Binding interactions of Vildagliptin with pepsin: A multi-spectroscopic and in-silico approach and a comparative account with metformin

Vildagliptin (VDG) and Metformin (Met) belong to a class of dipeptidylpeptidase-4 (DPP-4) inhibitor and biguanide, respectively and used for the management of diabetes mellitus type II (DMTII). Both the drugs are orally available which leads to various side effects due to its oral ingestion. Occurrence of these side effects might be due to some interactions with pepsin at a molecular level. Therefore, in order to investigate these interactions, multi-spectroscopic and in-silico techniques have been extensively studied to identify the binding characteristics of VDG with pepsin. Fluorescence data suggested that the quenching is due to dynamic and static mechanism and static was dominant one. However, fluorescence and UV-Vis spectroscopic measurement analysis suggested that VDG tends to associate with pepsin, via ground-state complex formation. Fluorescence study revealed the binding-constant value which was found to be 0.559 × 103 M-1 at 298.15 K that is non-covalent in nature. VDG-pepsin complex shows exothermic and spontaneous binding as confirmed by the calculated values of ΔH, ΔS, and ΔG, are majorly caused by van der Waals forces and H-bonding interactions. CD spectra of pepsin in presence of VDG confirmed post binding conformational change. Enzyme-activity assay showed that activity of pepsin was decreased by upto 28 %. FRET analysis suggested that energy transfer efficiency is negligible for VDG-pepsin interaction. In-silico analysis reveals that H-bonding and electrostatic negative forces are the significant driving forces involved in the interaction of VDG and pepsin.

Bimatoprost-loaded lipidic nanoformulation development using quality by design: liposomes versus solid lipid nanoparticles in intraocular pressure reduction

Background: Bimatoprost is a drug used to lower intraocular pressure in the treatment of glaucoma. Conventional eye drops have the limitations of repeated dosing, drug loss due to tear outflow and hence poor availability for action. Materials & methods: Using a systematic quality by design approach, liposomes and solid lipid nanoparticles were formulated and further encapsulated in thermo-sensitive in situ hydrogel. Results & conclusion: Optimized liposomes had 87.04% encapsulation efficiency and 306.78 nm mean particle size, while solid lipid nanoparticles had 90.51% and 304.21 nm. Bimatoprost liposomes had controlled zero-order drug kinetics and no initial burst release, making them better than solid lipid nanoparticles. Bimatoprost-loaded liposomes in thermo-sensitive hydrogel decreased intraocular pressure for 18 h.

Atypical Presentations of Childhood Simple Partial Seizures: a Case Series

Childhood epilepsy can masquerade as a variety of psychiatric disorders or behavioural abnormalities. Differentiating between simple partial seizure and psychiatric disorders remains a challenge. We report on three children with simple partial seizure, each presented atypically with migraine, tingling sensations, and/or crying spells. When dealing with atypical symptomatology, clinicians should utilise a multidirectional, rather than unidirectional, diagnostic approach when making their diagnosis.

Frequency-Dependent Squeezed Vacuum Source for the Advanced Virgo Gravitational-Wave Detector

In this Letter, we present the design and performance of the frequency-dependent squeezed vacuum source that will be used for the broadband quantum noise reduction of the Advanced Virgo Plus gravitational-wave detector in the upcoming observation run. The frequency-dependent squeezed field is generated by a phase rotation of a frequency-independent squeezed state through a 285 m long, high-finesse, near-detuned optical resonator. With about 8.5 dB of generated squeezing, up to 5.6 dB of quantum noise suppression has been measured at high frequency while close to the filter cavity resonance frequency, the intracavity losses limit this value to about 2 dB. Frequency-dependent squeezing is produced with a rotation frequency stability of about 6 Hz rms, which is maintained over the long term. The achieved results fulfill the frequency dependent squeezed vacuum source requirements for Advanced Virgo Plus. With the current squeezing source, considering also the estimated squeezing degradation induced by the interferometer, we expect a reduction of the quantum shot noise and radiation pressure noise of up to 4.5 dB and 2 dB, respectively.

