Laparoscopic cholecystectomy in a patient with pneumonectomy

Post pneumonectomy patients pose a challenge to the anaesthetist owing to the altered respiratory mechanics and decreased respiratory reserve. Performing laparoscopic surgery in such patients further deteriorates the already compromised lung functions. Authors report a case of laparoscopic cholecystectomy performed in post pneumonectomy patient. A clear understanding of respiratory mechanics and post pneumonectomy physiological changes helped us to administer a safe anaesthesia and safe perioperative outcome.

Alkaline pretreatment optimization for Pinus roxburghii needle biomass employing response surface methodology for bioethanol production by separate hydrolysis and cofermentation

Production of bioethanol from lignocellulosics can cater to the supply of renewable fuel to transport sector besides being environment friendly. In the present work, bioethanol production potential of Pinus roxburghii needle biomass (PNB) has been studied by optimizing the thermochemical pretreatment method using alkaline conditions (NaOH) firstly by one variable at a time (OVAT) approach, followed by Response Surface Methodology (RSM) with central composite design (CCD) tool. Total reducing sugar (TRS) yield was enhanced from 22.4 g/L (OVAT) to 32.4 g/L using design of experiment (DoE) approach. Effect of pretreatment on PNB was studied by FTIR, phloroglucinol staining and estimation of phenolics which indicated lignin removal. Enzymatic hydrolysis was done by the action of commercial enzymes cellulase and pectinase with loading of 5U/g biomass. The TRS yield was further enhanced to 67.95 g/L after enzymatic hydrolysis. Using separate hydrolysis and cofermentation (SHCF) approach for fermentation of PNB hydrolysate, 28.75 g/L bioethanol was obtained when combined cultures of Saccharomyces cerevisiae (MTCC-36) and Pichia stipitis (NCIM-3498) were used.

Vitamin D Supplementation for Treatment and Prevention of Pneumonia in Under-five Children: A Randomized Double-blind Placebo Controlled Trial.

Objective: To evaluate the efficacy of single oral mega-dose of Vitamin D3 for treatment and prevention of pneumonia in under-five children. Design: Randomized, double blind, placebo-controlled trial. Setting: Tertiary-care hospital. Participants: 324 children (of 980 assessed) between 6 mo-5 y age (median (IQR): 12 (7,19.8) mo) with WHO-defined severe pneumonia. Of these, 126 (39%) were vitamin D deficient (serum 25(OH)D <12 ng/mL). Intervention: 100,000 IU of oral cholecalciferol (n= 162) or placebo (n= 162) in single dose, administered at enrolment. Outcome variables: Primary: Time to resolution of severe pneumonia and proportion of children having recurrence of pneumonia in next 6 months; Secondary: Change in serum levels of 25(OH)D; immunoglobulins IgA, IgG, IgM, and cathelicidin 2 weeks following supplementation; and time taken for overall resolution of illness. Results: Median (95% CI) time for resolution of severe pneumonia was 30 (29, 31) h in the vitamin D group as compared to 31 (29,33) h in the placebo group [adjusted hazard ratio (95% CI): 1·39 (1·11, 1·76); P=0·005]. The risk of recurrence of pneumonia in next 6 months was comparable in the two groups [placebo: 36/158 (22·8%); vitamin D: 39/156 (25%); RR (95% CI): 1·13 (0·67,1·90); P=0·69]. Proportion of vitamin D deficient children declined from 38% to 4% in the supplementation group, and from 41% to 33% in the placebo group, two weeks after supplementation. There was no significant effect of vitamin D supplementation on serum levels of cathelicidin, IgA and IgG. The time taken for complete recovery from pneumonia, duration of hospitalization, and fever clearance time were comparable for the two groups. No adverse event was noted related to the intervention. Conclusion: There is no robust evidence of a definite biological benefit, either for therapy or prevention, to suggest a routine megadose supplement of vitamin D3 for under-five children with severe pneumonia.

Histopathological Spectrum of Renal Lesions in Adults with Proteinuria.

Background and Objectives: Proteinuria of more than 2.0 g in 24 hours is indicative of renal disease and a value of more than 3.5 g is a component of Nephrotic syndrome. The pathology resulting in proteinuria can be glomerular, tubular and others. Renal biopsy is gold standard in evaluation and management of patients with proteinuria especially Nephrotic syndrome. Methods: A retrospective analysis of all renal biopsies from adult patients with significant proteinuria over a period of 4 years was performed to study the pattern of renal pathology. The morphological findings were correlated with Clinical findings, laboratory findings &Immunofluorescence profile as per availability. Results: It was observed that clinical diagnosis matched the final pathological diagnosis in 79 (58.09%) cases. Further, Light Microscopy findings corresponded with Immunofluorescence in 142 out of 158 cases, while the diagnosis was changed in 16 (10.13%) cases after IF. Conclusions: The results thus indicate that renal biopsy along with IF plays an important role in diagnosis of cases with significant proteinuria a fact highlighted by low concordance % between the clinical and the pathological diagnosis. An accurate diagnosis is not only essential to initiate appropriate therapy but also in prognostication of renal lesions.

Organic Foods for Children: Health or Hype.

Organic foods are promoted as superior and safer options for today’s health-conscious consumer. Manufacturers of organic food claim it to be pesticide-free and better in terms of micronutrients. Consumers have to pay heavily for these products – and they are willing to – provided they are assured of the claimed advantages. Scientific data proving the health benefits of organic foods, especially in children, are lacking. Indian Government has developed strict guidelines and certification procedures to keep a check on manufacturers in this financially attractive market. American Academy of Pediatrics, in its recently issued guidelines, did not recommend organic foods over conventional food for children. Indian Academy of Pediatrics has not opined on this issue till date. In this perspective, we present a critical review of production and marketing of organic foods, and scientific evidence pertaining to their merits and demerits, with special reference to pediatric population.