Bioremediation of hydrocarbon by co-culturing of biosurfactant-producing bacteria in microbial fuel cell with Fe2O3-modified anode

The most common type of environmental contamination is petroleum hydrocarbons. Sustainable and environmentally friendly treatment strategies must be explored in light of the increasing challenges of toxic and critical wastewater contamination. This paper deals with the bacteria-producing biosurfactant and their employment in the bioremediation of hydrocarbon-containing waste through a microbial fuel cell (MFC) with Pseudomonas aeruginosa (exoelectrogen) as co-culture for simultaneous power generation. Staphylococcus aureus is isolated from hydrocarbon-contaminated soil and is effective in hydrocarbon degradation by utilizing hydrocarbon (engine oil) as the only carbon source. The biosurfactant was purified using silica-gel column chromatography and characterised through FTIR and GCMS, which showed its glycolipid nature. The isolated strains are later employed in the MFCs for the degradation of the hydrocarbon and power production simultaneously which has shown a power density of 6.4 W/m3 with a 93% engine oil degradation rate. A biogenic Fe2O3 nanoparticle (NP) was synthesized using Bambusa arundinacea shoot extract for anode modification. It increased the power output by 37% and gave the power density of 10.2 W/m3. Thus, simultaneous hydrocarbon bioremediation from oil-contamination and energy recovery can be achieved effectively in MFC with modified anode.

Technological and economic analysis of electrokinetic remediation of contaminated soil: A global perspective and its application in Indian scenario

Globally million hectares of land annually is getting contaminated by heavy metalloids like As, Cd, Cr, Hg, Pb, Co, Cu, Ni, Zn, and Se, with current concentrations in soil above geo-baseline or regulatory standards. The heavy metals are highly toxic, mobile, and persistent and hence require immediate and effective mitigation. There are many available remediation techniques like surface capping, encapsulation, landfilling, soil flushing, soil washing, electrokinetic extraction, stabilization, solidification, vitrification, phytoremediation, and bioremediation which have been evolved to clean up heavy metal-contaminated sites. Nevertheless, all of the technologies have some applicability and limitations making the soil remediation initiative unsustainable. Among the available technologies, electrokinetic remediation (EKR) has been comparatively recognized to mitigate contaminated sites via both in-situ and ex-situ approaches due to its efficiency, suitability for use in low permeability soil, and requirement of low potential gradient. The work critically analyzes the EKR concerning techno, economic, and sustainability aspect for evaluating its application on various substrates and environmental conditions. The current soil contamination status in India is presented and the application of EKR for the heavy metal remediation from soil has been evaluated. The present work summaries a comprehensive and exhaustive review on EKR technology proving its effectiveness for a country like India where the huge amount of waste generated could not be treated due to lack of infrastructure, technology, and economic constraints.

In Vitro and In Silico Studies on 4-Nitroacetophenone Thiosemicarbazone Potential Cytotoxicity Against A549 Cell Lines

Lung malignancy is a major worldwide issue that occurs due to the dysregulation of various growth factors. Lung cancer has no apparent signs in the early stages, which makes it harder to catch it in time and leads to a higher fatality rate. So, the goal of this work was to create and analyze a novel chemical molecule called 4-nitro acetophenone thiosemicarbazone (4-NAPTSc) against the lung cancer cell line A549 and human non-tumorigenic lung epithelial cell line BAES-2B. The ligand was synthesized by refluxing the reaction mixture of 4-nitro acetophenone and thiosemicarbazide and was further characterized by UV, FTIR, and 1H and 13C NMR and Differential Scanning Calorimetry (DSC) study. Cytotoxicity assay/MTT (3-(4,5-dimethylthiazol-2-yl))2,5-diphenyltetrazolium bromide) was used to evaluate the cytotoxicity of the compound. Epidermal growth factor receptors (EGFR), polo-like kinase-1 (PLK1), and vascular endothelial growth factor receptors (VEGFR) were chosen as the target proteins for molecular docking to find potential ligand binding sites and inhibit their function. A novel yellow-colored crystalline solid has been synthesized. 4-NAPTSc had an IC50 of 2.93 μg/mL against the A549 lung cancer cells. When the dosage is increased from 5 to 15 μg/mL along with time, the cell viability falls. Docking results showed that the compound binds with the targeted proteins' amino acid residues, and the likeness profile of the compound is also favorable. This study reveals that the compound has the potential for further investigation and can be used in multitargeted cancer therapies.

Case Series - Pediatric Tracheostomy for Upper Airway Obstruction

Certain congenital craniofacial malformations can cause upper airway obstruction. Due to neurological involvement, these craniofacial deformities with upper airway blockage frequently require tracheostomy. Children who need weeks or months of continuous ventilator assistance require tracheostomies, which improve pulmonary toilet and decrease laryngotracheal lesions such subglottic stenosis and tracheomalacia. In this case report we will be discussing about two patients who underwent Pediatric tracheostomy for Pierre Robin sequence and supraglottic stenosis in our institute. This paper emphasizes on some of the rare causes of pediatric upper airway obstruction - Pierre Robin sequence and supraglottic stenosis. Also the importance of tracheostomy procedure, which is the gold standard for management of upper airway obstruction in patients who are not responding to conservative management is emphasized.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03892-1.

