Expert panel recommendations for topical hemostatic agent use in varied bleeding sites and situations during neuro-spine surgeries

Intraoperative bleeding poses a substantial challenge, particularly in neuro-spine surgeries leading to complications such as hematomas, infections, and hemodynamic instability. Despite their proven efficacy, use of topical hemostatic agents (THAs) lacks comprehensive published literature and guidelines particularly in the Indian setting. The present study provides the first-ever Indian expert panel recommendations for effective adjunct THA use in different intraoperative bleeding sites and situations in neuro-spine surgeries. A comprehensive approach, encompassing a literature review, followed by experience sharing in a meeting using a survey helped integrate expert opinions in the form of practical algorithms to guide THA selection. Our survey results revealed a strong inclination towards specific THAs, flowable gelatin + thrombin being choice of THA for difficult to access and problematic bleeding situations during tumor removal/resection, transsphenoidal hypophysectomy and skull-based procedures. Both oxidized regenerated cellulose (ORC)/Fibrillar and flowable gelatin + thrombin were recommended for continuous oozing. ORC/Fibrillar was preferred for arteriovenous and cavernous malformations. This expert-panel guidance on THA use aims to optimize hemostat use practices and improve surgical outcomes in neuro-spine surgery.

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

BACKGROUND

Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation.

METHODS

WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109.

FINDINGS

Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital.

INTERPRETATION

In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates.

FUNDING

European Society of Intensive Care Medicine, European Respiratory Society.

Antibiogram of microorganisms isolated from fresh and frozen semen of crossbred frieswal bulls

BACKGROUND

The bacterial contaminants in the semen are a major concern for most of the semen production laboratories because they adversely affect the semen quality. During sperm cryopreservation, the inclusion of antimicrobials in extenders may help to minimize bacterial growth. However, due to bacterial resistance to commonly used antimicrobials, they cannot fully assure microbiological safety to the frozen semen.

OBJECTIVE

To estimate the microbial load and antibiogram of microorganisms isolated from the fresh and frozen bull semen.

MATERIALS AND METHODS

The bacterial load was estimated in fresh and frozen semen samples of crossbred Frieswal bulls by the pour plate method. Microorganisms were identified as Gram positive and Gram negative by Gram staining. The representative bacterial colonies were streaked onto different specific media which were further confirmed by biochemical tests. Bacterial isolates were subjected to in vitro antibiotic sensitivity test.

RESULTS

The average microbial load of fresh and frozen semen samples was found to be 8397.4 ± 524.3 cfu per mL and 680.9 ± 105.4 cfuper mL, respectively. Microorganisms belonging to Staphylococcus aureus, Staphylococcus epidermidis, Proteus, Klebsiella, Bacillus cereus, Bacillus subtilis, Actinomyces, E. coli, Rhodococcus, Neisseria and Micrococcus were identified in the semen samples. The antibiotic sensitivity testing of the bacterial isolates revealed that benzyl penicillin was found to be the least effective against the isolated organisms while gentamicin and spectinomycin were found to be most effective among the antibiotics used. Lincomycin, tylosin and streptomycin showed moderate efficacy against the bacterial isolates.

CONCLUSION

Gentamicin, tylosin, lincomycin, and spectinomycin (GTLS) antibiotic combination is more effective against bacterial isolates and may be added to semen extender to better control bacterial load and semen quality. doi.org/10.54680/fr22610110512.

Cryoprotection of humanin-like peptides in seminal plasma for ejaculated spermatozoa of crossbred bulls

BACKGROUND

Cryopreservation process negatively affects spermatozoa functions. Humanin, a small polypeptide encoded in the mitochondrial genome, is well known for its role in cell survival.

OBJECTIVE

To quantify the endogenous levels of humanin in seminal plasma of crossbred Frieswal bulls and to study its role in cryoprotection. The presence of humanin in bull spermatozoa was also investigated.

MATERIALS AND METHODS

A total of 40 semen samples were separated into two groups based on the initial progressive motility (IPM): Good (IPM >70%) and Poor (IPM <50%) groups; and/or based on the post-thaw motility (PTM): Freezable (PTM>50%) and Non-freezable (PTM < 50%) groups. Humanin concentration in seminal plasma (SP-HN) was quantified using ELISA.

RESULTS

SP-HN concentration ranged from undetectable to 67.6 pg/mL with a median level of 35.2 pg/mL. SP-HN level was significantly higher in the good quality semen group than in the poor quality semen group (p<0.001), and also significantly higher in the freezable group than in the non-freezable group (p<0.001). SP-HN level was positively correlated with initial progressive motility, post-thaw semen motility, viability, acrosome intactness and plasma membrane integrity, but negatively correlated the level of reactive oxygen species and malondialdehyde content. Immunochemical localization showed the presence of humanin in the proximal region of the middle piece of spermatozoa.

