satinder singh

India is an agriculture based country with Punjab as one of the leading food grain producing states. There is an ever increasing burden to feed the growing population. This has led to over-usage of pesticides which on one hand has contributed significantly to increase the crop yield while on the other hand has led to sharp increase in the poisoning cases in the region. The present study was undertaken to study the deaths related to poisoning in Malwa region of Punjab in 2010 with a view to assess the pattern, trends and incidence of poisoning in relation to age, sex, area, season and type of poison used. These constituted 17.6% of all the unnatural deaths. From the available data the mortality rate from poisoning in Patiala district comes to 60 per million; whereas for males it is 81 per million and for females it is 35 per million. The mortality rate from poisoning in urban population is 78 per million whereas in rural population it is 50 per million. The results of the present study have been compared to those from India and around the world.

ABSTRACT PURPOSE/AIM 1. Determine amount of radiation exposure to glandular breast at 80 kVp. 2. Review effect of lower tube voltage image quality, noise, contrast to noise ratio, and pulmonary vascular enhancement. 3. Determine effect of increased vascular enhancement in detecting pulmonary embolisms and determining optimal window and level for visualization. CONTENT ORGANIZATION • Calculated radiation dose reduction and image to noise ratio between 120 and 80 kvp studies using Monte Carlos simulation data and FONTRAN computer program to determine organ specific dose. The 80 kVp delivers 1.5 mGy to the breast tissue in comparison to 8.5 mGy form standard 120 KVp study. • The dense vascular enhancement need adjusting window and level for optimum visualization. The optimum W/L appears to be 300/800; will update after reviewing all low dose studies in past 3 months. SUMMARY The effect of 80 kVp for chest CTA includes: 1. Significant reduction in radiation dose especially to young breast tissue by factor of 4-6. 2. Increased contrast to noise ratio. 3. Dense vascular opacification requiring changing standard W/L levels of 50/400 for 120 kVp study to 300/800. 4. Decreased amount of contrast needed for PTE studies.

ABSTRACT PURPOSE/AIM Lung transplant, pneumonectomy, lobectomy are frequently performed major thoracic surgeries at tertiary care hospitals. Computed tomography (CT) plays a crucial role in evaluating the bronchial and arterial complications. The purpose of the exhibit is to emphasize the role of 3-D CT imaging in evaluating vascular and bronchial complications after lung surgeries. CONTENT ORGANIZATION The exhibit will be organized as below: Spectrum of complications and role of computed tomography after lung transplant, pneumonectomy, lobectomy. Role of 3D CT post processing in diagnosis of vascular and bronchial complications such as bronchial stenosis/occlusion, arterial stenosis, torsion of the lung, bronchopleural fistula, postpneumonectomy syndrome. Reviewing only the axial images can give false positive appearances. Present sample cases SUMMARY Major teaching points of this exhibit are as below: CT is important for detection of post surgical complications after lung surgeries. More importantly, 3D post processing helps in definitive diagnosis of arterial and bronchial complications.

ABSTRACT PURPOSE We describe variability in interpretation of baseline chest radiographs (CXRs) by radiologists in the Lung Screening Study (LSS) component of NLST. METHOD AND MATERIALS From about 17,000 participants in the CXR arm of LSS, 100 radiographs were randomly selected utilizing a stratified sampling scheme based on the original radiologist's interpretation, and represented normal scans, calcified nodules (CN), non-calcified nodules (NCN), and other abnormalities suggestive of lung cancer. NCN, lung cancers within NCN category, and other abnormalities were oversampled. The 100 radiographs were independently interpreted by nine LSS radiologists and a consensus panel (CP) of three additional radiologists under identical viewing conditions. Readers rated confidence for the presence of suspicious findings on a scale of 1 to 10. Reader interpretations were compared to each other, the CP, and year one CXR follow-up. Comparisons among readers used intraclass correlation coefficients (ICC) and multirater Kappa coefficient. Comparisons between readers and CP used Spearman rank correlation (SRC) and Kappa. RESULTS Thirty-eight CXRs were read as soft copy images and 62 as hard copies. Agreement among all readers for level of suspicion was 0.91 by ICC (95% CI 0.88 – 0.94). Mean agreement between each reader and CP as measured by SRC was 0.63, ± 0.08 (range 0.54-0.80). ROC analysis for level of suspicion showed a mean ROC area for readers of 0.787 (range 0.749-0.862). Average reader agreement on recommendations for further diagnostic procedures (none, minimal, urgent) was 89% (range 76%-98%). CONCLUSION Agreement among the nine readers and between readers and the CP was good in identifying suspicious findings and very good with follow-up recommendations CLINICAL RELEVANCE/APPLICATION The good agreement among the 9 readers in recognizing abnormalities suspicious for lung cancer in the base line chest radiographs from NLST, and follow up recommendations is reassuring

