Prevelance of Hearing Loss and Factors Association in Chronic Kidney Disease Patients

Aim: Chronic kidney disease (CKD) is becoming a great concern, especially in developing countries and SNHL among patients with CKD is considerably higher than general population. So, current study aims evaluation and assessment of degree of hearing loss in chronic kidney disease patients using pure tone audiogram and correlation of hearing loss with its contributing factors. Materials and methods:70 patients with CKD were included in this prospective observational cross sectional study performed in tertiary care hospital. A detailed history; general physical, otological examination, blood investigation was done.CKD staging was done using KDIGO guidelines and hearing assessment using pure tone audiometry. Hearing loss association with CKD and contributing factors were studied. Result: Out of 70 participants, SNHL was seen in twenty one participants. Hearing loss was present in 3 out of 22 participants of CKD-3; 6 out of 12 participants of CKD-4 and 12 out of 15 participants of stage CKD-5. A statistically significant association of hearing loss was found with CKD stage, albuminuria, hemodialysis, hypertension and other factors. Discussion: Since hearing impairment may well have a negative impact on the social function of an affected individual, the use of pure tone audiogram to monitor CKD patients should be considered as a routine procedure. Patients with CKD would benefit from early detection of hearing loss which will allow for early rehabilitative measures to be taken.

Future of TABST and LABST in the Indian Pharmacopoeia Monographs A Humane Society International/India Workshop Report

Humane Society International India (HSI India) organized and facilitated a workshop on the 'Future of Target Animal Batch Safety Test (TABST) and Laboratory Animal Batch Safety Test (LABST) in the Indian Pharmacopoeia (IP) Monographs'. The workshop hosted key Indian regulators from the Indian Pharmacopoeia Commission (IPC) and the Central Drugs Standard Control Organization (CDSCO), industry representatives from the Indian Federation of Animal Health Companies (INFAH), Asian Animal Health Association (AAHA), and international experts representing the European Directorate for the Quality of Medicines (EDQM), the International Cooperation on Harmonization of Technical Requirements for Registration of Veterinary Medicinal Products (VICH), and multinational veterinary products manufacturers. The workshop was organized to encourage a bidirectional flow of information and to discuss the deletion of TABST and LABST from the veterinary vaccine monographs in the IP. This workshop was built from the symposium held by Humane Society International on the 'Global Harmonization of Vaccine Testing Requirements' held in 2019. This report details the outcomes of the workshop with proposed activities to be taken up as part of the next steps for the elimination or waiving of these tests.

Analgesic Efficacy of Fascia Iliaca Compartment Block for Positioning During Spinal Anesthesia in Patients with Femur Fractures

Background Positioning patients with femur fractures for spinal anesthesia is associated with excruciating pain. Fascia iliaca compartment block has the potential to block all nerves supplying the femur and therefore may provide effective analgesia during positioning these patients for spinal anesthesia. Objective To assess the analgesic efficacy of Fascia iliaca compartment block, during positioning patients with femur fracture for spinal anesthesia. We also assessed the duration of analgesia and the requirement for rescue analgesics in the postoperative period. Method Seventy adult patients with fracture femurs were randomly divided into two equal groups (A and B). Patients in both groups received fentanyl one mcg/kg intravenously, 20 minutes before positioning them for spinal anesthesia. Patients of group B additionally, received ultrasound-guided Fascia iliaca compartment block with 40 ml of 0.25% Ropivacaine, immediately after intravenous fentanyl. Numerical rating score (0-10) was used for the assessment of pain at five, 10, and 20 minutes after the block and immediately after positioning patients for spinal anesthesia. Result Immediately after positioning patients for spinal anesthesia, the numerical rating score of pain was 5.06±1.5 in group A and 2.49±1.2 in group B (p<0.001). The duration of analgesia was 799.7±62.1 minutes in group B and 314.65±118.9 minutes in group A (p<0.001). One (2.8%) patient of group B and 18(51.4%) patients of group A required rescue analgesics within four to twelve hours in the postoperative period (p=0.001). In group A, seven patients were satisfied with the analgesia technique while in group B, 17 were satisfied and eight patients were strongly satisfied (p<0.001). Conclusion Ultrasound-guided Fascia iliaca compartment block is effective in reducing pain during positioning patients with femur fractures for spinal anesthesia. Patients receiving this block had a prolonged duration of analgesia, required lesser analgesics, and were more satisfied in the postoperative period as compared to patients not receiving the block.

Role of cord blood IGF-1 and maternal HbA1c levels to predict interventricular septal hypertrophy among infants of diabetic mothers: A case-control study

BACKGROUND

Infants of diabetic mothers (IDMs) develop interventricular septal hypertrophy (ISH) (> 6 mm) [1]. The proportion of IDMs developing ISH varies from country to country. Maternal HbA1c and cord blood Insulin-like growth factor-1 (IGF-1) levels have been found useful to predict ISH.

METHODS

This was a case-control study of term neonates of diabetic mothers (cases) and of non-diabetic mothers (controls) to evaluate echocardiographic (ECHO) differences among cases and controls and to find the correlation of interventricular septal thickness (IVS) thickness with maternal HbA1C and cord blood IGF-1 levels.

RESULTS

Of 32 cases and 34 controls (mean gestational age 37.7 ± 0.9 weeks), 15 (46.8 %) cases, no control developed ISH. Septal thickness was more (6 ± 0.15 cm vs 3 ± 0.06 cm; p = 0.027) in cases than controls. Functional ECHO parameters including left ventricle ejection fraction were comparable (p = 0.9) among the two groups. Maternal HbA1C levels were higher (6.5 % ± 1.3 vs 3.6 % ± 0.7; p = 0.001) with a positive correlation with IVS (Pearson's coefficient 0.784, p < 0.001). Cord blood IGF1 levels were too higher in cases (99.1 ± 6.09 ng/ml vs 37.1 ± 2.99 ng/ml; p < 0.001) with moderate correlation with IVS thickness (Pearson's coefficient 0.402; p = 0.00). Receiver operator curve analysis showed, that at a cut-off of 72 ng/ml, cord blood IGF1 predicted ISH with 72 % sensitivity; 88 % specificity and at a cut-off of 7.35 %, maternal HbA1c predicted ISH with sensitivity; specificity of 93.8 % and 72.1 % respectively.

CONCLUSION

ISH was present in 46.8 % in cases as compared to none in controls. IVS thickness correlated well with maternal HbA1C and moderately with cord blood IGF-1 levels. Functional parameters on ECHO were unaffected by maternal diabetic control. At the cut-off of maternal HbA1c of 7.35 % and cord blood IGF-1 of 72 ng /ml, babies need to be monitored clinically with ECHO to look for ISH.