CONCLUSION

Endogenous humanin level had significant correlation with semen quality and might protect sperm cells against freeze-induced oxidative stress. doi.org/10.54680/fr22510110712.

Effects of unconjugated gold, silver and titanium dioxide nanoparticles on bovine spermatozoa at various stages of cryopreservation

BACKGROUND

The increasing use of nanoparticles (NP) for gender-selected spermatozoa, sperm-enriched semen and novel extenders raises the concern of undesirable effects on fertility and sperm function.

OBJECTIVE

To investigate the effects of gold (Au-), silver (Ag-), and titanium dioxide (TiO₂-) NPs on the motility and sperm functions in bovine spermatozoa at various stages of cryopreservation.

MATERIALS AND METHODS

Frieswal (Sahiwal × Holstein Friesian) bull semen ejaculates (N = 24) were challenged with unconjugated and ligand-free Au-, Ag-, and TiO₂-NPs.

RESULTS

At post-dilution (fresh) stage, there was no significant difference observed in progressive motility and viability amongst the control and any nanoparticle-treated groups, though plasma membrane integrity was significantly reduced in nanoparticle-treated groups (p < 0.05). The acrosome intactness was also significantly reduced in the groups of Ag-NP and TiO₂ -NP (p < 0.05), while there was no effect observed in the Au-NP group. At post-equilibration stage, a significant reduction in motility, viability, and plasma membrane integrity was observed in all three nanoparticle-treated groups (p < 0.05). There was no difference in intact acrosome between the control and Au-NPs groups; which was significantly higher than the Ag-NP and TiO₂ -NP groups (p < 0.05). At post-thaw stage, all NP groups resulted in a significant reduction of motility, viability, acrosome intactness and plasma membrane integrity (p < 0.05). Besides, TiO₂-NPs appear to be significant more toxic (p < 0.05) among three NP groups, and Au-NPs appear to be lesser toxic.

CONCLUSION

Bovine spermatozoa are adversely affected by Au-, Ag- and TiO₂ -NPs that may impair sperm motility and other functions. doi.org/10.54680/fr22310110512.

Subclinical left and right ventricular dysfunction in COVID-19 recovered patients using speckle tracking echocardiography

Funding Acknowledgements

Type of funding sources: None.

Introduction

Myocardial injury during acute COVID-19 infection is well characterised however, its persistence during recovery is unclear.

Purpose

We assessed left ventricle (LV) global longitudinal strain (GLS) and right ventricular (RV) free wall longitudinal strain and RV global longitudinal strain (RV-GLS) using speckle tracking echocardiography (STE) in COVID-19 recovered patients (30-45 days post recovery) and studied its correlation with various parameters.

Methods

Of the 245 subjects screened, a total of 53 subjects recovered from COVID-19 infection and normal LV ejection fraction were enrolled. Routine blood investigations, inflammatory markers (on admission) and comprehensive echocardiography including STE were done for all.

Results

All the 53 subjects were symptomatic during COVID-19 illness and were categorized as mild: 27 (50.9%), moderate: 20 (37.7%) and severe: 6 (11.4%) COVID-19 illness. Reduced LV GLS was reported in 22 (41.5%), reduced RV-GLS in 23 (43.4%) and reduced RVFWS in 22 (41.5%) patients respectively. LVGLS was significantly lower in patients recovered from severe illness (mild: -20.3 ± 1.7%; moderate: -15.3 ± 3.4%; severe: -10.7 ± 5.1%; P < 0.0001). Similarly, RVGLS (mild: -21.8 ± 2.8%; moderate: -16.8 ± 4.8%; severe: -9.7 ± 4.6%; P < 0.0001) and RVFWS (mild: -23.0 ± 4.1%; moderate: -18.1 ± 5.5%; severe: -9.3 ± 4.4%; P < 0.0001) were significantly lower in subjects with severe COVID-19. Subjects with reduced LVGLS as well as RVGLS and RVFWS had significantly higher interleukin-6, C-reactive protein, lactate dehydrogenase and serum ferritin levels during index admission.

Conclusions

Subclinical LV and RV dysfunction was seen in majority of  COVID-19 recovered patients. Patients with severe disease during index admission had far lower LV and RVGLS as compared to mild and moderate cases. Our study highlights the need for close follow-up of COVID-19 recovered subjects in order to determine the long-term cardiovascular outcomes.