ABSTRACT PURPOSE To evaluate the relationship between the right heart catheterization, pulmonary artery distensibility, and diastolic right ventricular outflow tract (RVOT) wall thickness measured from ECG-gated 64-detector MDCT in patients with pulmonary hypertension (PHT) from different causes METHOD AND MATERIALS From our cardiac CT database we retrospectively selected 25 patients who had undergone gated cardiac CT for reasons other than PHT (group A) and 40 patients with PHT proven by right heart catheterization (group B). Patients in Group A did not have clinical, EKG or echocardiographic evidence of PHT. All patients underwent retrospectively gated cardiac CTA on 64 detector Phillips scanner after injection of 100 cc of omnipaque 350 and 40 cc of saline chaser at 5 cc/sec rate. Images from all 10 phases were postprocessed on Tera recon workstation. Pulmonary artery distensibility and diastolic RVOT wall thickness were measured in all 65 patients . Mean values were compared between groups. In group B correlation between the CT metrics data and right heart catheterization data as well as clinical assessment of disease severity was evaluated. RESULTS Mean RPA distensibility was 16.6% (group A) and 11.1% (group B) (p= 0.005). Mean LPA distensibility was 13.1% (group A) and 8.52% (group B) (p= 0.012). Mean diastolic RVOT wall thickness was 3.239 mm (group A) and 4.980 mm (group B) (p <0.001). Correlation analysis revealed positive correlation of RVOT wall thickness with mean pulmonary artery pressure (mPAP) (r= 0.633), pulmonary vascular resistance (PVR) (r= 0.224) and PHT severity (r=0.484). RPA distensibility measurements correlated with disease severity (r=-0.313) and LPA with PVR (r= -0.42). CONCLUSION Pulmonary artery distensibility is significantly decreased and diastolic RVOT wall thickness significantly increased in patients with PHT. RVOT wall thickness correlates with mPAP and PVR. CLINICAL RELEVANCE/APPLICATION EKG-gated MDCT should be evaluated further as potential noninvasive method for serial assessment of PHT.

ABSTRACT PURPOSE In lung cancer screening, interpretation of f/u CT involves detecting new abnormalities and evaluating the status of previously noted nodules, including changes in size, attenuation and contour which may be subject to reader interpretation. This study examined, in a small subset of images, reader variability in assessment of changes in lung nodules from the baseline to the 1st annual CT screen in NLST METHOD AND MATERIALS 100 examinations in which original interpretation found ≥ 4 mm non-calcified nodule in T-1 CT and a nodule in same location in T-0 CT were selected, nodules showing growth, change in attenuation or edge characteristics over sampled. Image sets of the100 cases containing nodule in its entirety from both CTs were interpreted from a 2-monitor PACS work station by 9 NLST radiologists, recording bi-dimensional measurements, presence/absence of change in size, attenuation & edges between 2 examinations, confidence level of each observation and f/u recommendations. Comparisons among readers used intraclass correlation coefficients (ICC) for continuous variables and multirater Kappa (MK) for discrete variables. For pairs of readers, MK were used, values given with 95% confidence limits RESULTS Agreement on measurements of nodules was excellent with ICCs of 0.91 - 0.96 for T0 and T1 diameters. Agreement on growth (Yes/No) was very good with MK of 0.75 (0.69 - 0.79). Readers had lower agreement on changes in attenuation (MK=0.33), margins (MK=0.36). Agreement on screening results (suspicious for lung cancer,suspicious but no significant change, not suspicious) was moderate: MK 0.48 (0.45 - 0.51). Diagnostic recommendations (none, low level, & high level procedures) had fair agreement: MK 0.24 (0.22, 0.26). Except for one outlier, agreement between screening results and diagnostic recommendations was excellent, 98% (range 84- 100%). CONCLUSION Readers generally agreed on nodule growth, assessment of screening result, and diagnostic recommendations, though agreement of latter two was less than the first. The results of this study demonstrate variability among readers and are consistent with previous studies measuring inter-reader agreement. The over-representation of nodules with changes limits the extent to which these results can be extrapolated to the CT arm of NLST as a whole CLINICAL RELEVANCE/APPLICATION Reader variability in f/u CT interpretation in NLST is similar to other image interpretations