Post Covid-19 Sinonasal Candidiasis: A Crisis Within the Pandemic

The aim of this study was to find out the association of sinonasal candidiasis and Covid-19 infection. A prospective observational study was conducted at a tertiary care centre from April to September 2021, involving all patients with invasive candidiasis of the paranasal sinuses having a history of Covid-19 infection. A total of 18 patients of covid associated sinonasal candidiasis among the 475 cases of fungal rhinosinusitis were studied. All patients had involvement of nose and sinuses and 2 patients had orbital involvement with no loss of vision, while 3 had intracranial extensions and 1 had pulmonary involvement. Mandible was involved in 1 patient alone, while the maxilla and palate were involved in 5 patients. 15 patients were hypertensive, 12 diabetics and 1 had aplastic anaemia. Cultures showed that 8 patients had C. parapsilosis, 5 had C. albicans, 3 had C. tropicalis and 2 had mixed fungal infections. All patients underwent surgical debridement and antifungal administration. They were followed up for a minimum of 3 months. There was only one mortality (with aplastic anaemia), rest 17 were disease free at the time of writing this article. This is perhaps the first case series of post covid sinonasal candidiasis in the world. Invasive sinonasal candidiasis is a newer sequela of COVID-19 infection. Uncontrolled diabetes and over-zealous use of steroids at the time of Covid-19 are few of the known risk factors. Early surgical intervention and anti-fungal treatment should be sought for management.

An Observational Study on Association of Clinical Outcome of Diphtheria Cases with Immunization Status: A Tertiary Care Hospital, Jaipur

BACKGROUND

Diphtheria is an important vaccine preventable disease with varied outcome from mild to death. It was observed that the outcome also gets affected with status of immunization. The outcome is relatively milder in immunized children.

OBJECTIVE

To find out the clinical presentation and outcome of diphtheria cases and its association with the immunization status.

METHODS

A descriptive analysis of 64 diphtheria cases admitted from January 2019 to May 2020 at SMS hospital, a tertiary care referral hospital in Jaipur.

RESULTS

Half of (51.56%, 33/60) patients were in the age group of 6-10 years. The peak load (48.44%) of diphtheria cases was seen in the monsoon season. Around 60% of the patients were fully immunized and around 10% partially immunized, every third case was un-immunized. The most common complication was neurological in 13 cases (20.31%), followed by cardiac complications in 11 cases (17.19%), and respiratory (7.81%). The proportion of complication was much lower (26.3%) in immunized cases as compare to partially immunized and un immunized. The proportion of myocarditis was significantly higher in un immunized cases (40%) than partially immunized (16.7%) and filly immunized group (5.3%). Similarly, Bronchopneumonia was also significantly higher (20%) in unimmunized.

CONCLUSION

Our study depicted that there has been a shift of age above 5 years for diphtheria which suggests the need for the booster dose. Also high chances of complications are seen in unimmunized and partially immunized calling for public awareness regarding complete immunization.

"An Observational Study on Association of Clinical Diagnosis of Diphtheria with Smear and Culture Test: A Tertiary Care Hospital, Jaipur"

Diphtheria is an acute infectious upper respiratory tract disease caused by toxigenic strains of Corynebacterium diphtheria and can lead to significant morbidity and mortality in all the age groups. Most of the time diagnosis of diphtheria is clinical. There may be a dirty white patch covering one or both tonsils on examination for which throat swabs are collected for Kleb's-Loeffler's Bacillus (KLB) by direct microscopy and for culture and sensitivity of the organism. To find out the association between clinical diagnosis of diphtheria with smear and culture positivity. 674 cases of Clinical diphtheria were admitted from June 2017 to September 2020 at a tertiary care hospital, Sawai Mansingh Hospital, Jaipur. throat, difficulty in swallowing and swelling in the neck. Out of 674 patients of clinical diphtheria, majority 610 cases (90.5%) were found to have both KLB smear and culture negative. 13 cases (1.9%) were found to have both KLB smear and culture positive. 19 cases (2.8%) were found to have KLB smear positive and culture negative and remaining 32 cases (4.8%) were found to have KLB smear negative and culture positive. Out of 19 patients of KLB smear positive,11 cases (3.5%) were found to have complications. Out of 32 culture positive patients,24 cases (7.7%) were found to have complications. Out of 13 patients of both KLB smear and culture positive,11 cases (3.5%) were found to have complications. Our study concluded that the negative report of KLB smear and culture does not rule out diphtheria and it is evident that percentage of complication is high in patients with either KLB smear or culture or both positive with respect to both being negative. The correlation is found to be significant (p < 0.001).

Spectrum of Neurological Outcomes in Diphtheria: A Case Series

Diphtheria is an acute infectious disease caused by the exotoxin produced by Corynebacterium diphtheriae, a gram positive bacteria. It has propensity to affect mainly cardiac muscle and nervous system. To study the percentage, spectrum of patients with various neurological complications and the pattern of recovery in followed up confirmed cases of diphtheria. Single centre prospective analysis of neurological complications in diphtheria patients from June 2019 to September 2020 at SMS Medical College and hospital,Jaipur. In this study, 60 cases were included. Immunised cases were 60% (36 out of 60 cases) whereas unimmunised constituted the rest 40% (24 out of 60 cases). Neurological complications were observed in 15% of the cases (9 out of 60). Isolated palatal palsy was the most common complication (4 out of 9 cases, 44.44%), succeeded by lower limb LMN palsies (2 out of 9 cases, 22.22%) with unilateral facial nerve palsy, bilateral abductor palsy and paralytic ileus constituting the rest (1 out of 9 cases each, 11.11% each). Onset of complications ranged from 10 to 36 days whereas recovery was complete and without any residual sequelae between 60 to 240 days. Our study concluded that neurological complications form a sizeable portion of post diptheritic complications and carries good prognosis, hence timely diagnosis and differentiation from other neuropathies is a pre requisite for rational management and contact tracing.

Lateral Skull Base Lesions: Our Experience of 15 Years

To analyse and report various aspects of lateral skull base surgery by describing the incidence and demographic variables, diagnostic and management challenges, surgical choices along with complications and their management and the long term morbidity and survival outcomes in our experience of 15 years. Retrospective review of complete records of all cases operated for lateral skull base tumors at a tertiary care teaching institution in India between timespan of 15 years from 2003 to 2018 was undertaken. 53 cases were selected and analysed. Those having follow up of less than 6 months were excluded. Outcomes were assessed in terms of incidence of types of tumors, benign or malignant, age and sex variation of the patients, staging status at presentation, status of facial and other lower cranial nerves pre-operatively, surgical techniques with complications if any, recurrences and survival. Of 35 benign tumors, tympanojugular paragangliomas were most common. Average age for these was 53 years with 19 females and 14 males. All were non-functional. Tinnitus and hearing loss were most common presentations. Class B2 and C1 tumors were most commonly encountered and the ITF A approach was most commonly used. Hearing loss and Facial palsy were commonest complication post-operatively. There were 2 recurrences. 18 malignancies were observed. Most were stage IV at presentation. Otorrhea and otalgia were most common presenting symptoms followed by hearing loss. 5 year survival was 55%. Successful treatment of lateral skull base lesions requires a multimodality therapy with team approach. Surgical resection is the primary management choice with variable approaches. ICA status related to the tumor is the most important consideration. Malignancies require more aggressive treatment for obtaining clear margins along with pre/post-op chemoradiation. Good results with acceptable complications can be obtained even with advanced tumors.

