Evidence and opportunities for developing non-transgenic genome edited crops using site-directed nuclease 1 approach

The innovations and progress in genome editing/new breeding technologies have revolutionized research in the field of functional genomics and crop improvement. This revolution has expanded the horizons of agricultural research, presenting fresh possibilities for creating novel plant varieties equipped with desired traits that can effectively combat the challenges posed by climate change. However, the regulation and social acceptance of genome-edited crops still remain as major barriers. Only a few countries considered the site-directed nuclease 1 (SDN1) approach-based genome-edited plants under less or no regulation. Hence, the present review aims to comprise information on the research work conducted using SDN1 in crops by various genome editing tools. It also elucidates the promising candidate genes that can be used for editing and has listed the studies on non-transgenic crops developed through SDN1 either by Agrobacterium-mediated transformation or by ribo nucleoprotein (RNP) complex. The review also hoards the existing regulatory landscape of genome editing and provides an overview of globally commercialized genome-edited crops. These compilations will enable confidence in researchers and policymakers, across the globe, to recognize the full potential of this technology and reconsider the regulatory aspects associated with genome-edited crops. Furthermore, this compilation serves as a valuable resource for researchers embarking on the development of customized non-transgenic crops through the utilization of SDN1.

Effect of Carbohydrate Loading in Diabetic Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Controlled Trial

INTRODUCTION

Investigations of preoperative oral carbohydrate (CHO) loading have primarily examined benefits among patients without diabetes. Preoperative CHO-rich beverages in general populations have resulted in reductions in insulin resistance after surgery, protein loss, metabolic derangements, and immune dysfunction. The aim of this study was to assess the effect of CHO loading in diabetic patients undergoing laparoscopic cholecystectomy.

METHODS

Diabetic patients controlled on oral hypoglycemic agent were randomly divided into two groups: (1) Group T - this group will be given 50 g of maltodextrin before two hours of surgery; (2) Group C - this group will be kept nil per oral as per standard protocol. Blood sugar, serum insulin, serum cortisol, and insulin requirement were compared in both groups.

RESULTS

Blood sugar levels of Group C were found to be significantly higher than that of Group T at six hours and 24 hours. In Group T, a rise in baseline serum insulin (8.94 ± 3.43 mIU/l) was observed at 24 hours (13.23 ± 5.71 mIU/l). A change of 4.29 ± 3.00 mIU/l in serum insulin level was observed. The change in baseline serum insulin levels was 47.99%. In Group C too, a rise in baseline serum insulin (6.27 ± 1.74 mIU/l) was observed at 24 hours (18.00 ± 5.34 mIU/l). A change of 11.73 ± 4.97 mIU/l in serum insulin level was observed. The change in baseline HOMA-IR (homeostatic model assessment for insulin resistance) levels in Group T was 53.66%. A rise (4.39 ± 1.63) in baseline HOMA-IR of Group C (1.65 ± 0.45) was observed at 24 hours (6.04 ± 1.76). The change in baseline HOMA-IR levels in Group C was 266.06%.

CONCLUSIONS

CHO loading is observed to be beneficial in diabetic patients undergoing laparoscopic cholecystectomy. No adverse effects or an increased risk of aspiration were observed in the intervention group during the study period.

Neuropsychiatric Outcomes in Intensive Care Unit Survivors

BACKGROUND

Over the last two decades, there has been phenomenal advancement in critical care medicine and patient management. Many patients recover from life-threatening illnesses that they might not have survived a decade ago. Despite a decrease in mortality, these survivors endure long-lasting sequelae like physical, mental, and emotional symptoms.

METHODS

Patients after intensive care unit (ICU) discharge were assessed in a follow-up outpatient department (OPD) clinic for anxiety, stress, and depression. Patients were asked to fill out the questionnaires Depression, Anxiety and Stress Scale-21 (DASS-21) and Short Form-36 (SF-36) for assessment of health-related quality of life (HRQOL) at 4th, 6th, and 8th months after discharge. ICU data were recorded, including patients' demographics, severity of illness and length of stay, and duration of mechanical ventilation. Patients who failed to follow-up in OPD on designated dates were assessed telephonically.

RESULTS

Depression showed a positive, strong, and moderate correlation between length of stay and mechanical ventilation duration. A positive correlation was found between stress and length of stay and duration of mechanical ventilation. A positive strong correlation was found between anxiety and length of ICU stay, and a moderate positive correlation was found between anxiety and duration of mechanical ventilation. A weak correlation was found between age and neuropsychiatric outcomes.

CONCLUSION

The severity of depression, anxiety, and stress was significantly higher at four months compared to six months. Severity decreased with time. Prolonged ICU stay increased levels of anxiety, depression, and stress. HRQOL improved from four to six months.

Non-channeled Video Laryngoscopy as an Alternative to Conventional Laryngoscopy for Intubating Adult Patients in the Intensive Care Unit

Background Endotracheal intubation in the intensive care unit (ICU) is often a risky procedure due to the emergency situation, unstable condition of the patient, and technical problems such as inadequate positioning. Several new techniques, such as video laryngoscopy, have been developed recently to improve the success rate of first-pass intubations and reduce complications. We conducted this study to compare a non-channeled reusable video laryngoscope BPL VL-02 (manufactured by BPL Medical Technologies, Bangalore, India) with a conventional laryngoscope for intubation of adult patients in the ICU. Methodology A total of 72 ICU patients were randomly allocated to be intubated with either conventional direct laryngoscopy via Macintosh blade (group A) or video laryngoscopy with BPL VL-02 (group B). All patients were intubated by the primary investigator and the assistant noted the following parameters: the total number of intubation attempts, total duration of intubation, assistance or alternative technique required, Cormack Lehane grading, and any complications. Results There was no significant difference in the Cormack Lehane grading, number of attempts, or complications between the two groups. On comparing the assistance required during intubation in patients, it was observed that four (11.11%) patients in group A and seven (19.44%) patients in group B needed backward, upward, and rightward pressure on the larynx assistance during intubation. In five (13.89%) patients in group B, Stylet was required during intubation. The difference was statistically significant (p = 0.0308). The video laryngoscopy group (group B) had a longer mean duration of intubation (64.36 ± 6.28 seconds) compared to group A (45.72 ± 11.45 seconds), and the difference was statistically significant (p < 0.0001). Conclusions Non-channeled video laryngoscope (BPL VL-02) is not a suitable alternative to conventional direct laryngoscopy with a Macintosh blade in terms of successful first-pass intubation, total duration of intubation, and assistance required.

Comparative transcriptome profiling of near isogenic lines PBW343 and FLW29 to unravel defense related genes and pathways contributing to stripe rust resistance in wheat

Stripe rust (Sr), caused by Puccinia striiformis f. sp. tritici (Pst), is the most devastating disease that poses serious threat to the wheat-growing nations across the globe. Developing resistant cultivars is the most challenging aspect in wheat breeding. The function of resistance genes (R genes) and the mechanisms by which they influence plant-host interactions are poorly understood. In the present investigation, comparative transcriptome analysis was carried out by involving two near-isogenic lines (NILs) PBW343 and FLW29. The seedlings of both the genotypes were inoculated with Pst pathotype 46S119. In total, 1106 differentially expressed genes (DEGs) were identified at early stage of infection (12 hpi), whereas expressions of 877 and 1737 DEGs were observed at later stages (48 and 72 hpi) in FLW29. The identified DEGs were comprised of defense-related genes including putative R genes, 7 WRKY transcriptional factors, calcium, and hormonal signaling associated genes. Moreover, pathways involved in signaling of receptor kinases, G protein, and light showed higher expression in resistant cultivar and were common across different time points. Quantitative real-time PCR was used to further confirm the transcriptional expression of eight critical genes involved in plant defense mechanism against stripe rust. The information about genes are likely to improve our knowledge of the genetic mechanism that controls the stripe rust resistance in wheat, and data on resistance response-linked genes and pathways will be a significant resource for future research.

Improvement in Patient Satisfaction and Anxiety With Perioperative Music Therapy in Patients Undergoing Total Abdominal Hysterectomy: A Single-Blind Prospective Study

Introduction Listening to music is a safe and low-cost way to reduce preoperative anxiety among patients, but more research is needed to evaluate its effectiveness fully. Aims The aim of the study is to identify the effect of intraoperative music therapy on the visual analogue scale for anxiety (VASA) scores (VASA 1 and VASA 2) and patient satisfaction score (PSS) perioperatively. Methods In a study of 188 patients aged 40-70, those in group A (94 patients) listened to pre-approved music during their surgery for abdominal hysterectomy, while group B (94 patients) did not. Both groups wore noise-cancelling earphones. VASA was recorded before (VASA 1) and after (VASA 2) the surgery. PSS was recorded in the postoperative ward. Music preferences were kept confidential from the investigator recording the scores. Result The two groups of patients had similar demographic profiles and baseline characteristics. The VASA 1 of both groups was similar, with a mean value of 4.36 ± 1.13 for group A and 4.23 ± 1.05 for group B (p = 0.606). However, group A had lower VASA 2 (1.79 ± 0.83) than group B (3.77 ± 0.98). The difference was statistically significant (p < 0.001). The patient satisfaction score in group A was notably higher than those in group B. A total of 52 patients were highly satisfied in group A as compared to none in group B (p < 0.001), and a total of 42 patients were moderately satisfied as compared to eight patients in group B (p < 0.001). Eighty-six patients in group B were unsatisfied. Conclusion According to our research, playing specific music at the right volume can significantly lower anxiety levels and increase patients' satisfaction scores for those who have had abdominal hysterectomy surgeries.

