LAPAROSCOPIC APPROACH TO A GIANT RUPTURED SPLENIC CYST: A CHALLENGING CASE REPORT

Splenic cysts are rare; their absence of an epithelial wall determines whether they're real cysts or pseudocysts. Spontaneous nonparasitic actual tumors are those that develop early in life at the anterior pole of the splenic and are typically epidermoid, dermoid, or endodermal. Surgical therapy is suggested for symptomatic, large (more than 5 cm) cysts or complicated. Inhaling splenic excision is a substitute for surgery, depending on the quantity, location, connection to the hilus, and dimension of the tumors. With an emphasis on less invasive treatments that preserve the spleen, laparoscopic methods have already established themselves as the accepted method for treating numerous disorders, including splenic cysts. They describe the effective decapsulation of a massive epidermoid spleen tumor under a prolonged, partially endoscopic technique. Laparoscopy, an operation commonly referred to as surgery with minimally invasive or keyhole surgery, is a technique that makes many tiny incisions in the belly to carry out different surgical procedures.

THE GUT-BRAIN AXIS: IMPLICATIONS FOR NEUROLOGICAL DISORDERS, MENTAL HEALTH, AND IMMUNE FUNCTION

A gut-brain axis (GBA) has a long history of conceptual development. Intestinal dysbiosis has now been recognized as a key player in the development of adult neurodevelopmental disorders, obesity, and inflammatory bowel disease. Recent developments in metagenomics suggest those nutrition and gut microbiotas (GM) are important regulators of the gut-brain communication pathways that cause neurodevelopmental and psychiatric problems in adulthood. Intestinal dysbiosis and neurodevelopmental disease outcomes in preterm newborns are being linked by recent research. Recent clinical investigations demonstrate that in critical care units, intestinal dysbiosis occurs before late-onset newborn sepsis and necrotizing enterocolitis. Strong epidemiologic data also shows a connection between necrotizing enterocolitis and extremely low birth weight babies' long-term psychomotor impairments and late-onset neonatal sepsis. The GBA theory suggests that intestinal bacteria may indirectly affect preterm newborns' developing brains. In this review, we emphasize the structure and function of the GBA and discuss how immune-microbial dysfunction in the gut affects the transmission of stress signals to the brain. Preterm babies who are exposed to these signals develop neurologic disorders. Understanding neuronal and humoral communication through the GBA may provide insight into therapeutic and nutritional strategies that may enhance the results of very low-birth-weight babies.

Experimental and Theoretical Exploration of ESIPT in a Systematically Constructed Series of Benzimidazole Based Schiff Base Probes: Application as Chemosensors

Herein, we have utilized 2-(2-hydroxyphenyl)benzimidazole (HBI) to synthesize 3-(1H-benzoimidazol-2-yl)-2-hydroxy-5-methyl-benzaldehyde (HBIA) followed by three Schiff bases by using -ortho (H₂ BIo), -meta (H₃ BIdm) and -para (H₂ BIp) substituted amino benzoic acids and studied their photophysical properties. We have successfully derived molecular structures of HBI, HBIA and H₃ BIdm which reveals that in HBI and HBIA, the phenolic -OH is intramolecularly hydrogen bonded with sp² N of benzimidazole group whereas in H₃ BIdm, it is hydrogen bonded with imine C=N of Schiff base moiety, which is responsible for different solid state emission properties of the reported compounds. Extensive experimental and theoretical studies show that for all three Schiff bases, in solution due to activation of C=N isomerization, ESIPT operates through benzimidazole site and displays different emission from the solid state. Furthermore, H₂ BIo, H₃ BIdm and H₂ BIp selectively sense Cu²⁺ in semi aqueous medium with nano-molar detection limit and in HuH-7 cells through the inhibition of ESIPT of process.