ABSTRACT PURPOSE/AIM Computed tomography (CT) innovations have supported a new focus on imaging the heart with targeted cardiovascular (CV) CT. Cardiac structures are also imaged every day on standard chest CT performed for other indications. This exhibit will review normal, variant normal and abnormal cardiac structures that can be evaluated on 5mm non gated chest CT CONTENT ORGANIZATION Normal CV anatomy in axial and coronal planes. Variants of normal (example Left SVC, atrial septal lipomatous hypertrophy) Congenital anomalies seen in adults (ex. L-Transposition,TOF, pericardial defects) Pathologic changes of cardiac structures including chambers, myocardium, valves, coronary vessels and pericardium (ex. tumor,myocardial infarct, endocarditis) Discussion of the limits of 5mm heart imaging and when to request additional reformations or subsequent targeted testing and imaging SUMMARY The major teaching points of this exhibit are: 1. Normal cardiac anatomy, common variants and several cardiac pathologies can be identified on standard non-gated multi-detector chest CT. 2. Screening for common cardiac abnormalities should be done and reported as part of interpreting standard chest CT . 3. The cardiac findings detected on standard chest CT can guide recommendations for further evaluation and follow up.

ABSTRACT PURPOSE/AIM This exhibit will: (1) illustrate potential venous collateral pathways found in patients with central venous obstruction, (2) determine the causes of venous collateral flow in patients without underlying disease, and (3) highlight features which distinguish these patterns from pathology. CONTENT ORGANIZATION Individual MDCT cases, with targeted multiplanar and/or 3d reformats, will be used to detail the paths and potential causes of : A. Major collateral routes(five)-azygous/hemi azygous, internal mammary,lateral thoracic/thoraco-epigastric, para-vertebral and anterior jugular B. Minor collateral routes-superior intercostal, vertebral, para-scapular, pericardial and superficial thoracic/abdominal C. Miscellaneous (unnamed) SUMMARY Venous collateral flow in the chest can occur due to pathologic or physiologic causes. Familiarity with these pathways on multi detector CT and multiplanar/3D reconstruction can facilitate identifying the location of the deviation of flow, separate pathologic from physiologic causes and avoid mistaking collateral veins for pathology.

ABSTRACT LEARNING OBJECTIVES 1) To illusrtrate common cardiac pathologies encountered in noninvasive imaging. 2) To review imaging protocols designed to best depict cardiac pathology. 3) To review image post-processing tools to render cardiac imaging findings for interpretation and communication with referring clinicians. This interactive session will use RSNA Diagnosis Live™. Please bring your charged mobile wireless device (phone, tablet or laptop) to participate. ABSTRACT This session will include live reads with experts in cardiac radiology to meet the learning objectives. Specific cases and clinical scenatios will be presented to best demonstrate the pathology and the strategies for imaging and image interpretation. URL's http://www.brighamandwomens.org/Departments_and_Services/radiology/Research/aisl.aspx

ABSTRACT PURPOSE To retrospectively assess right ventricle (RV) contractility in longitudinal, radial and circumferential planes from ECG-gated multi-detector computed tomography angiography (MDCTA) and correlate with severity of increased RV systolic pressure (RVSP) determined from right-sided heart catheterization (RHC). METHOD AND MATERIALS Study group consists of 63 patients with PAH who underwent both MDCTA and RHC. Image data reconstructed at 0% and 40% of the RR interval were defined as end-diastole (ED) and end-systole (ES). Image analyses was performed using software Image J. Myocardial strains both in interventricular septum (IVS) and RV free wall (RVFW) were defined as: length in ES– length in ED/ length in ED. Circumferential and radial strains were measured in cross-sections perpendicular to the left ventricular long-axis at basal, middle and apical segments. Longitudinal strains were measured in 4 chamber plane at the mitral and tricuspid valves level. Coefficients of correlation between strains and RVSP measured by the RHC procedure were obtained. RESULTS Longitudinal strain of RVFW had significant moderate correlation with RVSP, (r=0.457, p<0.01). Circumferential strain of RVFW in apical and middle segments had significant moderate and mild correlation with RVSP, respectively (r=0.492, p<0.01 and r=0.367, p<0.01), whereas, it had no significant correlation in basal segment. (r=0.117, p=0.36) Any other strains did not correlate with RVSP, except for apical radial strain of IVS (r=-0.291, p=0.02). CONCLUSION Both longitudinal and apical circumferential strain of RVFW had a positive correlation with RVSP and may serve as useful non-invasive predictor of severity of PAH. CLINICAL RELEVANCE/APPLICATION Apical circumferential and longitudinal strain in RVFW is a sensitive non-invasive marker of PAH severity.