Comparative CpG methylation kinetic patterns of cis-regulatory regions of heat stress-related genes in Sahiwal and Frieswal cattle upon persistent heat stress

The kinetic patterns of CpG methylation of the cis-regulatory region of heat stress-related genes on exposed to heat stress (at 42 °C) between the Sahiwal and Frieswal cattle was compared in the present study. Using an in vitro whole blood culture model, cells were continuously exposed to heat stress (at 42 °C) for 6 h. Methylation levels of five genes, viz., GPX1, HSP70, HSP90, c-FOS, and JUN were estimated by SyberGreen-based quantitative methylation-specific PCR (qMSP) assay. CpG methylation kinetics at different time points of heat stress (0.5, 1, 2, 4, 6 h) were analyzed using mixed ANOVA. The initial methylation level, estimated at 37 °C, of HSP70 was significantly high in the Sahiwal breed. A significant (p<0.001) time-dependent hypomethylation of an antioxidant gene (GPX1) CpG islands was detected at the acute phase of the stress. Heat shock protein gene (HSP70) showed a similar CpG methylation kinetics where the hypomethylation was prominent from 1 h and persisted up to 4 h. The heat stress responses of both Sahiwal and Frieswal cattle were identical as there was no distinctiveness in the methylation kinetics of CpG islands of studied genes. The acclimatization of Frieswal cattle-a breed developed in India over the years to the tropical climatic conditions, maybe one of the reasons for this similarity. Thus, the present study results could pave a path to understand the molecular mechanism of heat stress and adaptation of indigenous and crossbred cattle populations to the changing scenario in tropical climate conditions.

A huge ureteric stone in a functionally, metabolically and anatomically normal kidney: an alliance of rarity

Urinary stones are a common health problem, necessitating frequent outpatient visits and hospital admissions. Ureteric stones demand special attention, given their propensity for upstream hydroureteronephrosis and loss of renal function. They are usually predisposed by diverse anatomical, functional or metabolic abnormalities of the urinary tract and have an early symptomatic presentation. We report an exceptional clinical presentation of a huge ureteric stone yet functional renal moiety with no obvious anatomical or metabolic predilection for urolithiasis, and its minimally invasive management in a young woman. We emphasise that swift salvaging of the renal function is of utmost importance in these cases. Open exploration can be avoided in favour of laparoscopic ureterolithotomy with better cosmesis and early recovery.

Role of seminal MDA, ROS, and antioxidants in cryopreservation and their kinetics under the influence of ejaculatory abstinence in bovine semen

Despite many cryopreservation techniques in bovine semen, various stressors' detrimental effects remain a significant issue. The present study targeted to assess the role of semen quality parameters, sperm function tests, lipid peroxidation, reactive oxygen species (ROS), and different antioxidants in the cryopreservation of bovine semen. Further, the kinetics of lipid peroxidation, ROS, and antioxidants on repeated semen collection under short ejaculatory abstinence were studied. We designed a comparative study where bulls were grouped into good and low freezable semen groups (Freeze-groups) based on their post-thaw motility. All the bulls included had similar initial motility and qualified minimum standards for initial semen parameters viz. semen volume and sperm concentration. The present study detected a higher lipid peroxidation and ROS viz. superoxide anions (•O2-) and a lower total antioxidant capacity (TAC) in the low freeze-group compared to the good freeze-group. The ROS and antioxidants showed unique kinetics on repeated semen collection at short intervals, and no significant change was detected in semen volume, sperm motility, and sperm concentration. This study detected higher head abnormalities and poor acrosome integrity in the low freeze-groups. The present study results indicated that the sperm head might be the most vulnerable part of the sperm to cryopreservation stress. The present study finds significantly higher lipid peroxidation and ROS levels and reduced antioxidant capacity as the primary reasons for low cryopreservability. Further, repeated semen collection with a shorter or lack of abstinence does not impose any significant change in the semen volume and sperm concentration; moreover, it could be beneficial for higher antioxidant levels and lower lipid peroxidation levels. As seminal plasma has both inhibitory and stimulatory roles in sperm function and cryopreservation, identifying the critical role players of seminal plasma and identifying sperm related changes in cryopreservation could predict the cryopreservability potential of semen.