Turn on Fluorescence Sensing of Zn2+ Based on Fused Isoindole-Imidazole Scaffold

Optical chemosensors caused a revolution in the field of sensing due to their high specificity, sensitivity, and fast detection features. Imidazole derivatives have offered promising features in the literature as they bear suitable donor/acceptor groups for the selective analytes in the skeleton. In this work, an isoindole-imidazole containing a Schiff base chemosensor (1-{3-[(2-Diethylamino-ethylimino)-methyl]-2-hydroxy-5-methyl-phenyl}-2H-imidazo[5,1-a]isoindole-3,5-dione) was designed and synthesized. The complete sensing phenomena have been investigated by means of UV-Vis, fluorescence, lifetime measurement, FT-IR, NMR and ESI-MS spectroscopic techniques. The optical properties of the synthesized ligand were investigated in 3:7 HEPES buffer:DMSO medium and found to be highly selective and sensitive toward Zn²⁺ ion through a fluorescence turn-on response with detection limit of 0.073 μm. Furthermore, this response is effective in gel form also. The competition studies reveal that the response of the probe for Zn²⁺ ion is unaffected by other relevant metal ions. The stoichiometric binding study was performed utilizing Job’s method which indicated a 1:1 sensor–Zn²⁺ ensemble. Computational calculations were performed to pinpoint the mechanism of sensing.

Benzimidazole–acid hydrazide Schiff–Mannich combo ligands enable nano–molar detection of Zn2+ via fluorescence turn–on mode from semi–aqueous medium, HuH–7 cells, and plants

Herein, we have synthesized two unsymmetrical and dipodal Schiff–Mannich combo ligands, benzoic acid (3–benzoimidazol–1–ylmethyl–2–hydroxy–5–methyl–benzylidene)–hydrazide (H2BBH) and the hydroxyl analogue, 2–hydroxy–benzoic acid (3–benzoimidazol–1–ylmethyl–2–hydroxy–5–methyl–benzylidene)–hydrazide (H3BSH) for selective detection of Zn2+ in semi–aqueous...

Strategic Substitution of -OH/-NR2 (R=Et, Me) Imparts Colorimetric Switching between F- and Hg2+ by Salicyaldehyde/Benzaldehyde-Quinoxaline Conjugates

We herein report two salicyaldehyde-quinoxaline (HQS and HQSN) conjugates and a benzaldehyde-quinoxaline (QBN) conjugate to fabricate selective chemosensors for F^- and Hg²⁺ in the micromolar range. This work demonstrates how sensing outcomes are affected by modulating proton acidity by introducing an electron donating group, -NEt₂ , in the probe backbone. Interestingly, the un-substituted probe HQS can selectively detect F^- , whereas HQSN and QBN are selective for Hg²⁺ . In order to gain insights into the mechanism of sensing, geometry optimizations have been carried out on QS^(-1) , QS^(-1) ⋅⋅⋅HF, QSN^(-1) and QSN^(-1) ⋅⋅⋅HF and the experimental data are validated in terms of free energy and pK_a values. Detailed DFT and TD-DFT analyses provide ample support towards the mechanism of sensing of the analytes.

A requirement for flow to enable the development of Ureaplasma parvum biofilms in vitro

AIMS

To use a flow-based method to establish, quantify and visualize biofilms of Ureaplasma parvum.

METHODS AND RESULTS

Absorbance readings of a U. parvum HPA5 culture were taken at 550 nm every 3 h for 30 h in order to establish a growth curve, with viability determined by the number of colour changing units (CCUs). Biofilms were established using the DTU flow-cell with a flow rate of 0·01 ml min^-1 and compared to the static control. Titres of bacteria were determined by CCU and biofilm biomass was quantified by Syto9 staining and COMSTAT analysis. High-resolution images were obtained by scanning electron microscopy (SEM). Flow resulted in significantly more biofilm and higher cell titre (0·599 µm³ /µm²  ± 0·152 and 4 × 10⁸  CCU per ml, respectively) compared with static conditions (0·008 µm³ /µm²  ± 0·010 and no recoverable cells, respectively). SEM revealed pleomorphic cells, with signs of budding and possible membrane vesicle formation.

