Planning and designing of an inpatient isolation facility for hematopoietic stem cell transplant patients

During the last two decades the world has seen an increase in the use of Hematopoietic Stem Cell Transplant (HSCT) which has led to its worldwide expansion. Since, HSCT unit is an advanced set up, developing and maintaining a successful hematopoietic stem cell transplant program with a properly functioning unit enhances the credibility of any tertiary level medical facility especially for a country like ours which is in its early expanding phase of providing transplant services. The underlying principle for designing any HSCT facility is to maintain the highest possible level of aseptic environment for patients undergoing the transplant in order to prevent healthcare associated infections. Basic premises of designing the entire HSCT unit was to ensure restricted access to the facility and having an aseptic environment by implementing infection control parameters in design elements, which are explained subsequently in the article. The present manuscript describes the project experience of creating a positive pressure isolation facility for HSCT patients at a tertiary care hospital, India, which is a resource limited setting with an emphasis on need assessment, key elements in planning and designing along with the challenges associated with it.

Impact of ‘never use’ abbreviations (Error Prone Abbreviations-EPA’s) list on the incidence of EPAs in inpatient medical prescriptions in apex tertiary care public hospital in India

Aim:

The aim of the study was to assess the impact of never-use list and standardized abbreviations on error prone abbreviations

Background:

Abbreviations are commonly used in medical records to save time and space but use in prescriptions, which can lead to communication failures and preventable harm. Prescriptions need to be clear for correct interpretation. Hospitals should implement uniform use of approved abbreviations, such as an approved list or never-use list of abbreviations and symbols. In the hospital under study, there was no system of avoiding error prone abbreviations while prescribing any medication. Hence, an interventional study was performed to quantify and reduce the incidence of error prone abbreviations.

Objectives:

The main objectives were to determine the incidence of error prone abbreviations, development and implementation of ‘Never-use’ list and standardized abbreviations and finally determine its effectiveness in reducing the error prone abbreviations in the prescriptions.

Methods:

The study design was pre-post interventional / quasi-experimental design. The settings were inpatient wards of broad specialties of a tertiary care hospital. ‘Never-use’ list and standardized abbreviations were developed by review of relevant literature, existing lists by Institute for Safe Medication Practices and Australian Commission on Safety and Quality in Health Care compared against findings of pilot study of prescriptions for error prone abbreviations and experts’ input. Poster copies of the lists were affixed in inpatient wards, doctors were educated and poster pamphlets were distributed. Pre intervention data was collected by a retrospective closed in-patient medical record review. Post interventional incidence of error prone abbreviations was determined and the effectiveness of the same was assessed by using statistical analysis.

Results:

Incidence of error abbreviations in inpatient prescription was 47.5% and ‘Never Use’ list of abbreviation led to a statistically significant reduction of error-prone abbreviation by 8.2% from 47.5% to 43.6% (P\0.006).

Conclusion:

‘Never Use’ lists are effective in reducing incidence of common error-prone abbreviations and discipline wise variation is observed.

In silico to In vivo development of a polyherbal against Haemonchus contortus

Haemonchus contortus is a major constraint in the development of small ruminant subsector due to significant production losses incurred by it. The present study explores the antiparasitic potential of three anthelmintic plants (Butea monosperma, Vitex negundo and Catharanthus roseus (L.) G.Don) against H. contortus taking albendazole as the standard. In silico molecular docking and pharmacokinetic prediction studies were conducted with known bioactive molecules of these plants (palasonin, vinblastine, vincristine, betulinic acid and ursolic acid) against Glutamate Dehydrogenase (GDH) and tubulin molecules of the parasite. Methanolic extracts of these herbs were fractionated (hexane, ethyl acetate, chloroform and methanol) and used in in vitro larvicidal studies. Based on the in vitro data, two herbal prototypes were developed and clinically tested. All the 5 ligand molecules showed better binding affnity for GDH and tubulin protein as compared with albendazole and shared similar binding site in the core of the GDH hexamer with slight variations. Albendazole approximately stacked against GLY190A residue, showing hydrophobic interactions with PRO157A and a Pi-cation electrostatic interaction with ARG390 along with four hydrogen bonds. Vincristine formed 2 pi-anionic electrostatic bonds with ASP158 of B and C subunits alongwith hydrogen bonding and hydrophobic interaction and an additional pi-anion electrostatic interaction at ASP158A for vinblastine. Albendazole bound to α-tubulin next to colchicine site whereas vinblastine is bound at the nearby laulimalide/peloruside site of the dimer. Betulinic acid showed lateral interaction between the H2-H3 loop of one alpha subunit and H10 of the adjacent alpha subunit of two tubulin dimers. Ursolic acid and palasonin bound at the intradimer N site of microtubulin involving the H1-H7 and H1-H2 zone, respectively. The in vitro studies demonstrated good dose dependent anthelmintic potential. Both the prototypes were quite efficacious in clearing the infection, keeping it to a minimal for more than 5 months, probably, through direct anthelmintic effect through GDH, tubulin depolymerization and uncoupling as well as indirectly through immunomodulation along with antioxidant and anti-inflammatory properties.

More from less: Study on increasing throughput of COVID-19 screening and testing facility at an apex tertiary care hospital in New Delhi using discrete-event simulation software

Background

One of the challenges has been coping with an increasing need for COVID-19 testing. A COVID-19 screening and testing facility was created. There was a need for increasing throughput of the facility within the existing space and limited resources. Discrete event simulation was used to address this challenge.

Methodology

A cross-sectional interventional study was done from September 2020 to October 2020. Detailed process mapping with all micro-processes was done. Patient arrival patterns and time taken at each step were measured by two independent observers at random intervals over two weeks. The existing system was simulated and a bottleneck was identified. Two possible alternatives to the problem were simulated and evaluated.

