Identification of epidural space using loss of resistance syringe, infusion drip, and balloon technique: A comparative study

BACKGROUND AND OBJECTIVE

There are various techniques to identify epidural space but superiority of one technique over other has not been adequately studied. We conducted a study to Compare and evaluate the three techniques for epidural space localization that is, loss of resistance (LOR) syringe technique, balloon technique and drip infusion technique.

MATERIALS AND METHODS

Seventy-five patients of either sex, belonging to American Society of Anesthesiologists physical status Class 1 or 2, between 20 and 50 years of age, scheduled to undergo lower abdominal and lower limb surgeries were randomly allocated to one of the three groups (n = 25 each) depending upon epidural space localization. In Group I, epidural space localization was done with LOR syringe technique. In Group II Balloon technique and in Group III drip infusion technique was used. Distance of the epidural space from skin, number of attempts, time taken for epidural space localization and quality of the block were the parameter recorded during the study.

RESULTS

First attempt success rate for epidural space localization was highest in Group III (100%). The mean time taken for epidural space localization was least in Group III, and when compared with other groups it was found to be statistically significant with P = 0.016. Number of attempt for space localization and success rate of the block was better in the majority of patients of Group III, but the difference was found to be statistically nonsignificant. Complication rate was almost negligible in all three techniques.

CONCLUSION

We conclude that the time taken to localize the epidural space was least in drip infusion technique. As for number of attempts, quality of the block and complications is concerned, all the three techniques are comparable.

Characterisation of blaTEM genes and types of β-lactamase plasmids in Neisseria gonorrhoeae - the prevalent and conserved blaTEM-135 has not recently evolved and existed in the Toronto plasmid from the origin

Background

Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a major concern worldwide. It has been recently feared that the bla_TEM-1 gene is, via bla_TEM-135, evolving into an extended-spectrum β-lactamase (ESBL), which could degrade all cephalosporins including ceftriaxone. The aims of the present study were to characterize the bla_TEM genes, types of β-lactamase plasmids, the degradation of ampicillin by TEM-135 compared to TEM-1, and to perform molecular epidemiological typing of β-lactamase-producing N. gonorrhoeae strains internationally.

Methods

β-lactamase producing N. gonorrhoeae isolates (n = 139) cultured from 2000 to 2011 in 15 countries were examined using antibiograms, bla_TEM gene sequencing, β-lactamase plasmid typing, and N. gonorrhoeae multiantigen sequence typing (NG-MAST). Furthermore, the bla_TEM gene was sequenced in the first described Toronto plasmid (pJD7), one of the first Asian plasmids (pJD4) and African plasmids (pJD5) isolated in Canada. The degradation of ampicillin by TEM-135 compared to TEM-1 was examined using a MALDI-TOF MS hydrolysis assay.

Results

Six different bla_TEM sequences were identified (among isolates with 125 different NG-MAST STs), i.e. bla_TEM-1 (in 104 isolates), bla_TEM-135 (in 30 isolates), and four novel bla_TEM sequences (in 5 isolates). The bla_TEM-1 allele was only found in the African and Asian plasmids, while all Rio/Toronto plasmids possessed the bla_TEM-135 allele. Most interesting, the first described gonococcal Toronto plasmid (pJD7), identified in 1984, also possessed the highly conserved bla_TEM-135 allele. The degradation of ampicillin by TEM-135 compared to TEM-1 was indistinguishable in the MALDI-TOF MS hydrolysis assay.

Conclusions

bla_TEM-135, encoding TEM-135, is predominantly and originally associated with the Rio/Toronto plasmid and prevalent among the β-lactamase producing gonococcal strains circulating globally. bla_TEM-135 does not appear, as previously hypothesized, to have recently evolved due to some evolutionary selective pressure, for example, by the extensive use of extended-spectrum cephalosporins worldwide. On the contrary, the present study shows that bla_TEM-135 existed in the Toronto plasmid from its discovery and that bla_TEM-135 is highly conserved (not further evolved in the past >30 years). Nevertheless, international studies for monitoring the presence of different bla_TEM alleles, the possible evolution of the bla_TEM-135 allele, and the types of β-lactamase producing plasmids, remain imperative.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2334-14-454) contains supplementary material, which is available to authorized users.