ABSTRACT PURPOSE The aim of this study was to test the feasibility of performing adenosine augmented MDCT (AMDCT) using single source 64 detector scanner in a random population referred for SPECT and to compare the MDCT perfusion results with SPECT-MPI and coronary artery stenosis (CAS) METHOD AND MATERIALS This project was approved by our IRB. Consecutive patients (n=24, age: 62.7±13.4y, 10 female) with history of chest pain undergoing stress SPECT-MPI were enrolled. Retrospective MDCT protocol included a low dose AMDCT, followed by rest coronary CTA (CCTA) with adequate heart rate control & a delayed low dose CT (figure 1). Evaluation of CAD, LV function & wall motion analysis were performed from rest CTA. Perfusion analysis was done without the knowledge of CCTA results. Stress perfusion and DE analysis were performed using Mass software (Medis) with 16-segment model. Perfusion defects were defined as a myocardial segment having a signal density (SD) 2 standard deviations < the average myocardial SD; DE was determined as 1 SD deviation > the average. MDCT vs. SPECT MPI results were compared qualitatively, & they were correlated to coronary artery morphology from CTA (or both CTA & catheter angiography in 7 patients). RESULTS Results of 22 patients were evaluated (2 patients were excluded due to poor AMDCT image quality). In 15 patients, MDCT & SPECT yielded identical results (13 negative, 2 positive). In 5 MDCT showed perfusion defects, & significant CAS while SPECT was normal. In 1 patient (BMI=42) SPECT detected perfusion defect in Cx territory, while AMDCT & CTA were normal. In 1 patient AMDCT detected inferobasal perfusion defect (possibly beam hardening artifact), while SPECT and CTA were normal. DE was found in 1 patient with significant LAD stenosis & corresponding CT perfusion defects, but normal MPI CONCLUSION 1. AMDCT-MPI is feasible even with 64 detector single source scanner. 2. In this small cohort AMDCT showed more perfusion abnormalities than SPECT. 3. There was good concordance between CAS from CTA and perfusion defects. CLINICAL RELEVANCE/APPLICATION Adenosine augmented MDCT can provide comprehensive evaluation of coronary artery morphology, function and perfusion

ABSTRACT PURPOSE To retrospectively evaluate the accuracy of mathematical indices as shape descriptor of endo-myocardial border in both the right ventricle (RV) and left ventricle (LV) measured from ECG-gated multi-detector computed tomography angiography (MDCTA), in the prediction of pulmonary arterial pressure (PAP) in patients with pulmonary arterial hypertension (PAH) confirmed by right-sided heart catheterization (RHC). METHOD AND MATERIALS Study group consist of 63 patients who underwent both 64-row MDCT pulmonary angiography and RHC to evaluate PAH. Image data reconstructed at 0% and 40% of the RR interval were defined as end-diastole (ED) and end-systole (ES) respectively. Image analyses were performed at both ED and ES using software Image J. Circularity and roundness were defined as 4 × π × the area of object / (the perimeter of object) 2 and 4 × the area of object / π × (the major axis of object)2 , respectively and were measured as mathematical indices for configuration, by tracing endo-myocardial border excluding papillary muscle at basal, middle and apical segments perpendicular to ventricular long axis. Coefficients of correlation between circularity and systolic PAP measured by the RHC procedure, and between roundness and the systolic PAP were obtained at the 3 cross sections both in RV and LV. RESULTS Overall correlations between the mathematical indices and systolic PAP were stronger in ES than in ED. In RV, roundness did not correlate well with systolic PAP, whereas moderate correlations were shown between circularity and systolic PAP both in basal and middle segments (r=0.639 p<0.01 and r=0.713, p<0.01). In LV both circularity and roundness similarly correlated well with systolic PAP, and the strongest correlation with systolic PAP was demonstrated at circularity in middle segment (r=0.632, p<0.01). CONCLUSION Measured RV systolic circularity especially in the middle cardiac segment suggesting leftward interventricular septal deviation correlates well with systolic PAP. CLINICAL RELEVANCE/APPLICATION Assessment of right ventricular systolic circularity is a useful predictor of PAH.