Novel formulations for topical delivery of tranexamic acid: Assessing the need of epidermal targeting for hyperpigmentation disorders

INTRODUCTION

Tranexamic acid is used for the treatment of hyperpigmentation and the topical route is the most favorable route for its administration. Tranexamic acid lowers plasmin and tyrosinase, which reduces melanin and skin hyperpigmentation. Low penetration through the outer layer of skin and low availability at target melanocyte cells limit tranexamic acid topical administration. Different novel delivery systems like liposomes, microneedles, topical beads, and microparticles can help in overcoming these limitations.

AREAS COVERED

The mechanism of action of tranexamic acid and novel delivery systems for its topical delivery have been discussed. Further patents related to the topical delivery of tranexamic acid and clinical trials undertaken to analyze their potential have been discussed.

EXPERT OPINION

Targeting tranexamic acid in the epidermal layer makes more amount of drug available for action on melanocytes, the target site for tranexamic Acid. Novel drug delivery formulations like liposomes, SLNs, NLCs, and topical beads have the potential of achieving epidermal targeting. Epidermal targeting of tranexamic acid can help in the superior delivery of the drug, making its topical treatment more efficient.

The influence of prenatal screening on the contemporary operative outcomes and functional alleviation after vascular ring surgery in children

Objective: The impact of prenatal screening on contemporary operative outcomes and functional alleviation during pediatric Vascular Ring Surgery (VRS) is analysed in this research. Methods:All patients who had surgical treatment of an isolated VR at the Texas Children’s Hospitalbetween 1996 and 2018were included in the study. Patients who simultaneously underwent intracardiac repair were disqualified. Other congenital cardiac conditions, clinical symptomatology, contemporary surgical intervention, perioperative outcome, reoperation rates, functional alleviation, and complications were all examined in the data analysis.To examine the data for this investigation, we employed SPSS 13.0.Results: 148 participants were chosen for analysis. Of the 148, 72(48.6%)have a Double Aortic Arch (DAA), 69(47.2%) have a ligamentum and a normal left subclavian artery or Right Aortic Arch (RAA) with a left-sided ductus, 5 (2.7%)have an RAA, Left Descending Aorta (LDA) and 2(1.3%) had RAA, Left Ligamentum Arteriosum (LLA), mirror-image branching. Right aortic arch vascular ring(RAAVR) aregeneral than Double Aortic Arch Vascular Ring (DAAVR): 31 patients had the earlier, with a frequency of 5.7 per 10,000 live births, whereas 6 patients had the latter, with an incidence of 1.1 per 10,000 live births (p = 0.0001).Conclusion: VRs are a prevalent form of congenital cardiovascular abnormality, especially when they affect the right aortic arch. Additionally, prenatal screening reveals a significant percentage of VRs.

Search for Subsolar-Mass Binaries in the First Half of Advanced LIGO's and Advanced Virgo's Third Observing Run

We report on a search for compact binary coalescences where at least one binary component has a mass between 0.2  M_{⊙} and 1.0  M_{⊙} in Advanced LIGO and Advanced Virgo data collected between 1 April 2019 1500 UTC and 1 October 2019 1500 UTC. We extend our previous analyses in two main ways: we include data from the Virgo detector and we allow for more unequal mass systems, with mass ratio q≥0.1. We do not report any gravitational-wave candidates. The most significant trigger has a false alarm rate of 0.14  yr^{-1}. This implies an upper limit on the merger rate of subsolar binaries in the range [220-24200]  Gpc^{-3} yr^{-1}, depending on the chirp mass of the binary. We use this upper limit to derive astrophysical constraints on two phenomenological models that could produce subsolar-mass compact objects. One is an isotropic distribution of equal-mass primordial black holes. Using this model, we find that the fraction of dark matter in primordial black holes in the mass range 0.2  M_{⊙}<m_{PBH}<1.0  M_{⊙} is f_{PBH}≡Ω_{PBH}/Ω_{DM}≲6%. This improves existing constraints on primordial black hole abundance by a factor of ∼3. The other is a dissipative dark matter model, in which fermionic dark matter can collapse and form black holes. The upper limit on the fraction of dark matter black holes depends on the minimum mass of the black holes that can be formed: the most constraining result is obtained at M_{min}=1  M_{⊙}, where f_{DBH}≡Ω_{DBH}/Ω_{DM}≲0.003%. These are the first constraints placed on dissipative dark models by subsolar-mass analyses.

