ABSTRACT
Introduction:Veno-arterial extracorporeal membrane oxygenation (ECMO) is well-recognized treatment modality for patients with refractory cardiogenic shock. Uncomplicated cannulation is a prerequisite and basis for achieving a successful outcome in ECMO. Vascular access is obtained either by surgical cut-down. Common vascular access complications are bleeding and limb ischemia. Objective: To evaluate cannulation technique, the incidence of vascular complications, and their impact on the outcome. Methods: A retrospective data analysis conducted on 95 patients receiving ECMO from 2013 to 2020 was done. The patients were divided into two groups: no vascular access complications (non-VAC group) and vascular access complications (VAC group). The groups were compared related to the hospital and ICU stays and blood transfusion. Results: The patients in both groups were demographically and clinically comparable. The Non-VAC group had 75 patients, whereas the VAC group had a total of 20 patients. The main complication observed in the VAC group was bleeding from the cannulation site which required more blood transfusion than the non-VAC group (6.8 ± 1.02 vs 4.2 ± 1.26). Limb ischemia was another complication seen in the VAC group (4.2%, n = 4). Two patients had delayed bleeding after decannulation. The overall average length of stay in the hospital was statistically similar in both the groups (22 days in the VAC group vs 18 days in the non-VAC group), but the average ICU stay was more in the VAC group compared to the non-VAC group (18 days vs 12.06 days). Conclusion: Bleeding and limb ischemia are the important vascular access site complications, which increase blood transfusion requirements, ICU stay, and overall hospital stay.
ABSTRACT
Purpose:The aim of this study is to analyze anticoagulation?related complications in patients following mechanical valve replacement and factors influencing the outcome. Materials and Methods: A total of 250 patients were analyzed during OPD follow?up for anticoagulation?related complications and various factors influencing outcome. Patients received prosthetic valve at mitral and/or aortic or both. Results: Out of 250 patients, 48% were male and 52% were female. The mean age was 41.9 ± 14.4. A total of 139 had mitral valve replacement (MVR), 70 had aortic valve replacement (AVR), 40 had double valve replacement (DVR), and 1 patient had triple valve replacement. Valves implanted were mechanical bileaflet valve. The mean international normalization ratio (INR) in the study was 2.4 ± 0.56. A total of 49 events occurred during follow?up, of which 4.5% per patient years were anticoagulation?related hemorrhagic events and 4.8% per patient years were thromboembolic events. Among thromboembolic events, valve thrombosis occurred in 10 patients and cerebrovascular accidents occurred in 11 patients. Mean INR for thromboembolic events was 1.46 ± 0.25 and anticoagulation?related hemorrhagic events was 4.4 ± 1.03. Mortality rate was 1.6% in AVR, 4% in MVR, and 0.4% in DVR? groups; about 34% of patients needed dose modification of Acenocoumarol and reason for derangement of INR was associated with infectious process and poor compliance; 85% of cases showed good compliance for daily anticoagulation therapy. Conclusion: Anticoagulation for mechanical valve replacement can be managed with INR range of 2.0 to 2.5 in MVR and 1.5 to 2.0 in AVR with acceptable hemorrhagic and thromboembolic events. We must educate and counsel the patients during follow?up for better compliance to optimal anticoagulation.
ABSTRACT
The T(EB4)Nta, T(IBj5)Nta, and T(B362i)NtA strains were constructed by introgressing the insertionaltranslocations EB4, IBj5, and B362i from Neurospora crassa into the related species N. tetrasperma. Theprogeny from crosses of T(IBj5)Nta and T(B362i)NtA with opposite mating-type derivatives of the standard N.tetrasperma strain 85 exhibited a unique and unprecedented transmission ratio distortion (TRD) that disfavoredhomokaryons produced following alternate segregation relative to those produced following adjacent-1 segregation. The TRD was not evident among the [mat A ? mat a] dikaryons produced following either segregation. Further, crosses of the T(IBj5)Nta and T(B362i)NtA strains with the Eight spore (E) mutant showed anunusual ascus phenotype called ‘max-4’. We propose that the TRD and the max-4 phenotype are manifestations of the same Bateson-Dobzhansky-Muller incompatibility (BDMI). Since the TRD selects against 2/3 ofthe homokaryotic progeny from each introgression cross, the BDMI would have enriched for the dikaryoticprogeny in the viable ascospores, and thus, paradoxically, facilitated the introgressions.