High-Flow Nasal Cannula as an Alternate Weaning Strategy: A Randomized Controlled Trial

Background Extubation failure is associated with increased morbidity and poor outcomes. This study aimed to ascertain the effectiveness of a high-flow nasal cannula (HFNC) as a weaning method compared to conventional weaning. Methodology A total of 60 mechanically ventilated patients, aged 18-65 years, who were ventilated for 48 hours and whose underlying pathology had either resolved or was improving, were enrolled in this study. They were randomized in a 1:1 ratio to participate in the HFNC weaning method or receive conventional weaning. Patients in Group A were extubated and oxygen was provided via HFNC. Group B patients were given a spontaneous breathing trial (SBT) per the standard protocol and extubated after a successful SBT. Results Weaning failure was found in five patients and was higher in the conventional group (three patients in the conventional group and two patients in the HFNC group). The duration of stay of patients in intensive care units was significantly higher in the conventional group than in the HFNC group. Conclusions HFNC is a better alternative to conventional weaning through SBT.

TiO2 supported cobalt oxide for olefin epoxidation reaction - characterization, catalytic activities and mechanism - using a DFT model

Metal oxide catalysts are known to trigger C-H bond activation selectively, indicating their suitability for olefin epoxidation. Nano-structured Co₃O₄ supported on TiO₂ was prepared for selective epoxidation of a number of olefins under optimized reaction conditions. An appropriate synthetic procedure yielded a catalytic material (Co-Ti (NP)^HT) with desired crystal size and interface conditions. Incorporation of Co into the Ti matrix resulted in an enhancement in the specific surface of Ti-Co nanoparticles (77.93 m² g^-1). XPS measurements evaluated the surface cobalt atom concentration (5.77%) in Ti-Co(NP)^HT, indicating more dispersion of cobalt oxide species. Catalytic application of the material, using various olefins (under optimized reaction conditions) shows higher conversion (>85%) in a 6-h time interval. The substrate : oxidant (H₂O₂) concentration in an optimized molar ratio of 1 : 2 shows high olefin conversion for the formation of olefin oxide. The reactivity of olefins was found to be in the order: cyclohexene > methylstyrene > styrene > chlorostyrene > p-nitrostyrene. A DFT model compared the HOMO-LUMO energies of styrene and its substituted forms. The reusability of Ti-Co (NP)^HT tested up to four continuous cycles of batch operations indicates a negligible loss (0.25-0.30%) of catalytic activity.

Effect of Preoperative Duloxetine Hydrochloride on Reducing Postoperative Morphine Requirement after Open Radical Cholecystectomy in Cancer Patients: A Randomized Controlled Study

Background

Recently, opoids are linked with cancer recurrence. Duloxetine hydrochloride (DH), an anxiolytic may reduce total opoid requirement after cancer surgery.

Aims

We assessed the efficacy of a single dose of DH in reducing the total morphine requirement after open radical cholecystectomy. We also calculated the Visual Analog Scale (VAS) score, patient satisfaction score (PSS), and time taken to the use of the first rescue analgesic.

Setting and Designes

This is a prospective, randomized, double blind, controlled study conducted in the patients aged 20-70 years (American Society of Anaesthesiologists classes I-III) undergoing open radical cholecystectomy under general anesthesia for carcinoma gall bladder.

Materials and Methods

The patients were divided into two groups of 32 patients each by computer-generated randomization. Group A received oral DH (60 mg); Group B received identical placebo capsules 2 h before surgery with a sip of water. Postoperatively, intravenous morphine was given using a patient-controlled analgesia pump. After 24 h, total morphine consumption, the VAS score, time to the first rescue analgesia, and PSS were recorded.

Statistical Analysis

Statistical Package for the Social Sciences software (SPSS version 22.0, IBM Corp., Chicago, IL, USA 2013). P value < 0.05 or 0.001 was considered statistically significant.

Results

The total morphine consumption and VAS score were significantly lower in Group A. No significant effects was observed on PSS.

Conclusion

A single 60 mg dose of DH administered 2 h before open radical cholecystectomy reduced total morphine consumption and improved VAS score postoperatively with no effect on PSS.

Comparison of Ultrasound-based Diaphragmatic Thickness Fraction (DTF) with Rapid Shallow Breathing Index and DTF alone for Predicting Successful Weaning from Mechanical Ventilation: A Randomised Control Trial

Introduction: The timing for weaning from mechanical ventilator support is crucial because both early discontinuation and delayed weaning may lead to increased morbidity and mortality as well as high medical cost. Diaphragmatic Thickness Fraction (DTF), among the various ultrasound-based diaphragmatic measurements, can not only assess the readiness to wean but also predict the simple weaning. The Rapid Shallow Breathing Index (RSBI) or Yang Tobin index is a tool that is used in the weaning of mechanical ventilation. RSBI is the ratio of respiratory rate to tidal volume in litre (RR/VT). Aim: To estimate success of weaning process by using the ultrasound-guided DTF% alone as a weaning predictor, and compare it with the index derived from the combination of both DTF% and RSBI. Materials and Methods: This randomised control study was conducted on 100 patients admitted to Intensive Care Unit (ICU) during one year, from October 2019 to September 2020. When the patients satisfied the weaning criteria, they were given Spontaneous Breathing Trial (SBT). After SBT the ultrasound was done and RSBI were calculated. Composite Index (CI) was derived by combining DTF% and RSBI. Patients were divided in two groups. In “group C” CI was used as weaning predictor, and in “group D” DTF% alone was taken as weaning predictor. Incidence of weaning failure was noted in each group. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) Version 19.0. Chi-square test, Student’s t-test, Receiver Operating Characteristic (ROC) curve, 2x2 tables were used. Results: The DTF% value >44.0% was found to be 95.2% sensitive, and 96.2% specific based on the ROC curve. The proportion of cases requiring reintubation was significantly higher in group D (DTF%) compared to group C (CI) (30.0% vs. 12.0%). RSBI with DTF% had a better sensitivity and specificity than DTF% alone. Conclusion: DTF% with RSBI is a much better predictor than DTF% alone. Sonography is subjective and has a long learning curve DTF% can be combined with RSBI to improve patient outcome.

Comparison of Haloperidol and Quetiapine for Treatment of Delirium in Critical Illness: A Prospective Randomised Double-blind Placebo-controlled Trial

Introduction: Delirium is associated with an increased chance of death, prolonged hospitalisation, higher healthcare costs, and possibly long-term brain damage in survivors. Antipsychotics, both conventional and atypical, are the cornerstone of pharmacologic treatment for delirium in adults. Aim: To find out whether typical and atypical antipsychotic medication would result in a shorter duration of delirium than placebo and would improve other outcomes. Materials and Methods: This is a randomised, double-blind, placebo-controlled trial conducted on patients with delirium in Intensive Care Unit (ICU) of King George's Medical University, Lucknow, Uttar Pradesh, India from February 2021 to February 2022. Out of 45, 15 received enteral haloperidol (maximum dose 30 mg daily), 15 received quetiapine (maximum dose 300 mg daily) and 15 were controls receiving placebo through Ryle’s tube. Delirium was detected with the use of Confusion Assessment Method for the ICU (CAM-ICU), and side effects of the drugs were noted. Dose of a trial drug or placebo was placed halved or doubled at 12-hour intervals using these parameters. The primary end point was the number of days alive without delirium during the 14 day intervention period. Secondary end points included time to freedom from mechanical ventilation, time to ICU, hospital discharge and 30 day and 90 day survival. Results: Out of 45 patients screened, 25 were males and 20 were females with no comparable differences. The mean number of days alive without delirium or coma was 9.45 in the haloperidol group, 8.64 in the quetiapine group, and 8.57 in the placebo group (p-value=0.63) for overall effect across trial groups. The use of haloperidol or quetiapine as compared with placebo, had no significant effect on the primary end point. There were no significant between-group differences in respect to the secondary end points . Conclusion: The use of enteral haloperidol or quetiapine, as compared with placebo, did not significantly alter the duration of delirium in the critically-ill patients admitted in ICU.