An Observational Study Depicting Role of p16 in Detecting Human Papilloma Virus in Oral and Oropharyngeal Cancer and Associated Factors

The longstanding phrase, traditional risk factors like-smoking, tobacco and alcohol are the only causative agents of oral and oropharyngeal squamous cell carcinoma (SCC) is changing now. Etiological divergence is taking place which we have to know to reach upon an exact cause of the disease. Human papilloma virus (HPV) infection is a well-established cause of oral cancer. Escalating incidence of HPV associated cancer has a strong impact on its management. So, a concern clinician needs to get aware for it. Among various types of HPV, HPV-16 is more frequently associated with oral cancers. HPV detection will become a game changer in management of oral cancers. HPV infection and p16 protein expression has a strong and consistent correlation. Therefore, immunohistochemical analysis of p16 protein can be a surrogate biomarker in high risk groups. This hospital based prospective observational study recruited 180 subjects of oral and oropharyngeal SCC. We underwent immunohistochemical analysis of p16 in biopsy specimen of subjects and studied HPV status and associated environmental, clinical and behavioral factors. We observed 9.4% (17/180) incidence of p16 positivity with female predominance. Our observations showed that its prevalence was higher in urban patients who were non tobacco users, had sexually transmitted disease, early stage (T1-T2), poorly differentiated SCC with nodal metastasis. We conclude that keeping in mind HPV as a cause of oral and oropharyngeal SCC, p16 should be use as a biomarker for its detection in high risk cases.

Kimura Disease: A Case Report and Review of Literature

Kimura disease is a rare benign chronic inflammatory disorder characterised by multiple subcutaneous nodules and lymphadenopathy most commonly in head and neck region. It is seen in Asian men in their 2nd and 3rd decade. Kimura disease is usually confused for Angiolymphoid hyperplasia with eosinophilia and associated with eosinophilia and increased serum IgE. Kimura disease is also known for its recurrence. Diagnosis is by histopathological examination. Treatment is mainly surgical excision for cosmetic purposes.

Study of Two Different Volumes of 0.75% Ropivacaine for Ultrasound Guided Supraclavicular Brachial Plexus Block on Successful Blockade and Diaphragmatic Motility

Background Use of ultrasound guidance during supraclavicular brachial plexus block allows the usage of a lower anesthetics dose and minimizing unwanted effects of the anesthesia. Objective To compare the success of sensory blockade and the incidence of hemidiaphragmatic dysfunction in patients receiving two different volume of 0.75% Ropivacaine for ultrasound guided supraclavicular brachial plexus block. Method A prospective randomized double-blinded comparative study was conducted. Group A patients (n=30) received 20 ml and Group B (n=30) received 25 ml of 0.75% Ropivacaine for ultrasound guided supraclavicular brachial plexus block. Hemodynamic parameters, oxygen saturation, diaphragmatic excursion, onset of sensory blockade and time for completion of blockade were measured. Independent t-test, Chi-square test and Mann-Whitney U test were used to analyze the data at p value of less than 0.05 using Statistical Package for Social sciences (version 11.5). Result At 30 minutes, 29 (96.67%) patients in group B and 27 (90.0%) patients in group A had no sensation in median, radial, ulnar, musculocutaneous and medial cutaneous nerves teritories; however, it was not significant statistically (p value > 0.05). At 30 minutes in Group A, 25 (83.33%) patients had no diaphragmatic hemiparesis and five (16.67%) patients had partial diaphragmatic hemiparesis. However, three (10%) patients had no diaphragmatic hemiparesis in Group B, 25 (83.33%) patients had partial and two (6.67%) patients had complete diaphragmatic hemiparesis and it was statistically significant (p < 0.05). Age and sex had no effect on diaphragmatic hemiparesis in both groups (p value > 0.05). Conclusion The patients receiving lower volume of Ropivacaine had less incidence of hemidiaphragmatic dysfunction with similar sensory blockade as compared to the patients receiving higher volume of Ropivacaine.

Role of Vimentin and E-cadherin Expression in Premalignant and Malignant Lesions of Oral Cavity

To determine the role of Vimentin and E-cadherin expression in oral premalignant and malignant lesions. 68 histopathologically confirmed cases of premalignant and malignant oral cavity lesions enrolled. Biopsy specimens were taken from lesion of all cases and subjected to immunohistochemical evaluation of expression of E-cadherin and Vimentin. We examined the relationships between the expression of these markers and specific clinicopathological features were analyzed. Out of 68 cases 28 showed high vimentin expression (3 + and 4 + grade) and 40 showed low vimentin expression (1 + and 2 + grade). 20 cases out of 68 presented with high E-cadherin expression (3 + and 4 +) and rest 48 with low expression (1 + and 2 +) of the same. Smoking and tobacco chewing reflected non-significant association with their expression. In this study all 28 patients (100%) with high vimentin expression had malignant lesions and 17 (60.7%) presented with metastatic lymph nodes Out of 20 patients with high E-cadherin expression 8(40.0%) had malignant lesions and 12 (60.0%) had pre malignant lesions and 4 (20%) showed nodal metastasis. As tumor stage (TNM) progresses, it showed increased vimentin and decreased E-cadherin expression and vice versa. We concluded that increased vimentin and decreased E-cadherin expression in oral cancers are associated with metastasis and disease progression in terms of upstaging of disease. We can use cellular expression of vimentin and E-cadherin for early diagnosis of disease.

Oral Application of Mother's Own Milk for Prevention of Late Onset Sepsis in Preterm Very Low Birth Weight Neonates: A Randomized Controlled Trial

Background: Oral application of mother's own milk (MOM) in very low birth weight (VLBW) neonates may provide an effective method of cleaning the oral cavity and influencing the immunocompetent cells there. Methods: A double-blind randomized controlled trial was conducted in a tertiary level neonatal unit on VLBW neonates; that is, neonates with birth weight <1,500 g, hospitalized within 72 hours of birth. The intervention was oral care with MOM. The primary objective was to observe the effect of oral care with MOM on late onset sepsis (LOS) and also on mortality, days to attain full enteral feed, necrotizing enterocolitis (NEC), exclusive breastfeeding rates at discharge, and total hospital stay (THS). Results: One hundred ten neonates were randomized to intervention and no-intervention group; 55 in each group. Neonates in the intervention group developed LOS in 9.1% versus 27.3% in no-intervention group (p = 0.013). Mortality was 9.1% versus 16.4% (p = 0.252); days to attain full enteral feeds were 6.94 ± 2.34 versus7.4 ± 2.31 days (p = 0.306); exclusive BF rates at discharge were 83% versus 75% (p = 0.449); THS was 30.72 ± 8.72 versus 33.5 ± 8.7 days (p = 0.267) in the two groups, respectively. There was no effect on NEC. Conclusion: Oral care of VLBW neonates with MOM reduces LOS and mortality.

Covalent Triazine Framework as an Efficient Photocatalyst for Regeneration of NAD(P)H and Selective Oxidation of Organic Sulfide

Covalent triazine frameworks (CTFs), belonging to the super-family of covalent organic frameworks, have attracted significant attention as a new type of photosensitizer due to the superb light harvesting ability and efficient charge transfer originating from the large surface area. However, the wide optical band gap in CTFs, which is larger than 3.0 eV, hinders the efficient light harvesting in the visible range. To overcome this limitation, we developed the new type CTFs photocatalyst based on the donor-acceptor conjugation scheme by using melamine (M) and 2,6-diaminoanthraquinone (AQ) as monomeric units. The melamine-2,6-diaminoanthraquinone based covalent triazine frameworks (M-AQ-CTFs) photocatalyst shows the excellent light harvesting capacity with high molar extinction coefficient, and the suitable optical band gap involving the internal charge transfer character. Combination of M-AQ-CTFs and artificial photosynthetic system including the organometallic rhodium complex, acting as an electron mediator, exhibited the excellent photocatalytic efficiency for the regeneration of the nicotinamide cofactors such as NAD(P)H. In addition, this photocatalyst showed the high photocatalytic efficiency for the metal-free aerobic oxidation of sulfide. This study demonstrates the high potential of CTFs photocatalyst with the donor-acceptor conjugated scheme can be actively used for the artificial photosynthesis.