Evaluating the Outcomes of Closed Reduction of Different Types of Nasal Bone Fractures

This study was conducted to evaluate the outcomes of closed reduction of different types of nasal bone fractures depending on time between onset of injury and reduction and comparing the outcomes of early closed reduction (within 6 h) of nasal bone fracture with late closed reduction (after 2 weeks). A hospital based Prospective cohort type of study was conducted among cases of nasal bone fracture attending the outpatient department of Otorhinolaryngology at Chettinad Hospital and Research Institute, Chennai during the months of August 2021 to January 2022. A total of 54 participants were included in the study. Primary outcome was to assess the effectiveness of closed reduction of different types of nasal bone fractures postoperatively. The second objective was to compare the outcomes of early closed reduction (within 6 h) of nasal bone fracture with late closed reduction (after 2 weeks). Using chi square test, the association of factors such as age, sex, mode of injury, external framework deformity, type of fracture and treatment was analyzed with outcome measures such as post op degree of deviation, arch irregularity, malalignment, bony irregularity, bony displacement, olfactory disturbances and result. We analyzed the sample data statistically and measured the outcomes which showed that post operatively after undergoing closed reduction, some degree of deviation was present in 17(31.48./.), arch irregularity present in 12(22.2./.), malalignment in 11(20.37./.), bony irregularity in 24(44.44./.), bony displacement in 19(35.19./.), olfactory disturbances in 2(3.70./.). Comparing the outcome factors between early and late reduction, we found that the outcome was better in early closed reduction when compared with late closed reduction. Among the 54 patients studied, the results of closed reduction were found to be excellent in 27(50./.), Fair in 16(29.63./.), Good in 10(18.52./.) and poor in 1(1.85./.) We could thus conclude from this study that early closed reduction of nasal bone fracture gave better results than a late closed reduction in terms of post operative deformity, arch irregularity, malalignment, bony irregularity, bony displacement and olfactory disturbances.

A review on therapeutic mechanism of medicinal plants against osteoporosis: effects of phytoconstituents

Osteoporosis is a metabolic bone disorder that over time results in bone loss and raises the risk of fracture. The condition is frequently silent and only becomes apparent when fractures develop. Osteoporosis is treated with pharmacotherapy as well as non-pharmacological therapies such as mineral supplements, lifestyle changes, and exercise routines. Herbal medicine is frequently used in clinical procedures because of its low risk of adverse effects and cost-effective therapeutic results. In the current review, we have used a thorough strategy to identify some known medicinal plants with anti-osteoporosis capabilities, their origin, active ingredients, and pharmacological information. Furthermore, several signaling pathways, such as the apoptotic pathway, transcription factors, the Wnt/-catenin signaling pathway, and others, are regulated by bioactive components and help to improve bone homeostasis. This review will provide a better understanding of the anti-osteoporotic effects of bioactive components and the concomitant modulations of signaling pathways.

Varied Clinical Presentations of Allergic Fungal Rhinosinusitis-A Case Series

Fungal sinusitis is broadly classified into invasive and non invasive types. Invasive type presents with fungal hyphae within the mucosa, submucosa, bone, or blood vessels of the paranasal sinuses and includes Acute Invasive Fungal Sinusitis, Acute Fulminant, Chronic Invasive Fungal Sinusitis, Chronic Granulomatous Fungal Sinusitis. Invasive forms of fungal rhinosinusitis are rare and confined to groups of patients who are immunocompromised (Key in Fungal rhinosinusitis). Noninvasive type shows absence of fungal hyphae within the mucosa paranasal sinuses. It includes Allergic Fungal rhinosinusitis, Fungus Ball (fungus mycetoma). The study was performed on a total of 30 patients, in Department of Otorhinolaryngology, at our hospital after getting approved by the Instituitional Human Ethical Committee. We selected 30 patients diagnosed with allergic fungal sinusitis and studied their varied clinical presentations and treatment for a period of 1 year. It was a prospective case series type of study. Patients who presented with symptoms of allergic fungal rhinosinusitis were included. Patients who were referred with complaints of proptosis, diplopia were also included to rule out allergic fungal rhinosinusitis and its complications. Patients diagnosed with chronic granulomatous infection of nose and invasive fungal sinusitis were excluded. Evaluation of patients involved a detailed case history followed by clinical examination and radiologic investigation. After getting proper consent, we did a study of 30 patients who presented to our outpatient department with complaints of sinusitis. Our study included 12 male and 18 female patients. Among these patients, all of them had complaints of frequent allergic rhinosinusitis, nose block, facial heaviness. 12 among them had olfactory disturbances, reduced perception of smell. 4 patients presented with visual disturbances and proptosis which subsided after endoscopic sinus surgery was done.24 among these patients had presence of allergic fungal mucin in their nasal secretions and 10 patients had history of associated atopy and asthma and elevated Ig E levels. And 20 of these patients showed high eosinophil counts. All these patients in our case series were under the age group 22-70 years. These patients were treated with a course of nasal sprays and preoperative steroids in case of extensive polyposis and were taken up for functional endoscopic sinus surgery. Polypoidal mucosa was removed, diseased tissue was cleared, sinus blockage was released and fungal mucin/tissue bits were sent for histopathological analysis, KOH mount and fungal culture. This study included a series of cases which showed a wide range of the various clinical presentations that occur in cases of allergic fungal rhinosinusitis, its diagnosis and treatment. The advantage of this study was we had analyzed a good number of cases with varied presentations. Since AFRS is closely related with EMRS, CRS a proper clinical, radiological and immunological evaluation of the cases help in knowing the correct diagnosis and treatment.