Direct introgression of untapped diversity into elite wheat lines

The effective utilization of natural variation has become essential in addressing the challenges that climate change and population growth pose to global food security. Currently adopted protracted approaches to introgress exotic alleles into elite cultivars need substantial transformation. Here, through a strategic three-way crossing scheme among diverse exotics and the best historical elites (exotic/elite1//elite2), 2,867 pre-breeding lines were developed, genotyped and screened for multiple agronomic traits in four mega-environments. A meta-genome-wide association study, selective sweeps and haplotype-block-based analyses unveiled selection footprints in the genomes of pre-breeding lines as well as exotic-specific associations with agronomic traits. A simulation with a neutrality assumption demonstrated that many pre-breeding lines had significant exotic contributions despite substantial selection bias towards elite genomes. National breeding programmes worldwide have adopted 95 lines for germplasm enhancement, and 7 additional lines are being advanced in varietal release trials. This study presents a great leap forwards in the mobilization of GenBank variation to the breeding pipelines.

Anaesthetic challenges in perioperative management of thoracic paraganglioma in an 8-year-old child

Pheochromocytomas (PCC) are catecholamine-secreting tumours that arise from chromaffin cells of the sympathoadrenal system. These rare catecholamine-secreting tumours arising from adrenal glands are termed as PCC and those from extra--adrenal sites are termed paraganglioma (PGL). Thoracic PGL is very rarely found. we report the anaesthetic challenges and management of an 8-year-old child with functional thoracic PGL and its successful outcome.

Physiologic Specialization and Genetic Differentiation of Puccinia triticina Causing Leaf Rust of Wheat on the Indian Subcontinent During 2016 to 2019

Wheat is the second most cultivated cereal crop in the world and is an important crop in India. Leaf (brown) rust, caused by Puccinia triticina, was the most prevalent among the three rusts found in all the wheat-growing areas of India, Bhutan, and Nepal during 2016 to 2019. Leaf rust samples from wheat crops in these countries were pathotyped using the wheat differential genotypes and binomial Indian system of nomenclature. To facilitate international communication, each pathotype identified was also tested using the North American differentials. A total of 33 pathotypes were identified from 1,086 samples, including three new pathotypes: 61R47 (162-5 = KHTPM) and 93R49 (49 = NHKTN) from India and 93R57 (20-1 = NHKTN) from Nepal. Two pathotypes, 121R60-1 (77-9/52 = MHTKL) and 121R63-1 (77-5 = THTTM), accounted for 79.46% of the population. Virulence on Lr19 was identified in 0.27% of the samples from Nepal only. The proportion of pathotype 121R60-1 (77-9 = MHTKL) increased to 57.55% during these years. Virulence was not observed on Lr9, Lr24, Lr25, Lr28, Lr32, Lr39, Lr45, and Lr47 in the population of the Indian subcontinent. Eighteen polymorphic simple sequence repeat (SSR) primer pairs tested on the isolates amplified 48 alleles with an average of 2.66 alleles per primer pair. Based on SSR genotyping, these pathotypes could be grouped into two clades with another two subclades each. Many of the Lr genes present in Indian wheat germplasm (Lr1, Lr3a, Lr10, Lr11, Lr14a, Lr15, Lr16, Lr17, Lr20, Lr23, and Lr26) were ineffective for a majority of pathotypes. Most of these varieties possessed a high degree of leaf rust resistance. The field resistance of wheat varieties could be attributed to the interaction of genes, unknown resistance, or adult plant resistance.

A Comparative Study of the ProSeal Laryngeal Mask Airway Versus Endotracheal Tube in Neonates With Anorectal Malformations

BACKGROUND

Laryngeal mask airways (LMAs) are widely used in paediatric anaesthesia. However, LMA use in neonatal age groups (younger than seven days) is limited because many anaesthesiologists prefer to use endotracheal tube in neonates. In this study, we compared the ProSeal LMA and endotracheal tube by measuring their performance, including ease of insertion via number of attempts for placement of device, total effective time for intubation and extubation, hemodynamic responses and perioperative complications.

METHODS

In this prospective randomized study, 70 patients (neonates) weighing >2.5 kg, with American Society of Anaesthesiologists (ASA) classification grade 4 requiring emergency surgery for anorectal malformation were enrolled and divided into two groups. After induction, patients' airways were secured with either ProSeal LMA size 1 (Group I) or endotracheal tube (Group II). Anaesthesia was maintained on oxygen and sevoflurane with muscle relaxant atracurium.

RESULTS

Demographic and surgical data were similar between the two groups. The ProSeal LMA insertion time was shorter than endotracheal intubation. Hemodynamic variations were less in the ProSeal LMA group as compared to the endotracheal tube group. The total time for removal of airway devices from the end of surgery for the ProSeal group was lower than that for the endotracheal intubation group. Postoperative complications were less in the ProSeal group as compared to the endotracheal group.

CONCLUSIONS

The ProSeal LMA can be a better alternative to the endotracheal tube in neonates due to the ease of insertion, lesser changes in hemodynamic parameters and minimal postoperative complications.

Integration of Dual Stress Transcriptomes and Major QTLs from a Pair of Genotypes Contrasting for Drought and Chronic Nitrogen Starvation Identifies Key Stress Responsive Genes in Rice

We report here the genome-wide changes resulting from low N (N-W+), low water (N+W-)) and dual stresses (N-W-) in root and shoot tissues of two rice genotypes, namely, IR 64 (IR64) and Nagina 22 (N22), and their association with the QTLs for nitrogen use efficiency. For all the root parameters, except for root length under N-W+, N22 performed better than IR64. Chlorophyll a, b and carotenoid content were higher in IR64 under N+W+ treatment and N-W+ and N+W- stresses; however, under dual stress, N22 had higher chlorophyll b content. While nitrite reductase, glutamate synthase (GS) and citrate synthase assays showed better specific activity in IR64, glutamate dehydrogenase showed better specific activity in N22 under dual stress (N-W-); the other N and C assimilating enzymes showed similar but low specific activities in both the genotypes. A total of 8926 differentially expressed genes (DEGs) were identified compared to optimal (N+W+) condition from across all treatments. While 1174, 698 and 903 DEGs in IR64 roots and 1197, 187 and 781 in N22 roots were identified, nearly double the number of DEGs were found in the shoot tissues; 3357, 1006 and 4005 in IR64 and 4004, 990 and 2143 in N22, under N-W+, N+W- and N-W- treatments, respectively. IR64 and N22 showed differential expression in 15 and 11 N-transporter genes respectively, under one or more stress treatments, out of which four showed differential expression also in N+W- condition. The negative regulators of N- stress, e.g., NIGT1, OsACTPK1 and OsBT were downregulated in IR64 while in N22, OsBT was not downregulated. Overall, N22 performed better under dual stress conditions owing to its better root architecture, chlorophyll and porphyrin synthesis and oxidative stress management. We identified 12 QTLs for seed and straw N content using 253 recombinant inbred lines derived from IR64 and N22 and a 5K SNP array. The QTL hotspot region on chromosome 6 comprised of 61 genes, of which, five were DEGs encoding for UDP-glucuronosyltransferase, serine threonine kinase, anthocyanidin 3-O-glucosyltransferase, and nitrate induced proteins. The DEGs, QTLs and candidate genes reported in this study can serve as a major resource for both rice improvement and functional biology.

A multicentric, randomized, controlled phase III study of centhaquine (Lyfaquin ® ) as a resuscitative agent in hypovolemic shock patients

INTRODUCTION

Centhaquine (Lyfaquin ^® ) showed significant safety and efficacy in preclinical and clinical phase I and II studies.

METHODS

A prospective, multicentric, randomized phase III study was conducted in patients with hypovolemic shock having systolic blood pressure (SBP) of ≤90 mm Hg and blood lactate levels of ≥2 mmol/L. Patients were randomized in a 2:1 ratio, 71 patients to the centhaquine group and 34 patients to the control (saline) group. Every patient received standard of care (SOC) and was followed for 28 days. The study drug (normal saline or centhaquine (0.01 mg/kg)) was administered in 100 mL of normal saline infusion over 1 hour. The primary objectives were to determine changes (mean through 48 hours) in SBP, diastolic blood pressure (DBP), blood lactate levels, and base deficit. The secondary objectives included the amount of fluids, blood products, vasopressors administered in the first 48 hours, duration of hospital stay, time in ICU, time on the ventilator support, change in patient's Acute Respiratory Distress Syndrome (ARDS), Multiple Organ Dysfunction Syndrome (MODS) scores, and the proportion of patients with 28-day all-cause mortality.

