levels of several cytokines may be useful for evaluating the activity of TB disease and monitoring the clinical effects of anti-tubercular treatment (ATT). The serum TNF-α, IFN-γ, IL-12p 70 , IL-1β and IL-6 level can be a useful marker to diagnose the effectiveness of therapy in the patients.

Hydatid cyst is a disease caused by a parasitic tapeworm, Echinococcus granulosus, and most commonly involves liver and lung. Ruptured pulmonary hydatid cyst can present a diagnostic challenge, and radiograph can be inconclusive. Anaphylactic reaction is a rare complication of ruptured pulmonary hydatid cyst. A 22-year-old male came to our emergency department in shock with symptoms of shortness of breath and altered mental status from the previous day. Radiograph showed a thin-walled circular translucent area in the right upper lung field, which was misdiagnosed as pneumothorax, and an intercostal chest tube was inserted. After 5 days, repeat radiograph revealed a cavity with an air/fluid level. The chest tube was removed and contrast-enhanced computed tomogram showed a cavity with water-lily sign, which suggests ruptured hydatid cyst. Immunoglobin-G enzyme-linked immunosorbent assay for Echinococcus was positive. The patient responded well to treatment with crystalloid infusion, supplemental oxygen, and albendazole, and then underwent surgery. Anaphylactic reaction due to rupture of a hydatid cyst is rare, but hydatid disease should be suspected in patients from areas where Echinococcus is endemic.

Introduction The occurrence of tuberculosis in the flat bones of the skull is very rare. Only eight cases of tuberculosis of the frontal bone have been reported in the literature. Case presentation A 14-year-old girl of Asian ethnicity presented with gradual loss of vision. A computed tomography scan of her head showed a diffuse, homogeneously ill-defined hyperdense lesion of size 2.9 × 5.3 cm (anteroposterior × thickness) involving the right orbit. Biopsy of the lesion confirmed the presence of epithelioid cells and Langerhans giant cells with caseous material. After surgical debridement with antitubercular treatment, the patient had an uneventful recovery. Conclusion Although rare, tuberculosis can affect the flat bones of the skull. Tuberculosis of the frontal bone can be included in the differential diagnosis of blindness.

Introduction: Tuberculosis (TB) remains a significant public health problem, with an estimated one-third of the world's population being infected. Cytokines play a major role in protection against Mycobacterium tuberculosis ( M. tuberculosis ) infection and regulate the immune responses at a cellular level. Most studies on cytokines during TB are from in vitro -stimulated lymphoid cells with few reports on in vivo plasma levels. The aim of this study was to evaluate the levels of tumor necrosis factor-α (TNF-α) in new, undertreatment (UT), and multidrug-resistant (MDR) pulmonary and extrapulmonary cases. Materials and Methods: The study was conducted in the Department of Microbiology, Jawaharlal Nehru Medical College (J.N.M.C.), Aligarh Muslim University (A.M.U.), Aligarh, Uttar Pradesh, India. Results: The levels of TNF-α were measured in 76 serum samples from TB patients by an enzyme linked immunosorbent assay (ELISA) kit (Diaclone Sas, 1 BD, A Flemming Besancon Cedax, France), along with 10 healthy controls. Complete clinical, radiological and treatment data were collected. The TNF-α levels were elevated in new cases ( P P P > 0.05). Conclusions: An understanding of this response may lead to an insight into the pathogenesis and novel therapies for TB.

Mycobacterium tuberculosis (Mtb) infects approximately one third of world population. Many cytokines are produced during tuberculosis, with predominance of Th1 cytokines during the early stage and Th2 cytokines in the later stages of the infection. Most studies on cytokines during TB are from ‘in vitro’-stimulated lymphoid cells with few reports on in vivo plasma levels. The high expression of IL-4 has been implicated as a virulence factor. In the present study we examined the level of IL-4 in the serum of active tuberculosis in new cases, during anti-tubercular therapy and MDR cases. This Study was conducted at Department Of Microbiology, JNMC, AMU, Aligarh. A total 76 blood samples of Pulmonary & Extra-Pulmonary tuberculosis patients were tested by ELISA (Diaclone France) along with 10 healthy controls. The test was carried out according to the manufacturer instructions. O.D. was taken at 450 nm. There was no stastical difference in age and sex in our study. The level of IL-4 show significant changes in MDR TB cases (P 0.05). An understanding of the development of the cellular immune response may lead to insight into pathogenesis and novel therapies for TB. Further studies are needed to address the role of cytokines in immunity to TB under natural conditions.