ABSTRACT
Background: Positive attitude towards menopause is believed to be associated with positive menopausal experience and vice versa. In order to improve women’s menopausal experience, thereby improving quality of life, it is important to understand their attitude towards menopause. The objectives of the research were to explore the attitude towards menopause and its relationship with various socio-demographic and life style factors among postmenopausal woman in the rural setting.Methods: This community-based cross sectional study was conducted using non probability sampling and house-to-house visit in randomly selected villages falling under rural health block Kot-Bhalwal, Jammu. 245 postmenopausal women were interviewed using modified attitude towards menopause checklist. The data so collected was analyzed using Open Epi version 3.1. For finding statistical significance, unpaired t-test and analysis of variance were used wherever needed. A p value of less than 0.05 was considered statistically significant.Results: The highest percentage of agreement with the positive item was for “a woman gets more confidence in herself after menopause” (77%). The lowest percentage of agreement with the positive item was for “going through menopause really does not change a woman in any important way,” (42.5%). There was a statistically significant mean difference between mean attitude score and religion, and no. of living children (F value=3.14, p value=0.002). No significant association was found between other sociodemographic variables and attitude towards menopause scores.Conclusions: There is a large scope of counseling and health education for improving and enhancing quality of life of postmenopausal women in rural setting of our country.
ABSTRACT
Background: Fired clay bricks, an important construction material, are manufactured in non-mechanized, labour intensive brick kilns which mostly employ unskilled men and women. The workers, as an occupational hazard, are exposed to dust and air pollution leading to respiratory diseases.Methods: This cross sectional study was conducted among brick kiln workers in RS Pura block of Jammu district. The workers were assessed regarding respiratory symptoms and illnesses using translated version of American Thoracic Society Division of Lung Disease questionnaire (ATS-DLD-78A).Results: 692 brick kiln workers were interviewed during the course of survey and 58.8%of them were males. 45% of the respondents were working since last less than three years. Among the respiratory symptoms chronic cough, was present in 23.55% and phlegm in 22.83% of the respondents. Chronic bronchitis was present in 20.52% of the respondents. Association of respiratory symptoms in relation to sex of the respondents was found to be statistically significant (p<0.05).Conclusions: Respiratory symptoms and illness were found to be quite prevalent in the brick kiln workers. More research needs to be conducted to assess other health risks besides respiratory morbidity. Health planners need to plan for their basic sanitation facilities and periodic check ups.
ABSTRACT
Background: The Robson’s Ten-Group Classification System allows critical analysis of caesarean deliveries according to characteristics of pregnancy. The objective was to analyze caesarean section rates in a rural tertiary care teaching hospital in Bangalore, using Robson’s ten groups classification.Methods: This study was done in MVJ Medical College and Research Hospital, a rural tertiary care teaching hospital. All patients who underwent caesarean delivery, between November 2017 and October 2018, were included in the study. Women were classified in 10 groups according to Robson’s classification. For each group, authors calculated its relative contribution to the overall caesarean rate.Results: The overall caesarean section rate was 46.7%. The main contributors to this high caesarean rate were primiparous women in spontaneous labour (group 1) and women with previous caesarean section (group 5). 52.1% of CS were conducted on women who were unbooked or booked at a peripheral health facility and referred to present institution due to complications in labor. Strategies to lower CS rates would include encouraging women with previous CS, to undergo trial of labor to reduce CS rates for group 5C. Sensitization of staff in peripheral medical facilities for early referral of high-risk pregnancies to a tertiary care center for better control of medical complications like hypertensive disorders of diabetes mellitus. Other strategies include offering external cephalic version to eligible women with breech presentation and consider offering vaginal breech delivery to suitable women in groups 6 and 7.Conclusions: The Robson’s classification is easy to use. It is time to implement obstetric audit to lower the overall CS rates.