Results

Scenario 1 showed a maximum throughput of 316. The average milestone times of all the processes after the step of “Preparation of sampling kits” jumped 62%; from 82 to 133 min. Staff state times also showed that staff at this step was stretched and medical lab technicians were underutilized. Scenario 2 simulated the alternative with lesser time spent on sampling kit preparation with a 22.4% increase in throughput, but could have led to impaired quality check. Scenario 3 simulated with increased manpower at the stage of bottleneck with 26.5% increase in throughput and was implemented on-ground.

Conclusion

Discrete event simulation helped to identify the bottleneck, simulate possible alternative solutions without disturbing the ongoing work, and finally choose the most suitable intervention to increase throughput, without the need for additional space allocation. It therefore helped to optimally utilize resources and get “more from less.”

National guidelines for sanitation services: Addressing the unmet need of standardizing cleaning practices in tertiary care public health facilities of a developing country

BACKGROUND

Cleanliness is one of the main reasons for poor satisfaction among the patients and their attendants visiting healthcare facilities.

OBJECTIVE

To elevate and transform the sanitation in public sector facilities, a committee was constituted by Ministry of Health and Family Welfare, Government of India to study the existing system of Housekeeping in Central Government Hospitals and draft the Guidelines for house-keeping services, since no such literature is available in context of the healthcare facilities in India.

METHODS

The committee ascertained the housekeeping services in three tertiary care hospitals of Central Government and simultaneously conducted the literature review of the best practices in hospital sanitation and housekeeping.

RESULTS

Formulated national guidelines focus on various aspects of sanitation services in health facilities, i.e., hospital infrastructure; organization of sanitation services; human resource requirements; qualification, experience and training needs of sanitation staff; roles and responsibilities of different personnel; risk categorization of hospital areas; mechanized cleaning; cleaning agents; cleaning standards and standard operating procedures; effective supervision and monitoring; procurement of these services, etc.

CONCLUSION

Formulated guidelines can be adopted by developing countries aiming for standardizing cleaning practices in public health facilities.

Chemotactic factor inducing Interleukin-8 (IL8) gene is transcriptionally elevated in experimental enterotoxaemia in goats caused by Clostridium perfringens type D

The current study was designed to analyse the effects of experimental induction of enterotoxaemia through intra-duodenal inoculation of C. perfringens type D culture isolated from spontaneous outbreaks in goats. Twenty goats (6–9 month age) were divided into four groups and C. perfringens type D culture was inoculated intra-duodenally as per following: Group-I (whole cultures-WC), group-II (culture supernatant-CS), group-III (washed cells-WS), and group-IV (uninfected control-C). The treated animals were sacrificed after 72 h post infection (hpi), and necropsy showed gross changes including haemorrhages and congestion in the ileal and colon mucosa, pulmonary congestion and edema in lung. Kidney, brain and spleen exhibited severe to moderate congestion. Microscopic changes like haemorrhages, degenerative and necrotic changes in the mucosal epithelium of intestine and haemorrhages in kidney parenchyma were observed in the H&E stained sections. Lung alveolar sacs were filled with proteinaceous fluid. Immunohistochemistry revealed positive immunolabelling for etx (epsilon toxin) in the mucosa of intestine in WC and CS group. Control animals did not exhibit any significant gross or microscopic changes. PCR amplification of DNA extracted from intestinal tissues of WC and CS groups showed positive for etx gene demonstrating the production of epsilon toxin. Transcriptional responses in experimental groups were assessed by quantitative reverse transcription real time PCR (qRT-PCR). Genes including IL-1β and IL2 showed up-regulation in all the experimental groups (WC, CS&WS). Specifically the toxin-based experimental groups (WC&CS) showed up-regulation of the gene responsible for chemotaxis viz. IL-8, while the washed cells group (WS) showed higher transcriptional response to Cathepsin-L (Cat-L) gene denoting the acute inflammatory response due to neutrophil elastase activity. These results take a cue on the evolving nature of the enterotoxaemia in goats due to various strains circulating in the field. The host response and its modulation due to the novel enterotoxaemia strains throws light on the current challenges in efficient control of the disease in goats.

War on waste: Challenges and experiences in COVID-19 waste management

COVID-19 has posed formidable challenges including overwhelming bio-medical waste. Guidelines have been rapidly changing along with mounting pressure of waste generation. These challenges were managed by smart re-engineering of structure and processes for desired outcomes. Dedicated staff in PPE with appropriate training were deployed to collect waste using dedicated trolleys. A dedicated route plan was drawn with a dedicated lift meant for COVID-19. A new temporary holding area was created. Dedicated trucks with requisite labels were deployed to transport COVID-19 waste to CBWTF. Communication challenge was addressed through timely circulars, which were further reinforced and reiterated during various on-going training programs.Before the onset of COVID-19 pandemic Bio-Medical Waste generated was 1.93kg/Bed/Day and currently the quantum of COVID-19 biomedical waste generated is 7.76Kg/COVID Bed/Day. Daily COVID-19 waste generation data is maintained and uploaded in an android Application. Till date none of the worker handling COVID-19 waste has acquired Healthcare associated COVID-19 infection which reflects on the soundness of the new system and the infection control practices in the Institute. A responsive leadership harmonizing with a robust communication and training system has augmented timely re-engineering of structure and processes for better outcomes in the war on waste.