COPD patients are at increased risk for cardiovascular morbidity and mortality independent of smoking habits. Recent studies suggest CT emphysema is an independent predictor of cardiovascular risk as evidenced by its association with arterial stiffness and impaired endothelial function. We examined the relationship between demographics, lung function, CT emphysema and airway wall thickness and thoracic aortic calcification, another marker of cardiovascular risk, in the National Lung Screening Trial. We hypothesized that CT emphysema would be independently associated with thoracic aortic calcification. Two hundred forty current and former smokers were enrolled. After CT examination, we recorded subjects' demographics and they performed spirometry. Subjects were classified into COPD and non-COPD subgroups. CT emphysema was quantified as a percentage of lung volume and measurements of the right upper lobe airway were performed using standard methods and expressed as wall area (%). Total calcification scores for the thoracic aorta were computed using TeraRecon image analysis. Univariate and multivariate analyses were performed to determine the associations between calcium score and subject characteristics. Subjects with COPD were older, more often male, heavier smokers and had more CT emphysema and greater aortic calcification than those without COPD. Calcium score was associated with age, pack-years, CT emphysema, wall area%, and lung function on univariate testing but only with age and CT emphysema on multivariate analysis. We conclude that CT emphysema is independently associated with thoracic calcification and thus may be used to assess cardiovascular risk in smokers with and without COPD.

Cardiac paragangliomas are rare tumors arising from chromaffin cells. Two patients with cardiac paragangliomas underwent surgical resection with no evidence of recurrence three and 13 years following surgery. This report describes these two patients with cardiac paragangliomas and discusses their management. doi: 10.1111/jocs.12479 (J Card Surg 2015;30:135-139).

PURPOSE:: To measure reader variability related to the evaluation of screening chest radiographs (CXRs) for findings of primary lung cancer. MATERIALS AND METHODS:: From the National Lung Screening Trial (NLST), 100 cases were randomly selected from baseline CXR examinations for retrospective interpretation by 9 NLST radiologists; images with noncalcified lung nodules (NCNs) or other abnormalities suspicious for lung cancer as determined by the original NLST reader were oversampled. Agreement on the presence of pulmonary nodules and abnormalities suspicious for cancer and recommendations for follow-up were assessed by the multirater κ statistic. RESULTS:: The multirater κ statistic for interreader agreement on the presence of at least 1 NCN was 0.38. Rates at which readers reported the presence of at least 1 NCN ranged from 32% to 63% (mean, 41%); among 16 subjects with NCN and a cancer diagnosis within 1 year of the CXR examination, an average of 87% (range, 81% to 94%) of cases were classified as suspicious for cancer across all readers. The multirater κ for agreement on follow-up recommendations was 0.34; pairwise κ values ranged from 0.15 to 0.64 (mean, 0.36). For all subjects, readers recommended a follow-up procedure classified as high level (computed tomography, fluorodeoxyglucose-positron emission tomography, or biopsy) 42% of the time on average (range, 30% to 67%); this increased to 84% (range, 52% to 100%) when readers reported an NCN and 88% (range, 82% to 94%) for subjects with cancer. CONCLUSION:: Reader agreement for screening CXR interpretation and follow-up recommendations is fair overall but is high for malignant lesions.