Luminescence studies of binding affinity of vildagliptin with bovine serum albumin

Vildagliptin (VDG)is a frontier drug for diabetes mellitus. It is prescribed both in the monotherapy as well as in an amalgamation with other antidiabetic drugs. Drug-serum protein binding is an essential parameter which influences ADME properties of the drug. In current study, binding of VDG with serum protein (bovine serum albumin: BSA) was investigated using multi-spectroscopic techniques. A computational approach was also employed to identify the binding affinity of VDG with BSA at both Sudlow I and II sites. An enzyme activity assay specific for esterase was also investigated to know the post-binding consequences of VDG with BSA. Fluorescence spectra of BSA samples treated with VDG shows static quenching with binding parameters for VDG-BSA complex show single class of equivalent binding stoichiometry(n = 1.331) and binding constant 1.1 x 10⁴M^-1 at 298.15 K. The binding constant indicates important role of non-polar interactions in the binding process. Fluorescence resonance energy transfer (FRET) analysis of VDG absorption spectra and emission spectrum of BSA confirmed no significant resonance in energy transfer. Synchronous fluorescence of BSA after binding with VDG show maximum changes in emission intensity at tryptophan (Trp) residues. Post binding with VDG, BSA conformation changes as suggested by circular dichorism (CD) spectra of BSA and this lead to enhanced protein stability as indicated by a thermal melting curve of BSA.Communicated by Ramaswamy H. Sarma.

A Comprehensive Review on Anti-obesity Potential of Medicinal Plants and their Bioactive Compounds

Background:

Obesity is a complex health and global epidemic issue. It is an increasing global health challenge covering significant social and economic costs. Abnormal accumulation of fat in the body may increase the health risks including diabetes, hypertension, osteoarthritis, sleep apnea, cardiovascular diseases, stroke and cancer. Synthetic drugs available on the market reported to have several side effects. Therefore, the management of obesity got to involve the traditional use of medicinal plants which helps to search the new therapeutic targets and supports the research and development of anti-obesity drugs.

Objective:

This review aim to update the data and provide a comprehensive report of currently available knowledge of medicinal plants and phyto-chemical constituents reported for their anti-obesity activity.

Methodology:

An electronic search of the periodical databases like Web of Science, Scopus, PubMed, Scielo, Niscair, ScienceDirect, Springerlink, Wiley, SciFinder and Google Scholar with information reported the period 1991-2019, was used to retrieve published data.

Results:

A comprehensive report of the present review manuscript is an attempt to list the medicinal plants with anti-obesity activity. The review focused on plant extracts, isolated chemical compounds with their mechanism of action and their preclinical experimental model, clinical studies for further scientific research.

Conclusion:

This review is the compilation of the medicinal plants and their constituents reported for the managements of obesity. The data will fascinate the researcher to initiate further research that may lead to the drug for the management of obesity and their associated secondary complications. Several herbal plants and their respective lead constituents were also screened by preclinical In-vitro and In-vivo, clinical trials and are effective in the treatment of obesity. Therefore, there is a need to develop and screen large number of plant extracts and this approach can surely be a driving force for the discovery of anti-obesity drugs from medicinal plants.

Atypical presentations of cutaneous tuberculosis: Series of 10 cases

Cutaneous tuberculosis classically presents as Lupus vulgaris, scrofuloderma, tuberculosis verrucose cutis and tubercular abscess. Hypersensitivity reaction to the bacilli leads to Lichen scrofulosorum and papulonecrotic tuberculids. At the same time, it can have myriad of clinical presentations, many of which are still undescribed. It is important to regularly update ourselves with these unusual manifestations so as to ensure early treatment and reduction of overall morbidity. In this case series tuberculosis manifesting as rapidly progressing diffuse facial granulomas, sporotrichoid tuberculosis, tuberculosis mimicking squamous cell carcinoma, scrofuloderma as tubercular ulcer, lupus vulgaris with nasal septal perforation, lupus vulgaris resembling furuncle, psoriasis, dermatitis and BT Hansen are described in immunocompetent individuals. These cases highlight the importance of recognition of atypical forms of cutaneous tuberculosis to minimize scarring and dissemination of bacilli.

A Review on Himalayan Medicinal Plants against Cancer

Background:

Plants contributed numerous novel compounds for prophylactic and curative medicine to modern science.They are the important source of natural agents used in various pharmaceutical industries. Himalayan plants are abundant in various secondary metabolites such as anthraquinones, flavonoids, tannins, alkaloids and terpenes. The Himalayan plants grown in high altitude and have around 6500 years old history as traditional medicines.