Saving the Greater Adjutant Stork by Changing Perceptions and Linking to Assamese Traditions in India

The Greater Adjutant Stork (Leptoptilos dubius), locally known as Hargila (the bone swallower) is an endangered bird with an estimated global population of less than 1200. Habitat loss, poisoning, and poaching have caused large declines in populations of this stork in South Asia, with the Brahmaputra valley in Assam in northeastern India now the last stronghold for the species. The stork nests colonially in privately owned trees within thickly populated villages. Tree owners would cut down trees to prevent rotten food and excreta of this carnivorous bird from falling into their backyards. A change in attitudes of the nest-tree owners towards keeping their trees and towards Greater Adjutants has been the key to stork conservation. A conservation project involving community development, education and outreach, interlinking storks with local traditions and cultures, and capacity building of local communities was initiated in 2007. A rural women's conservation group named the Hargila Army was instituted and strong feelings of pride and ownership for the storks by the villagers have been generated. Cash incentives for nest protection were deliberately avoided, with schemes that indirectly contribute to the livelihoods of nest-tree owners and other villagers introduced instead. The success of the conservation program is shown by the increase in the number of nesting colonies in the village area of Dadara, Pachariya, and Singimari in Kamrup District in Assam from 28 nests in 2007–08 to 208 nests in the 2019–20 breeding season, making this the largest breeding colony of Greater Adjutant Storks in the world.

Perceived Climate Variability and Compounding Stressors: Implications for Risks to Livelihoods of Smallholder Indian Farmers

Micro-scale perspectives are seldom included in planned climate change adaptations, yet farmers' perceptions can provide useful insights into livelihood impacts from interactions between climatic and other stressors. This research aims to understand how climate variability and other stressors are impacting the livelihoods of smallholder farmers in Azamgarh district, eastern Uttar Pradesh, India. Data from 84 smallholder farmers were collected using mixed qualitative and quantitative approaches, including interview and participatory methods, informed by multiple stressor and sustainable livelihood frameworks. Results revealed that farmers are increasingly facing problems caused by the reduced duration and number of rainy days, and erratic rainfall. Anomalies in seasonal cycles (longer summers, shorter winters) seem to have altered the local climate. Farmers reported that repeated drought impacts, even in years of moderate rainfall, are adversely affecting the rice crop, challenging the formal definition of drought. Climate variability, identified as the foremost stressor, often acts as a risk multiplier for ecological (e.g., soil sodicity), socio-economic (e.g., rising costs of cultivation) and political (e.g., mismatching policies and poor extension systems) stressors. In addition to climate stresses, resource-poor marginal groups in particular experienced higher risks resulting from changes in resource management regimes. This study provides an important cue to revisit the formal definitions of normal rainfall and drought, accommodating farmers' perceptions that evenly distributed rainfall, and not total rainfall is a key determinant of crop yields. Though India has developed adaptive measures for climate change and variability, integration of farmers' perceptions of climate and other stressors into such policies can improve the resilience of smallholder farmers, who have hitherto depended largely on autonomous adaptation strategies.

Medical Social Service Officers and their contribution in COVID-19 Pandemic

Social workers perform diverse roles in a hospital setting. They constitute an important workforce extending help to patients for their varied needs. In the current pandemic as well, team of social workers worked round the clock to arrange for the resources and facilitated important hospital functions. They are the “unsung heroes” amongst the front line warriors who sometimes even do not get their due recognition.

A sustainable approach for graphene-oxide surface decoration using Oxalis corniculata leaf extract-derived silver nanoparticles: their antibacterial activities and electrochemical sensing

In this work, a facile green synthesis using Oxalis corniculata leaf extract (OCLE) as a biodegradable reducing and capping/stabilizing agent was carried out for the construction of Oxalis corniculata leaf extract-derived silver nanoparticles (OCLE-AgNPs). Moreover, OCLE-AgNPΔGO nanocomposites were fashioned simply by mixing a GO suspension and supernatant OCLE-AgNPs via a one-pot environmentally benign method. The AgNPΔGO nanocomposites are biocompatible materials for potential applications such as antibacterial activities against two different types of bacterial cells, namely Gram-positive Bacillus subtilis and Gram-negative Escherichia coli and selective electrochemical sensing to itraconazole (ITRA) at the fabricated GCE (AgNPΔGO@GCE). AgNPΔGO@GCE sensors gave excellent outcomes for ITRA as higher current response over the bare GCE. Under optimized conditions, the oxidation peak current of ITRA varied linearly with a wide range of the concentration between 26.7 μM and 103.8 μM with a correlation coefficient of 0.997 and a detection limit of 0.1276 μM, for differential pulse anodic stripping voltammetric (DP-ASV) technique. In addition, the possible mechanism for the ITRA oxidation was further verified and explained by single-electron transfer (SET) and proton removal mechanism steps. The developed sensor exhibited good repeatability, reproducibility, and stability. The use of environmentally benign and renewable plant material offers enormous benefits of eco-friendliness applicability.

Ageing of Polymer Frictional Interfaces: The Role of Quantity and Quality of Contact

When two objects are in contact, the force necessary for one to start sliding over the other is larger than the force necessary to keep the sliding motion going. This difference between static and dynamic friction is thought to result from a reduction in the area of real contact upon the onset of slip. Here, we resolve the structure in the area of contact on the molecular scale by means of environment-sensitive molecular rotors using (super-resolution) fluorescence microscopy and fluorescence lifetime imaging. We demonstrate that the macroscopic friction force is not only controlled by the area of real contact but also controlled by the "quality" of that area of real contact, which determines the friction per unit contact area. We show that the latter is affected by the local density of the contacting surfaces, a parameter that can be expected to change in time at any interface that involves glassy, amorphous materials.

Outcome of care in an apex tertiary care referral institute of North India – A study of 90,000 patients

Introduction:

Outcome of care is an important measure of quality in health care and also provides input for healthcare planning. It is an indicator which can be used for comparing performance of various hospital/Institute.

Aims:

Study intended to analyze the morbidity and mortality pattern among admitted patients with respect to selected hospital indices.

Study Settings:

All India Institute of Medical Sciences (AIIMS), New Delhi.

Subjects and Methods:

A cross-sectional retrospective study was conducted in 93,223 patients admitted at AIIMS, New Delhi. Information provided in Management Information System (MIS) was used for analysing morbidity as per International Statistical Classification of Diseases (ICD)-10.