RESULTS

The demographics of patients and baseline vitals in both groups were comparable. Trauma was the cause of hypovolemic shock in 29.41% of control and 47.06% of centhaquine, gastroenteritis in 44.12% of control, and 29.41% of centhaquine patients. An equal amount of fluids and blood products were administered in both groups during the first 48 hours of resuscitation. A lesser amount of vasopressors was needed in the first 48 hours of resuscitation in the centhaquine group. An increase in SBP from the baseline was consistently higher in the centhaquine group than in the control. A significant increase in pulse pressure in the centhaquine group than the control group suggests improved stroke volume due to centhaquine. The shock index was significantly lower in the centhaquine group than control from 1 hour (p=0.0320) till 4 hours (p=0.0494) of resuscitation. Resuscitation with centhaquine had a significantly greater number of patients with improved blood lactate and the base deficit than the control group. ARDS and MODS improved with centhaquine, and an 8.8% absolute reduction in 28-day all-cause mortality was observed in the centhaquine group.

CONCLUSION

Centhaquine is a highly efficacious resuscitative agent for treating hypovolemic shock. The efficacy of centhaquine in distributive shock due to sepsis and COVID-19 is being explored.

TRIAL REGISTRATION

Clinical Trials Registry, India; ctri.icmr.org.in, CTRI/2019/01/017196; clinicaltrials.gov, NCT04045327 .

KEY SUMMARY POINTS

A multicentric, randomized, controlled trial was conducted to evaluate the efficacy of centhaquine in hypovolemic shock patients.One hundred and five patients were randomized 2:1 to receive centhaquine or saline. Centhaquine was administered at a dose of 0.01 mg/kg in 100 mL saline and infused over 1 hour. The control group received 100 mL of saline over a 1-hour infusion.Centhaquine improved blood pressure, shock index, reduced blood lactate levels, and improved base deficit. Acute Respiratory Distress Syndrome (ARDS) and Multiple Organ Dysfunction Syndrome (MODS) score improved with centhaquine.An 8.8% absolute reduction in 28-day all-cause mortality was observed in the centhaquine group. There were no drug-related adverse events in the study.

Efficacy of Different Decontamination Processes in Mitigation of Pesticide Residues from Chili Crop

ABSTRACT

This study was conducted to evaluate the efficacy of seven decontamination processes in reducing the pesticide mixture load of six insecticides (quinalphos, profenophos, ethion, lambda-cyhalothrin, imidacloprid, and acetamiprid) from chili (Capsicum annuum L.). In the control treatment, the pesticide residues were extracted without following any decontamination procedure. The extraction of the insecticides from chili was initiated after 48 h of pesticide mixture spray and was done using the QuEChERS (quick, easy, cheap, effective, rugged, and safe) method. The quantitative analysis of four insecticides, namely quinalphos, profenophos, ethion, and lambda-cyhalothrin, was done by coupled gas chromatography-electron capture detection and that of imidacloprid and acetamiprid by high-performance liquid chromatography-UV detection. The results depicted reduction of pesticide residues in all the decontamination treatments compared with the control, although it varied for different insecticides. Solutions of 1 and 5% NaCl and 5% CH3COOH served as efficient decontaminants in removal of quinalphos, profenophos, ethion, and lambda-cyhalothrin residues from chili to ca. 90%, whereas for imidacloprid and acetamiprid there was a mild decontamination only (33.33 to 52.44%). The solutions of 5% NaHCO3 and 0.01% KMnO4 were effective only in removing lambda-cyhalothrin residues from the chili crop, but for all other pesticides the decontamination was not much pronounced.

HIGHLIGHTS

Bracka Urethroplasty with Buccal Mucosa Graft: Ergonomic Management of Penile Skin Dartos in the First Stage to Facilitate Second-stage Neourethral Coverage

Aims

The aim of the study was to report a new technique of ergonomic penile skin-dartos management during buccal mucosa graft (BMG) to provide adequate penile skin-dartos for neourethral coverage at the time of second-stage tubularization.

Materials and Methods

Ten proximal hypospadias with severe chordee underwent first-stage surgery with a new technique. An incision along the urethral plate margin and preputial edge was used to split inner prepuce off preputial dartos and penile degloving leaving inner prepuce attached to corona. Urethral plate was divided into the subfascial plane. Penile dartos was bisected in the dorsal midline. Distal half of penile skin-dartos bifurcated and joined to inner preputial edges. Mobilized and lateralized penile skin-dartos was sutured flanking edges of BMG. The second-stage tubularization after 6 months provided neourethral double dartos coverage with eccentric suture lines.

Results

Adequate dartos for neourethral coverage during second-stage tubularization was available in all. Subcoronal urethrocutaneous fistula occurred in one that was repaired.

Conclusions

Ergonomic management of inner-preputial skin and ventral transfer of penile skin-dartos helps in providing neourethral coverage during subsequent second-stage tubularization to minimize the occurrence of complications.

Outcome of Ulinastatin vs Metabolic Resuscitation using Ascorbic Acid, Thiamine and Glucocorticoid in Early Treatment of Sepsis- A Randomised Controlled Trial

Introduction: Sepsis is one the most common cause of morbidity and mortality worldwide. Sepsis and septic shock are life-threatening disease which increases mortality with circulatory, cellular and metabolic abnormalities. Urinary trypsin inhibitor is an important protease inhibitor found in human blood and urine, it is known as Ulinastatin (ULI) or bikunin. It is an acidic glycoprotein (molecular weight 30 kDa) and Kunitz-type serine protease inhibitor. It is derived from the larger inter-α-trypsin inhibitor molecule by action of neutrophil elastase in the presence of inflammation, and is believed to play an important anti-inflammatory role. Aim: To compare the outcome of intravenous ULI (protease inhibitor known as urinary trypsin inhibitor) versus the combination of hydrocortisone, ascorbic acid (vitamin C) and thiamine regarding outcome in sepsis and septic shock. Materials and Methods: In this randomised controlled trial conducted between July 2018 to June 2019 on total 60 sepsis patients were included and divided into two equal groups. Group A patients received combination of intravenous Hydrocortisone, Ascorbic acid and Thiamine (HAT) and group B Ulinastatin received intravenous Intensive Care Unit(ICU). Baseline demographic, clinical and laboratory data were recorded along with Acute Physiology and Chronic Health Evaluation (APACHE) 2 and Sequential Organ Failure Assessment (SOFA) scoring system at the time of admission in ICU. All statistical test were performed using SPSS 21.0 windows software. Comparisons between groups were assessed by using student t-test and chi-square test. Results: Mean age was comparable in both the groups (36.7±12.5 years in group A vs 37.5±12.9 years in group B). SOFA Score were significantly lower in group B as compared to group A on day 3 (7.76±3.67 vs 12.03±4.77) and day 5 (4.79±4.02 vs 12.10±7.36). Rate of reduction in serum procalcitonin level was also found to be significant in group B (p=0.008) as compared to group A (p=0.103). Lactate clearance rate was also fast in group B as compared to group A on day 3 and day 5. There was significant mortality benefit in group B (20%) as compared to group A (50%). Patients were followed up for 28 days till the start of treatment. Conclusion: This study showed that the ULI may play a beneficial role in early management of sepsis and septic shock.

Severe COVID-19: A distinct entity

Severe coronavirus disease-2019 (COVID-19) is a distinct entity that rapidly evolves and may abruptly culminate in to a critical illness. As per Chinese experience, approximately, 15% of patients of COVID-19 progress to severe disease and 5% become critically ill. The incidence of severe and critical illness is higher among men, patients older than 65 years of age and in persons with other medical comorbidities. Cytokine storm cause pronounced lung damage and multiorgan failure. Coagulopathy is a key component of severe COVID-19. Critically ill patients are generally predisposed to a high risk of thromboembolism as well. Lymphopenia predisposes to severe disease. None of the antiviral or immunomodulators has proven efficacy in severe COVID-19. Supplemental oxygen need be administered in patients with hypoxemia. Excessive breathing effort, acute respiratory distress syndrome (ARDS), encephalopathy, and multiorgan failure are indications for mechanical ventilation. In a large number of patients, the overall outcome is poor. Health care workers in intensive care units are exposed to the enormous risk of acquiring hospital acquired SARS-COV-2 infection.

Study of Variations in Axial Pattern Vessels of Penile Dartos in Hypospadias and Implied Surgical Significance

OBJECTIVES

To report the anatomical variations in axial pattern vessels of penile dartos in hypospadias.

METHODS

Eighty hypospadias undergoing repair with tubularized incised plate urethroplasty were studied with preoperative examination of visible vein through penile skin. Course of vein proximal to root of penis was studied with vein viewer. Modified penile degloving beginning at preputial edge, splitting inner preputial urothelium off the preputial dartos and proceeding to penile shaft in subdartos plane was performed. Axial pattern veins visible on penile dartos were studied. Axial pattern penile dartos arteries were studied by recording arterial pulsations. If arterial pulsations were not seen, arterial mapping on penile dartos completed with use of Doppler and images recorded. Variations in axial pattern dartos vessels were analyzed.