Aim:

This review article systematically presents information onHimalayan medicinal plants having anti-cancer potentials.

Methodology:

Around 160 articles were reviewed by using online search engines like PubMed, Scopus, Google Scholar, Web of Science, and floras of different Himalayan countries.

Results:

An attempt has been made to review anticancer plants and active constituents isolated from several anti-cancerous plants of Himalayan regions. Eighty three anticancer plants are reported in this review and total twenty two active chemical constituents including phenolic compounds, glycosides, terpenoidsand alkaloids from the plants were reported active against various cancer cell lines.

Conclusion:

Several synthetic agents are used to cure cancer but number of undesired side effects occurs during chemotherapy. Hence, the research is going on to investigate natural therapies, such as the use of the plant derived productsin cancer treatment. They may reduce adverse side effects.

Review On Documented Medicinal Plants Used For The Treatment Of Cancer

Background:

Cancer is a frightful disease and it is the second leading cause of death worldwide. Naturally derived compounds are gaining interest of research workers as they have less toxic side effects as compared to currently used treatments such as chemotherapy. Plants are the pool of chemical compounds which provides a promising future for research on cancer.

Objective:

This review paper provides updated information gathered on medicinal plants and isolated phytoconstituents used as anticancer agents and summarises the plant extracts and their isolated chemical constituents exhibiting anticancer potential on clinical trials.

Methods:

An extensive bibliographic investigation was carried out by analysing worldwide established scientific databases like SCOPUS, PUBMED, SCIELO, ScienceDirect, Springerlink, Web of Science, Wiley, SciFinder and Google Scholar etc. In next few decades, herbal medicine may become a new epoch of medical system.

Results:

Many researches are going on medicinal plants for the treatment of cancer but it is a time to increase further experimental studies on plant extracts and their chemical constituents to find out their mechanism of action at molecular level.

Conclusion:

The article may help many researchers to start off further experimentation that might lead to the drugs for the cancer treatment.

Bioremediation of heavy metals from wastewater: a current perspective on microalgae-based future

Heavy metals-containing drinking water and wastewater are posing a severe threat to the environment, and living beings on land, air and water. Different conventional, advanced nanomaterials-based and biological method has been employed for the treatment of heavy metals. Among the biological methods, microalgae are an important group of micro-organisms that have numerous environmental applications and can remediate heavy metals from wastewater. Also, it has numerous advantages over conventional remediation processes. Microalgae cells can uptake the heavy metal via different physiological and biological methods and are utilized as a nutrient source to regulate its metabolic process for the production of biomass. Furthermore, the enhancement in heavy metal removal efficiency can be improved using different strategies such as immobilization of algal cells, development of algal consortia and designing of microalgae-based nanocomposite materials. Also, it can significantly contribute towards environmental sustainability and future. Thus, the review provides a critical overview of heavy metals and their existence along with their negative effects on humans. This review provides insight on recent advanced nanomaterial approaches for the removal of heavy metals, overviews of microalgae-based heavy metal uptake mechanisms and their potential for the amputation of different heavy metals. Furthermore, the special focus is on recent strategies that enhance heavy metal removal efficiency and contribute towards sustainability for the development of a microalgae-based future.

Blood pressure normalizing effect of Talahridaya marma therapy: A case report

Ancient Ayurvedic literature described 107 vital regions of the body and considered them as a seat of prana (life force) and collectively termed them as marma. The applied aspect of this concept, marma chikitsa or marma therapy, is gaining popularity as it is being practiced by many clinicians in which these marma are stimulated in different ways to treat different diseases. Hypertension is one of the major disorders affecting majority of the world population. Inspite of available antihypertensive therapies, the hypertensive population of not only the older age group, but also of that of young adults is increasing. Blood pressure normalising effect of marma therapy is observed by clinicians practicing marma therapy due to its holistic effect on the body. Clinical data regarding efficacy of this therapy is very sparse and hence, its application in different diseases remained unexplored till date. This case report is of a young hypertensive male whose blood pressure significantly improved with Talahridaya marma therapy. This patient was detected with raised blood pressure on repetitive examinations. The volunteer was subjected to Talahridayamarma therapy where his classical Talahridaya marma point on left upper limb was physically stimulated in controlled way for 10 days and the patient was also taught to perform the therapy on himself. The blood pressure was recorded, both before and after giving the therapy on each day. The volunteer showed significant improvement in his blood pressure recordings.