CONCLUSIONS

Flow is an essential requirement for the establishment of U. parvum biofilms.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first quantification of biofilm biomass formed by U. parvum. It is now possible to establish viable biofilms of U. parvum which will allow for future testing of antimicrobial agents and understanding of virulence-associated with adhesion.

International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher.

CONCLUSIONS

Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.

Community-based active case-finding to reach the most vulnerable: tuberculosis in tribal areas of India

<sec> <title>BACKGROUND</title> India has the world's largest indigenous/tribal population. Many areas with large tribal populations suffer from weak infrastructure and services. Surveys have shown a high prevalence of TB among Saharia communities, who rarely access public services. We evaluated a community-based active TB case-finding intervention. </sec> <sec> <title>METHODS</title> Community health workers screened people for TB symptoms in Saharia communities, made referrals, collected sputum for transport to laboratories, and initiated and supported anti-tuberculosis treatment. Microscopy testing was performed at government laboratories. The intervention tracked the people screened, referrals, the people tested, laboratory results, treatment initiation and outcomes. </sec> <sec> <title>RESULTS</title> Community health workers verbally screened 65 230 people, 8723 (13%) of whom had symptoms. Of these, 5600 were tested, 964 (17%) of whom were smear-positive. During the intervention, we observed a +52% increase in people tested at laboratories and an +84% increase in TB case notifications. Pre-treatment loss to follow-up decreased and treatment success increased slightly. </sec> <sec> <title>CONCLUSIONS</title> In India, particularly among tribal populations, many people with TB are missed by current approaches due to poor access. Community-based active case-finding can help identify more people with TB in tribal and remote rural areas by addressing barriers to health seeking as well as help reach ambitious country and global notification targets. </sec>.

Utilization of unsaponifiable matter from rice bran oil fatty acid distillate for preparing an antioxidant-rich oleogel and evaluation of its properties

Rice bran oil fatty acid distillate (RBOFAD) is an important by-product obtained from the physical refining process. This fatty acid distillate contains high a amount of Unsaponifiable Matter (γ-oryzanol 3.27 gm/100gm UM; total tocopherol 10.93 mg/100 g UM; total phytosterol 21.81 g/100g UM; squalene 1.15 g/100 g UM and total fatty alcohol 73.34 g/100 g UM) and free fatty acids. Antioxidant-rich Oleogels were obtained from rice bran wax (RBW), rice bran oil fatty acid distillate (RBOFAD) and refined rice bran oil. The main objective of this study was to utilize the antioxidant-rich unsaponifiable matter of RBOFAD (UMRBOFAD) as an organogelator along with rice bran wax, which also acts as a good organogelator. Antioxidant-rich oleogel was prepared using UMRBFAD, ethylcellulose (EC) and RBW at 2%, 2%, 3% on weight basis, respectively, in refined rice bran oil and this antioxidant-rich oleogel was compared with rice bran oil oleogel using RBW at 7% on weight basis of rice bran oil. These oleogels were evaluated using a combination of techniques such as differential scanning calorimetry (DSC), polarized light microscopy (PLM), Viscosity, synchrotron radiation X-ray diffraction (SR-XRD) and FTIR Spectroscopy. The differential scanning calorimetry (DSC) measured the thermal properties of rice bran oil oleogel and high antioxidant-rich oleogel. Polarized light microscopy images revealed needle-like crystals for RBW. SR-XRD measurements were used for clarification of the crystal structures of the building blocks of these oleogels. The antioxidant activities of oleogels were evaluated involving DPPH and ABTS assays.