RESULTS

In 32 hyposapadias of 1 group, median superficial vein along the dorsal midline of penile dartos drained into left saphenous vein. In this group, dorsolateral vessels were not seen on either side in 20 cases. Unilateral dorsolateral vessel in 7 and bilateral dorsolateral vessels in five were seen. In 48 hypospadias of other group, median superficial vein was not seen. Bilateral dorsolateral vessels in 11, unilateral dorsolateral vessels in 27 and no definite pattern in 10 were seen. In both groups, superficial median artery was not discovered. Vessels were longitudinally oriented. Penile dartos was equally distributed.

CONCLUSION

In hypospadias, penile dartos vessels have axial pattern course longitudinally but not identical to normal. Eight patterns can be identified which can be diagnosed on careful clinical examination of penis.

Impact of socio-demographic variables on antenatal services in eastern Uttar Pradesh, India

We investigated the impact of socio-demographic variables on antenatal care (ANC) utilization and the low birth weight of a child. Data were collected from 300 pregnant females. Only 22.5% of females received full antenatal care (≥4 visits). Our results showed that female's age at marriage and education plays a significant role in improving ANC. We observed an overall decrease in the utilization of services provided during each antenatal visit. ANC visits from the first trimester decrease the risk of having a baby with low birth weight. Awareness programs and educating families about pregnancy care are recommended to improve ANC utilization.

Serum DHEA-S levels could be used as a comparable diagnostic test to assess the pubertal growth spurt in dentofacial orthopedics

Background

Pubertal growth spurt assessment guides the timing of intervention for correcting the skeletal discrepancies in dentofacial orthopedics. Serum hormones are being studied for the skeletal age assessment to avoid unnecessary radiographic exposure. The present study is to evaluate the relationship of serum hormones dehydroepiandrosterone-sulfate (DHEA-S), insulin-like growth factor (IGF-1), and cervical vertebral stages (CS stages) in the skeletal age assessment of orthodontics patients around the circumpubertal age.

Methods

A total of ninety subjects with age ranging from 7 to 21 years were selected and divided into two groups based on the sex (45 males, 45 females). They were further distributed in each group based on the six CS stages determined from the lateral cephalogram. Blood samples from each subject were collected to evaluate the serum DHEA-S and IGF-1 levels by using the enzyme-linked immunosorbent assay (ELISA). Collected data were analyzed in SPSS software with a test of normalcy, unpaired t test, and one-way analysis of variance (ANOVA) followed by the least significant difference (LSD) post hoc comparison test and univariate regression analysis.

Results

The highest mean serum hormone levels were found in CS 4 in group A (male) and CS 3 in group B (female). ANOVA results showed that there was a significant difference in the serum hormone levels among the different CS stages in both the groups for both the hormones. Statistically, a significant difference was found between each CS stages for both the hormones except in the DHEA-S levels between CS 5 and CS 6.

Conclusions

The mean serum DHEA-S levels followed a typical pattern from the CS 1 till CS 6 which was comparable and similar to the mean serum IGF-1 levels in respect to CS stages. Thus, serum DHEA-S levels could be used as a possible diagnostic test for the assessment of the skeletal pubertal growth spurt in dentofacial orthopedics.

A Novel Technique for Prevention of Gastroesophageal Reflux in Staged Repair of Long Gap Esophageal Atresia with Tracheoesophageal Fistula

Aim:

The objective of the study is to report a novel technique of preventing gastroesophageal reflux and air leak from fistula to stomach in patients of tracheoesophageal fistula with long gap atresia, to buy time for the staged procedure.

Methods:

Seven patients of tracheoesophageal fistula with upper pouch of esophagus at 2^nd thoracic vertebra were selected for the staged procedure. Weight ranged from 1.7 to 1.8 kg. During the 1^st stage surgery for gastrostomy, midline strip of linea alba attached to xiphoid process was harvested and slinged around the gastroesophageal junction, along with right cervical esophagostomy. After radio-nuclear scan, the demonstration of abolition of gastroesophageal reflux, gastrostomy feed was started. The 2^nd stage surgery performed after 6 weeks, included mobilization of esophagostomy, release of sling, thoracotomy, and tension-free esophageal anastomosis. Outcome measurement includes (1) prevention of air leak from esophagus into the stomach, (2) abolition of gastroesophageal reflux, (3) ability to start gastrostomy feeds, and (4) reversal of occlusion after release of the sling.

Results:

The placement of linea alba sling and elevation of gastroesophageal junction, abolished air leak from fistula to stomach in all. Radio nuclear scan demonstrated abolition of gastroesophageal reflux in 6 with weight gain after gastrostomy feeding. One patient expired due to sepsis. One patient underwent final repair with reversal of occlusion with release of the sling.

Conclusion:

Using a sling of the linea alba around the cardioesophageal junction, prevents gastroesophageal reflux and escape of air from esophagus into the stomach, gives time to improve the respiratory and nutritional status of the patient, for a subsequent safer delayed primary anastomosis.

Use of Echogenic Needles for Ultrasound-guided Transversus-Abdominis-Plane Block: Better Visibility Transforming into Better Postoperative Analgesia

Introduction: Ultrasound (USG)-guided Transversus-Abdominis-Plane (TAP) block is recommended due to its safety and reliability. Echogenic needles provide better needle visibility and might result in better postoperative analgesia after USG-guided TAP block. Aim: To compare visibilty and block-characteristics (including postoperative analgesia) of echogenic vs. non echogenic needle for USG-guided TAP block. Materials and Methods: This randomised double-blind study was carried out at King George’s Medical University, Lucknow over a period of one year (November 2018 to October 2019). Seventy patients undergoing abdominal surgeries were enrolled and randomly allocated to one of two groups Group-E (echogenic) and Group-NE (non echogenic). Bilateral TAP block was performed postoperatively in all the patients and 20 mL of 0.25% Bupivacaine was deposited on each side. In Group-E, echogenic needle was used and in Group-NE, non echogenic needle was used for TAP block. Research assistant documented the start and finish time of the block procedure, number of attempts and redirections based on predetermined criteria. Visibility of needle tip and shaft were graded on a 3-point scale based on recorded and de-identified video-clips. Total procedure-time, number of needle redirections and skin punctures, incidence of vascular punctures, Visual Analogue Scale (VAS) scores and rescue analgesia requirement were also noted. Statistical analysis was done using SPSS Version 21.0. Results: Needle visibility on USG was significantly better in Group-E than Group-NE (χ2=57.24, p<0.001). Mean time to reach the TAP plane (t=-16.89, p<0.001) and total procedure time (t=-15.76, p<0.001) were also significantly lesser in Group-E. Mean number of needle redirections (t=-11.21, p<0.001), mean number of skin punctures (t=-2.12, p=0.038) and postoperative VAS scores throughout the study were found to be significantly lesser in group-E as compared to group-NE. Postoperative analgesia required in 24 hour was lesser in group-E and time of first rescue analgesia required was earlier in group-NE (p<0.001). Patients in both the groups were haemodynamically stable throughout the study. Conclusion: Use of echogenic needle for USG-guided TAP block provides much better needle-visibility resulting in better block-performance. It also provided better analgesia in our study as evident by lesser VAS-scores and lesser requirement of rescue analgesia postoperatively. So, use of echogenic needle should be advocated in all the patients undergoing USG-guided TAP blocks provided there are no financial constraints.

Hemoadsorption by extracorporeal cytokine adsorption therapy (CytoSorb®) in the management of septic shock: A retrospective observational study

INTRODUCTION

Sepsis results in immunologic disturbances with the release of various inflammatory mediators such as cytokines. Cytokines can damage the cells, and the continuous release of inflammatory mediators leads to severely impaired immunity. Therefore, the reduction in cytokine levels by hemoadsorption represents a new concept for blood purification. CytoSorb^® as a hemoadsorption device is a detoxification system, which aims to decrease the cytokines levels. This study was conducted to understand any beneficial effects of CytoSorb^® therapy in septic patients.

METHODOLOGY

This was a retrospective and observational study, approved by the scientific and ethics committee of Max Super Specialty Hospital, Patparganj, Delhi, India and conducted in compliance with current International Council for Harmonization, Good Clinical Practice, Schedule Y, and Indian Council of Medical Research guidelines. Subjects of either gender (age > 18 year) were included in the study. The data were presented as mean ± standard deviation and categorical as frequency and percentage (%). A p value less than 0.05 (p < 0.05) was considered to be statistically significant.

RESULTS

A total number of 36 patients were included in the study. Majority of the patients were male with mean age (56.36 ± 14.83). After therapy, procalcitonin and total leucocyte count levels decreased within 24 h. Post therapy, sepsis-related organ failure assessment (SOFA) score of Day (D)1, D2, and D3 reduced to 10.4 ± 3.63, 8.7 ± 4.02, and 7.8 ± 3.67, respectively. The Acute Physiology and Chronic Health Evaluation (APACHE) II score and predicted mortality were lower in the survivor group as compared to the non-survivor group.