Mini-Clinical Evaluation Exercise as a Tool for Formative Assessment of Postgraduates in Psychiatry

Context

Introduction of competency-based medical education in India has necessitated a diversion from traditional methods of teaching and assessment.

Aim

The aim of this study was to assess the feasibility and acceptability of mini-clinical evaluation exercise (mini-CEX) as a tool for formative assessment of postgraduates in psychiatry at our institute.

Settings and Design

It was a prospective, quasi-experimental study carried out in the Department of Psychiatry, PGIMS, Rohtak (India).

Materials and Methods

After obtaining written informed consent, trainees (18) were sensitized and faculty members (5) were trained to use mini-CEX and regarding the feedback process with the help of workshops.

Statistical Analysis Used

Data collected were analyzed using descriptive statistics. Mean differences between the sessions were assessed using a paired sample t-test. P < 0.05 was considered as level of significance.

Results

Statistically significant difference was found between session 1 and session 6 for counseling skills but not for three sessions of diagnostic skills. Mini-CEX was accepted as a better learning method by 61% of the postgraduates, 36% felt that it improved their clinical skills, 64% reported a boost in their confidence, and 89% looked forward to these encounters. Majority of the postgraduates and faculty members suggested that the mini-CEX should be regularly used in academic settings and should be introduced early in the training.

Conclusions

Mini-CEX is a feasible formative assessment tool for postgraduates in psychiatry and an effective method of learning by the postgraduates, inducing a significant improvement in the counseling skills of students. Teaching faculty also accepted mini-CEX as an effective method of formative assessment.

A Case of Ruptured Perineal Epidermal Cyst

Epidermal cysts are common skin lesions. They are usually seen in the chronic sun-exposed areas of the skin. They can get complicated by inflammation, infection, rupture, or malignancy. Epidermal cyst in the perineal region is rare. We report a case of an infected ruptured perineal epidermal cyst mimicking gluteal abscess. The patient was successfully treated by complete surgical excision. Histology revealed epidermal cyst with foreign body giant cell reaction and no evidence of malignancy.

Limited effectiveness of four oral antifungal drugs (fluconazole, griseofulvin, itraconazole and terbinafine) in the current epidemic of altered dermatophytosis in India: results of a randomized pragmatic trial

BACKGROUND

Dermatophytic infections have undergone unprecedented changes in India in the recent past. Clinical trials to find out the effectiveness of the four main oral antifungal drugs are lacking.

OBJECTIVES

We tested the effectiveness of oral fluconazole, griseofulvin, itraconazole and terbinafine in chronic and chronic relapsing tinea corporis, tinea cruris and tinea faciei in an investigator-initiated, randomized, pragmatic trial.

METHODS

Two hundred patients with microscopy-confirmed tinea were allocated to four groups (50 patients in each group): fluconazole 5 mg kg^-1 per day, griseofulvin 10 mg kg^-1 per day, itraconazole 5 mg kg^-1 per day and terbinafine 7·5 mg kg^-1 per day. Allocation was performed by concealed block randomization and the patients were treated for 8 weeks or until cure. Effectiveness was calculated based on intention-to-treat analysis. The trial was registered with the Clinical Trials Registry India (CTRI/2017/04/008281).

RESULTS

At 4 weeks, all drugs were similarly ineffective, with cure rates being 8% or less (P = 0·42). At 8 weeks, the numbers of patients cured were as follows: fluconazole 21 (42%), griseofulvin seven (14%), itraconazole 33 (66%) and terbinafine 14 (28%) (P < 0·001). Itraconazole was superior to fluconazole, griseofulvin and terbinafine (adjusted P ≤ 0·048). Relapse rates after 4 and 8 weeks of cure with the four treatments were not different (P ≥ 0·42). Numbers needed to treat (vs. griseofulvin), calculated on the basis of cure rates at 8 weeks, were as follows: fluconazole 4, itraconazole 2 and terbinafine 8.