Acyclovir with Steroid and Steroid Alone in the Treatment of Idiopathic Facial Nerve Palsy: A Randomised Double-blinded Clinical Study from a Tertiary Care Centre, Chennai, India

Introdutcion: Idiopathic palsy of facial nerve is an acute disease which causes lower motor neuron palsy characterised by facial asymmetry leads to psychological effects and limits one’s social life. Steroids are very effective in the management of Bell’s palsy. The usage of antiviral is still in debate due to the idiopathic aetiology of Bell’s palsy. Aim: To evaluate the efficacy of acyclovir with steroid and steroid alone in the management of Bell’s palsy with respect to the recovery time. Materials and Methods: The randomised double-blinded study was conducted in the Department of Otorhinolaryngology, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India, from September 2021 to February 2022 among 100 patients with idiopathic facial nerve palsy. Patients were divided into two groups, 50 patients in each. One group treated with acyclovir (400 mg oral five times daily) and methylprednisolone (1 mg/kg/ day), and other group treated with steroid alone. Both the groups received physiotherapy in the Department of Physiotherapy and taught about home facial exercises. The patients were on regular follow-up for 6 months to monitor the time of the recovery. HouseBrackmann grading system was used for initial assessment and monitor the recovery of the patient. The improvement of House-Brackmann grade to I or II was considered a satisfactory recovery. The association between two groups were assessed by Chi-square test (χ2 ), repeated measures and paired t-test. The statistical significance was considered when p-value<0.05. Results: Out of 100 patients, 52 patients were male and 48 were female, while the age range was 19-58 years. At 2 months, 43 (86%) patients recovered in the combination group and 41 (82%) in the steroid alone group (p-value=0.0038). At 6 months, 48 (96%) patients recovered in the combination group and 42 (84%) in the steroid alone group (p-value=0.178). The overall recovery rate was higher in the combination group (96%) compared to steroid alone group (84%). Conclusion: The combination of acyclovir with steroids in the treatment of Bell’s palsy has better recovery compared to steroid alone therapy.

Harnessing virtual reality for management training: a longitudinal study

Purpose

Virtual reality (VR) technologies have been gaining popularity in training and development in many fields to promote embodied training. However, its adoption in management has been slow and rigorous empirical research to understand its impact on learning and retention is scarce. Thus, this paper aims to examine the benefits of VR technologies for management training.

Design/methodology/approach

Through a longitudinal experiment comparing VR platforms and a traditional video platform, this study examines two as yet unexplored benefits of VR technologies vis-à-vis management training – the cognitive outcome and affective reaction of the training experience over time.

Findings

This study finds that, for cognitive outcomes, immediate gains are similar across video and VR platforms, but subsequent knowledge retention is significantly higher for VR platforms. In terms of affective reaction, VR platforms generate significantly more enjoyment, which carries over to two weeks later, and is partially associated with higher knowledge retention.

Practical implications

This study has implications for management and human resource trainers and system designers interested in integrating VR for training and development purposes.

Originality/value

This study makes a unique contribution by unpacking the long-term benefits of an embodied training system, as well as identify a possible link between cognitive outcomes and affective reaction.

Does Our Employee Assistance Program Cover Voodoo Dolls? A Cry for Help on Behalf of Those Affected by Abusive Supervision

Consistent with the goals of a GOMusing to “refresh” readers’ minds about a topic, challenge readers to re-examine their assumptions about a topic, and/or spark a needed debate about a topic, we (1) provide a refresher on abusive supervision and the severity of its consequences, (2) acknowledge the wealth of research on its antecedents and moderators while highlighting the lack of applied research on successful interventions, and (3) encourage new research perspectives and methods to move the field forward. Our ultimate goal is to galvanize scholars to use existing knowledge as a basis to develop, test, and validate successful prevention and intervention strategies for organizations and individuals to deal with abusive supervision. As you might suspect from the title, we also hope to do all this with a bit of humor and a lot of compassion.

Comparative frequency distribution of glutathione S-transferase mu (GSTM1) and theta (GSTT1) allelic forms in Himachal Pradesh population

Background

Glutathione S-transferases (GSTs) are a class of important Phase II detoxification enzymes that catalyze the conjugation of glutathione and xenobiotic compounds (environmental carcinogens, pollutants and drugs) to protect against oxidative stress. GSTT1 and GSTM1 genetic polymorphisms have been extensively studied, and null genotypes or homozygous deletions have been reported in various populations. Previous studies have suggested that those who are homozygous null at the GSTM1 or GSTT1 loci are more susceptible and have a higher risk of cancers linked to environmental pollutants and drug-induced toxicity. Our study focused on GSTM1 and GSTT1 null allele frequency in the Doon population of Himachal Pradesh (India) with a comparison across other Inter and Intra-Indian ethnic groups to predict variation in the possible susceptible status.

Material and methods

Genomic DNA samples were extracted from 297 healthy unrelated individuals by a ReliaPrep™ Blood gDNA Miniprep kit (Promega, USA), and genotyped for allelic variation in GSTM1 and GSTT1 genotypes by multiplex polymerase chain reaction. Fisher's exact test was applied using SPSS.20 to analyze the genotypic distribution of GSTM1 and GSTT1 null alleles in male and female of Doon region (Solan) Himachal Pradesh.

Results

In our study, the frequency distribution of the homozygous null genotypes of GSTM1, GSTT1 individually as well as combined was found as 33.3%, 32% and 9%, respectively. Upon gender-wise comparison, a non-significant distribution (p > 0.05) for null genotypes of GSTM1 (32.8% and 35.4%, OR-0.77, 95% CI 0.42–1.41), GSTT1 (33.2% and 27.7%, OR-1.12, 95% CI 0.63–2.0) individually and combined GSTM1 and GSTT1 (10.8% and 3.7%, OR-0.31, 95% CI 0.07–1.42) were observed in studied population.

Conclusions

In our studied population, the frequency of GSTM1 null genotypes was found deviated from Inter- and Intra-Indian ethnic groups. However, the frequency of homozygous null type of GSTT1 was not significantly different, when compared to previous Indian studies, comparison with global ethnic groups showed deviation. Thus, our study has highlighted possible susceptibility risk to various xenobiotics in the Doon population of Himachal Pradesh, India.