Impact of thermal stress on expression dynamics of HSP60 in cardiac fibroblast cells of goat

The present study was aimed to determine the impact of thermal stress on expression dynamics of heat shock protein 60 (HSP60) mRNA in cultured cardiac fibroblast cells of the goat. The heart tissues (n = 6) from different goats were used for the culture study. The cardiac fibroblast cells were cultured and subjected to thermal stress at 42 °C for 0, 20, 60 and 100 min. The relative abundance of HSP60 mRNA was assessed by quantitative real-time PCR (qRT-PCR). The cardiac cells exposed to thermal stress at 42 °C for 0 min was taken as control. The relative abundance of HSP60 mRNA did not change at 20 min of thermal stress as compared to control. Thereafter, the relative abundance of HSP60 mRNA was significantly up-regulated (p < 0.05) at 60 min and 100 min of thermal stress. However, the highest mRNA expression of HSP60 was noticed at 100 min of thermal stress. The present study indicates that, thermal stress modulates the mRNA expression HSP60 in cultured caprine cardiac fibroblast cells.

Recurrent Encephalopathy with Transverse Myelitis: An Uncommon Presentation of Neurobrucellosis

Brucellosis (malta fever) is a zoonotic infection caused by a gram-negative coccobacillus which is a facultative intracellular pathogen. It causes a chronic granulomatous infection, similar in histology to tuberculosis. Brucellosis remains a diagnostic dilemma due to misleading, nonspecific manifestations and increasing trend of unusual presentations. In brucellosis, the nervous system involvement occurs in only 5 to 7% of untreated patients, and it may manifest with encephalitis, meningoencephalitis, radiculitis, and peripheral and cranial neuropathies. Transverse myelitis is an unusual occurrence. Here, the authors are reporting an unusual case of neurobrucellosis in an elderly male patient who visited multiple hospitals with recurring febrile encephalopathy and paraparesis. The diagnosis was suspected by his occupational history of working as an abattoir worker and was confirmed by the presence of high titers of Brucella immunoglobulin (Ig) M and IgG antibodies in the serum. The patient was managed with injection gentamicin for 2 weeks along with oral course of doxycycline and rifampicin for 6 weeks. He made a good clinical recovery and went back to work with mild residual deficits.

Variations in antibiotic use across India: multi-centre study through Global Point Prevalence survey

The aim of the study was to assess antimicrobial prescribing patterns, and variation in practice, in India. A point prevalence survey (PPS) was conducted in October to December 2017 in 16 tertiary care hospitals across India. The survey included all inpatients receiving an antimicrobial on the day of PPS and collected data were analysed using a web-based application of the University of Antwerp. In all, 1750 patients were surveyed, of whom 1005 were receiving a total of 1578 antimicrobials. Among the antimicrobials prescribed, 26.87% were for community-acquired infections; 19.20% for hospital-acquired infections; 17.24% for medical prophylaxis; 28.70% for surgical prophylaxis; and 7.99% for other or undetermined reasons. Antibiotic prescribing quality indicators, such as reason in notes and post-prescription review score, were low. This PPS showed widespread antibiotic usage, underlining the need for antibiotic stewardship to promote evidence-based practice.

What will it take to eliminate drug-resistant tuberculosis?

Drug-resistant tuberculosis (DR-TB) is challenging to diagnose, treat, and prevent, but this situation is slowly changing. If the world is to drastically reduce the incidence of DR-TB, we must stop creating new DR-TB as an essential first step. The DR-TB epidemic that is ongoing should also be directly addressed. First-line drug resistance must be rapidly detected using universal molecular testing for resistance to at least rifampin and, preferably, other key drugs at initial TB diagnosis. DR-TB treatment outcomes must also improve dramatically. Effective use of currently available, new, and repurposed drugs, combined with patient-centered treatment that aids adherence and reduces catastrophic costs, are essential. Innovations within sight, such as short, highly effective, broadly indicated regimens, paired with point-of-care drug susceptibility testing, could accelerate progress in treatment outcomes. Preventing or containing resistance to second-line and novel drugs is also critical and will require high-quality systems for diagnosis, regimen selection, and treatment monitoring. Finally, earlier detection and/or prevention of DR-TB is necessary, with particular attention to airborne infection control, case finding, and preventive therapy for contacts of patients with DR-TB. Implementing these strategies can overcome the barrier that DR-TB represents for global TB elimination efforts, and could ultimately make global elimination of DR-TB (fewer than one annual case per million population worldwide) attainable. There is a strong cost-effectiveness case to support pursuing DR-TB elimination; however, achieving this goal will require substantial global investment plus political and societal commitment at national and local levels.