Results:

Diseases related to the genitourinary system (14.25%) and neoplasms (14.18%) were the most common cause of admissions. Overall, predominance of adult age group (61.6%) followed by geriatric age group (20.5%) was observed. Male predominance was observed in diseases related to mental, behavioural, and neurodevelopmental disorders (89.2%). Overall, median length of stay was calculated to be 4 days (mean LOS-7 days), maximum for diseases related to mental, behavioural, and neurodevelopmental disorders (median 13 days). Gross and net death rate for admitted patients was calculated to be 4.3% and 3%, respectively, with maximum rate for diseases related to respiratory system (22.7% and 17%).

Conclusions:

Analysis of morbidity and mortality in high volume tertiary care centers and segregation of the patients according to their ailment and disease behaviour helps in establishing priorities in healthcare delivery system and thus allocating limited resources accordingly.

Multimetal tolerance mechanisms in bacteria: The resistance strategies acquired by bacteria that can be exploited to 'clean-up' heavy metal contaminants from water

Heavy metal pollution is one of the major environmental concerns worldwide. Toxic heavy metals when untreated get accumulated in environment and can pose severe threats to living organisms. It is well known that metals play a major role either directly or indirectly in different metabolic processes of bacteria. This allows bacterial cells to grow even in the presence of some toxic heavy metals. Microbial biotechnology has thus emerged as an effective and eco friendly solution in recent years for bioremediation of heavy metals. Therefore, this review is focused on summarising bacterial adaptation mechanisms for various heavy metals. It also shares some applications of have metal tolerant bacteria in bioremediation. Bacteria have evolved a number of processes for heavy metal tolerance viz., transportation across cell membrane, accumulation on cell wall, intra as well as extracellular entrapment, formation of complexes and redox reactions which form the basis of different bioremediation strategies. The genetic determinants for most of these resistances are located on plasmids however some may be chromosomal as well. Bacterial cells can uptake heavy by both ATP dependent and ATP independent processes. Bacterial cell wall also plays a very important role in accumulating heavy metals by bacterial cells. Gram-positive bacteria accumulate much higher concentrations of heavy metals on their cell walls than that of metals gram -ve bacteria. The role of bacterial metallothioneins (MTs) in heavy metal has also been reported. Thus, heavy metal tolerant bacteria are important for bioremediation of heavy metal pollutants from areas containing high concentrations of particular heavy metals.

Response of stigma receptivity in CMS and male fertile line of Indian mustard (B. juncea) under variable thermal conditions

Field experiments were conducted for 2 years to examine the response of stigma in two different pollination systems, viz., CMS line (MJA5) and open-pollinated variety (Pusa Bold) of Indian mustard (Brassica juncea), to varying weather conditions created by different sowing dates. The CMS line MJA5 (female) with its male line in 8:2 (A:R) row ratio, and Pusa Bold in an isolated field were sown on 21st of October, 30th of October, and 18th of November in 2 consecutive years in North Indian condition. Temporal differences in sowing provided differed weather conditions during flowering, which resulted in variations in the duration to attain the peak flowering stage. Stigma was receptive for longer duration (8 days from the day of anthesis) in CMS line which needs an external pollen source for fertilization to happen, whereas it was only 4 days in open-pollinated variety, assessed in terms of siliqua set and number of seeds/siliqua. Substantial effect of sowing date on stigma receptivity was observed; it was longer in plants sown during October in comparison to those of November in both years. The energy requirement parameters, viz., growing degree days and photo-thermal unit, confirmed that plants sown later failed to accumulate sufficient energy for satisfactory phenological growth and for good seed development.

Evaluation of multiplex polymerase chain reaction as an alternative to conventional antibiotic sensitivity test

Aim

This study was designed to evaluate the potential of the use of multiplex polymerase chain reaction (PCR) as an alternative to conventional antibiotic sensitivity test.

Materials and Methods

Isolates of Staphylococcus aureus (total = 36) from clinical cases presented to Teaching Veterinary Clinical Complex of College of Veterinary and Animal Sciences (CVAS), Navania, Udaipur, were characterized by morphological, cultural, and biochemical methods. Then, the isolates were further subjected to molecular characterization by PCR targeting S. aureus-specific sequence (107 bp). Phenotypic antibiotic sensitivity pattern was analyzed by Kirby-Bauer disc diffusion method against 11 commonly used antibiotics in veterinary medicine in and around Udaipur region. The genotypic antibiotic sensitivity pattern was studied against methicillin, aminoglycosides, and tetracycline targeting the gene mecA, aacA-aphD, and tetK by multiplex PCR.

Results

There was 100% correlation between the phenotype and genotype of aminoglycoside resistance, more than 90% correlation for methicillin resistance, and 58.3% in the case tetracycline resistance.

Conclusion

As there is a good correlation between phenotype and genotype of antibiotic resistance, multiplex PCR can be used as an alternative to the conventional antibiotic susceptibility testing, as it can give a rapid and true prediction of antibiotic sensitivity pattern.

Effect of nutrient management on soil organic carbon sequestration, fertility, and productivity under rice-wheat cropping system in semi-reclaimed sodic soils of North India