Occupational health hazards and wide spectrum of genetic damage by the organic solvent fumes at the workplace: A critical appraisal

Long-term exposure to organic solvents is known to affect human health posing serious occupational hazards. Organic solvents are genotoxic, and they can cause genetic changes in the exposed employees' somatic or germ cells. Chemicals such as benzene, toluene, and gasoline induce an excessive amount of genotoxicity results either in genetic polymorphism or culminates in deleterious mutations when concentration crosses the threshold limits. The impact of genotoxicity is directly related to the time of exposure, types, and quantum of solvent. Genotoxicity affects almost all the physiological systems, but the most vulnerable ones are the nervous system, reproductive system, and blood circulatory system. Based on the available literature report, we propose to evaluate the outcomes of such chemicals on the exposed humans at the workplace. Attempts would be made to ascertain if the long-term exposure makes a person resistant to such chemicals. This may seem to be a far-fetched idea but has not been studied. The health prospect of this study is envisaged to complement the already existing data facilitating a deeper understanding of the genotoxicity across the population. This would also demonstrate if it correlates with the demographic profile of the population and contributes to comorbidity and epidemiology.

Assessment of Effects on Prolonged Usage of Face Mask by ENT Professionals During Covid-19 Pandemic

The protection efficacy of face masks during this covid 19 pandemic has been well documented. The changes in human nasal functions after wearing facemask for prolonged period is not known. The aim of this study is to determine the effects of prolonged usage of facemask by ENT professionals during covid 19 pandemic. It is a cross sectional study conducted in department of ENT in Chettinad Hospital and Research Institute, Kelambakkam. A self-constructed questionnaire containing 21 queries regarding the effects of prolonged use of face mask, after being analysed by the experts of our institution were distributed to 124 ENT professionals all over India. People who are ENT by professionals can participate in this study. Participation is voluntary. Study period was from March 2020 to December 2020. All answered questionnaires were sent for statistical analysis. 63.71% experienced difficulty in breathing while wearing face mask, 37.10% experienced dry nose, 46.77% experienced dry mouth. The most common modality of prevention in an OPD setup was face mask with face shield (31.45%). About 80.65% people believed there are side effects due to wearing mask. Since facemasks are essential to protect us from COVID-19, certain strategies can be followed to reduce the discomfort due to its prolonged usage such as encouraging nasal breathing, taking short breaks from wearing mask in a safe environment and to maintain hydration.

Cancer risk and nullity of Glutathione-S-transferase mu and theta 1 in occupational pesticide workers

Occupational exposure to pesticides has been associated with adverse health conditions, including genotoxicity and cancer. Nullity of GSTT1/GSTM1 increases the susceptibility of pesticide workers to these adverse health effects due to lack of efficient detoxification process created by the absence of these key xenobiotic metabolizing enzymes. However, this assertion does not seem to maintain its stance at all the time; some pesticide workers with the null genotypes do not present the susceptibility. This suggests the modulatory role of other confounding factors, genetic and environmental conditions. Pesticides, aggravated by the null GSTT1/GSTM1, cause genotoxicity and cancer through oxidative stress and miRNA dysregulation. Thus, the absence of these adverse health effects together with the presence of null GSTT1/GSTM1 genotypes demands further explanation. Also, understanding the mechanism behind the protection of cells - that are devoid of GSTT1/GSTM1 - from oxidative stress constitutes a great challenge and potential research area. Therefore, this review article highlights the recent advancements in the presence and absence of cancer risk in occupational pesticide workers with GSTT1 and GSTM1 null genotypes.

Thyroglossal Duct Cyst with Multiple Tracts- A Case Report

A thyroglossal duct cyst is an embryological remnant which persists due to failure in the closure of thyroglossal duct. Worldwide the prevalence of thyroglossal cysts is about 7%. There is no sexual predominance seen. Normally at about 10th week of gestation the thyroglossal duct involutes, if there is any persistent duct remnant then this can lead to thyroglossal duct cyst formation. There is 1% chance of malignant transformation (papillary carcinoma). A 21-year-old female presented to the Ear, Nose and Throat Department with the complaint of swelling in front of the neck for the past one month. A 2×1.5 cm2 swelling was observed in the anterior aspect of neck-infrahyoid region extending till thyroid notch. The swelling moved upwards with protrusion of the tongue and deglutition. Ultrasound neck revealed a complex cystic lesion in midline of neck of size 2×1×2.2 cm3 suggestive of thyroglossal cyst. Fine Needle Aspiration Cytology (FNAC) showed features suggestive of thyroglossal duct cyst. Patient was prepared for Sistrunk procedure. Intraoperatively multiple tracts of thyroglossal duct cyst were seen and the same were removed in toto. Patient was on regular follow-up postoperatively for a period of one year and no evidence of any recurrence was seen.

Papillary Carcinoma of Thyroid in Thyroglossal Cyst- A Case Report

Thyroglossal duct cysts are most commonly occurring congentinal midline swellling of the neck. Usually carcinomas in thyroglossal duct cysts is extremely rare, commonly known as papillary carcinomas. However, the diagnosis is only made postoperatively after excision of the cyst. Although the Sistrunk procedure is often regarded as adequate but controversies exist, the need for thyroidectomy is based on histopathological findings. This is a case report of 43-year-old male presenting with swelling in the midline of the neck for one year. On examination, a cystic swelling was present in the midline of the anterior aspect of the neck. Ultrasonography (USG) neck revealed heteroechoic cystic lesion with solid component and microcalcifications present within the cyst suggestive of thyroglossal duct cyst probably neoplastic. The mass was surgically excised and sent for histopathological examination and reported as thyroglossal duct cyst with papillary carcinoma of thyroid. Appropriate history, clinical examination and investigation leads to the correct diagnosis and treatment. Incomplete removal of the mass leads to recurrence. Histopathological examination is a must postoperatively. The patient is still on follow-up and no recurrence have been noted.