CONCLUSIONS

The results show limited effectiveness of all four antifungal drugs. In view of cure rates and the number needed to treat, itraconazole is the most effective drug, followed by fluconazole (daily), terbinafine and then griseofulvin, in chronic and chronic relapsing dermatophytosis in India. What is already known about this topic? Oral antifungal drugs are considered to have a high cure rate in tinea corporis, tinea cruris and tinea faciei. Unprecedented changes have been noticed in the last few years in India in the morphology, course and treatment responsiveness of tinea; however, data about the effectiveness of oral antifungals are lacking. What does this study add? Our results show limited effectiveness of four oral antifungal drugs (fluconazole, griseofulvin, itraconazole and terbinafine) in the current epidemic of altered dermatophytosis in India. Among the four drugs tested, oral itraconazole is the most effective. Linked Comment: Elewski. Br J Dermatol 2020; 183:798-799.

NWChem: Past, present, and future

Specialized computational chemistry packages have permanently reshaped the landscape of chemical and materials science by providing tools to support and guide experimental efforts and for the prediction of atomistic and electronic properties. In this regard, electronic structure packages have played a special role by using first-principle-driven methodologies to model complex chemical and materials processes. Over the past few decades, the rapid development of computing technologies and the tremendous increase in computational power have offered a unique chance to study complex transformations using sophisticated and predictive many-body techniques that describe correlated behavior of electrons in molecular and condensed phase systems at different levels of theory. In enabling these simulations, novel parallel algorithms have been able to take advantage of computational resources to address the polynomial scaling of electronic structure methods. In this paper, we briefly review the NWChem computational chemistry suite, including its history, design principles, parallel tools, current capabilities, outreach, and outlook.

Mycetoma: reviewing a neglected disease

Mycetoma caused by either filamentous fungi (eumycotic) or bacteria (actinomycotic) has recently been recognized by the World Health Organization as a neglected tropical disease. Although mycetoma is preventable and treatable, especially in the early stages, it carries high morbidity and a huge socioeconomic burden. Skin and subcutaneous tissue is affected, with a classic presentation of hard woody swellings, discharging sinuses and presence of grains (containing the causative organism). Variants with swelling without sinuses have also been described. Left untreated it may involve underlying bone and muscle, leading to permanent disability. Common actinomycotic species include Streptomyces somaliensis, Actinomadura madurae, Actinomadura pelletieri, Nocardia brasiliensis and Nocardia asteroides, while Madurella mycetomatis, Madurella grisea, Pseudoallescheria boydii and Leptosphaeria senegalensis are common eumycotic agents. Men are more commonly affected than women, and the leg is the most frequently affected site. Diagnosis in suspected lesions is made with the help of grain examination, microscopy, imaging (radiography, ultrasonography, magnetic resonance imaging) and culture, and more recently by molecular methods such as PCR and molecular sequencing. Molecular sequencing for both fungi and bacteria is important for rapid and correct diagnosis, especially in culture-negative cases. Treatment is long, more successful in actinomycetoma than eumycetoma, and may require a holistic approach comprising antimicrobials, surgery and rehabilitation. Mycetoma can be prevented by simple measures such as wearing protective garments and shoes, especially in rural areas and during outdoor activities.

Phenotypic and virulence traits of Escherichia coli and Salmonella strains isolated from vegetables and fruits from India

AIMS

The present study was designed to assess the phenotypic traits and virulence determinants of vegetable-/fruit-origin Escherichia coli and Salmonella strains.

METHODS AND RESULTS

A total of 520 fresh vegetables/fruits samples were analysed for the presence of E. coli, including Shiga toxin-producing E. coli (STEC), and Salmonella. The vegetable-/fruit-origin E. coli and Salmonella strains were further assessed for antimicrobial resistance, biofilm formation, extracellular matrix production and in vitro invasion/intracellular survivability assays. A total of 73 E. coli, including four STEC, and 26 Salmonella strains were recovered from vegetables/fruits in the present study. Most of the E. coli and Salmonella isolates were able to form biofilm with higher production of cellulose/curli-fimbriae. Furthermore, more resistance was observed in E. coli isolates (61·6%) than in Salmonella isolates (38·5%) against tested antimicrobials. Additionally, invasion/intracellular survival results showed that majority of the E. coli and Salmonella isolates were able to efficiently invade/replicate intracellularly in the human epithelial cells.