Effect of imatinib on male reproductive hormones in BCR-ABL positive CML patients: A preliminary report

Multiple animal studies, few clinical case reports and one study have observed decreased testosterone production and gynaecomastia as adverse effect of imatinib therapy. We have prospectively studied testosterone, LH and FSH levels at baseline and at 6 months of imatinib treatment in 34 newly diagnosed male BCR-ABL positive CML patients. While none of the patients had gynaecomastia at 6 months, the proportion of patients with low testosterone level increased significantly from 11.8% at baseline to 58.8% (p < 0.001) and those with high LH and FSH increased significantly from 26.4% and 23.5% to 82.4% and 76.4%, respectively (p < 0.001 and p < 0.001). Serum testosterone levels decreased significantly (p = 0.002) and serum LH and FSH levels increased significantly at 6 months of imatinib therapy (p = 0.001 and p = 0.003) in comparison to baseline levels. The findings document the effect of imatinib on testosterone levels in adult CML patients much before than reported earlier.

An experimental setup for the simultaneous measurement of thermoelectric power of two samples from 77 K to 500 K

We report on an experimental setup for the simultaneous measurement of the thermoelectric power (TEP) of two samples in the temperature range from 77 K to 500 K using optimum electronic instruments. The setup consists of two rectangular copper bars in a bridge arrangement for sample mounting, two surface mount (SM) chip resistors for creating alternate temperature gradient, and a type E thermocouple in differential geometry for gradient temperature (ΔT) measurement across the samples. In addition, a diode arrangement has been made for the alternate heating of SM resistors using only one DC current source. The measurement accuracy of ΔT increases with the differential thermocouple arrangement. For the calibration of the setup, measurements of TEP on a high purity (99.99%) platinum wire and type K thermocouple wires Chromel and Alumel have been performed from 77 K to 500 K with respect to copper lead wires. Additionally, this setup can be utilized to calibrate an unknown sample against a sample of known absolute TEP.

Tubercular mastitis - A case report with uncommon presentation

Tuberculosis of the breast is significant due to its rare occurrence and mistaken identity with breast cancer and pyogenic breast abscess. It typically affects young lactating multiparous women and can present either as an abscess or as a unilateral, painless breast mass. A case of 22 year unmarried female presented with discharge breast and a small abscess. Radiological and cytological methods remained nonspecific and tubercular mastitis was diagnosed on Zeihl Neelsen staining and culture for Mycobacteria. A multifaceted approach is needed to reach the correct diagnosis. DOI: http://dx.doi.org/10.3126/ajms.v6i1.10143 Asian Journal of Medical Sciences Vol.6(1) 2015 119-121

Foetal type posterior cerebral artery -a case report

Posterior cerebral artery (PCA),terminal branch of basilar artery join the posterior communicating artery to complete the circle of Willis. The morphological variations of posterior segment of the circle of Willis are much of importance in the diagnosis & treatment of different cerebrovascular diseases.In a series of anatomical dissections of the cerebral arterial territory in 30 cadaveric brain specimens,an important variation of the precommunicating segment of the posterior cerebral artery Pl was found. In this variation, an embryonic derivation of the posterior cerebral artery from the internal carotid artery (ICA) known as foetal type posterior cerebral artery was seen. This type of variation may lead to the appearance and severity of syndromes of vascular insufficiency in adults.

Design and synthesis of novel 2-phenyl-5-(1,3-diphenyl-1H-pyrazol-4-yl)-1,3,4-oxadiazoles as selective COX-2 inhibitors with potent anti-inflammatory activity

A novel series of 2-phenyl-5-(1,3-diphenyl-1H-pyrazol-4-yl)-1,3,4-oxadiazoles were designed and synthesized for selective COX-2 inhibition with potent anti-inflammatory activity. Among the compounds tested, 9g (2-(3-(4-nitrophenyl)-1-phenyl-1H-pyrazol-4-yl)-5-phenyl-1,3,4-oxadiazole) was found to be the most potent inhibitor of COX-2 with IC50 of 0.31 μM showing promising degree of anti-inflammatory activity in the carrageenan-induced rat paw edema model with ED50 of 74.3 mg/kg. The lead compound 9g further showed suppression of acetic acid-induced writhes comparable to that of aspirin and gastro-sparing profile superior to the aspirin. Molecular docking analysis displayed higher binding affinity of ligands towards COX-2 than COX-1.

