Beneficiation Studies on Cobalt Bearing Ore from Africa

Cobalt bearing ore is used in Africa for hydro-metallurg-ical extraction of Co. The party desired to know whether it is possible to pre-concentrate this ore in order to reduce the material handled by metallurgical operations. This cobalt bearing sample (5% Co) was beneficiated in the Modern Mineral Processing Laboratory and Pilot Plant of Indian Bureau of Mines at Nagpur. The cobalt was ident-ified by EPMA to be present as WAD where manganese is replaced by cobalt. The as-received sample was dominated by fines. Screening the as received sample on 10 mesh followed by desliming of -10 mesh fraction yielded a Co concentrate assaying 7.2% Co with 94.6% cobalt recovery. Although the concentrate assays only 7.2% Co, this simple process developed offers the advantage that around 33% of the slimes (<20 microns in size assaying around I% Co) can bypass the metallurgical operations to follow thus drast-ically reducing the handling, settling and filtration problems in the extraction of Co by hydrometallurgical route with minimum Co losses in the tailings

Intrapleural Fibrinolytic Therapy in Pediatric Loculated Pleural Effusion: A Case Report

Introduction: Pleural effusion drainage in addition to antibiotics is used for the management of empyema and complex parapneumonic effusions (CPE). Fibrinolytics aid in drainage because fibrin adhesions create loculations in the pleural space. Although open thoracotomy and video-assisted thoracoscopic surgery (VATS) are the best therapeutic modalities, their widespread use is limited by operational risk and increased costs. Thus, intrapleural fibrinolytic therapy (IPFT) must be considered before more expensive and invasive techniques. Case description: We present a case of a 10-year-old girl who presented with fever, dry cough, and loss of appetite for 2 weeks along with breathlessness for 1 week. Her chest radiograph revealed left-sided massive pleural effusion for which left tube thoracostomy was done. It was a tubercular, exudative lymphocytic effusion. The patient was advised to undergo thoracic surgery in the form of VATS with thoracotomy for failed tube drainage. Instead of subjecting her to an expensive and major surgical procedure, she was subjected to IPFT with three doses of streptokinase. There was complete resolution of the loculated pleural effusion, and she was discharged after 3 days. Conclusion: Regardless of the etiology, IPFT is an affordable option for all kinds of loculated pleural collections and needs to be presented as the first choice, even when VATS is available

Asthma-chronic obstructive pulmonary disease misdiagnosis: cause for concern or false alarm?

Chronic obstructive pulmonary disease (COPD) and asthma are both heterogeneous disorders characterized by overlapping respiratory symptoms. Due to overlapping symptoms and underuse of spirometry, there is often misdiagnosis between these two disorders. A cross-sectional observational study was carried out at the respiratory outpatient department (OPD) of a tertiary care respiratory center in western Maharashtra for 1 year. All patients over the age of 40 who were diagnosed with asthma or COPD and were referred to the respiratory OPD for management or were already under follow-up at the center were included in the study. Questionnaires and spirometry were used to evaluate all patients. A total of 85 patients who met the inclusion criterion without any exclusion requirements were included; 5 patients out of 45 who were initially labelled as having asthma (11.11%) and 29 patients out of 40 who were initially labelled as having COPD (72.5%) were found to have been misdiagnosed according to study protocol. In conclusion, there is a significant prevalence of misdiagnosis amongst obstructive airway disease. The patients with a diagnostic label of COPD are more likely to be misdiagnosed due to a lack of knowledge of diagnostic protocol, underuse and misinterpretation of spirometry, and overreliance on chest radiography. Use of spirometry is dismally low and correlates with other studies from India. The study clearly indicates the urgent requirement of educating doctors, especially primary care clinicians, about the correct diagnostic protocols used in the diagnosis of COPD and bronchial asthma

A study of empyema thoracis and role of intrapleural streptokinase in its management