Vitamin D Status of Very Low Birth Weight Neonates at Baseline and Follow-up after Daily Intake of 800 IU Vitamin D

INTRODUCTION

Vitamin D deficiency (VDD) is rampant in neonates. Recommendations for supplementation are variable.

METHODS

An observational study was done on less than 32 weeks of very low birth weight neonates to find prevalence of VDD (<20 ng/ml) at baseline; at 38 ± 2 weeks post-menstrual age (PMA) after daily intake of 800 IU vitamin D (vit D). Secondary objectives were to find determinants of VDD, to compare growth in deficient; vit D sufficient (VDS) neonates; to find vit D toxicity.

RESULTS

Of 83 neonates, 81 (97.6%) were VDD at baseline and 5 (6%) at 38 ± 2 weeks PMA. Determinants for VDD at baseline were inadequate maternal sun exposure (p < 0.001) and vit D supplementation (p = 0.007). Factors for VDD at 38 ± 2 weeks PMA were male gender (p = 0.049), morbidities (p = 0.006), ventilation >24 h (<0.001), sepsis (p = 0.032), caffeine (p ≤ 0.001) and missed supplements (p < 0.001). Weight and length gain of VDD to VDS neonates were (6.70 ± 2.40 to 8.96 ± 2.21 g/day); (0.82 ± 0.34 to 1.08 ± 0.37 cm/week), respectively (p < 0.001). Head circumference gain (cm/week) of VDS; VDD neonates was 0.58 ± 0.09; 0.54 ± 0.06 (p = 0.054), respectively. No neonates developed vit D toxicity.

CONCLUSIONS

In preterm VLBW neonates, the prevalence of VDD was 97.6% but decreased by >90% at 38 ± 2 weeks with a daily intake of 800 IU vit D. Inadequate maternal vit D intake and sun exposure determined low baseline vit D status of neonates. Male gender, morbidities, ventilation, sepsis, caffeine, missed vitamin D supplements were determinants of poor vit D status at follow-up. Weight gain and length increments were more in the VDS group.

Vitamin D: A Modulator of Allergic Rhinitis

Allergic rhinitis is a topic of concern among clinicians. Despite of being treated in form of oral medicines, nasal drops and sprays several patients come back with complaint of no relief. This necessitates to review and focus on etiology and to find some other treatment regimen. Established relation of serum vitamin D level and various allergic conditions attracts us to use it as a therapeutic agent for allergic rhinitis. It is a case-control observational study recruited 80 subjects with 40 cases and 40 controls. There was drop out of two subjects among cases. Cases were supplement with oral vitamin D (cholecalciferol-1000 IU OD) and controls received no treatment. Serum vitamin D level, Total nasal symptom score (TNSS) and total eosinophilic count (TEC) were calculated at 0, 1 and 3 months and compared. Pre-treatment average serum vitamin D level of cases was 20.15 + 10.26 ng/ml and of control was 27.94 + 13.38 ng/ml. The TNSS score of cases was 7.43 + 1.87 and of controls was 5.00 + 1.52. TEC of cases was 546.15 + 113.39 and of controls was 313.33 + 125.08. Post-treatment serum vitamin D level of cases was 38.05 + 14.62 and of controls was 27.43 + 12.76. TNSS of cases was 3.53 + 0.68 and 4.43 + 1.17 in control group, TEC of cases was 68.13 + 38.95 and of controls was 197.03 + 123.36. This study concludes that vitamin D acts as disease modulator in allergic rhinitis In case of allergic rhinitis with vitamin D deficiency its supplementation gives symptomatic relief and also lowers down the values of TNSS and TEC.

Predictors of Poor Outcome in Neonates with Pyogenic Meningitis in a Level-Three Neonatal Intensive Care Unit of Developing Country

BACKGROUND

The mortality of neonatal pyogenic meningitis is reduced to 10-15%, but morbidity is unchanged.

METHODS

Primary objective is to determine the outcome, i.e. death or abnormal neurological examination (NE) at discharge and abnormal developmental quotient (DQ) at 3 months. Secondary objective is to find predictors of poor outcome.

RESULTS

In all, 89 neonates enrolled, 10 expired and 24 neonates had abnormal NE at discharge. A total of 59 neonates came for follow up, 13 had DQ < 70. Prolonged shock (odds ratio, OR: 8.28; p = 0.001), coma (OR: 4.3; p = 0.001), seizures (OR: 14; p = 0.012), mechanical ventilation (OR: 18.55; p = 0.00), orogastric feeding (OR: 2.78; p = 0.042) and electroencephalography (EEG; OR: 9.6; p = 0.00) predicted poor short-term outcome. Abnormal NE at discharge (OR: 15.6; p = 0.001), EEG (OR = 10.60; p = 0.00) and brainstem-evoked reflex audiometry (OR = 37.20, p = 0.00) predicted a low DQ at 3 months. Mortality and morbidity of neonates with Pyogenic Meningitis (PM) were similar to that in developed countries. Outcome depended on severity of the disease and NE at discharge.

Cheiro-Oral Syndrome

Cheiro-Oral Syndrome (COS) is a very rare neurological syndrome associated with varied etiology. We report a 53-year-old man presented with left sided perioral and ipsilateral hand/fingers burning sensation for a one-month duration. On examination, he had hypesthesia over left perioral and distal palmar aspect of all five fingers. MRI revealed subacute infarct in the posterior limb of right internal capsule adjacent to and minimally involving thalamus. He was diagnosed as CheiroOral Syndrome as a result of ischemic stroke and managed.

Bifidobacteria and its rice fermented products on diet induced obese mice: analysis of physical status, serum profile and gene expressions

Obesity is highly correlated with the dysbiosis of intestinal microbiota, and bifidobacteria are one of the soft targets of this metabolic syndrome. The aim of this study is to evaluate the efficacy of Bifidobacterium sp. MKK4 and rice-based fermented foods on physical, haematological, gut microbiota and lypogenic-lypolytic marker genes in diet-induced obese mice. Adult male mice (21±0.7 g) were randomly divided into four groups (n=10) according to the type of diet: normal diet (ND), high fat diet (HFD), HFD supplemented with Bifidobacterium sp. MKK4 and HFD supplemented with MKK4 associated rice-fermented food. 8 weeks of bacterial therapy in the obese mice resulted in significant reduction of body and organ weights, improved serum levels of glucose, triglyceride and cholesterol, the histological structure of the liver (steatosis), and re-establishment of gut Lactobacillus, Bifidobacterium and Bacteroides species. The bacterial therapy led to up-regulation of lipolytic transcription factors, such as peroxisome proliferator-activated receptor (PPAR)-α, PPAR-δ, and their regulated gene products in fatty acid metabolism and glucose uptake, such as acyl-CoA oxidase, carnitine palmitoyl-transferase-1, uncoupling protein-3 and glucose transporter-4. Concomitantly, both adipocytogenesis and fatty acid synthesis were arrested as reflected by the down-regulation of sterol regulatory element binding protein-1c, acetyl-CoA carboxylase, fatty acid synthase and tumour necrosis factor alpha genes. The effectiveness of the fermented product was more profound than the single bacterium. These data provide experimental support with regard to the use of Bifidobacterium sp. MKK4 as a natural therapeutic agent to control obesity.