Epley’s Maneuver versus Semont’s Maneuver in the Treatment of Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: A Cohort Study

Introduction: Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo in otorhinolaryngological practice. Canalolithiasis and cupulolithiasis are the main theories which describe the pathophysiology of BPPV. Particle repositioning maneuvers are non invasive, simple, bedside procedure that are better tolerated by patients and give symptomatic relief. Aim: To compare the effectiveness of Epley’s vs Semont’s maneuver in the treatment of Posterior Semicircular Canal (PSC) BPPV. Materials and Methods: A cohort study was conducted in Otorhinolaryngology Department of Chettinad Hospital and Research Institute from October 2020-March 2021. A total of 108 patients who reported to the outpatient department and were diagnosed with PSC BPPV were included in this study. A detailed clinical history was recorded audio vestibular examination was conducted and Dix-Hallpike maneuver were performed to confirm the diagnosis. Following which, patients were subjected to treatment with either Epley’s maneuver or Semont’s maneuver. A total of 54 patients were treated with Epley’s maneuver and 54 patients were treated with Semont’s maneuver. Patients were followed-up one week after performing the maneuver. In case of presence of persistent symptoms, the maneuver was repeated upto a maximum of three times. Successful treatment was assessed based upon the patient’s symptomatic improvement of vertigo and a negative Dix-Hallpike test which was performed at the follow-up. Data was presented in proportion (descriptive statistics) and chi-square test was used. The p-value <0.05 was considered as statistically significant. Results: In a total of 108 cases, the most common age group affected by BPPV was that of 21-40 years. Left side BPPV was noted in 50 (46.3%) patients, right side BPPV in 48 (44.4%) patients and 10 (9.3%) patients were found to have bilateral BPPV. Fifty two patients responded well for Epley’s maneuver and had complete resolution of symptoms on first follow-up and 46 patients responded to Semont’s maneuver and improved symptomatically. Conclusion: Greater number of patients improved symptomatically in the first visit itself with Epley’s maneuver compared to Semont’s maneuver. Hence, Epley’s maneuver is the preferred initial treatment and effective modality for PSC BPPV.

Cholesteatoma Masquerading as Cerumen

Cerumen is composed of glandular secretions and desquamated epithelial cells. It protects and lubricates the external auditory canal. Impacted cerumen causes canal occlusion and pressure over the tympanic membrane, causing ear discomfort, conductive hearing loss, itching, etc. Up to 6% of the general population are affected with impacted cerumen, which includes 10% of children, more than 30% of the elderly and people with cognitive impairment. Persistent symptoms despite resolution of impaction and patient repeatedly should raise suspicion of alternative diagnosis and prompt for further evaluation. A 20-year-old female patient came with complaints of decreased hearing and ear discharge. On otoscopic examination of left ear, impacted cerumen was seen in the attic region. On removal of wax with the aid of oto-endoscopy, attic region was found to be filled with cholesteatoma debris. On pure tone audiometry, patient had mild conductive hearing loss of 30 db and computed tomography of left temporal bone revealed ill-defined soft tissue density in the middle ear (epitympanum) with erosion of head of malleus and short process of incus. Blunting of scutum was also seen. Attic reconstruction and type III tympanoplasty was performed. On histopathological examination, the section showed keratin flakes with bacterial colonies which were consistent with cholesteatoma. In conclusion, any case of impacted cerumen should not be ignored by otorhinolaryngologist. Further evaluation with thorough examination under otomicroscope/otoendoscope has to be done which can lead to different diagnosis and treatment plan.

Cost-saving medication therapy management for outpatients

Objective:

Medication costs comprise the majority of health system budgets and continue to increase faster than other health-care expenditures. The objective of this study is to evaluate the causes and monetary value of cost-saving prescription interventions made by clinical pharmacists in outpatient pharmacy.

Materials and Methods:

Outpatient prescriptions were randomly audited for a period of 11 months (August 2017–June 2018) using a customized outpatient prescription audit tool integrated with computerized physician order entry. Drug-related problems were communicated to respective prescribers, and their response to each intervention was documented in accordance with PCNE classification. Both unit dose cost and anticipated dose cost savings were calculated to evaluate the monetary benefit for patients.

Results:

Unit dose cost of INR 4875.73 and anticipated dose cost of INR 26890.8 were saved from outpatients. Majority of the prescribing errors were associated with therapeutic duplication (43.4%) and drug interaction (25.7%) that account for anticipated dose cost savings of INR 17812.65 for patients. Major contributory drug classes that reduced the cost of therapy were antibiotics (24.23%), proton-pump inhibitors (13.27%), and analgesics (12.34%). Prescribers' response to pharmacist intervention varied, 53% responded to stop the drug, 21% responded to change the brand, and 20% changed the frequency of administration. Necessary instructions were verbally given to patients without making any modification in the prescription for 3.2% (n = 10) of cost-saving interventions.

Discussion and Conclusion:

As clinical pharmacist has the expertise to detect, resolve, and prevent medication errors, the development of clinical pharmacy practice in a hospital outpatient pharmacy will have a significant impact on reducing prescription errors and health-care cost also.

Bioremediation of synthetic fatliquors under microaerobic condition

Synthetic fatliquors are useful as a fatliquoring agent, flotation agent and emulsifying agent in a wide range of industrial applications such as leather, pharmacy and farm chemicals. These fatliquors remain recalcitrant to natural biota in existing treatment plants. In the present study, the isolated microaerophilic Serratia sp. HA1 strain CSMB3 is capable of utilizing structurally different fatliquors as the sole substrate for their growth under microaerobic conditions. Degradation of vegetable fatliquors was observed from 95 to 97% in terms of lipids, with the production of lipase at 72 h. Degradation of synthetic fatliquors was observed in terms of chemical oxygen demand from 85% to a minimum of 25%. It is in the order of sulfited/sulfated fatliquors > sulfochlorinated fatliquors > chlorinated fatliquors. A thin layer chromatography chromatogram confirmed the degradation of non polar fatliquor to polar compounds. Production of the red pigment prodigiosin in synthetic fatliquors enhanced the growth of the isolate. Fourier transform infrared spectroscopy (FTIR) confirmed the bioremediation of sulfochlorinated fatliquor into lipids and fatty acids and gas chromatography-mass spectrometry (GC-MS) results confirmed that alcohols and esters are the final end products. Thus the isolated strain CSMB3 may be used in the treatment of wastewaters containing vegetable and synthetic fatliquors.