Nitrogen-doped carbon quantum dots conjugated isoreticular metal-organic framework-3 particles based luminescent probe for selective sensing of trinitrotoluene explosive

Amine group-containing isoreticular metal-organic framework (IRMOF-3) particles are utilized for the first time as a trinitrotoluene (TNT) sensing material. IRMOF-3 particles are synthesized using zinc nitrate as a metal precursor and 2-amino-1,4-benzenedicarboxylic acid as a linker. The nitrogen-doped carbon quantum dots (NCQDs) are synthesized from citric acid and ethylenediamine as carbon and nitrogen precursor, respectively. The NCQDs are conjugated with IRMOF-3 particles as IRMOF-3/NCQDs. The TEM micrograph revealed the average size of IRMOF-3 particles to be 363.66 nm. The photoluminescence emission intensity of IRMOF-3 particles at λ_em 430 nm is highly increased in the presence of NCQDs (λ_ex 330 nm). Both the as-synthesized IRMOF-3 and IRMOF-3/NCQD particles are explored for TNT detection to compare the effect of NCQDs on the IRMOF-3 particle surface. Lower limit of detection (7.5 × 10^-8 M) and higher Stern-Volmer constant (4.46 × 10⁶ M^-1) are achieved by IRMOF-3/NCQD particles. The association constant also increased from 5.3 × 10⁴ to 2.78 × 10⁶ M^-1 after the conjugation of IRMOF-3 particles with NCQDs. Moreover, enhanced selectivity for TNT over trinitrophenol is achieved using the IRMOF-3/NCQD particles. Graphical Abstract.

Cardiological society of India document on safety measure during echo evaluation of cardiovascular disease in the time of COVID-19

An echocardiographic investigation is one of the key modalities of diagnosis in cardiology. There has been a rising presence of cardiological comorbidities in patients positive for COVID-19. Hence, it is becoming extremely essential to look into the correct safety precautions, healthcare professionals must take while conducting an echo investigation. The decision matrix formulated for conducting an echocardiographic evaluation is based on presence or absence of cardiological comorbidity vis-à-vis positive, suspected or negative for COVID-19. The safety measures have been constructed keeping in mind the current safety precautions by WHO, CDC and MoHFW, India.

Effect of heat stress on superoxide anion production in native and crossbred cattle under in vitro whole blood culture model

Impact of global warming on the dairy industry has gained attention due to huge economic losses through low production and fertility caused by heat stress. Exposure to hyperthermia provokes a series of complex responses in mammals which are been related to morphological and physiological alterations including the production of reactive oxygen species (ROS). A quantitative spectrophotometric based nitroblue tetrazolium (NBT) reduction assay was used to estimate the superoxide anion (•O₂^-) level in heat stressed (at 42 °C) whole blood cultures of native and crossbred bulls (Sahiwal and Frieswal), in vitro. The breed effect in the kinetics of •O₂^- production at different time periods of continual heat stress was analyzed by repeated measures ANOVA. Comparison between different time periods in reference to 37 °C was analyzed by paired t-test. The •O₂^- level was significantly different (p < 0.05) between cells at 37 °C and 42 °C at different periods of incubation. Kinetics study showed increment of •O₂^- production on the acute phase of stress followed by a reduction in both Sahiwal and Frieswal breeds. In Sahiwal breed, the inflated superoxide level continued abated till 4 h and raised again at 6 h, while in Frieswal •O₂^- level reverted to raise sooner with in 2 h of incubation itself. Contrarily, kinetic of •O₂^- level in plasma showed a significant reduction (p < 0.001) at 30 min of 42 °C incubation followed by increment of •O₂^- level. Further, the breed variation was significant (p < 0.05) and a significant high reduction of •O₂^- level was observed in Sahiwal breed. Our finding indicates that, a better and longer •O₂^- production homeostasis and higher plasma scavenging ability of native breed may be one of the reasons for the higher thermal tolerance of these breeds in tropical climate.

Efficacy of Liquorice and Propolis Extract Used as Cavity Cleaning Agents against Streptococcus mutans in Deciduous Molars Using Confocal Microscopy: An In Vitro Study

Background/introduction

Cavity disinfection before restoration aids in reducing the number of residual bacteria, thus, decreasing the rate of secondary caries. Propolis, at low concentrations, inhibits the growth of cariogenic bacteria. Liquorice roots are known to have antimicrobial, anti-inflammatory, and antioxidant properties.

Aim and objectives

Evaluation and comparison of antimicrobial efficacy of liquorice and propolis extract gels used as cavity cleaning agents against Streptococcus mutans in deciduous molars by confocal laser scanning microscopy (in vitro study).

Materials and methods

Liquorice and propolis extracts were converted into gels after recording the minimum inhibition concentration. Class I cavity was prepared on 135 extracted deciduous molars and subjected to inoculation with S. mutans. Teeth were randomly divided into groups I, II, and III which were treated with gels of liquorice, propolis, and distilled water, respectively, for 60, 120, and 180 seconds each. Specimens were sectioned and stained with fluorescent dyes and observed under a confocal laser scanning microscopy (CLSM). The data obtained were statistically evaluated.