Short-term regulation of Visfatin release in vivo by oral lipid ingestion and in vitro by fatty acid stimulation

Visfatin represents a new adipokine secreted by visceral adipose tissue and possibly regulating insulin sensitivity. Data on the regulation of visfatin are sparse and contradictory. Our study investigates the regulation of serum visfatin concentrations in healthy and non-diabetic subjects in response to the ingestion of a newly developed oral lipid solution (OLI) in vivo. Furthermore, the effects of a broad spectrum of fatty acids on adipocytic visfatin release were investigated in vitro.100 (42 male and 58 female) healthy volunteers were included in the study. Anthropometric and laboratory parameters (lipoproteins, glucose, insulin, C-peptide) were measured after an overnight fast at 0 h and 2 h, 4 h, and 6 h after OLI. 3T3-L1 preadipocytes were differentiated into mature adipocytes and stimulated with increasing doses of 10 different fatty acids, and the release of visfatin into the supernatants was measured by ELISA.Serum triglycerides significantly rose after OLI. This was accompanied by a significant decrease of glucose, insulin and C-peptide. Serum visfatin levels significantly decreased after OLI. Fasting visfatin levels were negatively correlated with fasting glucose levels. Of the 5 saturated fatty acids tested, only palmitic acid exerted significant effects by strongly downregulating visfatin release by about 66%. The mono-unsaturated fatty acids palmitoleic acid and oleic acid exerted opposite effects decreasing/increasing visfatin release, respectively. Both of the poly-unsaturated fatty acids linoleic acid and arachidonic acid decreased visfatin release.Oral lipid ingestion is a physiological regulator of systemic visfatin release. Fatty acids differentially regulate visfatin release in vitro.

Prevalence of intestinal parasitic infections in HIV-infected individuals and their relationship with immune status

BACKGROUND AND OBJECTIVES

Intestinal parasitic infection is a common entity in patients infected with human immunodeficiency virus (HIV). These infections may lead to fatal complications in the immuno suppressed individuals. The aim of the present study was to determine the prevalence of intestinal parasitic infections in HIV sero-positive patients and their relationship with the immune status of individuals.

MATERIALS AND METHODS

Fecal samples from 100 HIV sero-positive and an equal number of HIV sero-negative individuals were collected and examined for enteric parasites by direct microscopy. CD4 counts were carried out in only HIV sero-positive patients. Prevalence of intestinal parasites in patients with CD4 count<200 cells/μl, 200-499 cells/μl, and ≥500 cells/μl in HIV-infected patients were compared.

RESULTS

Enteric parasites were detected in 59.3% HIV-infected patients with CD4 count<200 cells/μl as compared with 23.5% in patients with CD4 count>200 cells/μl (P<0.01). Prevalence of coccidian parasites was significantly (P<0.01) higher (14%) in HIV sero-positive subjects compared with HIV sero-negative subjects (2%). Isospora belli (25%) was the most common parasite with CD4 count<200 cells/μl, followed by Cryptosporidium parvum (12.5%). Prevalence of intestinal parasitic infections was significantly higher in patients with diarrhea, 73.6% than without diarrhea, 25.9%, (P<0.05). The mean CD4 count of HIV sero-positive patients presenting with diarrhea was significantly (P<0.01) lower (181.26±135.14) than without diarrhea (352.02±204.03).

CONCLUSION

This study emphasizes the need for routine screening of parasites especially in patients with lower CD4 count so as to decrease the morbidity by ensuring the early treatment of the cases.