The ever shrinking agricultural land availability and the swelling demand of food for the growing population fetch our attention towards utilizing partially reclaimed sodic soils for cultivation. In the present investigation, we compared six treatments, like control (T1), existing farmers' practice (T2), balanced inorganic fertilization (T3) and combined application of green gram (Vigna radiate) with inorganic NPK (T4), green manure (Sesbania aculeate) with inorganic NPK (T5), and farmyard manure with inorganic NPK (T6), to study the influence of nutrient management on soil organic carbon sequestration and soil fertility under long-term rice-wheat cropping system along with its productivity in gypsum-amended partially reclaimed sodic soils of semi-arid sub-tropical Indian climate. On an average, combined application of organics along with fertilizer NPK (T4, T5, and T6) decreased soil pH, ESP, and BD by 3.5, 13.0, and 6.7% than FP (T2) and 3.7, 12.5, and 6.7%, than balanced inorganic fertilizer application (T3), respectively, in surface (0-20 cm). These treatments (T4, T5, and T6) also increased 14.1% N and 19.5% P availability in soil over the usual farmers' practice (FP) with an additional saving of 44.4 and 27.3% fertilizer N and P, respectively. Long-term (6 years) incorporation of organics (T4, T5, and T6) sequestered 1.5 and 2.0 times higher soil organic carbon as compared to the balanced inorganic (T3) and FP (T2) treatments, respectively. The allocation of soil organic carbon into active and passive pools determines its relative susceptibility towards oxidation. The lower active to passive ratio (1.63) in FYM-treated plots along with its potentiality of higher soil organic carbon (SOC) sequestration compared to the initial stock proved its acceptability for long-term sustenance under intensive cropping even in partially reclaimed sodic soils. Among all the treatments, T4 yielded the maximum from second year onwards. Moreover, after 6 years of continuous cultivation, the observed EWY (2011-2012) was found to be 41.9 and 33.1% higher in T4 as compared to FP (T2) and T3, respectively. Thus, for maintaining higher yield coupled with improved SOC sequestration and nutrient availability, T4 followed by T6 treatments would be the suitable options for long-term intensive rice-wheat system in partially reclaimed sodic soils of northern India.

Prevalence and bacterial etiology of subclinical mastitis in goats reared in organized farms

Aim:

Assessment of the status of subclinical mastitis (SCM) in Jamunapari and Barbari goats in Indian organized farms, the involvement of bacterial pathogens and their sensitivity to antibiotics.

Materials and Methods:

A total of 181 composite milk samples were aseptically collected from the apparently healthy Barbari (n=95) and Jamunapari (n=86) goats. The California mastitis test (CMT) and somatic cell count (SCC) were used to diagnose SCM. The milk samples with CMT scores of 0 and +1 were considered as negative, while the samples with the score of +2 or +3 were taken as positive, and further, the positive samples were used for the bacteriological examination. An antibiotic sensitivity test was performed by disk diffusion method using seven commercially available antibiotic discs.

Results:

All the samples having CMT score of +2 or +3 demonstrated SCC more than 1 million. Overall, the prevalence of SCM in the goats was assessed as 19.89% (36/181). The prevalence of SCM in Barbari and Jamunapari goats was found as 24.21% (23/95) and 15.12% (13/86), respectively. Out of 11 isolates of Staphylococci, 9 isolates were identified as coagulase-negative Staphylococci (CNS), whereas 2 isolates were found as Staphylococcus aureus. The identified bacterial isolates (n=30) did not show antibiotic resistance.

Conclusion:

The current investigation showed the considerable prevalence of SCM among Jamunapari and Barbari goats which may have a negative impact on quantity and quality of the milk. CNS was found as the most prevalent cause of SCM in the goats. Negligible antibiotic resistance was found among the identified udder pathogens.

1-(4-Methoxyphenyl)-3-[2-(4-methylpiperazin-1-yl)quinolin-3-yl]prop-2-en-1-one

In the title molecule, C24H25N3O2, the piperazine ring adopts a chair conformation. The methoxyphenyl-substituted ring makes a dihedral angle of 6.79 (5)° with the quinoline ring system. In the crystal, molecules are consolidated in the crystal packing by a combination of weak C—H...N and C—H...O interactions. π–π stacking interactions also occur.

Sex differences and other correlations of Human Corpus Callosum: A review

There is a wide spectrum in the field of sex differences and other correlation in human corpus callosum. More recent literatures have raised doubts as to whether the anatomic size of the corpus is actually different. The aim of this review article is to bring out the actual facts about gender distinction and various associations in human corpus callosum. Related literatures in the subject were reviewed through electronic database like PubMed, NCBI, Google Scholar, Web of science and conclusion was derived comparing the similarities, dissimilarity and relationship of corpus callosum. A simple ratio of corpus callosum to whole brain size is not an appropriate way to analyse data and can create a false impression of dimorphism in the corpus callosum. Overall no sex difference could be found in the size of the corpus callosum, whether ornot explanation was taken oflarger male brain size. RecentMRI studies showed no difference in thickness of the corpus callosum when accounting for the size of the subject. The corpus callosum has been reported to be larger in musicians, left-handed persons whereas smaller in children with dyslexia. Hypogenesis, dysgenesis and agenesis of corpus callosum are rare congenital anomalies presented with feeding problems and delays in holding the head erect during sitting, standing & walking; and impairments in mental & physical development, hand-eye coordination and visual & auditory memory.

Assessing soil properties and nutrient availability under conservation agriculture practices in a reclaimed sodic soil in cereal-based systems of North-West India

Soil quality degradation associated with resources scarcity is the major concern for the sustainability of conventional rice-wheat system in South Asia. Replacement of conventional management practices with conservation agriculture (CA) is required to improve soil quality. A field experiment was conducted to assess the effect of CA on soil physical (bulk density, penetration resistance, infiltration) and chemical (N, P, K, S, micronutrients) properties after 4 years in North-West India. There were four scenarios (Sc) namely conventional rice-wheat cropping system (Sc1); partial CA-based rice-wheat-mungbean system (RWMS) (Sc2); CA-based RWMS (Sc3); and CA-based maize-wheat-mungbean (Sc4) system. Sc2 (1.52 Mg m^-3) showed significantly lower soil bulk density (BD). In Sc3 and Sc4, soil penetration resistance (SPR) was reduced and infiltration was improved compared to Sc1. Soil organic C was significantly higher in Sc4 than Sc1. Available N was 33% and 68% higher at 0-15 cm depth in Sc3 and Sc4, respectively, than Sc1. DTPA extractable Zn and Mn were significantly higher under Sc3 and Sc4 compared to Sc1. Omission study showed 30% saving in N and 50% in K in wheat after four years. Therefore, CA improved soil properties and nutrient availability and have potential to reduce external fertilizer inputs in long run.