Results

The mean nonviable/viable bacterial count and the depth of penetration were found to be maximum in group I and minimum in group III. A statistically significant difference was found to be between groups I and II and groups I and III, while with groups II and III, it was nonsignificant at all 60, 120, and 180 seconds. The bacterial depth penetration between groups I and II at 180 seconds was nonsignificant.

Conclusion and clinical significance

Though liquorice showed better antimicrobial potential as compared to propolis extract, both can be used efficiently as cavity disinfectants.

How to cite this article

Godbole E, Tyagi S, et al. Efficacy of Liquorice and Propolis Extract Used as Cavity Cleaning Agents against Streptococcus mutans in Deciduous Molars Using Confocal Microscopy: An In Vitro Study. Int J Clin Pediatr Dent 2019;12(3):194–200.

Incorporating baseline functional status to improve validity of neurological outcome assessments following cardiac arrest

BACKGROUND

Neurological status at hospital discharge is routinely used to assess patient outcome after cardiac arrest. However, attribution of impairment to the arrest is valid only if baseline neurological status is known. This study evaluated whether incorporating baseline neurological status improves performance of a widely employed neurological outcome scale for quantifying arrest-attributable morbidity.

METHODS

Retrospective cohort study of two U.S. hospitals. Neurological function was assessed via Cerebral performance category (CPC), an ordinal five-point scale with 1 indicating sufficient cognition to lead an independent life and 5 representing brain death. Hospitalized adult patients who suffered in-hospital cardiac arrest for which cardiopulmonary resuscitation was attempted between 2011-2015 were included. Patients were identified through a quality improvement registry that captures all inpatient arrests in the two hospitals.

RESULTS

Of 486 patients who suffered in-hospital cardiac arrest, 124 (25.5%) had baseline abnormal neurological function (pre-hospitalization CPC>1). Although 54 patients had a normal discharge CPC of 1, 80 patients had no change in CPC from their prior baseline (11.1% vs. 16.5% met criterion for "normal" outcome defined as CPC of 1 vs. change-in-CPC of 0; McNemar p < .01; kappa for agreement: .78, 95% CI .69-.86). Across several formulations of criteria for "good" neurological outcome, similar discordance existed between conventional definitions considering only discharge CPC and modified definitions that included change-in-CPC from baseline.

CONCLUSIONS

Incorporating change-in-CPC into criteria for "good" neurological outcome post-arrest yields discordant results from traditional approaches that consider discharge CPC only and increases face validity of reporting arrest-related morbidity.

Effectiveness of Various Tongue Cleaning Aids in the Reduction of Tongue Coating and Bacterial Load: A Comparative Clinical Study

AIM

To remove tongue biofilm and improve breath odor, specific instruments (tongue scrapers) or toothbrushes are used.

MATERIALS AND METHODS

This study compared the effectiveness of a manual toothbrush that has a tongue scraper on the back of its head and two commercially available tongue scrapers in reducing the tongue coating and aerobic and anaerobic microbiota of the tongue dorsum. A randomized, negative controlled, double-blind, parallel design study for three different treatment interventions was conducted.

RESULTS

All tongue cleaners showed a significant reduction in Winkle's tongue coating scores with significant values of reduction (p <0.001) of the anaerobic bacterial count with plastic and metal tongue scraper when compared to brush scrapper.

CONCLUSION

There was an effective reduction of bacterial load on tongue dorsum with the use of tongue cleaners, with maximum load reduction by using plastic tongue cleaners.

CLINICAL SIGNIFICANCE

The results of the present study may be helpful for the dentists while prescribing tongue cleaners to their patients in their clinical practice.

Shock subtypes by left ventricular ejection fraction following out-of-hospital cardiac arrest

Background

Post-resuscitation hemodynamic instability following out-of-hospital cardiac arrest (OHCA) may occur from myocardial dysfunction underlying cardiogenic shock and/or inflammation-mediated distributive shock. Distinguishing the predominant shock subtype with widely available clinical metrics may have prognostic and therapeutic value.

Methods

A two-hospital cohort was assembled of patients in shock following OHCA. Left ventricular ejection fraction (LVEF) was assessed via echocardiography or cardiac ventriculography within 1 day post arrest and used to delineate shock physiology. The study evaluated whether higher LVEF, indicating distributive-predominant shock physiology, was associated with neurocognitive outcome (primary endpoint), survival, and duration of multiple organ failures. The study also investigated whether volume resuscitation exhibited a subtype-specific association with outcome.