A quinoxaline-diaminomaleonitrile conjugate system for colorimetric detection of Cu2+ in 100% aqueous medium: observation of aldehyde to acid transformation

In this work, we have strategically incorporated a quinoxaline derivative and a diaminomaleonitrile moiety to construct a chemosensor, 2-amino-3-[(quinoxalin-2-ylmethylene)-amino]-but-2-enedinitrile (H2qm). The notable feature of this strategy is to generate a highly conjugated Schiff base platform with interesting binding properties. Remarkably, H2qm exhibited a visual sensing ability towards Cu2+ in 100% aqueous medium. The effectiveness of the chemosensor has been demonstrated by utilizing it to determine the Cu2+ concentration in real samples. Interestingly, the reaction between H2qm and Cu(ClO4)2·6H2O in DMSO yielded a quinoxaline-2-carboxylic acid based compound and single crystal X-ray diffraction analysis unveiled the resulting structure as [(qa)2Cu(H2O)2] (Hqa = quinoxaline-2-carboxylic acid).

Visual detection of fluoride ion based on ICT mechanism

A novel chemosensor (H₃NTS) has been designed for a fast and accurate detection of F^- in acetonitrile medium. The UV-Vis, ¹H, ¹³C NMR experiments and computational calculations demonstrate that H₃NTS probe offers a potential colorimetric sensor for discriminating F^- among other relevant anions. The detection limit is as low as 6 μM and a reversible colorimetric switch could be devised by sequential addition of F^-/Ca²⁺. The promising application of H₃NTS is also confirmed in real examples where the concentration of F^- is a critical parameter, e.g., commercial toothpaste, paper strip and gel form analysis of samples.

Operation and performance of the ATLAS Tile Calorimeter in Run 1

The Tile Calorimeter is the hadron calorimeter covering the central region of the ATLAS experiment at the Large Hadron Collider. Approximately 10,000 photomultipliers collect light from scintillating tiles acting as the active material sandwiched between slabs of steel absorber. This paper gives an overview of the calorimeter's performance during the years 2008-2012 using cosmic-ray muon events and proton-proton collision data at centre-of-mass energies of 7 and 8 TeV with a total integrated luminosity of nearly 30 fb - 1 . The signal reconstruction methods, calibration systems as well as the detector operation status are presented. The energy and time calibration methods performed excellently, resulting in good stability of the calorimeter response under varying conditions during the LHC Run 1. Finally, the Tile Calorimeter response to isolated muons and hadrons as well as to jets from proton-proton collisions is presented. The results demonstrate excellent performance in accord with specifications mentioned in the Technical Design Report.

Isolation of the unsaponifiable matter (squalene, phytosterols, tocopherols, γ-oryzanol and fatty alcohols) from a fatty acid distillate of rice bran oil

Rice bran oil is characterized by its unique composition of unsaponifiable matter such as oryzanol, squalene, sterols, tocopherols and fatty alcohols. Rice bran oil fatty acid distillate (RBOFAD) is an important by-product of physical refining plants. In the present study, an appropriate fractionation methodology is proposed for isolating the unsaponifiable matter into two fractions, squalene, phytosterols and fatty alcohols as fraction 1; tocopherols and γ- oryzanol as fraction 2. The two fractions together constitute the total unsaponifiable matter in the RBOFAD. The individual unsaponifiable matter components (γ-oryzanol 1.78g/100g, squalene 209.63 mg/100g, tocopherol 2.45mg/100g, total phytosterols 3.79g/100g and fatty alcohols 94.23g/100g) were isolated from RBOFAD by combining a chemical esterification process and liquid-liquid extraction process with 95% ethanol which extracted tocopherol, γ-oryzanol, sterols, squalene, FFA, monoglycerides; later with hexane extraction of the alkaline phase to remove squalene, sterols and fatty alcohols. The alkaline salts of tocopherols and γ-oryzanol are decomposed by the acidification and extraction of the unsaponifiable matter with n-hexane.