Cochlear Implantation in Children with Anomalous Cochleovestibular Anatomy: Our Experience

To report operative findings, postoperative course, and postimplantation performance in patients with cochlear malformations who underwent cochlear implantation. Seventeen patients with malformations which included enlarged vestibular aqueduct (n = 6), Mondini's dysplasia (n = 5) common cavity deformity (n = 3) and incomplete partition type 2 (n = 3) underwent cochlear implantation with Nucleus 22 straight array device at our center. Operative findings described facial nerve anatomy and cerebrospinal fluid leak. Standard tests of speech perception were used to evaluate the postoperative performance for each subject. Operative findings included cerebrospinal fluid leak (thirteen patients) all of which were repaired successfully with graft. None had abnormal facial nerve anatomy. No surgical complications occurred. All the patients except two with common cavity had complete insertion. Electrode thresholds and discomfort levels were variable for several months after implantation. All patients demonstrated improved performance after implantation. Patients with enlarged vestibular aqueduct fared better than patients with other inner ear malformations. Cochlear implantation can be a successful method of rehabilitation in patients with congenital deafness who have cochlear malformations.

Role of MRI in a Series of Cases with Biceps Injuries of the Shoulder

Dislocation and injury of the biceps is associated with acute and chronic trauma, degenerative changes, repetitive microtrauma, or injuries associated with recurrent and neglected cases of shoulder dislocation. The cases of displaced biceps injuries are relatively rare (only 1/6^th of all rotator cuff injuries). The dislocation of biceps is manifested with pain and restriction of movements. The X-ray shoulder is not of much help in this condition barring for ruling out the fractures of humerus and scapula. Ultrasound is an important tool in the dislocation and shows empty bicipital groove which raises the suspicion of the soft tissue injures. Ultrasound is a problem solving tool when the equivocal findings in MRI (Magnetic Resonance Imaging) in other muscular injuries also. MRI is the modality of choice in these conditions. The bone and anatomy is better visualised on the T1WI images and the pathology is better visualised on the PDFS (Proton Density Fat Saturation) and the STIR (Short Tau Inversion Recovery) images. The role of Non Contrast Computed Tomography (NCCT) is important in associated suspicious bony abnormalities as highlighted in the article. The biceps region is a hidden area and challenging on arthroscopy due to poor visualisation of the extra-articular tendon part. MRI study helps the orthopaedicians for better management of the hidden areas. This series highlights the role of each modality in the diagnosis and management of the biceps lesions.

Cardiac MR Imaging in the Evaluation of Rheumatic Valvular Heart Diseases

INTRODUCTION

Rheumatic heart disease is the most common cause of valvular heart disease throughout the world. Echocardiography is the dominant imaging investigation in the assessment of cardiac valvular disease and the role of Magnetic Resonance Imaging (MRI) is so far limited. However, due to rapid improvements in the cardiac MRI technology in past few years, this non invasive technique is gaining interest in the examination of cardiac valves.

AIM

Our study was undertaken to define the role of MRI in the evaluation of Rheumatic valvular heart disease and to compare the role of MRI with transthoracic echocardiography with regard to quantity of stenosis and volume regurgitation.

MATERIALS AND METHODS

ECG gated Cardiac MRI was performed with a 1.5-Tesla system (MAGNETOM SYMPHONY- Model 2005) using basic cardiac software (Argus viewer) by a phased-array multicoil on 50 subjects who were known cases of Rheumatic valvular heart disease. A chest radiograph and echocardiography were done in all patients before MR examination. Informed consent was taken from all patients.

RESULTS

Mitral stenosis either as an isolated valvular abnormality or in combination with other valvular abnormalities constituted the major bulk of Rheumatic valvular heart disease in our study population. The average ejection fraction by ECHO is 64.94±7.11 and by MRI 67.52±7.84. The average mitral valve area by ECHO is 1.79±0.43 cm(2) and by MRI 1.82±0.47 cm(2). The average aortic valve area by ECHO is 1.10±0.21 cm(2) and by MRI 1.12±0.25 cm(2). The Coefficient of Correlation (r) is 0.82 for ejection fraction, 0.98 for mitral valve area and 0.92 for aortic valve area which means a strong positive association between the results by ECHO and MRI. In all instances, the p-value is <0.00001, suggesting that the test is highly significant.

CONCLUSION

In our study echocardiography was found to be the gold standard for the diagnosis of Rheumatic valvular heart disease and the role of MRI remained only complimentary to Echocardiography. However with advanced cardiac software, more advanced techniques, and faster imaging sequences, MRI may become a valuable procedure for investigation and follow-up of patients with valvular heart disease.

A Case of Cervical Spine Tuberculosis in an Infant

Tuberculosis of cervical spine is an extremely rare entity in infants with only few case reports available in the literature. The diagnosis is often delayed due to less dramatic effects of paraplegia or quadriplegia in an infant as compared to older paediatric population. Along with clinical and laboratory investigations, imaging plays a crucial role in defining the extent of involvement, evaluation of complications, providing suitable differential diagnosis and monitoring response to treatment. Tuberculosis typically involves the discovertebral complex while involvement of isolated vertebral body or multiple vertebrae without involving the intervertebral discs is much less common. We present such an unusual case of cervical spine tuberculosis in an infant involving a single vertebral body without adjacent intervertebral disc involvement complicated with tuberculous meningitis (TBM) and communicating hydrocephalus. The early medical intervention in this case resulted in early diagnosis, active treatment and resultant near normal recovery.

Primary Peritoneal Papillary Serous Cystadenocarcinoma - A Rare Malignancy

Primary peritoneal papillary serous carcinoma is a rare primary malignancy diffusively involving the peritoneum of abdomen and pelvis. Epithelial ovarian cancers and primary peritoneal cancers arise from the common germinal epithelium which develops from the coelomic epithelium. Due to a common embryonic origin of the ovary and the peritoneum, carcinoma of the ovary and primary peritoneal carcinoma have much histological similarity. However the incidence of Primary peritoneal serous carcinoma is considerably lower than that of epithelial ovarian cancer and is mostly seen in elderly women. Early stages of this disease may be asymptomatic; symptoms of the advance stages of the disease include abdominal distention, abdominal lump, non-specific abdominal pain, vomiting and dyspnoea all as a result of massive ascites. Patients diagnosed with primary peritoneal papillary serous carcinoma are treated using the same staging, surgical and chemotherapeutic approach as epithelial ovarian cancer because of the similarities in biological behavior.

Uterine artery embolisation for uterine fibroids: Our experience at a tertiary care service hospital

BACKGROUND

Uterine artery embolisation (UAE) has evolved as a minimally invasive and effective alternative, treatment modality for women with symptomatic fibroids. We discuss our initial experience of UAE in the management of symptomatic fibroids.

METHODS

Twenty five symptomatic patients of uterine fibroids were treated with UAE by selectively cannulating and injecting poly vinyl alcohol particles into the uterine arteries. Post treatment follow up was done at 2 and 6 months respectively.