Results

Of 162 patients with post-resuscitation shock, 48% had normal LVEF (> 40%), consistent with distributive shock physiology. Higher LVEF was associated with less favorable neurocognitive outcome (OR 0.74, 95% CI 0.58–0.94 per 10% increase in LVEF; p = 0.01). Higher LVEF also was associated with worse survival (OR 0.81, 95% CI 0.67–0.97; p = 0.02) and fewer organ failure-free days (β = – 0.67, 95% CI – 1.28 to − 0.06; p = 0.03). Only 51% of patients received a volume challenge of at least 30 ml/kg body weight in the first 6 h post arrest, and the volume received did not differ by LVEF. Greater volume resuscitation in the first 6 h post arrest was associated with favorable neurocognitive outcome (OR 1.59, 95% CI 0.99–2.55 per liter; p = 0.03) and survival (OR 1.44, 95% CI 1.02–2.04; p = 0.02) among patients with normal LVEF but not low LVEF.

Conclusions

In post-resuscitation shock, higher LVEF—indicating distributive shock physiology—was associated with less favorable neurocognitive outcome, fewer days without organ failure, and higher mortality. Greater early volume resuscitation was associated with more favorable neurocognitive outcome and survival in patients with this shock subtype. Additional studies with repeated measures of complementary hemodynamic parameters are warranted to validate the clinical utility for subtyping post-resuscitation shock.

Electronic supplementary material

The online version of this article (10.1186/s13054-018-2078-x) contains supplementary material, which is available to authorized users.

Spectrum of hemostatic disorders in Indian females presenting with bleeding manifestations

INTRODUCTION

Hemostatic disorders are often missed in women with bleeding particularly menorrhagia. Preexisting hemostatic disorders are now known as common risk factor for postpartum hemorrhage and prolonged bleeding in puerperium. Females with bleeding complaints constitute an important population referred to hematology clinic. Hence, we aim to evaluate the type and frequency of hemostatic disorders among females presenting with bleeding in a tertiary care hospital and a basic hemostatic laboratory.

METHODS

Three-year data were retrospectively analyzed for 200 females with various bleeding complaints. Due to resource constraints, a hemostatic workup was done with prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen assay, clot solubility test, mixing studies, specific factor assays, platelet function test, and von Willebrand factor antigen level.

RESULTS

A total of 200 females were investigated to identify the cause of their bleeding. Thirty-five of 200 (17.5%) females were found with an underlying bleeding disorder. Of these 35 females, 65.7% presented with bleeding from more than 1 site. Most common bleeding manifestation was spontaneous bruising in 18 of 35 (51.4%) patients followed by petechiae (48.6%). Inherited bleeding disorders were noted in majority. The most common inherited bleeding disorder identified was von Willebrand disease (VWD) in 34.3% females. Second most common disorder was Glanzmann's thrombasthenia accounting for 22.8%. Rare coagulation factor deficiency, such as factors VII, X, and XIII deficiencies, was noted. Three cases revealed acquired causes of coagulation defects.

CONCLUSION

Underlying hemostatic defects should be searched for in women with unexplained bleeding complaints. This will not only help in diagnosis but also in proper management for future hemostatic challenges.

Surface analysis of gutta percha after disinfecting with sodium hypochlorite and silver nanoparticles by atomic force microscopy: An in vitro study

BACKGROUND

Sodium hypochlorite (5.25% NaOCl) and silver nanoparticles (70 ug/ml AgNPs) have a broad spectrum of antimicrobial efficacy for disinfecting gutta percha (GP) point, so this study was conducted to analyze the assay surface topography of GP when disinfected with AgNPs and 5.25% of NaOCl using atomic force microscopy (AFM).

MATERIALS AND METHODS

In this in vitro study a total of thirty cones were taken. The samples were divided into three treatment groups: Group I and II with 70 μg/ml AgNPs and 5.25% NaOCl. The time duration was 1 min. Untreated GP points served as control group. After treatment of 1 min for each solution, the samples were positioned in the AFM. For comparison, the root mean square (RMS) was used to investigate the structure of the GP points. Unpaired t-test and ANOVA test were used. The differences among the groups were tested by Tukey's honestly significant difference test and were considered significant when P < 0.05.

RESULTS

5.25% NaOCl created RMS value of 202.48 nm at 1 min as compared to 70 μg/ml of AgNPs and control which produced RMS value of 44.48 nm and 24.1 nm, respectively (<0.0001).

CONCLUSION

The study showed irregularity in the surface of GP with NaOCl and lesser deterioration with AgNPs which could affect the postoperative prognosis. In this study, it was found that NaOCl causes 10 times more surface topography deterioration of GP when compared to AgNPs at 700 times lesser concentration.