Itch in dermatomyositis: the role of increased skin interleukin-31

BACKGROUND

Interleukin (IL)-31 is implicated in pruritus associated with pruritic skin diseases like atopic dermatitis. Although pruritus is a prominent feature in dermatomyositis (DM), few studies have evaluated the pathogenesis of DM-associated itch.

OBJECTIVES

To establish the prevalence of itch in DM, and to investigate the role of IL-31 in DM-related itch.

METHODS

Pruritus and disease activity of DM were evaluated by a visual analogue scale (VAS) and the Cutaneous Disease and Activity Severity Index (CDASI), respectively. Expression of IL-31 and IL-31 receptor alpha (IL-31RA) in lesional DM, nonlesional DM and healthy control skin was evaluated by quantitative reverse-transcriptase polymerase chain reaction and immunofluorescence. Flow cytometry was performed on skin cells isolated from lesional DM skin to identify cellular sources of IL-31 in DM.

RESULTS

Among 191 patients with DM, 50·8% had moderate-to-severe itch, and itch was correlated with increased cutaneous severity (r = 0·34). In patients with itchy DM, gene expression of IL31 and IL31RA in lesional skin was upregulated compared with nonlesional skin and healthy control skin. IL31 mRNA expression positively correlated with VAS itch score (r = 0·67). On immunofluorescence, immunoreactivity for IL-31 and IL-31RA was stronger in lesional skin. Flow cytometry showed that lesional DM skin contained significantly more IL-31-producing cells, and CD4⁺ cells were the most common cell type. Lenabasum, an emerging treatment for DM, significantly downregulated IL-31 from CpG-stimulated peripheral blood mononuclear cells.

CONCLUSIONS

Increased skin IL-31 may play a role in DM-associated itch, and ongoing trials will evaluate the effects of systemic treatment on IL-31 and itch in DM.

A versatile quinoxaline derivative serves as a colorimetric sensor for strongly acidic pH

A strongly acidic colorimetric pH sensor induced by the acidity of [Fe(H₂O)₆]³⁺, and single crystal to single crystal transformation between the protonated and deprotonated form.

Bio-inspired CO2 reduction by a rhenium tricarbonyl bipyridine-based catalyst appended to amino acids and peptidic platforms: incorporating proton relays and hydrogen-bonding functional groups

Herein, we report a new approach to bio-inspired catalyst design. The molecular catalyst employed in these studies is based on the robust and selective Re(bpy)(CO)3Cl-type (bpy = 2,2'-bipyridine) homogeneous catalysts, which have been extensively studied for their ability to reduce CO2 electrochemically or photochemically in the presence of a photosensitizer. These catalysts can be highly active photocatalysts in their own right. In this work, the bipyridine ligand was modified with amino acids and synthetic peptides. These results build on earlier findings wherein the bipyridine ligand was functionalized with amide groups to promote dimer formation and CO2 reduction by an alternate bimolecular mechanism at lower overpotential (ca. 250 mV) than the more commonly observed unimolecular process. The bio-inspired catalysts were designed to allow for the incorporation of proton relays to support reduction of CO2 to CO and H2O. The coupling of amino acids tyrosine and phenylalanine led to the formation of two structurally similar Re catalyst/peptide catalysts for comparison of proton transport during catalysis. This article reports the synthesis and characterization of novel catalyst/peptide hybrids by molecular dynamics (MD simulations of structural dynamics), NMR studies of solution phase structures, and electrochemical studies to measure the activities of new bio-inspired catalysts in the reduction of CO2.