RESULTS

Pre-treatment, the sizes of fibroids were between 3.9 and 10.9 cm (mean 7.4) on ultrasonography. Of the total 25 patients, 49 uterine arteries were embolised with a technical success rate of 98%. Menorrhagia persisted in 7 patients, dysmenorrhea in 4 patients and pressure symptoms in 2 patients respectively in follow up study of six months which corresponds to a reduction in symptoms by 68% for menorrhagia, 71% for dysmenorhoea and 75% for those with pressure symptoms respectively. At 2 months follow-up post embolisation, the mean diameter of the fibroid was 4.03 cm (range 2-5.2 cm) and at 6 months 3.2 cm (range 1.3-4.1 cm), corresponding to size reduction of 45.5% and 57%, respectively. Follow up with ultrasonography at 2 and 6 months period showed successful fibroid reduction in 24 patients with corresponding reduction in the symptomatology. One patient remained symptomatic with increase in fibroid size and had to undergo hysterectomy.

CONCLUSION

Uterine artery embolisation can be considered as an alternative to hysterectomy in appropriately selected symptomatic patients of uterine fibroids.

Genetic analysis to identify good combiners for ToLCV resistance and yield components in tomato using interspecific hybridization

The interspecific hybridization for tomato leaf curl virus (ToLCV) resistance was carried out among 10 genetically diverse tomato genotypes (diversified by 50 SSR markers). Among the 10 parents, four susceptible cultivars of Solanum lycopersicum were crossed with six resistant wilds, such as S. pimpinellifolium, S. habrochaites, S. chemielewskii, S. ceraseforme, S. peruvianum and S. chilense in a line x tester mating design. All the 24 hybrids and their parents were grown in the field and glasshouse conditions to determine the general-combining abilities (GCA) and specific-combining abilities (SCA). The variances due to SCA and GCA showed both additive and nonadditive gene effects. Based on GCA estimates, EC-520061 and WIR-5032 were good general combiners while based on SCA estimates, PBC x EC-520061 and PBC x EC-521080 were best specific combiners for coefficient of infection and fruit yield per plant in both the environments. These lines could be selected and utilized in ToLCV resistance and high yield breeding programme for improving the traits.

Biodegradation of pyrene and phenanthrene by bacterial consortium and evaluation of role of surfactant

High molecular weight poly aromatic hydrocarbons (HMW PAHs) are well known for their hydrophobicity and they get strongly adsorbed onto the soil particles. Generally, surfactants facilitate the biodegradation of PAH by enhancing their solubility and desorption of hydrophobic compounds from soil particles. To investigate the role of synthetic surfactant in biodegradation of PAHs, two bacterial strains BP10 and P2 were incubated in soil spiked with pyrene and phenantherene (100 μg g-1of soil each) in isolation and in combination with/without Tween 80. After 14 days of incubation, pyrene and phenantherene were degraded by a combination of BP10 and P2 to the extent of 98% and 99%, respectively. Addition of tween 80 reduced the degradation of pyrene and phenantherene by 35 and 10%, respectively. Biosurfactant produced by selected strains i.e. BP10 and P2 could enhance desorption of pyrene (100 μg g-1of soil) by about 27% and 12%, respectively. However, desorption activity was relatively higher (32 and 29%, respectively) in case of phenanthrene (100 μg g-1of soil) from the spiked soil. Present study showed that in spite of additional chemical surfactant, bioaugmentation of highly petroleum hydrocarbon degrading bacterial combination was very effective in boosting the bioremediation of PAHs- contaminated sites.

Bacteria-mediated aerobic degradation of hexacosane in vitro conditions

In vitro degradation of hexacosane (C26H54), a HMW n-alkane, was studied in MSM by two bacterial strains i.e., Pseudomonas sp. BP10 and Stenotrophomonas nitritireducens E9, isolated from petroleum sludge, in isolation and combination. The results revealed that both the strains were able to metabolize hexacosane by 82% in isolation and 98% in their consortium after 7days. An enhancement of 16% in hexacosane degradation by the consortium indicated an additive action of bacterial strains. However, in control, a degradation of 21% was attributed to abiotic factors. During incubation with hexacosane, both the bacteria continued to multiply in isolation and consortium, which reflected that hexacosane was utilized by bacteria as a carbon and energy source. Activities of alkane hydroxylase and alcohol dehydrogenase were differentially expressed in isolation and combination, indicating their involvement in hexacosane degradation. Enhanced cell surface hydrophobicity and emulsification index and reduced surface tension also supported the degradation process.

Bacteria induced degradation of fluoranthene in minimal salt medium mediated by catabolic enzymes in vitro condition

Fluoranthene is highly toxic and ubiquitous in the environment. A study on degradation of 200 ppm of fluoranthene in MSM by two bacterial strains Pseudomonas aeruginosa PSA5, Rhodococcus sp. NJ2 and their consortium revealed that fluoranthene was degraded 74% by Rhodococcus sp. NJ2, 61% by Pseudomonas sp. PSA5 and 97% by their consortium. Higher degradation in the consortium may be attributed to synergistic action between two bacteria. It was also observed that several degradative enzymes catechol 1,2 dioxygenase, catechol 2,3 dioxygenase, protocatechuate 2,3 dioxygenase, protocatechuate 3,4 dioxygenase, protocatechuate 4,5 dioxygenase, salicylate hydroxylase and 2-carboxybenzaldehyde dehydrogenase were differentially induced at different stages of fluoranthene degradation. Biodegradation kinetics indicated half life period of fluoranthene degradation. Besides, glycolipid, as a biosurfactant, was induced to facilitate the degradation process. Hence, both the bacteria may be used individually or in combination for effective decontamination of oil and sludge contaminated soil.

Constructed wetland as an ecotechnological tool for pollution treatment for conservation of Ganga river

With aim to develop an efficient and ecofriendly approach for on-site treatment of sewage, a sub-surface flow constructed wetland (CW) has been developed by raising potential aquatic macrophytes; Typha latifolia, Phragmites australis, Colocasia esculenta, Polygonum hydropiper, Alternanthera sessilis and Pistia stratoites in gravel as medium. Sewage treatment potential of CW was evaluated by varying retention time at three different stages of plant growth and stabilization. After 6 months, monitoring of fully established CW indicated reduction of 90%, 65%, 78%, 84%, 76% and 86% of BOD, TSS, TDS, NO3-N, PO4-P and NH4-N, respectively in comparison to inlet after 36 h of retention time. Sewage treatment through CW also resulted in reduction of heavy metal contents. Thus, CW proved an effective method for treatment of wastewater and may be developed along river Ganga stretch as an alternative technology. Treated water may be drained into river to check further deterioration of Ganga water quality.

Induced phytoremediation of metals from fly ash mediated by plant growth promoting rhizobacteria

A study was carried out to observe the impact of a consortium of bacteria isolated from the fly ash on the metal accumulation by T. latifolia. When a consortium of bacteria Bacillus endophyticus NBRFT4 (MTCC 9021), Paenibacillus macerans NBRFTS (MTCC 8912) and Bacillus pumilus NBRFT9 (MTCC 8913) was bioaugmented into the rhizosphere of T. latifolia, it enhanced the metal concentration in root, stem and leaves of the plants through increased bioavailability of metals Fe, Cd, Pb, Cr, Ni, Cu and Zn in the fly ash. Besides, these bacteria also promoted the plant growth perhaps due to utilization of ACC, synthesis of phytoharmones and solubilisation of essential metals found in fly ash. As compared to fly ash alone, the accumulation of Fe was maximally enhanced by 164%, 196%, and 251%, followed by Ni by 92%, 44% and 56%, Zn by 82%, 57% and 91%, Cu by 71%, 53% and 60%, Cr by 96%, 80% and 105%, Pb by 119%, 87% and 140%, Cd by 80%, 109% and 115% in root, stem and leaves, respectively in fly ash with bacteria. Thus, an increased solubilisation of metals coupled with enhanced plant growth stimulated the phytoextraction of metals by T. latifolia from fly ash.