CONCLUSION

Hemoadsorption using the extracorporeal adsorption device (CytoSorb^®) might be an effective rescue therapy in stabilizing septic shock patients.

A comparison of two doses of ketamine with dexmedetomidine for fiberoptic nasotracheal intubation

Background and Aims:

Flexible fiber-optic intubation is considered to be the gold standard for management of difficult airway. Fiber-optic intubation does require effective sedation and blunting of airway reflexes for which various drug regimens have been utilized in the past. In a quest to find the noble drug combination, we combined ketamine and dexmedetomidine in two different doses, to evaluate the clinical efficacy and safety profile of ketamine and dexmedetomidine for fiber-optic intubation.

Materials and Methods:

This prospective randomized study was conducted in 72 patients of 20–50 years’ age group of either sex with the American Society of Anesthesiologists Physical Status I and II with difficult airway. We compared two doses of ketamine 20 mg (Group I) and 40 mg (Group II) with a common dose of dexmedetomidine at 1 μg/kg body weight, given as an infusion over 10 min (a solution of 50 ml with normal saline). Sedation scores, hemodynamic variables in terms of blood pressure, heart rate (HR), and oxygen saturation were studied along with 24-h postoperative patient discomfort and recall of procedure.

Results:

Group II patients showed less variation from their baseline values in terms of HR (ranged between 0.73% and 4.75%) and mean arterial pressure (ranged between 0% and 3.97%) in comparison to Group I HR (ranged between 0.09% and 9.81%) and mean pressures (ranged between 0.3% and 10.38%). Discomfort during procedure (P < 0.001) and recall of procedure scale (P = <0.001) were found significantly better/lower in Group II as compared to Group I.

Conclusion:

Ketamine 40 mg in comparison to 20 mg with dexmedetomidine provides better hemodynamic conditions with better tolerance and lower recall to the fiber-optic intubation.

RNAseq analysis reveals drought-responsive molecular pathways with candidate genes and putative molecular markers in root tissue of wheat

Drought is one of the major impediments in wheat productivity. Traditional breeding and marker assisted QTL introgression had limited success. Available wheat genomic and RNA-seq data can decipher novel drought tolerance mechanisms with putative candidate gene and marker discovery. Drought is first sensed by root tissue but limited information is available about how roots respond to drought stress. In this view, two contrasting genotypes, namely, NI5439 41 (drought tolerant) and WL711 (drought susceptible) were used to generate ~78.2 GB data for the responses of wheat roots to drought. A total of 45139 DEGs, 13820 TF, 288 miRNAs, 640 pathways and 435829 putative markers were obtained. Study reveals use of such data in QTL to QTN refinement by analysis on two model drought-responsive QTLs on chromosome 3B in wheat roots possessing 18 differentially regulated genes with 190 sequence variants (173 SNPs and 17 InDels). Gene regulatory networks showed 69 hub-genes integrating ABA dependent and independent pathways controlling sensing of drought, root growth, uptake regulation, purine metabolism, thiamine metabolism and antibiotics pathways, stomatal closure and senescence. Eleven SSR markers were validated in a panel of 18 diverse wheat varieties. For effective future use of findings, web genomic resources were developed. We report RNA-Seq approach on wheat roots describing the drought response mechanisms under field drought conditions along with genomic resources, warranted in endeavour of wheat productivity.

Development of species specific putative miRNA and its target prediction tool in wheat (Triticum aestivum L.)

MicroRNA are 20-24 nt, non-coding, single stranded molecule regulating traits and stress response. Tissue and time specific expression limits its detection, thus is major challenge in their discovery. Wheat has limited 119 miRNAs in MiRBase due to limitation of conservation based methodology where old and new miRNA genes gets excluded. This is due to origin of hexaploid wheat by three successive hybridization, older AA, BB and younger DD subgenome. Species specific miRNA prediction (SMIRP concept) based on 152 thermodynamic features of training dataset using support vector machine learning approach has improved prediction accuracy to 97.7%. This has been implemented in TamiRPred ( http://webtom.cabgrid.res.in/tamirpred ). We also report highest number of putative miRNA genes (4464) of wheat from whole genome sequence populated in database developed in PHP and MySQL. TamiRPred has predicted 2092 (>45.10%) additional miRNA which was not predicted by miRLocator. Predicted miRNAs have been validated by miRBase, small RNA libraries, secondary structure, degradome dataset, star miRNA and binding sites in wheat coding region. This tool can accelerate miRNA polymorphism discovery to be used in wheat trait improvement. Since it predicts chromosome-wise miRNA genes with their respective physical location thus can be transferred using linked SSR markers. This prediction approach can be used as model even in other polyploid crops.

Dexmedetomidine as Bolus or Low-dose Infusion for the Prevention of Emergence Agitation with Sevoflurane Anesthesia in Pediatric Patients

Background

This study was designed to compare the prevention of emergence agitation (EA) of sevoflurane anesthesia by an intraoperative bolus or low-dose infusion of dexmedetomidine in pediatric patients undergoing lower abdominal surgeries.

Materials and Methods

Forty-eight patients, aged 2-12 years, undergoing lower abdominal surgeries with sevoflurane anesthesia were enrolled in this study. Patients were randomly assigned to receive either intravenous bolus over 10 min. 0.4 μg/kg dexmedetomidine (Group I, n = 24) or low-dose infusion 0.4 μg/kg/h of dexmedetomidine (Group II, n = 24) after intubation. Heart rate and mean arterial pressure were recorded before induction, at induction and every 5 min after induction. Observational pain scores (OPS), pediatric anesthesia emergence delirium (PAED) scores, and Ramsay sedation scores (RSS) were recorded on arrival to the postanesthesia care unit and at 5, 10, 15, 30, 45, 60 min thereafter. Extubation time, emergence time, and time to reach Aldrete score ≥9 were recorded.

Results

OPS and PAED scores and percentage of patients with OPS ≥4 or PAED scale ≥10 were significantly higher in Group II as compared to Group I. RSS score, extubation time, emergence time, and time to reach Aldrete score ≥9 did not show any significant difference.

Conclusion

Both bolus or low-dose infusion of dexmedetomidine was effective for the prevention of EA with sevoflurane anesthesia, but bolus dose of dexmedetomidine was more effective.

Free radical scavenging potential of sericin obtained from various ecoraces of tasar cocoons and its cosmeceuticals implication

Tropical tasar silkworm Antheraea mylitta is a wild sericigenous insect which is distributed in different geographical regions and named as different ecoraces. In the present study, we investigated the molecular characterisation and cosmeceutical properties of sericin extracted from different ecoraces of tasar cocoons. The surface morphology and molecular weight of cocoons were determined by scanning electron microscope (SEM) and SDS-PAGE, respectively. Characterisation of sericin was performed by various methods such as FTIR, CHNS, TGA and amino acid analyzer. The anti-tyrosinase, anti-elastase, glutathione-S-transferase inhibition, free radical scavenging potential and inhibition of oxidative damages were measured in tasar ecoraces sericin. SEM images have revealed the removal of sericin from the surface of cocoons. SDS-PAGE of sericin depicted the presence of diverse molecular weight of proteins. Structural determination by FTIR revealed the presence of both α-helical and β-sheet structures. Thermal properties of sericin were studied by TGA which showed a 50% weight loss at temperature 410 °C-430 °C. Additionally, ecoraces sericin contains 17 amino acids in which serine, aspartic acid and glycine are predominantly present (55.68-59.61%). Further, anti-tyrosinase, anti-elastase, inhibition of glutathione-S-transferase activity, free radical scavenging potential and inhibition of lipid peroxidation were also observed in ecoraces sericin. Our findings suggest that the present study appear to be helpful in exploiting sericin as potential biomaterial in cosmeceutical and allied field.

The Physiochemical, Biological Quality and Seasonal Variability of River Ganges in Varanasi, Uttar Pradesh, India

Background: The Ganga River is a life-line, a symbol of purity and virtue for countless people of India. Nearly all the sewage, industrial effluent, runoff from chemical fertilizers and pesticides used in agriculture within the basin, and large quantities of solid waste, including thousands of animals carcasses and hundreds of human corpses are dumped in the river everyday which posed a considerable public health threat to the religious bathers and a large number of people living along the river who uses Ganges water for drinking and other household purposes. Objective: To assess the physiochemical and biological quality of river Ganges water and to study the seasonality pattern of pollution of River Ganges. Materials and Methods: Two points namely Samne ghat and Rajghat (entry and exit point of Ganga into the city) were selected as the first and the last sampling stations, beside 8 other intermediate sampling stations to assess the physiochemical and biological quality of River Ganga water. The study was conducted from April 2013 to March 2014 and this period was crudely divided into three seasons viz Winter, Summer and Rainy season for the purpose of studying seasonality pattern of pollution. Results: As the river progress through city of Varanasi, Total dissolved solids (TDS), Chloride, Conductivity, Biochemical Oxygen Demand (BOD), Nitrate, Nitrite and Most Probable Number (MPN) increases, DO decreases progressively and Temperature and pH remain same. Conclusion: As far as quality of water with regard to recreational and industrial purposes are concerned, Ganges water may be considered useful but most of the parameters observed across different seasons indicates that it may not be used as potable water.