2-Chloro-N-[4-(4-chlorophenyl)-1,3-thiazol-2-yl]acetamide

In the title acetamide, C11H8Cl2N2OS, the chlorophenyl ring is oriented at an angle of 7.1 (1)° with respect to the thiazole ring. In the crystal, molecules are linkedviaC—H...O intermolecular interactions, formingC(10) chains propagating in a zigzag manner along thebaxis.

Glutathione S-Transferase Gene Polymorphisms: Modulator of Genetic Damage in Gasoline Pump Workers

This study investigated genetic damage in gasoline pump workers using the cytokinesis blocked micronucleus (CBMN) assay. Blood and urine samples were collected from 50 gasoline pump workers and 50 control participants matched with respect to age and other confounding factors except for exposure to benzene through gasoline vapors. To determine the benzene exposure, phenol was analyzed in urinary samples of exposed and control participants. Urinary mean phenol level was found to be significantly high (P < 0.05) in exposed workers. The CBMN frequency was found to be significantly higher in gasoline pump workers (6.70 ± 1.78) when compared to control individuals (2.20 ± 0.63; P < 0.05). We also investigated influence of polymorphisms of GSTM1, GSTT1, and GSTP1 genes on CBMN frequency. The individuals having GSTM1 and GSTT1 null genotypes had significantly higher frequency of CBMN (P < 0.05). Our study indicates that chronic and long-term exposure of gasoline vapors can increase genotoxic risk in gasoline pump workers.

Crystal structure of 2-[4(E)-2,6-bis-(4-chloro-phen-yl)-3-ethyl-piperidin-4-yl-idene]acetamide

In the title piperidine derivative, C₂₁H₂₂Cl₂N₂O, the piperidine ring adopts a chair conformation. The chloro­phenyl rings are oriented at an angle of 45.59 (14)° with respect to each other. In the crystal, mol­ecules are linked via N—H⋯O hydrogen bonds, forming C(4) chains along [100]. The chains are linked by C—H⋯O hydrogen bonds, forming sheets parallel to the ab plane. Within the sheets, there are N—H⋯π inter­actions present. The crystal studied was refined as an inversion twin.

Crystal structure of 2-(2,4-diphenyl-3-aza-bicyclo-[3.3.1]nonan-9-yl-idene)aceto-nitrile

In the title 3-aza­bicyclo­nonane derivative, C₂₂H₂₂N₂, both the fused piperidine and cyclo­hexane rings adopt a chair conformation. The phenyl rings attached to the central aza­bicylononane fragment in an equatorial orientation are inclined to each other at 23.7 (1)°. The amino group is not involved in any hydrogen bonding, so the crystal packing is stabilized only by van der Waals forces.

Changes in quality of life during orthodontic correction of midline diastema

Aim:

The aim of our study is to evaluate the changes in quality of life among patients treated for maxillary midline diastema by fixed orthodontic appliances.

Materials and Methods:

This prospective longitudinal study consists of 40 patients of age group 20-30 years who underwent orthodontic correction of midline diastema. The patient's quality of life is evaluated using 22-item orthognathic quality of life questionnaire. They were evaluated prior to appliance therapy, 1 month after appliance fixation, 4^th and 8^th month during treatment and 1 month after treatment.

Results:

Our results showed moderate improvement in quality of life as early as at the start of orthodontic therapy. The response was equal among both sexes. The quality of life experience improved only mildly during the orthodontic treatment. However, the condition specific quality of life at the end of appliance therapy improved by nearly 50% when compared with prior to treatment.

Conclusion:

Our study has concluded that the correction of midline diastema has improved the quality of life among young people by nearly 50%. The acceptance to orthodontic therapy and patient perception toward fixed appliance has demonstrated remarkable improvement in quality of life during the treatment. Our study calls for additional patient counseling and motivation during the course of fixed appliance therapy.

Odontogenic Keratocyst: A Case Series of five Patients

During the time period of August 2009 to August 2010, five cases of odontogenic keratocyst were admitted and treated under the care of Department of Otorhinolaryngology, MGMC and RI, Puducherry. Patients came to the ENT OPD with history of swelling in the cheek region, nasal obstruction, numbness in the upper alveolar region. On examination diffuse swelling of size 7 × 3 cm in one patient and size of 5 × 3 cm in two patients, and other two patients size of 6 × 3 cm present in the maxillary region with ill defined borders, the swelling was firm in consistency, no warmth, non tender. Anterior rhinoscopy reveals mass pushing the lateral wall medially, septum pushed to opposite side, mucopus present in nasal cavity, airway reduced on the side of swelling. On examination of oral cavity, a small granulation of size 1.0 × 0.5 cm present in two patient and swelling of size 1.5 × 1.0 cm seen in two patients in vestibule, no swelling in one patient and swelling of size 3 × 2 cm seen in hard palate of two patients and no swelling in three patients, no loosening of tooth seen in all patients. X-ray PNS reveals maxillary hazziness, diagnostic nasal endoscopy reveals lateral wall of nose pushed medially and septum pushed to opposite side. FNAC reveals resolving inflammatory aspirate in one patient, few macrophages seen in two of patients, few keratinocytes seen in two of the patients. CT nose and PNS revealed a large cystic lesion with erosion of anterior and medial wall and floor of maxilla in relation to the root of the last molar tooth in two patients and there is erosion of anterior and medial wall in other three patients. A combined endonasal and external sublabial (Caldwell-luc) approach was performed in four patients and the cystic lesion was removed and in other one patient only endonasal approach was done and cystic lesion was removed and sent for biopsy. Biopsy sent for HPE revealed odontogenic keratocyst.