Postoperative nausea and vomiting in patients undergoing total abdominal hysterectomy under subarachnoid block: a randomized study of dexamethasone prophylaxis

BACKGROUND

Postoperative nausea and vomiting is a common distressing problem in patients undergoing gynaecological surgery under anaesthesia including central neuraxial blockade, which requires frequent medical interventions.

OBJECTIVES

We aimed to find out the antiemetic effect of prophylactic dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing total abdominal hysterectomy under subarachnoid block. Influences of dexamethasone on patient satisfaction and postoperative analgesia were also observed as secondary objectives.

METHODS

This was a prospective, randomized, double blind, placebo controlled study conducted in BPKIHS, from January 2009 to April 2009. This study involved 80 American Society of Anaesthesiologist Physical Status I and II patients undergoing total abdominal hysterectomy under subarachnoid block. Patients were divided into two groups of 40 each to receive either 4 mg of dexamethasone (group D) or normal saline (group N) in volume of 2 ml intravenously 1 hour prior to subarachnoid block. Surgery was allowed to start with block height of at least T8 dermatome. Intraoperative and postoperative nausea and vomiting was observed using nausea and vomiting scale every 4 hour for 24 hours.

RESULTS

Seven (17.4%) patients in group D and 11 (27.5%) patients in group N had nausea and vomiting in the intraoperative period (P=0.284). Sixteen (40%) patients in group D experienced nausea and vomiting in the postoperative period as compared to 27 (67.5%) in group N (P =0.0136). Accordingly, the mean requirement of rescue antiemetic was less in group D compared to Group N (P=0.042). Further, only 15 (37.5%) patients in group D required postoperative supplemental analgesic as compared to 23 (57.5%) in group N (P=0.058). After 24 hrs of surgery, 26 (65%) patients expressed satisfaction in group D as compared to 16 (40.0%) in group N (P =0.025).

CONCLUSIONS

Use of dexamethasone prior to subarachnoid block in patients undergoing total abdominal hysterectomy significantly reduces the incidence of nausea and vomiting and the requirement of antiemetic in the postoperative period, with better patient satisfaction.

Bacterial degradation of pyrene in minimal salt medium mediated by catechol dioxygenases: enzyme purification and molecular size determination

In vitro degradation of pyrene was studied in MSM by three bacterial strains individually, designated as BP10, NJ2 and P2. Among these strains, NJ2 was the highest degrader (60%) of pyrene, followed by BP10 (44%) and the least was P2 (42%) in MSM with pyrene (50 μg ml(-1)) in 8 days. During pyrene degradation, catechol 1,2 dioxygenase (C12O) activity was induced by 13 folds in BP10 and 17 folds in P2 as compared to catechol 2,3 dioxygenase (C23O). However, in NJ2, C23O activity was augmented 1.3 times more than C12O. This clearly indicated that C12O played a major role in pyrene degradation by BP10 and P2, while in NJ2, C23O contributed more to degradation process than C12O. Molecular weight of highly inducible C12O was determined as ~64 kDa by size exclusion chromatography and as ~32 kDa on denaturing SDS PAGE in BP10 which indicated dimeric nature of the enzyme.

High frequency oscillatory ventilation versus synchronized intermittent mandatory ventilation in preterm neonates with hyaline membrane disease: a randomized controlled trial

This randomized controlled study was conducted to compare the efficacy and safety of High frequency oscillatory ventilation (HFOV) and Synchronized intermittent mandatory ventilation (SIMV) in preterm neonates with hyaline membrane disease requiring ventilation. The ventilation strategy in both the groups included achieving optimal lung recruitment and targeted blood gases. 49 patients received HFOV and 61 SIMV. The baseline characteristics were similar in both the groups. HFOV group demonstrated better early oxygenation, enabled reduction in oxygenation index (OI) within 24 h of ventilation (difference in mean OI at 1, 6, and 24 h of ventilation: P=0.004 in HFOV, and 0.271 in SIMV group). Duration of hospital stay was shorter in HFOV group (P=0.003). The complication rate and survival were similar in two groups.

Propofol sedation during spinal anaesthesia- a dose finding study

BACKGROUND

It is important to be able to measure and maintain a specific sedation level to compare outcomes of different levels of sedation during anesthesia and the aims include general patient comfort, freedom from specific discomfort, and some amnesia for both the block procedure and the surgical operation, in order to meet the patient preference and safety. In this prospective randomized clinical study, we compared the three different infusion doses of propofol.

OBJECTIVE

To find out the appropriate infusion dose of propofol for optimal sedation without causing undue side effects in patients undergoing spinal anaesthesia.

METHOD

One hundred twenty patients ASA PS I-II were randomly allocated to three groups 1, 2 and 3 receiving propofol infusion at the rate of 25, 50 and 75 microgram/kg/min with concentration of (0.5%), (1%) and (1.5%) respectively. They were observed for sedation score, hemodynamic parameters and satisfaction level. The adverse effects like respiratory depression, nausea and vomiting score were assessed.

RESULT

Median sedation score increased in a dose dependent manner, with significantly higher scores in group 2 and 3 compared with group 1. Hemodynamic parameters were better in group 1 and 2 as judged by mephentermine requirement. The awakening time after stoppage of infusion was significantly delayed in group 3 (p < 0.001). Respiratory depression, nausea and vomiting were comparable clinically. Almost three fourth of the patients were satisfied with the techniques used.

CONCLUSION

Propofol infusion at the rate of 50 mcg/kg/min for sedation in spinal anaesthesia provides optimal sedation, early awakening and excellent satisfaction level in the postoperative period.

Stimulated phytoextraction of metals from fly ash by microbial interventions

Various combinations of fly ash tolerant bacteria isolated from the rhizospheric zone of Typha latifolia naturally growing on a fly ash dump site were tested for enhanced metal uptake by Brassica juncea grown in fly ash amended with press mud. After enrichment of the bacteria in a nutrient broth, they were subsequently applied to the rhizospheric zone of B. juncea in different combinations. When the metal analysis was done in the plants at their maturity, it was revealed that out of 11 bacterial consortia prepared from the different combinations of four bacterial strains, Micrococcus roseus NBRFT2 (MTCC 9018), Bacillus endophyticus NBRFT4 (MTCC 9021), Paenibacillus macerans NBRFT5 (MTCC 8912) and Bacillus pumilus NBRFT9 (MTCC 8913), a combination of NBRFT5, NBRFT4 and NBRFT9 (ST3) was found to have induced the highest metal accumulations as compared to other consortia. The bioaugmentation of the ST3 consortium enhanced Fe accumulation by 247%, Ni by 231% and Zn by 223% in B. juncea as compared to control plants. These values were found to be significantly higher than the other bacterial consortia. Bacteria were also found to produce siderophores which could enhance the metal uptake by plants through metal mobilization. Besides siderophores, bacteria are also known to produce protons, organic acids and enzymes which enhance the metal mobilization and boost the phytoextraction process. The translocation of metals from root to stem was invariably higher than from stem to leaf. Hence, ST3 was adjudged the best consortium to be used in the field application to accelerate the phytoextraction of metals from fly ash by B. juncea.