Tasar silk fiber waste sericin: New source for anti-elastase, anti-tyrosinase and anti-oxidant compounds

The present study investigates the properties of sericin extracted from tasar silk fiber waste (TSFW). The surface morphology of TSFW was observed by scanning electron microscope (SEM). SEM images revealed the removal of residual sericin over the surface of TSFW. The molecular weight distribution of sericin was examined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). The results suggested that TSFW sericin represented a family of proteins with wide-ranging molecular weight distribution (11-245 kDa). Structural determination by FTIR revealed the presence of both α-helical and β-sheet structures. The colour was studied by colorimeter indicating less brightness, more red and yellow colour intensities. The carbon: nitrogen ratio (C:N) was studied by CHNS element analyzer and the ratio is 5.15-7.85. Thermal properties of TSFW sericin have been studied by thermogravimetric analysis (TGA) method. TGA curve showed higher thermal stability and variable degradation profiles. Furthermore, TSFW sericin contains 17 amino acids where serine, aspartic acid and glycine are the more significant compounds (54.34-60.49%). In addition, sericin was found to inhibit tyrosinase, elastase and glutathione-S-transferase activity, and had apparent radical scavenging impacts on 2.2‑diphenyl‑1‑picryl‑hydrazil (DPPH), hydrogen peroxide and inhibition of lipid peroxidation. Result suggested that TSFW sericins might be a valuable ingredient for cosmoceutical products.

Prevalence and Associated Risk Factors of Hypertension: A Cross-Sectional Study in Urban Varanasi

Hypertension is a major public health problem and important area of research due to its high prevalence and being major risk factor for cardiovascular diseases and other complications. Objectives. (1) To assess the prevalence of hypertension and its associated factors and (2) to estimate awareness, treatment, and adequacy of control of hypertension among study subjects. Methods and Materials. A community based cross-sectional study with multistage sampling design was conducted among urban population of Varanasi. A modified WHO STEPS interview schedule on 640 study subjects aged 25-64 years was used. Results. The prevalence of hypertension was 32.9% (male: 40.9%, female: 26.0%). Mean systolic and diastolic BP were 124.25 ± 15.05 mmHg and 83.45 ± 9.49 mmHg, respectively. Higher odds of being hypertensive were found in male subjects, eldest age group, married subjects, subjects of upper socioeconomic status, illiterate subjects, and retired subjects. Tobacco and alcohol consumption, overweight, obesity, and abdominal obesity were also associated with hypertension. Out of the total hypertensive 211 subjects, only 81 (38.4%) were aware about their hypertension status; out of those, 57 (70.4%) were seeking treatment and 20 (35.08%) had their blood pressure adequately controlled. Conclusion. Around one-third of the subjects were hypertensive and half of the study subjects were prehypertensive in this area. The awareness, treatment, and control of high blood pressure were also very low.

Outcome of Titanium Elastic Intramedullary Nail in the Treatment of Shaft of Femur Fracture in Children

Background Femoral-shaft fractures are among the most common fractures of the lower extremity in children. There are several different options for treating femoral-shaft fractures in children. Elastic stable intramedullary nailing (ESIN) has become the standard treatment for fractures of shaft of femur in children for reasons including mini-invasive surgery, no need for casting, early mobilization and discharge as well as growing concerns toward cost-effectiveness. Objective To demonstrate the effectiveness of intramedullary fixation of fracture shaft of femur in skeletally immature children using the titanium elastic intramedullary nails. Method Forty children who underwent fixation with titanium intramedullary nails because of fracture of shaft of femur (Winquist and Hansen type 1 and 2) were reviewed. There were 60% male and 40% female patients and mean follow-up was six months. Time of union, deformity at fracture site, limb length discrepancy, knee range of motion and complications were assessed. Result Average age of the patients was 5.17 years (range 3 to 10). All patients achieved complete healing at a mean 12.8 weeks (range 10 to 20 weeks). Average limb length discrepancy was -0.16 cm (range -1.0 to 1.1 cm) average knee range of motion was 137.55 degrees (range 118 to 152 degrees). Complications were recorded in 13 (31.7%) patients and included: Five malunion which did not show any deformity or functional impairment and eight superficial wound infections which were healed after removal of nail. All patients were active as their pre injury levels at six months follow up. Conclusion Elastic stable intramedullary nailing is the method of choice for the simple pediatrics fracture shaft of femur, as it is minimally invasive and shows good functional and cosmetic results. It allows short hospital stay and quick recovery from pain and is cast-free.

Immunohistochemical Expression of Human Epidermal Growth Factor Receptor 2 (HER2) and p53 in Gastric Adenocarcinoma: A Pilot Study from Northern India

INTRODUCTION

After the recent approval of Trastuzumab (anti-HER2 antibody) for the treatment of HER2 overexpressed Gastric Adenocarcinoma (GA), importance of HER2 testing is increasingly recognized. However, there is paucity of studies for HER2 overexpression in the Indian patients of GA. Similarly, study of p53 expression in the Indian patients of GA is infrequent.

AIM

To study immunohistochemical expression of HER2 and p53 in GA biopsy samples.

MATERIALS AND METHODS

This was a cross-sectional observational study. The expression of HER2 and p53 by immunohistochemistry were analyzed in 50 cases of GA. The HER2 expression was scored as negative (0 and 1+), equivocal (2+), and overexpression (3+). The p53 expression was quantified as negative (0-9% tumour cells) and positive (≥10% tumour cells). The intensity of p53 expression was assessed as strong and weak.

RESULTS

Mean age of the patients was 56.8±14.8 years. Male:female ratio was 2:1. Histological types of adenocarcinoma were intestinal (68%), diffuse (28%), and indeterminate (4%). HER2 overexpression and equivocal results were present in 10% cases, each. Overall, a positive expression of p53 was seen in 72% (strong and weak intensities: 66.7% and 33.3% cases, respectively).

CONCLUSION

As compared to HER2 overexpression, a higher incidence of p53 expression was seen (10% vs.72%) in GA.

Nutritional Status of Dalit Children: A Comparative Study with Non-Dalit Children in Eastern Terai of Nepal

IntroductionThe poor nutritional status of under five children has been considered a serious problem in Nepal for many years. Children need adequate nutrition for their proper physical, emotional as well as psychological development.ObjectiveThe objective of this study was to assess and compare the nutritional status of under five children and explore its socio demographic determinants.MethodologyAn analytical cross-sectional study was conducted in Eastern Terai, ecological belt of Nepal. Predesigned, pretested interview schedule was used to collect the information. Information was collected from 720 Dalit as well as Non-dalit mothers about their youngest children. The nutritional status was measured byusing anthropometric measurements.  ResultsIn bi-variate analysis the significant difference were observed among children's nutritional status between castes as well as a number of socio-demographic variables however in multivariate analysis only caste, number of Children Ever Born (CEB) and mother's education were found significant determinants of height for age, mother's education was found significant determinant for weight for height and caste, age of children and mother's education were found significant determinants of weight for age of children.ConclusionDalit children were found much more malnourished than Nondalit. The castes, age of child, CEB to mother and mothers' education were found as the determinants of nutritional status among under-five children.Birat Journal of Health Sciences Vol.2/No.1/Issue 2/ Jan - April 2017, Page: 117-126

Evaluation of Fastrach Laryngeal Mask Airway as an Alternative to Fiberoptic Bronchoscope to Manage Difficult Airway: A Comparative Study

INTRODUCTION

Awake intubation via Fiberoptic Bronchoscope (FB) is the gold standard for management of difficult airway but patients had to face problems like oxygen desaturation, tachycardia, hypertension and anxiety due to awake state. This study was conducted to assess feasibility of Fastrach Laryngeal Mask Airway (FLMA) to manage difficult airway as a conduit for intubation as well as for ventilation.

MATERIALS AND METHODS

After ethical approval and informed consent, 60 patients with difficult airway were randomly enrolled in FB group and FLMA group. In FB group, patients were sedated with midazolam/fentanyl. Airway anaesthetization of oropharynx was done with xylocaine spray and viscous and larynx and trachea by superior laryngeal nerve block and transtracheal block respectively. In FLMA group, initially patients were induced with propofol for FLMA insertion then succinylcholine was given for Tracheal Intubation (TI). The first TI attempt was done blindly via the FLMA and all subsequent attempts were performed with fiberoptic guidance. Haemodynamic monitoring was done during induction, intubation, immediately post insertion and there after at five minutes interval for 30 minutes.