Endovascular therapies are increasingly used for treatment of critical limb ischemia (CLI). Infrapopliteal (IP) occlusions are common in CLI, and successful limb salvage may require restoration of arterial flow in the distribution of a chronically occluded vessel. We sought to describe the procedural characteristics and outcomes of patients with IP occlusions who underwent endovascular intervention for treatment of CLI. All patients with IP interventions for treatment of CLI from 2006 to 2012 were included. Angiographic and procedural data were compared between patients who underwent intervention for IP occlusions vs IP stenosis. Restenosis was determined by Doppler ultrasound imaging. Limb salvage was the primary end point of the study. Additional end points included primary patency, primary assisted patency, secondary patency, occlusion crossing success, procedural success, and amputation-free survival. A total of 187 patients with CLI underwent interventions for 356 IP lesions, and 77 patients (41%) had interventions for an IP occlusion. Patients with an intervention for IP occlusion were more likely to have zero to one vessel runoff (83% vs 56%; P < .001) compared with interventions for stenosis. Compared with IP stenoses, IP occlusions were longer (118 ± 86 vs 73 ± 67 mm; P < .001) and had a smaller vessel diameter (2.5 ± 0.8 vs 2.7 ± 0.5 mm; P = .02). Wire crossing was achieved in 83% of IP occlusions, and the overall procedural success for IP occlusions was 79%. The overall 1-year limb salvage rate was 84%. Limb salvage was highest in the stenosis group, slightly lower in the successful occlusion group, and lowest in the failed occlusion group (92% vs 75% vs 58%, respectively; P = .02). Unsuccessfully treated IP occlusions were associated with a significantly higher likelihood of major amputation (hazard ratio, 5.79; 95% confidence interval, 1.89-17.7) and major amputation or death (hazard ratio, 2.69; 95% confidence interval, 1.09-6.63). Successful endovascular recanalization of IP occlusions can be achieved with guidewire and support catheter techniques in most patients. In patients selected for an endovascular-first approach for IP occlusions in CLI, this strategy can be successfully implemented with favorable rates of limb salvage.

Interactive voice response (IVR) calls enhance health systems' ability to identify health risk factors, thereby enabling targeted clinical follow-up. However, redundant assessments may increase patient dropout and represent a lost opportunity to collect more clinically useful data. We determined the extent to which previous IVR assessments predicted subsequent responses among patients with depression diagnoses, potentially obviating the need to repeatedly collect the same information. We also evaluated whether frequent (ie, weekly) IVR assessment attempts were significantly more predictive of patients' subsequent reports than information collected biweekly or monthly. Using data from 1050 IVR assessments for 208 patients with depression diagnoses, we examined the predictability of four IVR-reported outcomes: moderate/severe depressive symptoms (score ≥10 on the PHQ-9), fair/poor general health, poor antidepressant adherence, and days in bed due to poor mental health. We used logistic models with training and test samples to predict patients' IVR responses based on their five most recent weekly, biweekly, and monthly assessment attempts. The marginal benefit of more frequent assessments was evaluated based on Receiver Operator Characteristic (ROC) curves and statistical comparisons of the area under the curves (AUC). Patients' reports about their depressive symptoms and perceived health status were highly predictable based on prior assessment responses. For models predicting moderate/severe depression, the AUC was 0.91 (95% CI 0.89-0.93) when assuming weekly assessment attempts and only slightly less when assuming biweekly assessments (AUC: 0.89; CI 0.87-0.91) or monthly attempts (AUC: 0.89; CI 0.86-0.91). The AUC for models predicting reports of fair/poor health status was similar when weekly assessments were compared with those occurring biweekly (P value for the difference=.11) or monthly (P=.81). Reports of medication adherence problems and days in bed were somewhat less predictable but also showed small differences between assessments attempted weekly, biweekly, and monthly. The technical feasibility of gathering high frequency health data via IVR may in some instances exceed the clinical benefit of doing so. Predictive analytics could make data gathering more efficient with negligible loss in effectiveness. In particular, weekly or biweekly depressive symptom reports may provide little marginal information regarding how the person is doing relative to collecting that information monthly. The next generation of automated health assessment services should use data mining techniques to avoid redundant assessments and should gather data at the frequency that maximizes the value of the information collected.

Vitiligo is an acquired depigmenting disorder characterized by the loss of functional melanocytes from the epidermis. Although the etiology of vitiligo is unknown, over the last few years, substantial data from clinical research has greatly supported the 'Autoimmune theory' and this is supported by the frequent association of vitiligo with disorders that have an autoimmune origin, including Hashimoto's thyroiditis, Graves disease, type 1 insulin-dependent diabetes mellitus, and Addison's disease. As cytokines are important mediators of immunity, there is evidence to suggest that they play a major role in the pathogenesis of autoimmune diseases. Keeping this in view we have assayed sera for cytokine IL-6, IL-2, Tumor necrosis factor (TNF)-α, and IFNγ in 80 cases of vitiligo and compared it with healthy subjects, in order to find out whether they play a role in the pathogenesis of vitiligo or not. Serum IL-6, IL-2, TNF-α, and IFNγ were done by the indirect enzyme linked immunosorbent assay (ELISA). The mean serum IL-6 and IL-2 levels in the patient group were significantly higher when compared with those of the normal controls. The mean serum IFNγ level in patients with vitiligo was significantly lower than that in the control group. There was no significant difference in the serum level of TNF-α between vitiligo and healthy controls. An increase in the production of proinflammatory cytokines such as IL-6 and IL-2 in vitiligo patients may play an important role in melanocytic cytotoxicity. Thus, we speculate that the cytokine production of epidermal microenvironment may be involved in vitiligo.