ABSTRACT
Violence against women a social evil in the society despite a lot of talk of women empowerment. Assessmentof burden in terms of prevalence will go a long way in planning the services for those affected bydomestic violence. To find the prevalence of domestic violence and associated risk factors among marriedfemales in a rural area of Jammu. This community based cross-sectional study was conducted amongrural married females using a structured and pretested questionnaire. Data was analysed using simpleproportions, chi-square test and logistic regression. 171/301(56.6%) of the respondents reported someform of the domestic violence. Psychological, physical and sexual violence rates were found to be32.16%, 9.9% and 2.33% respectively. A statistically significant association was found with variables likeliteracy, type of family, family income, sex of children etc. Relatively high levels of domestic violence inthis rural setting calls for a multidisciplinary approach involving improvement of literacy levels amongfemales, creating awareness about legal aid and screening the victims at primary health centres to mitigatethis problem.
ABSTRACT
Introduction: Lateral internal sphincterotomy is an effective treatment for fissure in ano but carries a definite risk of incontinence. In trail to avoid this complication and to study the clinical outcomes such as the symptomatic relief, early postoperative wound healing, safety, and efficacy after segmental internal sphincterotomy, it was used to treat chronic anal fissure. Materials and Methods: This is hospital-based, cohort study was conducted at the NKP Salve Institute of Medical Sciences and Research Centre, Nagpur, Maharashtra, India. This study was undertaken on 62 patients (35 male and 27 female, with mean age 38 years) with chronic fissure in ano from March 2012 to March 2015. Surgical intervention, i.e., lateral internal segmental sphincterotomy done in two segments under direct vision under spinal anesthesia. Post-operative course with early and long-term result was recorded. Mean follow-up was 32 weeks (ranging from 2 to 48 weeks). Results and Discussion: In all patients, the technique was done under spinal anesthesia. The fissure and anal wound were healed within 4 weeks. The pain was reduced at postoperative day 1 in all patients. There were no early complications; one male patient had an infection at anal wound site at the 4th post-operative week which was managed conservatively. No transient or any persistent degree of incontinence occurred in these patients group. Conclusion: Segmental lateral internal sphincterotomy is a safe, easy, and effective procedure and not associated with risk of incontinence for the treatment of chronic anal fissure.
ABSTRACT
The current retrospective cross sectional study was undertaken using suspected ADR data collection form used under Pharmacovigiliance Programme of India (PvPI). A total of 2586 ADR events were recorded in 3years out of which 392(15.15%) were because of antimicrobials. males constituted 253 patients (64.54%) and females constituted 139 patients (35.45%) with male: female ratio as 1.8:1. Adults were more commonly affected followed by geriatric and pediatric population in both the groups. I.V route followed by oral route of drug administration accounted maximum ADR in similar way in both the genders. Monotherapy was responsible for 81.81% for males and 82.01% for females. Among combinations 78.26% in males and 64% in females were irrational as per latest WHO13th essential drug list. Majority of ADR, 88.14% and 92.80% were of moderate severity among males and females respectively. Maximum ADR were latent, type-A, probable in nature as per Naranjo and WHO-UMC scale. Inj.ceftriaxone followed by tab. azithromycin, tab.ofloxacin-ornidazole were the commonest antimicrobials responsible for ADRs in both the genders. The most common system involved was dermatological followed by GI in both males and females. On statistical comparison, no significant differences were observed among both the genders in any of the parameters except causality assessment scale (P<0.5). The current study suggests the ADRs due to antimicrobials are a significant health problem. No major gender related differences were observed in ADR profile of our study cohort.