Ethylenediamine mediated luminescence enhancement of pollutant derivatized carbon quantum dots for intracellular trinitrotoluene detection: soot to shine

Vehicle-generated toxic pollutants are composed of gaseous smoke and particulate byproducts accumulated as a black substance at its exhaust. This particulate matter (soot) is utilized for the green synthesis of highly stable, non-toxic, environment friendly, carbon quantum dots (CQD). The CQDs are synthesized via the simple hydrothermal route in the absence (C1) and presence (C2) of oxidants. The as-synthesized CQDs are amine functionalized using ethylenediamine. The amine functionalized CQDs (C1N and C2N) are explored for trinitrotoluene detection. From transmission electron microscopy, the average size of C1 and C2 was found to be about 4.2 nm and 5.6 nm respectively. The incorporation of amine groups lead to an increase in quantum yields from 5.63% to 12.7% for C1 and from 3.25% to 8.48% for C2 QDs. A limit of detection (LOD) of 13 ppb was displayed by C1N while the LODs of 11 ppb and 4.97 ppb were delivered by C2N at λ_ex 370 nm and λ_ex 420 nm respectively. The Stern–Volmer constant for C1N is 2.02 × 10⁶ M⁻¹ while for C2N at λ_ex 370 nm and λ_ex 420 nm is 0.38 × 10⁶ M⁻¹ and 0.48 × 10⁶ M⁻¹ respectively. Furthermore, C1N presents high selectivity for TNT compared to C2N. Owing to their higher luminescence, C1N particles are successfully demonstrated for their applicability in intracellular TNT detection.

Vehicle-generated toxic pollutants are composed of gaseous smoke and particulate byproducts accumulated as a black substance at its exhaust.

Favorable Neurocognitive Outcome with Low Tidal Volume Ventilation after Cardiac Arrest

RATIONALE

Neurocognitive outcome after out-of-hospital cardiac arrest (OHCA) is often poor, even when initial resuscitation succeeds. Lower tidal volumes (Vts) attenuate extrapulmonary organ injury in other disease states and are neuroprotective in preclinical models of critical illness.

OBJECTIVE

To evaluate the association between Vt and neurocognitive outcome after OHCA.

METHODS

We performed a propensity-adjusted analysis of a two-center retrospective cohort of patients experiencing OHCA who received mechanical ventilation for at least the first 48 hours of hospitalization. Vt was calculated as the time-weighted average over the first 48 hours, in milliliters per kilogram of predicted body weight (PBW). The primary endpoint was favorable neurocognitive outcome (cerebral performance category of 1 or 2) at discharge.

MEASUREMENTS AND MAIN RESULTS

Of 256 included patients, 38% received time-weighted average Vt greater than 8 ml/kg PBW during the first 48 hours. Lower Vt was independently associated with favorable neurocognitive outcome in propensity-adjusted analysis (odds ratio, 1.61; 95% confidence interval [CI], 1.13-2.28 per 1-ml/kg PBW decrease in Vt; P = 0.008). This finding was robust to several sensitivity analyses. Lower Vt also was associated with more ventilator-free days (β = 1.78; 95% CI, 0.39-3.16 per 1-ml/kg PBW decrease; P = 0.012) and shock-free days (β = 1.31; 95% CI, 0.10-2.51; P = 0.034). Vt was not associated with hypercapnia (P = 1.00). Although the propensity score incorporated several biologically relevant covariates, only height, weight, and admitting hospital were independent predictors of Vt less than or equal to 8 ml/kg PBW.

CONCLUSIONS

Lower Vt after OHCA is independently associated with favorable neurocognitive outcome, more ventilator-free days, and more shock-free days. These findings suggest a role for low-Vt ventilation after cardiac arrest.

Higher rate of central nervous system involvement by flow cytometry than morphology in acute lymphoblastic leukemia

INTRODUCTION

Central nervous system (CNS) involvement in acute lymphoblastic leukemia (ALL) is diagnosed traditionally by cytopathology (CP) of the cerebrospinal fluid (CSF). Role of flow cytometry (FC) to diagnose CNS involvement has not been extensively investigated.

METHODS

We aimed to detect CNS involvement in 42 ALL patients (33 B-ALL, nine T-ALL) at diagnosis by FC and comparing it with CP and to correlate it with known risk factors for CNS disease like Lactate dehydrogenase (LDH). A receiver operating characteristic curve was used to determine the cutoff of LDH to predict CSF involvement. For the analysis of categorical/quantitative variables, Fisher's exact test was used. For the analysis of continuous variables, Mann-Whitney test was used. A P value of <.05 was taken as significant.