Identification of mega-environments and rice genotypes for general and specific adaptation to saline and alkaline stresses in India

In the present study, a total of 53 promising salt-tolerant genotypes were tested across 18 salt-affected diverse locations for three years. An attempt was made to identify ideal test locations and mega-environments using GGE biplot analysis. The CSSRI sodic environment was the most discriminating location in individual years as well as over the years and could be used to screen out unstable and salt-sensitive genotypes. Genotypes CSR36, CSR-2K-219, and CSR-2K-262 were found ideal across years. Overall, Genotypes CSR-2K-219, CSR-2K-262, and CSR-2K-242 were found superior and stable among all genotypes with higher mean yields. Different sets of genotypes emerged as winners in saline soils but not in sodic soils; however, Genotype CSR-2K-262 was the only genotype that was best under both saline and alkaline environments over the years. The lack of repeatable associations among locations and repeatable mega-environment groupings indicated the complexity of soil salinity. Hence, a multi-location and multi-year evaluation is indispensable for evaluating the test sites as well as identifying genotypes with consistently specific and wider adaptation to particular agro-climatic zones. The genotypes identified in the present study could be used for commercial cultivation across edaphically challenged areas for sustainable production.

Atlantooccipital Fusion: Prevalence and its Developmental and Clinical Correlation

INTRODUCTION

Atlantooccipital fusion or occipitalization of atlas or assimilation of atlas is a rare or uncommon abnormality recorded in anatomical, morphological and radiological studies. It is usually associated with reduction in dimensions of foramen magnum leading to acute or chronic neurovascular compression and clinical manifestations of varying severity. Though, atlantooccipital fusion is rare but it is important and significant for the physicians and surgeons for their diagnostic and therapeutic approach.

AIM

To know the prevalence of atlantooccipital fusion in South Asian population predominantly in Central India and its embryological and clinical correlation by reviewing literature and earlier studies.

MATERIALS AND METHODS

This study included careful examination for the atlantooccipital fusion on total 192 human skulls of both genders, available in the Department of Anatomy AIIMS Raipur, Chhattisgarh, India, Department of Anatomy and Forensic Medicine of Gandhi Medical Colledge, Bhopal, Madhya Pradesh, India and Pt. Jawahar Lal Nehru Memorial Medical College, Raipur. Morphometric measurements of the abnormal skulls were done, analysed and recorded. Observations and findings of this study were correlated embryologically and clinically with the results and claims of previous studies and literature, and accordingly the conclusions were drawn.

RESULTS

We found only two skulls with atlantooccipital fusion, in overall study of 192 skulls. The first skull showed incomplete atlantooccipital fusion on the left side with little right lateral inclination and missing posterior tubercle/spinous process and adjoining part of posterior arch of atlas, whereas the second skull showed complete atlantooccipital fusion.

CONCLUSION

We conclude that the prevalence of atlantooccipital fusion including complete and incomplete fusion was 1.04%, which is higher than the proclaimed prevalence rate of 0.12% to 0.72%, by the previous studies. In accordance with the fact that the atlantooccipital fusion represents a synostosis between the atlas and the occipital bone due to developmental abnormal segmentation of cranial part of paraxial mesoderm and abnormal fusion between segments of caudal occipital and cranial cervical sclerotomes, we would like to thereby assert that the fusion associated with the reduction in dimensions of foramen magnum (reduction also seen in our study) is definitely significant for diagnostic and therapeutic purposes to clinicians.

A new method in estimation of total hexavalent chromium in Portland pozzolan cement

Variamine blue was used first time for the detection of hexavalent chromium from cement samples. In present method, cement was treated sequentially with water, sulphate and carbonate buffer to extract soluble, sparingly soluble and insoluble hexavalent chromium respectively. Extracted Cr (VI) was determined using variamine blue as chromogenic reagent. The determination is based on the reaction of hexavalent chromium with potassium iodide in an acid medium to liberate iodine. This oxidizes variamine blue to form a violet coloured species having an absorption to maximum at 556 nm. Energy-dispersive X-ray spectroscopy (EDX) and Infrared Spectroscopy (IR) confirmed the complete extraction of hexavalent chromium by sequential extraction process. SRM 2701 (Reference material from NIST, USA) was used for revalidating the results. The percentage of recovery for proposed and reference method (diphelycarbazide method) varied from 98.5 to 101 and 97.5 to 100.5. Whereas, their relative error percentage varied from -1.5 to 0.33 and -2.5 to 0.5.

Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs

BACKGROUND & OBJECTIVES

Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India.

METHODS

This prospective study was done in the seven bedded PICU of a large multi-specialty tertiary care hospital in New Delhi, India. A total of 20 children with HAI (cases) and 35 children without HAI (controls), admitted to the PICU during the study period (January 2012 to June 2012), were matched for gender, age, and average severity of illness score. Each patient's length of stay was obtained prospectively. Costs of healthcare were estimated according to traditional and time driven activity based costing methods approach.

RESULTS

The median extra length of PICU stay for children with HAI (cases), compared with children with no HAI (controls), was seven days (IQR 3-16). The mean total costs of patients with and without HAI were ' 2,04,787 (US$ 3,413) and ' 56,587 (US$ 943), respectively and the mean difference in the total cost between cases and controls was ' 1,48,200 (95% CI 55,716 to 2,40,685, p<0.01).

INTERPRETATION & CONCLUSIONS

This study highlights the effect of HAI on costs for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care.

Arsenic in the groundwater: Occurrence, toxicological activities, and remedies

Arsenic (As) contamination in groundwater has become a geo-environmental as well as a toxicological problem across the globe affecting more than 100-million people in nearly 21 countries with its associated disease "arsenicosis." Arsenic poisoning may lead to fatal skin and internal cancers. In present review, an attempt has been made to generate awareness among the readers about various sources of occurrence of arsenic, its geochemistry and speciation, mobilization, metabolism, genotoxicity, and toxicological exposure on humans. The article also emphasizes the possible remedies for combating the problem. The knowledge of these facts may help to work on some workable remedial measure.