ABSTRACT
Objectives: CLVs play an important role in prevention and treatment of diarrhoea. However, only a small proportion of the cases treated by these semi-literate CLVs are reported and fed into the Health Management Information Systems (HMIS). Micronutrient Initiative capacitated and equipped semiliterate female CLVs to report on childhood diarrhoea cases as part of the ‘Reducing deaths from diarrhoea’ in the Indian state of Bihar. Methods: Simple pictorial reporting tools that could be used by semiliterate CLVs were developed, pilot tested and provided to 42,258 CLVs. Hands-on training was undertaken for the CLVs and their capacities were continuously enhanced through an appropriate supportive supervision mechanism. Results: In 15 demonstration districts between 2011 to 2013, a total of 1,037,910 diarrhoea cases have been reported treated in the public sector of which 55% of the cases were treated by CLVs. Majority of the above cases were not being reported previously. The successful demonstration has encouraged the state government to scale-up the involvement of CLVs in reporting on childhood diarrhoea through use of pictorial tools. However, 64% of CLVs do not report regularly due to non-availability of tools and poor accountability. The programme is considering strengthening of supportive supervision and provision of incentives to improve compliance to reporting. Conclusions: Reporting from CLVs is feasible by providing simple reporting tools and imparting them training to use the tools along with continuous follow-up and handholding. Improved reporting of childhood diarrhoea cases treated by CLVs is useful in informing program decisions and initiating corrective action.
ABSTRACT
Management of patients with congenitally missing mandibular second premolars continues to challenge clinicians to find the best treatment options. The Orthodontist must make the proper decision at the appropriate time regarding management of the edentulous space. If space is left for an eventual prosthetic replacement, the clinician should try to create the exact amount of space required and leave the alveolar ridge in an ideal condition for the future restoration. If the space is to be closed orthodontically, detrimental changes to the occlusion and facial profile must be prevented. Therefore, the correct decision must be made at the appropriate time. This paper presents a case report of a congenitally missing lower left second premolar where molar protraction with orthodontic temporary anchorage device has been done.
ABSTRACT
Initial stability at the placement and development of osseointegration are two major issues for implant survival. Implant stability is a mechanical phenomenon which is related to the local bone quality and quantity, type of implant, and placement technique used. The application of a simple, clinically applicable, non-invasive test to assess implant stability and osseointegration is considered highly desirable. Resonance frequency analysis (RFA) is one of such techniques which is most frequently used now days. The aim of this paper was to review and analyze critically the current available literature in the field of RFA, and to also discuss based on scientific evidence, the prognostic value of RFA to detect implants at risk of failure. A search was made using the PubMed database to find all the literature published on "Resonance frequency analysis for implant stability" till date. Articles discussed in vivo or in vitro studies comparing RFA with other methods of implant stability measurement and articles discussing its reliability were thoroughly reviewed and discussed. A limited number of clinical reports were found. Various studies have demonstrated the feasibility and predictability of the technique. However, most of these articles are based on retrospective data or uncontrolled cases. Randomized, prospective, parallel-armed longitudinal human trials are based on short-term results and long-term follow up are still scarce in this field. Nonetheless, from available literature, it may be concluded that RFA technique evaluates implant stability as a function of stiffness of the implant bone interface and is influenced by factors such as bone type, exposed implant height above the alveolar crest. Resonance frequency analysis could serve as a non-invasive diagnostic tool for detecting the implant stability of dental implants during the healing stages and in subsequent routine follow up care after treatment. Future studies, preferably randomized, prospective longitudinal studies are certainly needed to establish threshold ranges for implant stability and for implants at risk for losing stability for different implant system.
Subject(s)
Bone Density/physiology , Dental Implantation, Endosseous/methods , Dental Implants , Dental Prosthesis Retention , Elastic Modulus , Humans , Osseointegration/physiology , VibrationABSTRACT
Green auto-fluorescence (GAF) of different age groups of mouse blood erythrocytes was determined by using a double in vivo biotinylation (DIB) technique that enables delineation of circulating erythrocytes of different age groups. A significant increase in GAF was seen for erythrocytes of old age group (age in circulation more than 40 days) as compared to young erythrocytes (age less than 15 days). Erythrocytes are removed from blood circulation by macrophages in the reticulo-endothelial system and depletion of macrophages results in an increased proportion of aged erythrocytes in the blood. When mice were depleted of macrophages for 7 days by administration of clodronate loaded liposomes, the overall GAF of erythrocytes increased significantly and this increase could be ascribed to an increase in GAF of the oldest population of erythrocytes. Using the DIB technique, the GAF of a cohort of blood erythrocyte generated during a 5 day window was tracked in vivo. GAF of the defined cohort of erythrocytes remained low till 40 days of age in circulation and then increased steeply till the end of the life span of erythrocytes. Taken together our results provide evidence for an age dependent increase in the GAF of blood erythrocytes that is accentuated by depletion of macrophages. Kinetics of changes in GAF of circulating erythrocytes with age has also been defined.