Phytochemical analysis of Achyranthes aspera and its activity on sesame oil induced lipid peroxidation

The effect of Achyranthes aspera on lipid peroxidation were studied in rats fed with Sesame Oil. Increase in the levels of LPO in sesame oil treated groups returned towards normalcy in the plant extract treated groups revealing the antioxidant potential of the plant. Phytochemical studies revealed the presence of secondary metabolites. According to the results obtained Achyranthes aspera inhibited Ferrous Ascorbate stimulated LPO.

Hypolipidemic Efficacy of Achyranthes aspera on Lipid Profile in Sesame oil fed Rats

The present study was designed to evaluate the antihyperlipidemic effect of aqueous extract of Achyranthes aspera a in experimental rats fed with diet containing sesame oil. Hyperlipidemia and the effect of Achyranthes aspera in experimental rats were studied by assessing parameters such as cholesterol, phospholipids, freefattyacids and triglycerides in serum, liver, and heart and kidney tissues. The levels of HDL, LDL, VLDL and atherogenic index were assessed. Hyperlipidemia in experimental rats were evidenced by a significant enhancement in the levels of cholesterol phospholipids, freefattyacids and triglycerides in serum, liver heart and kidney tissues by atherogenic diet feeding. A significant fall in HDL in both Anjali and Idhayam oil treated groups were observed in serum. These values retrieved towards normalcy in Achyranthes aspera treated groups. This study unveiled the antihyperlipidemic activity of Achyranthes aspera.

Antibacterial effect of bulbophyllum neilgherrense wt. (Orchidaceae). An in vitro study

The antibacterial activity of Bulbophyllum neilgherrense was tested against five species of bacteria, viz., Escherichia coli, Staphylococcus aureus, Bacillus pumilus, Pseudomonas aeruginosa and Pseudomonas putida Aqueous, ethanolic and chloroform soluble extracts of leaf and pseudobulb (5.50 w/v) were screened for their antibacterial potential. The zone of inhibition was seen to be largest when alcoholic extract was used.

Current perspectives of herpesviral retinitis and choroiditis

Vision-threatening viral retinitis are primarily caused by members of the herpesvirus family. The biology and molecular characterization of herpesviruses, clinical presentations of retinopathies, pathology and pathogenesis including the host responses, epidemiology and the laboratory methods of aetiological diagnosis of these diseases are described. Clinical syndromes are acute retinal necrosis (ARN), progressive outer retinal necrosis (PORN), cytomegalovirus (CMV) retinitis, multifocal choroiditis and serpiginous choroiditis besides other viral retinopathies. Herpes simplex virus (HSV) retinitis is more common in immunocompetent persons while varicella zoster virus (VZV) affects both immunocompetent and immunosuppressed patients equally. CMV retinitis is most common among patients with AIDS. The currently employed laboratory methods of antigen detection, virus isolation and antibody detection by enzyme linked immuno-sorbent assay (ELISA) have low sensitivity. Polymerase chain reaction (PCR) has increased the value of diagnosis due to its high clinical sensitivity and absolute specificity in detection of herpesviruses in intraocular specimens.

Use of uniplex polymerase chain reaction & evaluation of multiplex PCR in the rapid diagnosis of viral retinitis

BACKGROUND & OBJECTIVES

Polymerase chain reaction (PCR) has been known to be a rapid and accurate diagnostic test for causative viruses of viral retinitis, but cost is the limiting factor. In the present study an attempt was made to standardize a multiplex PCR (mPCR) on intraocular specimens from patients with viral retinitis for the detection of one or more viruses [herpes simplex virus (HSV), varicella zoster virus (VZV) or cytomegalovirus (CMV)] in order to reduce the period of time required for uniplex polymerase chain reaction (uPCR).

METHODS

Using the uniplex PCR (uPCR) primers, a nested mPCR was developed and standardized for the simultaneous detection of HSV, VZV and CMV. mPCR and uPCRs were applied on 9 stored specimens and 38 prospective specimens obtained from patients with viral retinitis.

RESULTS

The specificity and sensitivity of the mPCR were concordant with that of uPCRs. Clinical specificity and sensitivity of mPCR was further confirmed by the detection of the same herpes viral DNA on the 9 stored specimens. Of the 38 specimens collected prospectively, mPCR detected HSV in 3 (7.9%), VZV in 9 (23.7%), CMV in 5 (13.2%) and both VZV and CMV in 2 (5.3%). Co-infections of two viruses were found in 7 (14.89%) of the 47 specimens.

INTERPRETATION & CONCLUSION

mPCR is a rapid, specific and sensitive diagnostic tool in viral retinitis. Compared to uPCR, mPCR is less time-consuming and cost effective.

Phenotypic and genotypic methods for the detection of herpes simplex virus serotypes

Typing of herpes simplex virus (HSV) into its serotypes plays a major role in epidemiology and management of reactivation. To develop and evaluate a polymerase chain reaction (PCR)-based restriction fragment length polymorphism (RFLP) was employed using Hae III and Taq I against neutralization test, allele-specific PCR and DNA sequencing for the detection of HSV serotypes. Neutralization test, allele-specific PCR, DNA sequencing and PCR-based RFLP were applied simultaneously to 2 standard strains (HSV-1 and HSV-2) and 23 clinical isolates. PCR-based RFLP was applied further to 20 culture negative PCR positive clinical specimens. The 179 bp product of the clinical isolates and specimens amplified using the type-common primers of HSV was subjected to DNA sequencing and PCR-based RFLP. Allele-specific PCR was absolutely specific and highly sensitive. All the typing methods differentiated concordantly 23 clinical isolates into 12 HSV-1 and 11 HSV-2. DNA sequencing did not reveal any nucleotide variations within the serotypes among the isolates sequenced. PCR-based RFLP typed a further 20 culture negative clinical specimens into 15 HSV-1 and 5 HSV-2. PCR-based RFLP was a reliable, less laborious and cost-effective molecular biological tool for the determination of HSV serotypes both for the clinical isolates and culture negative specimens.