RESULTS

All patients in the FLMA group were successfully ventilated (100%). In both the groups 28 (93.33%) patients were successfully intubated. However, first/second/third attempt intubation rate in FLMA vs FB group was 15 (50%) vs 13 (43.3%), 8 (26.66%) vs 10 (33.33%) and 5 (16.66%) in both groups respectively. Patients in the FLMA group were more satisfied with their method of TI and had lesser complications (p<0.05).

CONCLUSION

So the FLMA may be a better technique for management of patients with difficult airways.

Standardization and Classification of In vitro Biofilm Formation by Clinical Isolates of Staphylococcus aureus

BACKGROUND

Staphylococcus aureus is Gram-positive bacterium commonly associated with nosocomial infections. The development of biofilm exhibiting drug resistance especially in foreign body associated infections has enabled the bacterium to draw considerable attention. However, till date, consensus guidelines for in vitro biofilm quantitation and categorization criterion for the bacterial isolates based on biofilm-forming capacity are lacking. Therefore, it was intended to standardize in vitro biofilm formation by clinical isolates of S. aureus and then to classify them on the basis of their biofilm-forming capacity.

MATERIALS AND METHODS

A study was conducted for biofilm quantitation by tissue culture plate (TCP) assay employing 61 strains of S. aureus isolated from clinical samples during May 2015- December 2015 wherein several factors influencing the biofilm formation were optimized. Therefore, it was intended to propose a biofilm classification criteria based on the standard deviation multiples of the control differentiating them into non, low, medium, and high biofilm formers.

RESULTS

Brain-heart infusion broth was found to be more effective in biofilm formation compared to trypticase soy broth. Heat fixation was more effective than chemical fixation. Although, individually, glucose, sucrose, and sodium chloride (NaCl) had no significant effect on biofilm formation, a statistically significant increase in absorbance was observed after using the supplement mix consisting of 222.2 mM glucose, 116.9 mM sucrose, and 1000 mM NaCl (P= 0.037).

CONCLUSIONS

The present study puts forth a standardized in vitro TCP assay for biofilm biomass quantitation and categorization criteria for clinical isolates of S. aureus based on their biofilm-forming capacity. The proposed in vitro technique may be further evaluated for its usefulness in the management of persistent infections caused by the bacterium.

Clinical and cone beam computed tomography comparison of NovaBone Dental Putty and PerioGlas in the treatment of mandibular Class II furcations

OBJECTIVE

The objective of this study is to compare the putty form of bioactive glass (NovaBone Dental Putty) and particulate form (PerioGlas) in the resolution of Class II furcation defects.

BACKGROUND

Use of bone regeneration materials is becoming common in periodontal surgeries including furcation defects and the promising role of bioactive allograft materials has encouraged their presentation in different morphologic forms with their own advantages and disadvantages giving the operator ample of choices in his/her periodontal armamentarium.

MATERIALS AND METHODS

A total of 28 patients with 40 Class II furcation defects were enrolled in the study and were randomly allocated to two groups with 20 sites in each group. Measurement of defects was done using clinical and cone beam computed tomography (CBCT) methods. The patients were followed-up at 6 months. Intergroup comparisons were done using Mann-Whitney U-test.

RESULTS

There was no significance between group differences in clinical parameters and defect size at the baseline. After 6 months, particulate form showed a mean resolution of 50.48 ± 16.47% and 51.11 ± 9.48%, respectively for vertical defect and horizontal defect while putty form showed a mean resolution of 43.48 ± 9.33% and 42.88 ± 11.09%, respectively. Mean resolution in furcation width was 40.15 ± 13.00% for particulate form as compared with 36.27 ± 11.41% in putty form. Statistically, there was no significant difference between two groups except for the horizontal defect fill where PerioGlas showed statistically better results.

CONCLUSION

Putty form was comparable to particulate form for resolution of Class II furcation defects.

Analysis of socket preservation using polylactide and polyglycolide (PLA-PGA) sponge: a clinical, radiographic, and histologic study

The aim of this study was to evaluate the extraction socket healing and dimensional changes following alveolar ridge preservation using polylactide and polyglycolide (PLA-PGA) sponge. Fifteen patients were selected for alveolar socket preservation immediately following tooth extraction. Monoradicular maxillary and mandibular teeth were evaluated. The selected sockets had intact sockets walls with a minimum of 7 mm of residual alveolar bone height. The test sites were thoroughly debrided and grafted with PLA-PGA sponge, while the control sites underwent natural healing. Computed tomography (CT) measurements were taken at baseline and 6 months. After 6 months of healing, final CT measurements were performed, and trephine core biopsy specimens were obtained for histologic analysis. Implants were placed immediately after biopsy harvesting. All subjects completed the study, and all sites healed without adverse events and allowed for implant placement. The mean difference in socket height, width, and density after 6 months was statistically significantly higher in the test sites compared with control sites. Clinical measurement at the midbuccal site of the alveolar socket showed a mean loss of 2.45 ± 0.67 mm in the control group, compared with a mean gain of 1.28 ± 0.58 mm in the test group. All test sites showed minimal ridge alterations, and statistically significant differences were observed between the test and control sites with respect to bone composition and horizontal and vertical bone loss, indicating that PLA-PGA sponge is suitable for alveolar ridge preservation.

Trials of Improved Practices (TIPs) to Enhance the Dietary and Iron-Folate Intake during Pregnancy- A Quasi Experimental Study among Rural Pregnant Women of Varanasi, India

Background

Behavior Change Communications (BCC) play a decisive role in modifying socio-cultural norms affecting the perception and nutritional practices during pregnancy.

Objective

To examine the effectiveness of ‘Trials of Improved Practices’ (TIPs) on dietary and iron-folate intake during pregnancy.

Design

Community based quasi experimental study with a control group

Setting

Four villages of Chiraigaon Community Development Block of Varanasi, India from May 2010 and recruited from August 2010. End line assessment, after 12 weeks of intervention, was completed in April 2011.

Participants

Pregnant women in 13–28 weeks of gestation

Intervention

TIPs was implemented in addition to ongoing essential obstetric care services in two villages through 3 home (assessment, negotiation and evaluation) visits and only assessment and evaluation visits in the other two control villages. Interpersonal communication, endorsing the active participation of family members and home based reminder materials were the TIPs based strategies. The effect of TIPs was assessed by comparing key outcome variables at baseline and after 12 weeks of intervention.

Outcome Measures

Hemoglobin%, anemia prevalence, weight gain, compliance for iron-folate supplementation and dietary intake of calorie, protein, calcium and iron.

Results

A total of 86 participants completed the study. At the end, mean hemoglobin levels were 11.5±1.24 g/dl and 10.37±1.38 g/dl in the TIPs and control groups, respectively. The prevalence of anemia reduced by half in TIPs group and increased by 2.4% in the control group. Weight gain (grams/week) was significantly (p<0.01) higher in TIPs group (326.9±91.8 vs. 244.6±97.4). More than 85% of the PW in TIPs group were compliant for Iron-folate and only 38% were compliant among controls. The mean intake of protein increased by 1.78gm in intervention group and decreased by 1.81 gm in controls (p<0.05). More than two thirds of PW in TIPs group were taking one extra meal and only one third of controls were doing the same.

Conclusion

TIPs found to be an effective approach to improve the nutritional status of pregnant women in the study area. TIPs strategy could be further explored on larger sample representing different socio-cultural and geographical areas.

Trial Registration

Clinical Trial Registry of India CTRI/2015/02/005517

Erratum to: Nasotracheal Fiberoptic Intubation: Patient Comfort, Intubating Conditions and Hemodynamic Stability During Conscious Sedation with Different Doses of Dexmedetomidine

[This corrects the article DOI: 10.1007/s12663-012-0469-0.].

Evaluation of intrabony defects treated with platelet-rich fibrin or autogenous bone graft: A comparative analysis

Objective:

The primary objective of this study was to compare clinically and radiographically the efficacy of autologous platelet rich fibrin (PRF) and autogenous bone graft (ABG) obtained using bone scrapper in the treatment of intrabony periodontal defects.

Materials and Methods:

Thirty-eight intrabony defects (IBDs) were treated with either open flap debridement (OFD) with PRF or OFD with ABG. Clinical parameters were recorded at baseline and 6 months postoperatively. The defect-fill and defect resolution at baseline and 6 months were calculated radiographically (intraoral periapical radiographs [IOPA] and orthopantomogram [OPG]).

Results:

Significant probing pocket depth (PPD) reduction, clinical attachment level (CAL) gain, defect fill and defect resolution at both PRF and ABG treated sites with OFD was observed. However, inter-group comparison was non-significant (P > 0.05). The bivariate correlation results revealed that any of the two radiographic techniques (IOPA and OPG) can be used for analysis of the regenerative therapy in IBDs.

Conclusion:

The use of either PRF or ABG were effective in the treatment of three wall IBDs with an uneventful healing of the sites.