RESULTS

CP and FC were positive in five (11.9%) and 11 patients (26.14%) respectively with FC detecting a significantly higher level of involvement (P=.001). All CP-positive cases were FC positive. A LDH value of >472 U/L had a sensitivity of 61% and specificity of 62.5% for diagnosis of CSF involvement by FC.

CONCLUSIONS

CSF FC detects CNS disease in ALL patients at diagnosis at a rate double than CP alone and is statistically associated with an elevated LDH level. It should be incorporated in the evaluation of CSF to detect CNS involvement.

In-hospital cardiac arrest among patients with malignancy

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Background: Malignancy is generally considered a poor prognosticator for in-hospital cardiopulmonary arrest. Recent studies have shown that overall survival in those with localized disease and fewer than two comorbidities approximates the general population, likely reflective of advances in cancer treatment and more selective use of cardiopulmonary resuscitation. The present study was conducted to evaluate whether malignancy is an independent risk factor for death before discharge following in-hospital cardiopulmonary arrest. Methods: This single-center retrospective study included consecutive in-hospital cardiac arrests for whom cardiopulmonary resuscitation was attempted between 2011-2015. Patients were identified from an inpatient cardiac arrest registry and excluded if the arrest occurred in the operating room or emergency department prior to admission. Data related to each patient’s oncologic history was obtained via manual chart review by physician investigators. The primary outcome was survival to discharge among patients according to malignancy status. Results: Over the five-year study, 532 patients experienced in-hospital arrest and met inclusion criteria. Fifteen percent (n = 81) had a known cancer diagnosis at the time of arrest; 9% of arrests (n = 46) had a cancer that was considered active (not in remission). One-fourth of all cancer diagnoses at time of arrest were hematologic malignancies. Overall post-arrest survival to discharge was 34%. Survival did not differ significantly for patients with versus without current or prior malignancy (OR 0.69, 95% CI 0.41-1.18; p = 0.17), nor with active malignancy at time of arrest (OR 0.52; 95% CI 0.25-1.07; p = 0.08). The subgroup of patients with hematologic malignancy had significantly lower survival (OR 0.21, 95% CI 0.05-0.91; p = 0.04). Conclusions: Malignancy was not associated with decreased survival to hospital discharge among patients experiencing in-hospital arrest for whom resuscitation was attempted.

Interaction between dyslipidaemia, oxidative stress and inflammatory response in patients with angiographically proven coronary artery disease

INTRODUCTION

Coronary artery disease (CAD) is emerging as the biggest killer of the 21st century. A number of theories have been postulated to explain the aetiology of atherosclerosis. The present study attempts to elucidate the interaction, if any, between inflammation, oxidative stress and dyslipidaemia in CAD.

METHODS

A total of 753 patients undergoing angiography were evaluated and 476 were included in the study. The parameters studied included complete lipid profile, and apolipoprotein B, ferritin and nitric oxide (NO) levels. Statistical analysis was carried out to determine the interrelationship between these parameters and the best predictor of CAD risk. Cut-off points were determined from the receiver operating characteristics curves, and the specificity, sensitivity, positive predictive value, negative predictive value, odds ratio and confidence intervals were calculated.

RESULTS

The levels of the parameters studied increased with the stenotic state and a positive correlation was observed between ferritin, NO and apolipoprotein B. NO emerged as the most reliable predictor of CAD, with an area under the curve of 0.992 and sensitivity and specificity of 97 and 98%, respectively.

CONCLUSION

Environmental and genetic risk factors for CAD interact in a highly complex manner to initiate the atherosclerotic process. These risk factors should be considered mutually inclusive, not exclusive when devising pharmacological interventions, as multi-factorial risk management is the cornerstone of CAD management.

Bovine Circadian Locomotor Output Cycles Kaput (CLOCK) and Clusterin (CLU) mRNA Quantitation in Ejaculated Crossbred Bull Spermatozoa

Mammalian circadian locomotor output cycles kaput (CLOCK) gene encodes a transcription factor that affects both the persistence and the period of circadian rhythms. Earlier reports suggested that CLOCK gene might be associated with male infertility in human. Present investigation, for the first time, reports that CLOCK gene expresses differentially between good and poor quality crossbred bull semen. The relative expression of CLOCK was significantly (p < 0.05) higher among good quality bull semen than motility-impaired ones. Clusterins (CLU) are series of genes associated with a variety of physiological activities including spermatogenesis, apoptosis and degenerative disease conditions. In the present context, we also investigated that the expression of CLU gene was significantly (p < 0.05) higher among motility-impaired crossbred bull semen compared to the good quality one.