Subject(s)
Animals , Erythrocyte Aging/physiology , Erythrocytes/metabolism , Female , Fluorescence , Humans , Kinetics , Mice , Mice, Inbred C57BLABSTRACT
Tuberculosis of the cystic duct lymph node without involvement of gall bladder is exceedingly rare. Cholelithiasis is a usual accompaniment. A case of 65-year-old woman was diagnosed to have cholelithiasis. Laparoscopic cholecystectomy was performed and a prominent cystic lymph node was excised for biopsy. Histopathology surprisingly reported tuberculosis of cystic duct lymph node without affecting the gall bladder. Thereupon, she was treated with antituberculous chemotherapy.
Subject(s)
Aged , Antitubercular Agents/therapeutic use , Cholelithiasis/diagnosis , Cystic Duct/pathology , Female , Humans , Lymph Nodes/pathology , Tuberculosis, Lymph Node/diagnosisABSTRACT
Effect of M. tuberculosis infection was studied on the expression of intercellular adhesion molocule-1 (ICAM-1) and Mac-1 markers on murine peritoneal macrophages. Intraperitoneal administration of M. tuberculosis resulted in a marked increase in the proportion of Mac-1+ cells whereas the proportion of ICAM-1+ cells declined sharply 4 h post infection. Absolute numbers of Mac-1+ and ICAM-1+ cells however increased at all time points after the infection. Comparison of kinetics of changes observed in Mac-1+ and ICAM-1+ cell populations with differential leukocyte counts in peritoneal cells indicated that these alterations could be due to cellular influx, especially that of neutrophils, or up regulation of these markers on macrophages and other peritoneal cells. In adherent peritoneal macrophages infected in vitro with M. tuberculosis, proportion of Mac-1+ and ICAM-1+ cells increased markedly within 24 h of infection. Mean expression of these markers on per cell basis also increased significantly. Similar results were obtained by using RAW 264.7 mouse macrophage cell line, suggesting that the enhanced expression of Mac-1 and ICAM-1 markers was a direct effect of M. tuberculosis infection and not mediated by contaminating cell types present in adherent macrophage preparations. Mac- 1 and ICAM-1 expression was further studied on macrophages that had actually engulfed M. tuberculosis and compared with bystander macrophages without intracellular M. tuberculosis. For this purpose M. tuberculosis pre-stained with DilC18 fluorescent dye were used for infecting adherent peritoneal macrophages. Mac-1 and ICAM-1 expression on gated DilC18 positive and negative cell populations was analyzed. Our results indicate that the expression of Mac-1 and ICAM- 1 markers was significantly enhanced on all macrophages incubated with M. tuberculosis but was more pronounced on macrophages with internalized mycobacteria. Taken together, our results suggest that the expression of Mac-1 and ICAM-1 markers is significantly up regulated
Subject(s)
Animals , Mice , Biomarkers/analysis , Cells, Cultured , Intercellular Adhesion Molecule-1/analysis , Macrophage-1 Antigen/analysis , Macrophages, Peritoneal/immunology , Mice, Inbred C57BL , Mycobacterium tuberculosis , Peritoneum/microbiology , Phagocytosis/physiology , Tuberculosis/immunology , Up-RegulationABSTRACT
Effect of lipopolysaccharide (LPS) on RAW264.7 macrophage cell line was studied. LPS-treated RAW264.7 cells increased in cell size and acquired distinct dendritic morphology. At the optimal dose of LPS (1 mg/ml), almost 70% RAW264.7 cells acquired dendritic morphology. Flow cytometric studies indicate that the cell surface markers known to be expressed on dendritic cells and involved in antigen presentation and T cell activation (B 7.1, B 7.2, CD40, MHC class II antigens and CD1d) were also markedly upregulated on LPS-treated RAW 264.7 cells. Our results suggest the possibility that LPS by itself could constitute a sufficient signal for differentiation of macrophages into DC-like cells.
