Survey of arsenic in food composites from an arsenic-affected area of West Bengal, India.

An investigation of total arsenic in food composites, collected from the villagers, was carried out in arsenic-affected areas of the Murshidabad district, West Bengal where the agricultural system is mostly groundwater dependent. The shallow, large-diameter tubewells installed for agricultural irrigation contain an appreciable amount of arsenic (mean 0.085 mg/l, n=6). Even the soil is arsenic-contaminated (mean 11.35 mg/kg, n=36), so some arsenic can be expected in the food chain from crops cultivated in this area. The results revealed that the individual food composite and food groups containing the highest mean arsenic concentrations (microg/kg) are potato skin (292.62 and 104), leaf of vegetables (212.34 and 294.67), arum leaf (331 and 341), papaya (196.50 and 373), rice (226.18 and 245.39), wheat (7 and 362), cumin (47.86 and 209.75), turmeric powder (297.33 and 280.9), cereals and bakery goods (156.37 and 294.47), vegetables (91.73 and 123.22), spices (92.22 and 207.60) and miscellaneous items (138.37 and 137.80) for the Jalangi and Domkal blocks, respectively. Arsenic is absorbed by the skin of most of the vegetables. The arsenic concentration in fleshy vegetable material is low (mean 2.72 microg/kg, n=45). Higher levels of arsenic were observed in cooked items compared with raw. Daily dietary intakes of arsenic (microg) from the foodstuffs for adults are 171.20 and 189.13 and for children are 91.89 and 101.63 in the Jalangi and Domkal blocks, respectively.     

Unrecognized tamponade diagnosed pre-induction by focused echocardiography

Purpose

We report a case of unrecognized cardiac tamponade diagnosed pre-induction by focused transthoracic echocardiography (TTE). The value of focused perioperative TTE, the anesthetic implications of Churg-Strauss syndrome, and the diagnosis of cardiac tamponade are discussed.

Clinical features

A 58-yr-old man with a history of severe asymptomatic aortic stenosis presented for elective endoscopic sinus surgery for intractable nasal polyps with recurrent sinusitis. His cardiologist and cardiac surgeon had recommended proceeding with surgery, as aortic valve replacement was not indicated because he was asymptomatic. Prior to induction, a focused TTE was performed by anesthesia in order to document the degree of aortic stenosis, baseline ventricular function, and baseline volume status. This provided a baseline for comparison in case the patient’s hemodynamic status should deteriorate intraoperatively. Unexpectedly, the TTE examination revealed cardiac tamponade. After confirmation of the diagnosis by cardiology, urgent pericardiocentesis was performed. A diagnosis of Churg-Strauss syndrome was ultimately made, and the patient was treated with high-dose prednisone therapy.

Conclusion

Focused TTE has significant clinical utility for the diagnosis and assessment of hemodynamically significant cardiac conditions, particularly in the complex patient where clinical examination is challenging and echocardiographic findings can have immediate management implications.     

Chronic serotonin syndrome: A retrospective study

BACKGROUNDSerotonin syndrome (SS) is an underdiagnosed drug-induced clinical syndrome resulting from the excess intrasynaptic concentration of serotonin. Very limited information is available about chronic SS.AIMTo evaluate the epidemiological, clinical, and other aspects of the insidious onset SS.METHODSWe retrospectively evaluated 14 consecutive adult patients (> 18 years) who had complaints for more than 6 wk at the time of consultation and met the Hunter criteria for SS.RESULTSThe mean age was 41.1 years (range: 21-61 years), with a male preponderance (64%). Although tremors were observed in all patients, this was a presenting complaint in only 43% of patients. Generalized body pain, insomnia, and restlessness were common presenting features (50% each). Other common clinical features were stiffness of the limbs (43%), diaphoresis (43%), gait disturbances (36%), bowel disturbances (36%), dizziness (29%), sexual dysfunctions (21%), incoordination (14%), and fatigue (14%) The mean duration of symptoms before the diagnosis of SS was 13.5 ± 5.8 wk (range: 6-24 wk). Amitriptyline was the most common drug (n = 6, 43%), followed by tramadol (n = 5, 36%) and sodium valproate (n = 5, 36%). All patients received cyproheptadine, a 5- hydroxytryptamine2A antagonist, as treatment and noted an excellent response over the course of 4-14 d.CONCLUSIONThis study represents the largest study on chronic SS. We suggest that patients receiving serotonergic drugs should be physically examined for the presence of SS upon the development of new symptoms.     

Rapid Developability Assessments to Formulate Recombinant Protein Antigens as Stable,Low-Cost,Multi-Dose Vaccine Candidates: Case-Study With Non-Replicating Rotavirus (NRRV) Vaccine Antigens

A two-step developability assessment workflow is described to screen variants of recombinant protein antigens under various formulation conditions to rapidly identify stable, aluminum-adjuvanted, multi-dose vaccine candidates. For proof-of-concept, a series of sequence variants of the recombinant non-replicating rotavirus (NRRV) P[8] protein antigen (produced in Komagataella phaffii) were compared in terms of primary structure, post-translational modifications, antibody binding, conformational stability, relative solubility and preservative compatibility. Based on these results, promising P[8] variants were down-selected and the impact of key formulation conditions on storage stability was examined (e.g., presence or absence of the aluminum-adjuvant Alhydrogel and the preservative thimerosal) as measured by differential scanning calorimetry (DSC) and antibody binding assays. Good correlations between rapidly-generated developability screening data and storage stability profiles (12 weeks at various temperatures) were observed for aluminum-adsorbed P[8] antigens. These findings were extended and confirmed using variants of a second NRRV antigen, P[4]. These case-study results with P[8] and P[4] NRRV variants are discussed in terms of using this vaccine formulation developability workflow to better inform and optimize formulation design with a wide variety of recombinant protein antigens, with the long-term goal of rapidly and cost-efficiently identifying low-cost vaccine formulations for use in low and middle income countries.     

Vascular endothelial growth factor (VEGF) receptor antibody bevacizumab (avastin) induces regression of renal cell carcinoma in an adolescent resulting in residual tumorectomy

Renal cell carcinoma is a chemo- and radiation-resistant malignancy that is very rare in childhood. In advanced cases, survival is extremely poor, but cure can be achieved with complete tumorectomy. We report a 14-year-old female with left renal cell carcinoma, with regional lymphadenopathy extending up to the diaphragm. Complete tumor resection was impossible. The tumor progressed after 10 months of treatment with high-dose interleukin-2. After 7 months of outpatient vascular endothelial growth factor receptor antibody bevacizumab and no significant adverse effects, dramatic tumor shrinkage enabled complete resection.