CONCLUSIONS

Our results demonstrate that vegetable-/fruit-origin E. coli and Salmonella significantly exhibited distinct phenotypic/virulence traits which could be linked to their plant-associated lifestyle with food safety issues.

SIGNIFICANCE AND IMPACT OF THE STUDY

The present study provides valuable baseline information that E. coli and Salmonella may use plants as an alternative host with significant clinical importance.

Interpretive structural modeling for integrating quality management in manufacturing and service counterparts

Purpose

The purpose of this paper is to identify and rank the contextual relationship among the quality management (QM) constructs for manufacturing and its related service organizations providing integrated value bundles, which has got limited research attention.

Design/methodology/approach

The QM constructs of manufacturing and services are selected by performing the citation analysis. Studies related to manufacturing and service are selected by reviewing their citations index in the three major research databases namely ProQuest, Scopus and Google Scholar. The subjective responses from both industry and academia are taken in order to gain better understanding of the contextual relationship among the QM constructs. Finally, an integrated model is proposed using Micmac analysis and Interpretive Structural Modeling (ISM).

Findings

The citation analysis lead to identification of 12 QM constructs: top management commitment, supplier relationship management, human resource management, strategic focus, customer focus, quality of information sharing, process management, servicescape, employee involvement, service quality, supply chain flexibility and customer satisfaction. The expert opinions of executives in the automotive industry and academia resulted in the development of contextual relationships among the identified QM constructs for the development of an ISM model, which is a major contribution of this study.

Originality/value

The unique focus of this study is on analyzing the contextual relationship among QM aspects in manufacturing and services as clubbed offering. The researchers in the existing literature have so far differentiated between manufacturing and services but this study integrates the QM constructs for manufacturing and its associated services through expert feedback and proposes an ISM model.

Post-operative analgesia using intermittent vs. continuous adductor canal block technique: a randomized controlled trial

BACKGROUND AND OBJECTIVES

Intermittent boluses for neural blockade provide better post-operative analgesia when compared to continuous infusion. However, these techniques of administration have not yet been compared while performing adductor canal block (ACB). We compared intermittent vs. continuous ACB for managing post-operative pain following anterior cruciate ligament (ACL) reconstruction. The primary endpoint was total morphine consumption for 24 h post-operatively in both the groups. Secondary outcomes included evaluation of pain scores and opioid-related side effects.

METHODS

After ethics board approval, subjects presenting for ACL reconstruction were randomized to receive either continuous ACB (n = 25) with 0.5% ropivacaine infusing at 2.5 ml/h or intermittent boluses (n = 25) of 15 ml of 0.5% ropivacaine every 6 h. Total morphine consumption 24 h following surgery was recorded in each group.

RESULTS

Fifty subjects completed this study. The mean 24-h total morphine consumption in the intermittent group, [11.36 (6.82) mg], was significantly reduced compared with the continuous group, [23.40 (10.45) mg] (P < 0.001). The mean visual analogue scale (VAS) pain score at rest and on knee flexion was significantly reduced in the intermittent group at 4, 6, 8, and 12 h compared with the continuous group.

CONCLUSION

Intermittent ACB allowed significantly reduced consumption of morphine for 24 h in the post-operative period compared with continuous ACB when identical doses of ropivacaine were used in each group.

Successful management of a refractory case of postoperative herniorrhaphy pain with extended duration pulsed radiofrequency

Chronic postsurgical pain (CPSP) is a distressful condition following hernia surgery. A 25-year-old, 55 kg male patient presented with severe pain on the right side of the lower abdomen that radiated to the testicle and the inner side of the thigh. Patient was symptomatic since 5 months following inguinal herniorrhaphy surgery. The pain was not relieved with pharmacological and interventional nerve blocks. An ultrasound-guided ilioinguinal-iliohypogastric (II-IH) block with extended duration (42°C, four cycles of 120 s each) pulsed radiofrequency (PRF) and a diagnostic genital branch of genitofemoral nerve (GGFN) block provided pain relief. After 1-month, an extended duration PRF in GGFN resulted in complete resolution of symptoms. During a regular follow-up of 9 months, patient reported an improved quality-of-life. We believe the successful management of CPSP following hernia repair with single extended duration PRF of II-IH and GGFN has not been described in the literature.