Microbial degradation of n-hexadecane in mineral salt medium as mediated by degradative enzymes

In the present study, n-hexadecane degradation in MSM was investigated by three bacteria identified as Pseudomonas aeruginosa PSA5, Rhodococcus sp. NJ2 and Ochrobactrum intermedium P2, isolated from petroleum sludge. During 10 days of incubation, n-hexadecane was degraded to 99% by P. aeruginosa PSA5, 95% by Rhodococcus sp. NJ2 and 92% by O. intermedium P2. During degradation process, the induction of catabolic enzymes alkane hydroxylase, alcohol dehydrogenase and lipase were also examined. Among these enzymes, the highest activities of alkane hydroxylase (185 μmol mg(-1) protein) and alcohol dehydrogenase (75.78 μmol mg(-1) protein) were recorded in Rhodococcus sp. NJ2 while lipase activity was highly induced in P. aeruginosa PSA5 (48.71 μmol mg(-1) protein). Besides, accumulation of n-hexadecane in inclusion bodies was found to be maximum 60.8 g l(-1) in P. aeruginosa PSA5, followed by Rhodococcus sp. NJ2 (56.1 g l(-1)) and the least (51.6 g l(-1)) was found in O. intermedium P2. Biosurfactant production by bacterial strains was indicated by the reduction in surface tension and induction of cell surface hydrophobicity and pseudosolubilization which facilitated n-hexadecane degradation.

Unsynchronized Nasal Intermittent Positive Pressure Ventilation to prevent extubation failure in neonates: a randomized controlled trial

OBJECTIVE

To evaluate the role of Unsynchronized Nasal Intermittent Positive Pressure Ventilation (NIPPV) in prevention of extubation failure in mechanically ventilated preterm neonates weighing less than 2,000 g.

METHODS

This randomized controlled trial was conducted in the neonatal intensive care unit of a tertiary care teaching hospital. Preterm neonates weighing less than 2,000 g, mechanically ventilated for more than 24 h were included after extubation. Neonates were randomized into two groups. Group 1 was given unsynchronized nasal intermittent positive pressure ventilation with shortened endotracheal tube by ventilator and Group 2 was given head box oxygen, fraction of oxygen in inspired air was 50%. Primary outcome variable was rate of extubation failure within 72 h of extubation.

RESULTS

Birth weight, gestational age, age at intubation, indication for mechanical ventilation and antenatal details were comparable in the two groups. Extubation failure rate was 16% in Group 1 vs 63% in Group 2 (RR = 0.25; 95% CI: 0.12, 0.51, p value = 0.00), that is a reduction of 47%. Unsynchronized nasal intermittent positive pressure ventilation did not have any serious side effects, however it did not reduce total hospital stay.

CONCLUSIONS

Unsynchronized Nasal Intermittent Positive Pressure Ventilation is a simple technique of noninvasive ventilation which significantly reduces the rate of extubation failure in preterm neonates and is not associated with serious side effects.

In vitro degradation of fluoranthene by bacteria isolated from petroleum sludge

An investigation was carried out for in vitro degradation of fluoranthene by four bacterial strains (PSM6, PSM7, PSM10 and PSM11) isolated from the petroleum sludge. Although all the strains registered their growth in MSM with 100 ppm fluoranthene, PSM11 growth was better than other strains. Growth of bacterial strains invariably corresponded to their degradation potential of fluoranthene. After 168 h of incubation, 61% fluoranthene was degraded by PSM11, followed by PSM10 (48%) and PSM6 (42%) and the least was recorded in PSM7 (41%). Besides, 11% loss in fluoranthene was attributed to abiotic factors. Thirty-eight times more activity of catechol 2,3-dioxygenase than catechol 1,2-dioxygenase showed that it played a significant role in fluoranthene degradation. Molecular weight of catechol 2,3-dioxygenase isolated from PSM11 was determined as ∼ 136 kDa by size exclusion chromatography and 34 kDa on denaturing SDS-PAGE, indicating tetrameric nature of the enzyme.

Phytoremediation of metals from fly ash through bacterial augmentation

Different combinations of four bacterial strains isolated from fly ash were used by us to study their impact on phytoextraction of metals from fly ash by Brassica juncea grown in fly ash amended with farm yard manure (50:50 w/w). Out of 11 bacterial consortia, a combination of two strains i.e. Paenibacillus macerans NBRFT5 + Bacillus pumilus NBRFT9 (C7) inoculated in the rhizosphere was found to enhance Pb accumulation maximally by 278%, Mn by 75%, Zn by 163%, Cr by 226% and Ni by 414% compared to control. It is possible that these bacteria, known for N(2) fixation, solubilization of phosphorus and uptake of micronutrient, could promote the plant growth resulting in higher accumulation of metals. However, a combination of four bacteria, namely Micrococcus roseus NBRFT2 + Bacillus endophyticus NBRFT4 + Paenibacillus macerans NBRFT5 + Bacillus pumilus NBRFT9 (C4) was able to increase Cd uptake maximally by 237%. Further, the translocation of metal was invariably more from root to stem than from stem to leaf which was regulated by plant transport mechanism and metal mobility. Bacteria are known to excrete protons, organic acids, enzymes and siderophores to enhance the mobilization of metals which boosted the phytoextraction of metals from fly ash.

Perioperative intravenous lidocaine infusion on postoperative pain relief in patients undergoing upper abdominal surgery

Due to unpleasant nature and physiological consequences of postoperative pain, search of safe and effective modalities for its management has remained a subject of interest to clinical researchers. Analgesic action of lidocaine infusion in patients with chronic neuropathic pain is well known but its place in relieving postoperative pain is yet to be established. The study aimed to assess the effectiveness of perioperative intravenous lidocaine infusion on postoperative pain intensity and analgesic requirement. Sixty patients undergoing major upper abdominal surgery were recruited in this randomized double blinded study. Thirty patients received lidocaine 2.0% (intravenous bolus 1.5 mg/kg followed by an infusion of 1.5 mg/kg/h), and 30 patients received normal saline according to randomization. The infusion started 30 min before skin incision and stopped 1 h after the end of surgery. Postoperative pain intensity and analgesic (diclofenac) requirement were assessed at the interval 15 minutes for 1 hour then 4 hourly up to 24 hours. The pain intensity at rest and movement as well as the total postoperative analgesic (diclofenac) requirement were significantly lower (142.50 +/- 37.80 mg vs.185.00 +/- 41.31 mg, P<0.001) in lidocaine group. The extubation time was significantly longer in lidocaine group (14.43 +/- 3.50 minutes vs. 6.73 +/- 1.76 minutes, P<0.001). The time for the first dose of analgesic requirement was longer in lidocaine group (60.97 +/- 18.05 minutes vs.15.73 +/- 7.46 minutes, P<0.001). It can be concluded that perioperative infusion of low dose of lidocaine decreases the intensity of postoperative pain, reduces the postoperative analgesic consumption, without causing significant adverse effects in patients undergoing upper abdominal surgery.