ABSTRACT The concentrations of dissolved boron have been measured during different seasons in three estuaries, the Tapi, Narmada and the Mandovi situated on the western coast of India, to investigate its geochemical behavior and inputs from the localized anthropogenic pressures of industrial effluents and sewage discharge. The measured boron concentrations in these estuaries (except the Tapi during non-monsoon) at salinity ≤0.1 fall in a narrow range ~2-4 μmol/kg (average B ~2.4 ± 0.8 μmol/kg) within the reported wide range ~0.1-18.6 μmol/kg for global rivers. The much higher estimate of boron concentration in the Tapi River during non-monsoon is attributed to its possible additional supply from the sewage and/or industrial effluents discharged along the river course. During monsoon, the rains seem to be a significant source of dissolved boron to all the three rivers. The distribution of dissolved boron in each estuary exhibits a conservative behavior during the seasons sampled suggestive of no measurable addition or removal of boron in the estuarine region. The orders of magnitude differences in boron concentration between the river waters and seawater, and the conservative behavior of dissolved boron indicate that its major contributor to the estuaries sampled is seawater.

Voltage stability has been a major concern for power system utilities because of several events of voltage collapses in the recent past. With the developments of flexible ac transmission system (FACTS) devices, power system performance has improved. This paper proposes an approach based on fuzzy neural network to calculate loadability margin of the power system with static synchronous compensator (STATCOM). A multi-input, single output fuzzy neural network is developed. Kohonen self-organizing map is employed to cluster the real and reactive loads at all the buses to reduce the input features, thus limiting the size of the network and reducing computational burden. Uncertainties of real and reactive loads, real and reactive generations, bus voltages and STATCOM parameters are taken into account by transforming them into fuzzy domains using combination of different nonlinear membership functions. A three-layered feed-forward neural network with fuzzy input variables is developed to evaluate the loadability margin. All ac limits are considered. The proposed methodology is applied to IEEE-30 bus and IEEE-118 bus systems. The proposed methodology is fast and accurate as compared to the conventional techniques. This method can also be used for online calculation of the voltage stability of the large power systems.

Voltage stability has become a major concern among the utilities over the past decade. With the development of FACTS devices, there is a growing interest in using these devices to improve the stability. In this paper a method using parallel self-organizing hierarchical neural network (PSHNN) is proposed to estimate the loadability margin of the power system with static var compensator

We prospectively studied the incidence of catheter-related sepsis in 51 critically ill patients who underwent 52 arterial and 37 pulmonary artery catheterizations over a period of 3 months. Daily cultures of blood and catheter insertion site were done and the catheters were cultured semiquantitatively at the time of removal. Catheter colonization defined as growth of 15 or more colonies was observed with 9 (10%) catheters and bacteremia with 4 (4.5%) catheters. The skin cultures were positive in 56% of the colonized catheters compared with 11% of sterile catheters (p less than 0.01). The mean duration of catheterization of 3.8 days in colonized catheters was not different than 3.3 days in noncolonized catheters. Presence of concurrent infection and use of antibiotic did not change the rate of catheter colonization. Often, microorganisms other than those colonizing the catheter were recovered from blood. Femoral arterial catheterization appeared to be more often associated with colonization than radial catheters. It appears that the arterial and pulmonary artery catheter colonization occurs in about 10% of catheters and predisposes to catheter-related sepsis. Semiquantitative cultures of the catheter may aid in better documentation of catheter-induced sepsis.