BACKGROUND: Clinical spectrum, microbiology and outcome of empyema thoracis are changing. Intrapleural instillation of fibrinolytic agents is being increasingly used for management of empyema thoracis. The present study was carried out to describe the clinical profile and outcome of patients with empyema thoracis including those with chronic empyema and to study the efficacy and safety of intrapleural streptokinase in its management. METHODS: Clinical profile, etiological agents, hospital course and outcome of 31 patients (mean age 40 ± 16 years, M: F 25: 6) with empyema thoracis treated from 1998 to 2003 was analyzed. All patients were diagnosed on the basis of aspiration of frank pus from pleural cavity. Clinical profile, response to therapy and outcome were compared between the patients who received intrapleural streptokinase (n = 12) and those who did not (n = 19). RESULTS: Etiology was tubercular in 42% of the patients (n = 13) whereas the rest were bacterial. Amongst the patients in which organisms could be isolated (n = 13, 42%) Staphylococcus aureus was the commonest (n = 5). Intrapleural streptokinase was instilled in 12 patients. This procedure resulted in increase of drainage of pleural fluid in all patients. Mean daily pleural fluid drainage after streptokinase instillation was significantly higher for patients who received intrapleural streptokinase than those who did not (213 ml vs 57 ml, p = 0.006). Only one patient who was instilled streptokinase eventually required decortication, which had to be done in five patients (16.1%). Mean hospital stay was 30.2 ± 17.6 days whereas two patients died. CONCLUSIONS: Tubercular empyema is common in Indian patients. Intrapleural streptokinase appears to be a useful strategy to preserve lung function and reduce need for surgery in patients with late stage of empyema thoracis

Tuberculosis (TB) Aftermath: study protocol for a hybrid type I effectiveness-implementation non-inferiority randomized trial in India comparing two active case finding (ACF) strategies among individuals treated for TB and their household contacts

Background : Approximately 7% of all reported tuberculosis (TB) cases each year are recurrent, occurring among people who have had TB in the recent or distant past. TB recurrence is particularly common in India, which has the largest TB burden worldwide. Although patients recently treated for TB are at high risk of developing TB again, evidence around effective active case finding (ACF) strategies in this population is scarce. We will conduct a hybrid type I effectiveness-implementation non-inferiority randomized trial to compare the effectiveness, cost-effectiveness, and feasibility of two ACF strategies among individuals who have completed TB treatment and their household contacts (HHCs). Methods : We will enroll 1076 adults (≥ 18 years) who have completed TB treatment at a public TB unit (TU) in Pune, India, along with their HHCs (averaging two per patient, n = 2152). Participants will undergo symptom-based ACF by existing healthcare workers (HCWs) at 6-month intervals and will be randomized to either home-based ACF (HACF) or telephonic ACF (TACF). Symptomatic participants will undergo microbiologic testing through the program. Asymptomatic HHCs will be referred for TB preventive treatment (TPT) per national guidelines. The primary outcome is rate per 100 person-years of people diagnosed with new or recurrent TB by study arm, within 12 months following treatment completion. The secondary outcome is proportion of HHCs < 6 years, by study arm, initiated on TPT after ruling out TB disease. Study staff will collect socio-demographic and clinical data to identify risk factors for TB recurrence and will measure post-TB lung impairment. In both arms, an 18-month “mop-up” visit will be conducted to ascertain outcomes. We will use the RE-AIM framework to characterize implementation processes and explore acceptability through in-depth interviews with index patients, HHCs and HCWs (n = 100). Cost-effectiveness will be assessed by calculating the incremental cost per TB case detected within 12 months and projected for disability-adjusted life years averted based on modeled estimates of morbidity, mortality, and time with infectious TB. Discussion : This novel trial will guide India’s scale-up of post-treatment ACF and provide an evidence base for designing strategies to detect recurrent and new TB in other high burden settings. Trial registration : NCT04333485, registered April 3, 2020. CTRI/2020/05/025059 [Clinical Trials Registry of India], registered May 6 2020.Research reported in this manuscript was supported by the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health(NIH) under award number R01AI143748. See funding documentation in Additional file3. The funding body does not have a role in the collection, analysis, and interpretation of data for TB Aftermath nor were they involved in writing this manuscript