Laboratory methods in the detection of herpes simplex virus (HSV) in keratitis--a 9-year study including polymerase chain reaction (PCR) during last 4 years

Conventional methods of fluorescent antibody test (FAT) and virus isolation (VI) and molecular method of polymerase chain reaction (PCR) were compared for the detection of HSV in keratitis during a 9-year period. Of 186 corneal scraping specimens, 108 were subjected to FATand VI in the pre-PCR period (initial 5 years) while 78 to FAT, VI and PCR in the PCR period (latter 4 years). HSV was detected by FAT in 44/186 (23.7%), VI in 18/186 (9.7%) and PCR in 27/78 (34.6%) specimens. Overall, HSV was diagnosed in 56/186 (30.1%) specimens. PCR has increased the clinical sensitivity by 12.8%, which is statistically significant (McNemar test, P-0.002). VI should be replaced by PCR. FAT though less sensitive should always be employed as a routine to give an early diagnosis, the results of which could be further confirmed, if necessary, by PCR, which is a more sensitive and specific diagnostic tool.

Detection of cytomegalovirus from vitreous humor in a patient with progressive outer retinal necrosis

A case of progressive outer retinal necrosis (PORN) caused by Cytomegalovirus (CMV), and diagnosed by polymerase chain reaction (PCR) is reported.

Preparation of amniotic membrane for ocular surface reconstruction

We describe the preparation and preservation of human amniotic membrane required for transplantation in the management of ocular surface diseases. Informed consent is obtained and the donor is screened to exclude risk of transmissible infections such as human immunodeficiency virus (HIV), hepatitis B virus, hepatitis C virus, and Treponema pallidum infections. Ideally, the media and washing solutions needed for the preparation of amniotic membrane are prepared only a week to 10 days prior to use and not stored in the freezer weeks ahead. The AM obtained under sterile conditions after elective caesarian section is washed free of blood clots and chorion. With the epithelial surface up, amniotic membrane is spread uniformly without folds or tears on individually sterilized 0.22 micron nitrocellulose membranes of the required sizes. The prepared filter membrane with the adherent amniotic membrane is placed in the preservative medium and stored at -80 degrees C. The membranes are released when the repeat serology for HIV after the window period has excluded virus infection in the donor. Depending on consumption they may be used up to 6 months after preparation, though many have recommended storage for an indefinite period. Since the amniotic membrane has only incomplete expression of HLA antigens and amniotic epithelial cells do not express them, it is not rejected after transplantation. The presence of several cytokines in the amniotic membrane promotes epithelialization with reduction of fibrosis during healing.

Pseudomonas cepacia lipase--mediated transesterification reactions of hydrocinnamates

Use of lipase from Pseudomonas cepacia in transesterifcation reactions of ethyl hydrocinnamate with different alcohols has been examined. Among the alcohols tested, viz., n-butanol, iso-amyl alcohol, benzyl alcohol, n-octanol and 1-phenylethanol, only n-butanol yielded the transesterified product. Among the solvents tested, viz., n-heptane, n-hexane, cyclohexane, toluene, diisopropylether and n-butanol, the initial rate of transesterification proceeded in the order cyclohexane > n-heptane > n-hexane > diisopropylether > n-butanol > toluene. Using hexane as the solvent and a substrate to enzyme ratio of 1:5, the substrate to alcohol ratio was varied to maximize the yield. n-Butyl hydrocinnamate was obtained in 92% yield in 48 hr by employing a 1:1 (wt/wt) ratio of ethyl hydrocinnamate to lipase and a 1:5 (vol/vol) ratio of ethyl hydrocinnamate to n-butanol in hexane.

Diagnostic value of enzyme linked immuno-sorbent assay for cytomegalovirus disease

BACKGROUND

Since interpretation of results of enzyme linked immuno-sorbent assay (ELISA) for diagnosis of Cytomegalovirus (CMV) infection in India is difficult, its diagnostic value required evaluation.

AIMS

To evaluate the diagnostic value of ELISA against polymerase chain reaction (PCR) in CMV disease.

SETTINGS AND DESIGN

Results of ELISA test for CMV antibodies in CMV-DNA PCR positive and negative patients and normal healthy blood donors were analysed.

METHODS AND MATERIAL

Anti-CMV antibodies were assayed by ELISA on the sera of 26 CMV PCR positive and 21 PCR negative patients and 35 normal healthy blood donors.

STATISTICAL ANALYSIS

Chi square and Fischer exact test were used for statistical analysis.

RESULTS

Anti-CMV antibodies (IgG or IgG and IgM) were present in 20 (76.9%) of 26 PCR positive and 13 (61.9%) of 21 PCR negative patients. ELISA was negative in six (23.1%) of 26 PCR positive patients. Of the 28 paediatric patients, ELISA was positive in 14 (73.7%) of 19 PCR positive and three (33.3%) of nine PCR negative patients showing a statistically significant difference (Chi square test, P value 0.038). Among the 19 patients having complications after organ transplant, ELISA showed anti-CMV antibodies in six (85.7%) of seven PCR positive and 11 (91.7%) of 12 PCR negative patients showing no significant difference. CMV-DNA was not detected in the buffy coat of 35 sero-positive blood donors.

CONCLUSION

ELISA has no diagnostic value in the detection of CMV activation although it may help in the differential diagnosis of CMV infection in the paediatric age group.