Nosocomial infection of CCHF among health care workers in Rajasthan, India

BACKGROUND

Ever since Crimean-Congo hemorrhagic fever [CCHF] discovered in India, several outbreaks of this disease have been recorded in Gujarat State, India. During the year 2011 to 2015 several districts of Gujarat and Rajasthan state (Sirohi) found to be affected with CCHF including the positivity among ticks and livestock. During these years many infected individuals succumbed to this disease; which subsequently led to nosocomial infections. Herein, we report CCHF cases recorded from Rajasthan state during January 2015. This has affected four individuals apparently associated with one suspected CCHF case admitted in a private hospital in Jodhpur, Rajasthan.

CASE PRESENTATION

A 30-year-old male was hospitalized in a private hospital in Jodhpur, Rajasthan State, who subsequently had developed thrombocytopenia and showed hemorrhagic manifestations and died in the hospital. Later on, four nursing staff from the same hospital also developed the similar symptoms (Index case and Case A, B, C). Index case succumbed to the disease in the hospital at Jodhpur followed by the death of the case A that was shifted to AIIMS hospital, Delhi due to clinical deterioration. Blood samples of the index case and Case A, B, C were referred to the National institute of Virology, Pune, India for CCHF diagnosis from the different hospitals in Rajasthan, Delhi and Gujarat. However, a sample of deceased suspected CCHF case was not referred. Subsequently, blood samples of 5 nursing staff and 37 contacts (Case D was one of them) from Pokhran area, Jaisalmer district were referred to NIV, Pune.

CONCLUSIONS

It clearly indicated that nursing staff acquired a nosocomial infection while attending the suspected CCHF case in an Intensive Care Unit of a private hospital in Jodhpur. However, one case was confirmed from the Pokhran area where the suspected CCHF case was residing. This case might have got the infection from suspected CCHF case or through other routes. CCHF strain associated with these nosocomial infections shares the highest identity with Afghanistan strain and its recent introduction from Afghanistan cannot be ruled out. However, lack of active surveillance, unawareness among health care workers leads to such nosocomial infections.

RADIATION DOSE DUE TO RADON AND HEAVY METAL ANALYSIS IN DRINKING WATER SAMPLES OF JAMMU DISTRICT, JAMMU & KASHMIR, INDIA

In the present investigation, radon concentration and heavy metal analysis were carried out in drinking water samples in Jammu district, Jammu & Kashmir, India. The radon concentration was measured by using RAD-7, portable alpha particle detector. The values of radon concentration in drinking water samples were also compared within the safe limit recommended by different health agencies. The total annual effective dose ranged from 53.04 to 197.29 µSv y^-1 The annual effective dose from few locations from the studied area was found to be greater than the safe limit (100 µSv y^-1) suggested by World Health Organisation (WHO) and EU Council. Heavy metal concentration was determined by atomic absorption spectrophotometer. A total of eight elements were analysed, viz. arsenic, mercury, zinc, iron, copper, chromium, manganese and cadmium. Heavy metals are considered to be the major pollutants of water sources. The results were compared with the limits of WHO, EU and Indian organisations. The trace metal analysis is not on the exceeding side of the permissible limit in all the samples.

Screening and structure-based modeling of T-cell epitopes of Nipah virus proteome: an immunoinformatic approach for designing peptide-based vaccine

Identification of Nipah virus (NiV) T-cell-specific antigen is urgently needed for appropriate diagnostic and vaccination. In the present study, prediction and modeling of T-cell epitopes of Nipah virus antigenic proteins nucleocapsid, phosphoprotein, matrix, fusion, glycoprotein, L protein, W protein, V protein and C protein followed by the binding simulation studies of predicted highest binding scorers with their corresponding MHC class I alleles were done. Immunoinformatic tool ProPred1 was used to predict the promiscuous MHC class I epitopes of viral antigenic proteins. The molecular modelings of the epitopes were done by PEPstr server. And alleles structure were predicted by MODELLER 9.10. Molecular dynamics (MD) simulation studies were performed through the NAMD graphical user interface embedded in visual molecular dynamics. Epitopes VPATNSPEL, NPTAVPFTL and LLFVFGPNL of Nucleocapsid, V protein and Fusion protein have considerable binding energy and score with HLA-B7, HLA-B*2705 and HLA-A2MHC class I allele, respectively. These three predicted peptides are highly potential to induce T-cell-mediated immune response and are expected to be useful in designing epitope-based vaccines against Nipah virus after further testing by wet laboratory studies.

Development and evaluation of low cost honey heating-cum-filtration system

A fully mechanized honey heating-cum-filtration system was designed, developed, fabricated and evaluated for its performance. The system comprised of two sections; the top heating section and the lower filtering section. The developed system was evaluated for its performance at different process conditions (25 kg and 50 kg capacity using processing condition: 50 °C heating temperature and 60 °C heating temperature with 20 and 40 min holding time, respectively) and it was found that the total time required for heating, holding and filtration of honey was 108 and 142 min for 25 kg and 50 kg capacity of machine, respectively, irrespective of the processing conditions. The optimum capacity of the system was found to be 50 kg and it involved an investment of Rs 40,000 for its fabrication. The honey filtered through the developed filtration system was compared with the honey filtered in a high cost honey processing plant and raw honey for its microbial and biochemical (reducing sugars (%), moisture, acidity and pH) quality attributes. It was observed that the process of filtering through the developed unit resulted in reduction of microbes. The microbiological quality of honey filtered through the developed filtration system was better than that of raw honey and commercially processed honey. The treatment conditions found best in context of microbiological counts were 60 °C temperature for 20 min. There was 1.97 fold reductions in the plate count and 2.14 reductions in the fungal count of honey processed through the developed filtration system as compared to the raw honey. No coliforms were found in the processed honey. Honey processed through developed unit witnessed less moisture content, acidity and more reducing sugars as compared to raw honey, whereas its quality was comparable to the commercially processed honey.