Genital Chlamydia trachomatis: an update

Chlamydia trachomatis is the most common cause of curable bacterial sexually transmitted infection (STI) worldwide. It manifests primarily as urethritis in males and endocervicitis in females. Untreated chlamydial infection in man can cause epididymitis and proctitis. Though most women with Chlamydia infection are asymptomatic or have minimal symptoms, some develop salpingitis, endometritis, pelvic inflammatory disease (PID), ectopic pregnancy and tubal factor infertility. It is associated with an increased risk for the transmission or acquisition of HIV and is also attributed to be a risk factor for the development of cervical carcinoma. Early diagnosis and treatment of infected individuals is required to prevent the spread of the disease and severe sequelae. Traditionally, tissue culture was considered the gold standard for the diagnosis. However, with the availability of newer diagnostic techniques particularly molecular methods which are not only highly sensitive and specific but are cost-effective also, the diagnosis has became fast and easy. The purpose of this review is to study the various aspects of genital C. trachomatis infection. Also the advances related to the clinical picture, various diagnostic modalities, prevention, treatment, drug resistance and control measures will be dealt with.

Therapeutic potential of natural products from terrestrial plants as TNF-α antagonist

Tumor necrosis factor-alpha (TNF-α) is a multifunctional cytokine produced by monocytes, macrophages, neutrophils, T-cells, mast cells, epithelial cells, osteoblasts and dendritic cells. It can regulate numerous cellular and biological processes such as immune function, cell differentiation, proliferation, apoptosis and energy metabolism. It is also involved in the pathogenesis of multiple chronic inflammatory or autoimmune diseases. The biological activities of TNF-α mediated by two receptors TNFR1 and TNFR2. Its activity can be inhibited by neutralizing monoclonal antibodies or soluble TNF receptors. The inhibition of its biological activities using anti TNF-α antibodies represents an approved strategy for the treatment of various diseases like cancer, autoimmune diseases, inflammations etc. The involvement of TNF-α cytokine in the various types of diseases provide the therapeutic rationale for the development of TNF-α antagonist. A large number of natural and synthetic compounds are currently being investigated for TNF-α inhibitory activity. Since the synthetic molecules are always associated with their side effects hence it is beneficial to develop the natural strategies as the alternative sources. There are many medicinal plants which are traditionally used for the treatment of the diseases associated with TNF-α inhibition. Hence, in this review article we make an approach to provide a platform for the development of TNF-α antagonist from natural resources.

Highly efficient iron phthalocyanine catalyzed oxidative synthesis of imines from alcohols and amines

An efficient iron phthalocyanine catalyzed method was developed for direct oxidative coupling of alcohols with amines to afford corresponding imines. The present protocol is applicable to various substituted aromatic and aliphatic alcohols and amines. The reaction is believed to proceed via activation of alcohols by iron phthalocyanines through Lewis acid–base interaction to form aldehydes, which by nucleophilic attack of amines are converted into the corresponding imines.

Development of web based database on biochemical characteristics of rapeseed-mustard

Rapeseed-mustard oil is an essential dietary component, in India. The modification of rapeseed- mustard for fatty acid composition of seed oil to develop new genotypes having alternative oil and meal characteristics has been an important objective in quality breeding. Moreover, Breeding efforts in India are in progress to develop double low varieties to meet the internationally acceptable standards of oil and seed meal. So, information on the nutritional and anti-nutritional make-up of rapeseed-mustard oil and seed meal of the existing germplasm would be quite useful for the researchers especially breeders involved in the quality improvement programmes. In the present study database on biochemical characteristics of rapeseed-mustard has been developed using open source technology LAMP. The database provides the information on 14 important biochemical characters such as oil, saturated fatty acids, oleic, linoleic, linolenic, eicosenoic, erucic acid, monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA), ω6/ω3 ratio, protein, glucosinolate, phenol, and fiber content. It offers web interface to submit and search data in the database. The database presently comprises biochemical characteristics of germplasm accessions, advance breeding lines and notified varieties of rapeseed-mustard. The database developed will be useful to the breeders in the selection of desired genotype with specific traits.