Under-utilization of pacemaker therapy for sinus node dysfunction - Real world data from South Asia

OBJECTIVE

Chronic symptomatic sinus node dysfunction (SND), the most common bradyarrhythmia, can be effectively managed by permanent cardiac pacing. Yet the care pathway and barriers to adoption of pacing therapy are not well understood - particularly in low volume implanting countries. The IMPROVE Brady study is a quality improvement initiative being conducted at centers in South Asia, Latin America, and Russia. We assessed the rates of SND diagnosis and pacemaker treatment for SND in the South Asia cohort.

METHODS

The prospective study enrolled patients with heart rate of  ≤50 beats per minute presenting with symptoms including syncope, dizziness, and/or dyspnea from ten centers in India and Bangladesh. Patients were followed to identify the proportion diagnosed with SND and subsequently treated with pacemaker therapy.

RESULTS

A total of 508 patients meeting criteria were enrolled and followed on average for 8.3±8.0months. Patients were on average 58 years of age, 77% were male, and 91% had completed at least primary education. An SND diagnosis was made in 368 (72%) of patients, with the majority (80%) of diagnoses occurring within 1 month of enrollment. Of the patients with an SND diagnosis, 63 (17%) were treated with a pacemaker. Reasons for not receiving treatment were: subject refusal or deferred decision (45%), unaffordability (34%), physician determined - not-indicated (20%), and other (1%). Older age, female gender, history of hypertension, lower resting heart rate, and syncopal or pre-syncopal symptoms were associated with a higher probability of implant.

CONCLUSIONS

In a care pathway assessment for the diagnosis and treatment of symptomatic SND in South Asia only 1 in 6 patients received pacemaker indicated therapy, largely due to patient refusal and physician decision. Phase II of the study will be aimed to improve this treatment rate.

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs.

CONCLUSIONS

Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically.

Efficacy of light based detection systems for early detection of oral cancer and oral potentially malignant disorders: Systematic review

Background

Earlier detection of oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD) is essential for dental professionals to improve patient survival rates. The aim of this systematic review is to to evaluate the effectiveness of devices that utilise the principles of chemiluminescence and tissue autofluorescence as adjuncts in the detection of OSCC and OPMD.

Material and Methods

The electronic retrieval systems and databases searched for relevant articles were PubMed [MEDLINE] and Science direct. The search was for limited articles published in English or with an English abstract and articles published during the period from January 2005 to April 2014. Clinical trials utilized ViziLite, Microlux TM/DL and Visual Enhanced Light scope (VELscope) for early detection of OPMD and OSCC.

Results

Twenty primary studies published satisfied our criteria for selection - 10 utilised chemiluminescence and 10 tissue autofluorescence. Senstivity of Vizilite for detecting OSCC nad OPMD ranged from 77.1 % to 100% and specificity was low that ranged from 0% to 27.8%.Most have shown that chemiluminescence increases the brightness and margins of oral mucosal white lesions and thus assist in identification of mucosal lesions not considered under Conventional visual examination. However, it preferentially detects leukoplakia and may fail to spot red patches. Clinical trials demonstrated that sensitivity of VELscope in detecting malignancy and OPMD ranged from 22 % to 100 % and specificity ranged from 16 % to 100%. Most studies concluded that VELscope can help the experienced clinician to find oral precursor malignant lesions. But it couldnot differentiate between dysplasia and benign inflammatory conditions.

Conclusions

Both devices are simple, non-invasive test of the oral mucosa but are suited for clinicians with sufficient experience and training. More clinical trials in future should be conducted to establish optical imaging as an efficacious adjunct tool in early diagnosis of OSCC and OPMD.

Key words:Oral cancer, early diagnosis, potentially malignant disorders, chemiluminescence, tissue autofluorescence, VELscope, ViziLite plus.