A Study of personality profile and criminal behavior in substance abusers

AIM

The aim of the present study was to study the personality characteristics and criminal behavior in the substance abusers. The role of various sociodemographic variables in substance abusers, which affected their criminal behavior was also studied. Moreover, in the present study, the personality profile of substance users and nonusers was compared using psychoticism, extraversion, and neuroticism (PEN) inventory.

MATERIALS AND METHODS

A total of 50 consecutive subjects diagnosed as per International Classification of Diseases-10 criteria for substance abuse, fulfilling the inclusive and exclusive criteria were taken. A well-matched control was also assessed to compare the studied subject using a well-designed semi-structured proforma and PEN inventory.

RESULTS

Most of the substance abusers were Hindus, married, belonged to 21-30 age group and urban domicile, and were presently unemployed, educated up to middle class, and belonged to lower socioeconomic status. Family history of substance use was significant in the subjects, and the chief substance of use was opioids. Scores for psychoticism and neuroticism, as well as the criminal behavior was significantly higher in studied subjects.

CONCLUSION

Thus, conclusions drawn were that personality characteristics of the substance abusers differed significantly from the control group and second, the number of variables including occupational status, socioeconomic status, family history of substance use, and type of substance of abuse significantly correlated with the criminal behavior in the substance abusers. Identifying these variables can be the first step in the intervention in substance abusers in order to reduce their future criminal behavior.

Excellent impact strength of ethylene-methyl acrylate copolymer toughened polycarbonate

The notched izod impact strength of PC/EMA blends showed a positive blending effect and increased 381% with incorporation of a very little amount of EMA (5%) with a marginal decrease in tensile strength of PC.

System efficiency analysis for high power solid state radio frequency transmitter

This paper examines some important relationships, related with the system efficiency, for very high power, radio frequency solid-state transmitter; incorporating multiple solid-state power amplifier modules, power combiners, dividers, couplers, and control/interlock hardware. In particular, the characterization of such transmitters, at the component as well as the system level, is discussed. The analysis for studying the influence of the amplitude and phase imbalance, on useful performance parameters like system efficiency and power distribution is performed. This analysis is based on a scattering parameter model. This model serves as a template for fine-tuning the results, with the help of a system level simulator. For experimental study, this approach is applied to a recently designed modular and scalable solid-state transmitter, operating at the centre frequency of 505.8 MHz and capable of delivering a continuous power of 75 kW. Such first time presented, system level study and experimental characterization for the real time operation will be useful for the high power solid-state amplifier designs, deployed in particle accelerators.

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.

Study of C-reactive protein and C3 complement as acute phase reactants in unstable angina

Prevalence rates of coronary artery disease are reported to be very high in Asian Indians. Traditional risk factors alone fail to explain the high rates of coronary artery disease in Indians. Acute phase reactants C-reactive protein and C3 in Indian subjects with unstable angina were evaluated and compared them with suitable controls to test the hypothesis that a relationship exists between acute phase reactants and unstable angina. Forty cases of unstable angina and forty suitable controls were enrolled for the study. Cases of unstable angina had significantly increased level of CRP as compared to control group (p = 0.01098). Statistically significant difference was found between case and control groups in TLC (p = 0.0037) and ESR (p = 0.0368), TLC and ESR being more in case group as compared to control group. C-reactive protein was significantly correlated with TLC, ESR and C3 in case group and TLC and ESR in control group. C3 was significantly correlated with all the other three inflammatory markers. C-reactive protein, TLC and ESR in case group while no correlation was observed with any variable in control group. The present study concludes that a relationship exists between acute phase reactants studied and unstable angina.

Fluoride in groundwater: toxicological exposure and remedies

Fluoride is a chemical element that is found most frequently in groundwater and has become one of the most important toxicological environmental hazards globally. The occurrence of fluoride in groundwater is due to weathering and leaching of fluoride-bearing minerals from rocks and sediments. Fluoride when ingested in small quantities (<0.5 mg/L) is beneficial in promoting dental health by reducing dental caries, whereas higher concentrations (>1.5 mg/L) may cause fluorosis. It is estimated that about 200 million people, from among 25 nations the world over, may suffer from fluorosis and the causes have been ascribed to fluoride contamination in groundwater including India. High fluoride occurrence in groundwaters is expected from sodium bicarbonate-type water, which is calcium deficient. The alkalinity of water also helps in mobilizing fluoride from fluorite (CaF2). Fluoride exposure in humans is related to (1) fluoride concentration in drinking water, (2) duration of consumption, and (3) climate of the area. In hotter climates where water consumption is greater, exposure doses of fluoride need to be modified based on mean fluoride intake. Various cost-effective and simple procedures for water defluoridation techniques are already known, but the benefits of such techniques have not reached the rural affected population due to limitations. Therefore, there is a need to develop workable strategies to provide fluoride-safe drinking water to rural communities. The study investigated the geochemistry and occurrence of fluoride and its contamination in groundwater, human exposure, various adverse health effects, and possible remedial measures from fluoride toxicity effects.

Epidural volume extension: a review

Epidural volume extension is a technical modification of the combined spinal epidural block. It involves the epidural injection of normal saline or a small volume of local anaesthetic after an intrathecal injection, aiming to augment the post-spinal sensory level. Although the consequent sensory block augmentation has been adequately documented, the probable factors influencing epidural volume extension and its implications for clinical practice are not well defined. This article reviews published literature relating to the probable factors affecting epidural volume extension, its clinical implications, case reports of its successful clinical application and summarises its unexplored effects.