Subject(s)
Animals , Antigen Presentation , Antigens, CD1/immunology , CD40 Antigens/immunology , Biomarkers , Cell Differentiation/drug effects , Cell Line , Dendritic Cells/cytology , Histocompatibility Antigens Class II/immunology , Lipopolysaccharides/pharmacology , Lymphocyte Activation , Macrophages/cytology , Rats , T-Lymphocytes/metabolism , Up-Regulation/drug effectsABSTRACT
C57Bl/6 female mice were infected with an intrapulmonary dose of 2.5 x 10(4) BCG (Mycobacterium bovis Bacillus Calmette-Guerin). Lymphocyte populations in lung interstitium and lung-associated tracheal lymph nodes (LN) were examined at 1, 2, 4, 5, 6, 8 and 12 weeks after infection. BCG load in lungs peaked between 4-6 weeks post-infection and declined to very low levels by the 12th week of infection. Lung leukocytes were obtained over the course of infection by enzyme digestion of lung tissue followed by centrifugation over Percoll discontinuous density gradients. By 4 to 6 weeks after infection, numbers of lung leukocytes had more than doubled but the proportions of lymphocytes (about 70%), macrophages (about 18%) and granulocytes (about 12%) remained essentially unaltered. Flow cytometric studies indicated: (i) the total number of CD3+ T cells in lungs increased by 3-fold relative to uninfected controls at 5 to 6 weeks post-infection, but the relative proportions of CD4 and CD8 cells within the T cell compartment remained unaltered; (ii) relative proportion of NK cells in lungs declined by 30% but the total number of NK cells (NK1.1+) per lung increased by about 50%, 5-6 weeks post infection; (iii) tracheal LN underwent marked increase in size and cell recoveries (6-10-fold increase) beginning 4 weeks after infection. While both T and B cells contributed to the increase in cell recoveries from infected tracheal LNs, the T/B ratio declined significantly but CD4/CD8 ratio remained unaltered. In control mice, IFNgamma producing non-T cells outnumbered T cells producing IFNgamma. However, as the adaptive response to infection evolves, marked increase occur in the number of IFNgamma producing T cells, but not NK cells in the lungs. Thus, T cells are the primary cell type responsible for the adaptive IFNgamma response to pulmonary BCG infection. Few T cells in tracheal LN of BCG infected mice produce IFNgamma, suggesting that maturational changes associated with migration to the lungs or residence in the lungs enhance the capability of some T cells to produce this cytokine.
Subject(s)
Animals , Antibodies, Bacterial/blood , Colony Count, Microbial , Disease Models, Animal , Female , Flow Cytometry , Humans , Interferon-gamma/biosynthesis , Lung/immunology , Lymph Nodes/cytology , Lymphocyte Subsets/physiology , Mice , Mice, Inbred C57BL , Mycobacterium bovis/growth & development , Trachea , Tuberculosis, Pulmonary/immunologyABSTRACT
Sensitivity of Fas expressing tumor cells (high levels in Hut78 & Jurkat; low levels in P815) toward the cytotoxic Con-A (5 microg/ml) activated spleen cells from young (12 to 16 week old males) and old (2 year old males) mice were studied. The spleen cells from young mice activated for a day showed high levels of cytotoxic activity against Hut78 and Jurkat cell lines but not against P815 cells. The cytotoxic activity against P815 cells were detected in the spleen cells from old but not young mice following a longer period of Con-A activation (three days). Comparable levels of cytotoxic activity against Hut78 and Jurkat cells were observed in the spleen cells from both young and old mice following three days of activation. Treatment of Hut78 cells with anti-Fas antibody affected the tumor cells become resistant against the cytotoxic activity of the spleen cells from young mice in a dose dependent manner however P815 cells were not affect by the anti-Fas antibody treatment. These results show that there are differences in the sensitivity of target tumor cells toward Con-A induced cytotoxic spleen cells from young and old mouse. Mitogen-induced cytotoxic lymphocytes from young mouse spleen appear to kill targets through mechanisms involving Fas antigen, specially, in early stage (1 day) of activation. Old mouse spleen cells generated high levels of cytotoxic cells in later phase (3 days), which appear to kill through Fas-unrelated mechanisms.