Effect of drinking water temperature on physiological variables of crossbred dairy cattle at high altitude temperate region of Himalayas

AIM

The objective of study was to investigate the effects of drinking water on certain physiological parameters such as heart rate (HR), respiration rate (RR), rectal temperature (RT) and, ruminal motility (RM).

MATERIALS AND METHODS

The experiment was carried out on 18 farm bred lactating crossbred cows. The animals selected for the study were divided into three groups of six animals each on the basis of milk yield and parity and were allotted to three treatment group of six each such as ambient drinking water temperature at 10.25±0.28°C (ambient water, T1), drinking water temperature at 15-20°C (T2) and drinking water temperature at 35-40°C (T3). All the managemental practices were kept similar during experiment except drinking water temperatures physiological variables such as HR, RR, RT, and RM of the individual cow was measured and recorded twice in a day at 800 h and again at 1400 h two consecutive days in a week 15 min after providing drinking water.

RESULT

HR and RR at morning and at evening recorded were within the normal physiological level for all the treatment groups. However, RT at morning was comparable in all the treatments whereas at evening it was significantly (p<0.01) higher for cows consuming in T2 and in T3 than cows consumed (T1). The RM during morning among the treatments were non-significant as compared to the rumen motility at evening was significantly higher for (T1) and (T2) than for cows in (T3).

CONCLUSION

It can be concluded that offering warm drinking water at 35-40°C to crossbred lactating dairy cow is beneficial during winter at high altitude temperate region.

Factors affecting survivability of local Rohilkhand goats under organized farm

AIM

To study the pattern of mortality as affected by age, season and various diseases in local goats of Rohilkhand region maintained at the Indian Veterinary Research Institute, Bareilly.

MATERIALS AND METHODS

Post-mortem records of 12 years (2000-01 to 2011-12) were used, and total 243 mortality data were collected and analyzed. The causes of mortality were classified into seven major classes viz. digestive disorders, respiratory disorders, cardiovascular disorders, musculoskeletal disorder, parasitic disorders, mixed disorders (combination of digestive, respiratory, parasitic, and cardiovascular disorders) and miscellaneous disorders (cold, hypoglycemia, emaciation, endometritis, traumatic injury, etc.).

RESULTS

The average mortality was 10.93%. The overall mortality was more during rainy season followed by winter and summer season. The mortality in 4-6 months of age was high (2.52%) followed by 0-1 month (2.34%) and 2-3 months (1.35%). The average mortality among adult age groups (>12 months) was 3.42%. The mortality showed declining trend with the advancement of age up to 3 months and then again increased in 4-6 months age group. The digestive diseases (3.51%) followed by respiratory diseases (1.89%) and parasitic diseases (1.48%) contributed major share to the total mortality occurred and the remaining disorders were of lesser significance in causing death in goats. There is significant (p<0.01; χ(2)=55.62) association between year with season and age with the season (p<0.05, χ(2)=16.083) found in the present study.

CONCLUSION

This study confirms that overall mortality rate averaged 10.93% (ranged between 1.10% and 25.56%) over 12 years under semi-intensive farm condition. It was generally higher in rainy season. The mortality remains higher in kids particularly under 1 month of age. The digestive diseases contributed major share to overall mortality.

Luffa echinata: healer plant or potential killer

Bristly luffa (Luffa echinata), a member of the cucurbitaceae family is an Ayurvedic medicinal plant, which has been used in the traditional system of medicine for variety of symptoms. The active constituents like cucurbitacin, saponin, echinatin, β-Sitosterol, oleanolic acid and flavonoids have important pathophysiological effects on human body. However, there is no earlier published report of any toxicity on humans. We report a case of a 50-year-old gentleman, who presented with gastrointestinal bleeding, deranged liver function and shock following consumption of dried fruits of Luffa echinata soaked overnight in water. He had antral gastritis and duodenal erosions on upper gastrointestinal endoscopy and was managed conservatively and recovered completely.