Surveillance of hospital-acquired infection (HAI), particularly device-associated infection (DAI), helps in determining the infection rates, risk factors, and in planning the preventive strategies to ensure a quality healthcare in any hospital. The present study was carried out to know the prevalence of DAI in a tertiary care teaching hospital of rural Gujarat. A prospective, site-specific surveillance of three common DAIs that is catheter-associated urinary tract infection (CA-UTI), IV-catheter-related bloodstream infection (IV-CRBSI), and ventilator-associated pneumonia (VAP) was carried out between July 2007 and April 2008, in different wards/ICUs. A surveillance plan, with guidelines and responsibilities of nurses, clinicians and microbiologist was prepared. Infection surveillance form for each patient suspected to have DAI was filled. The most representative clinical sample, depending on the type of suspected DAI, was collected using standard aseptic techniques and processed for aerobes and facultative anaerobes. All the isolates were identified and antimicrobial sensitivity testing performed as per CLSI guidelines. An accurate record of total device days for each of the indwelling devices under surveillance was also maintained. Data, collected in the prescribed formats, were analysed on monthly basis; and then, compiled at the end of the study. Descriptive analysis of the data was done and DAI rate was expressed as number of DAI per 1000 device days. The overall infection rate for CA-UTI, IV-CRBSI, and VAP were found to be 0.6, 0.48, and 21.92 per 1000 device days, respectively. The organisms isolated were Staphylococcus aureus, CONS, Enterococci, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli. Duration of indwelling devices was found to be the major risk-factor for acquiring DAIs. Low DAI rate might have been due to use of antibiotics, often prophylactic. Active surveillance is quite a tedious and time-consuming process; however the outcome is useful in prevention and control of DAIs.

Objective:The present study was undertaken to explore the effect of piperine in obesity-induced dyslipidemia.Materials and Methods:Male Sprague Dawley rats were fed high-fat diet (HFD) for the first eight weeks, to develop obesity-induced dyslipidemia. Later on piperine (40 mg / kg) and sibutramine (5 mg / kg) were administered for three weeks along with the continuation of HFD to two separate groups, which served as the test and standard groups, respectively. Body weight, food intake, serum triglyceride, total cholesterol, LDL, VLDL, and HDL were measured at the end of the fourth, eighth (before treatment), and eleventh (after treatment) week, while the fat mass was measured at the end of the eleventh week in the normal, HFD-control, test, and standard groups.Results:Supplementing piperine with HFD significantly reduced not only body weight, triglyceride, total cholesterol, LDL, VLDL, and fat mass, but also increased the HDL levels, with no change in food intake.Conclusion:The above results suggest that piperine possesses potential fat reducing and lipid lowering effects, without any change in food appetite, at a small dose of 40 mg / kg. The mechanism of action for such an activity needs to be determined. However, looking to structural similarity with the presently known Melanocortin-4 (MC-4) agonists, involvement of MC-4 receptors in its activity can be guessed.

The purpose of this study is to describe the utility and limitations of gated contrast-enhanced cardiac computed tomography angiography in assessing left ventricular assist device function. Computed tomography angiography (CTA) was used in 14 patients with left ventricular assist devices (LVADs) who had persistent heart failure symptoms, hemodynamic instability, or potential problems with LVAD flows. Retrospectively gated contrast-enhanced CTA was performed on 64-detector scanner, and the CTA images were postprocessed in multiple curved projections on TeraRecon workstation. This study describes the use of CTA to identify LVAD-related issues that altered clinical management and explores the role of CTA and other techniques in evaluating LVAD function. Six of 14 LVAD patients who demonstrated no abnormality on CTA remained stable with medical management. In the remaining eight patients, CTA was abnormal, including abnormalities specifically related to the LVAD cannula. As a result of findings detected by CTA, six patients underwent surgical intervention, including device exchange and heart transplant. Computed tomography angiography is a noninvasive method that enhances diagnostic evaluation of patients with suspected LVAD dysfunction and can lead to changes in patient management.

Assessment of patients with left ventricular assist devices (LVADs) can be challenging, and multiple modalities are sometimes necessary to arrive at the accurate diagnosis. We describe two patients with persistent heart failure symptoms after HeartMate II LVAD placement. After initial evaluation was unrevealing, retrospectively gated computed tomographic angiography (CTA) was used to diagnose partial inflow obstruction, leading to important changes in management. We describe the techniques and role of retrospective gating and discuss functional assessment by CT as well as future applications.

Voltage stability has become of major concern for the power utilities. In this paper, multi input, single output fuzzy neural network is developed for voltage stability evaluation of the power systems with SVC by calculating the loadability margin. Uncertainties of real and reactive loads, real and reactive generations, bus voltages and SVC parameters are taken into account. All ac limits