Importance Of Non–dipping Pattern In Chronic Kidney Disease Patients

Introduction: Hypertension was prevalent in 80 to 90% of patients with chronic kidney disease (CKD), Hypertension was widely known to accelerate the progression of CKD and increase the risk of cardiovascular (CV) events. In essential hypertension, it was observed that 24hr ambulatory BP and a non–dipping profile were closely associated with increased target–organ damage and a worsened CV outcome than clinic BP. Objective: The purpose of this study was to evaluate the relation between non dipping pattern, traditional risk factors such as age, gender, cholesterol, asymptomatic atherosclerosis markers (LVMI, Carotid IMT, ABI) and cardiovascular mortality in CKD patients. Methodology: Patients attending hemodialysis unit and the outpatient department of the Osmania General Hospital were formed as the material of study. Results: According to the Sleep /Awake BP ratio> 0.9 in their ambulatory BP recordings; The percentage of non dipping pattern was observed in 72% and the remaining 28% had dipping phenomenon. The estimated glomerular filtration rate (eGFR) calculated by Modification of diet in renal disease study (MDRD) equation has ranged around 4.8 to 77 ml/mim/1.73m2 and was negatively correlated with sleep/awake BP ratio. The percentage of diabetes was observed to be higher in the non–dippers. The non–dipping phenomenon was significantly associated with asymptomatic atherosclerosis markers (LVMI, Carotid IMT, and ABI). There was a high prevalence of CV events (1 in dipper and 17 in non–dippers) and CV related deaths (1 in dipper and 9 in non–dippers) in non dippers.

Use Of Early Labour Room Bubble Cpap In Preterms Born At 28-32 Weeks Of Gestation

Objective: To study the use of early labour room Bubble CPAP in preterm neonates born at 28–32 weeks of gestation and to analyse the outcome in relation to need for mechanical ventilation, duration of hospital stay and mortality at the Neonatal Intensive Care Unit (NICU), Tertiary Care Teaching Government Hospital Kurnool, Andhra Pradesh for a period of 1 Year. Methods : Facility Based Interventional Studied (Randomised Control Study) Participants : Study sample of 109 preterm babies of age 28–32 weeks of gestation Cases : 54 cases, neonates with respiratory distress who were started on CPAP in the labour room within 15 minutes of life. Controls : 55 babies, neonates with respiratory distress who were started on CPAP after 15 minutes to 6 hours of life. In the present study, both the groups(cases and controls) were monitored till they were discharged and the need for mechanical ventilation was noted. Clinical diagnosis of RDS was made based on the time of onset of respiratory distress and clinical examination and respiratory scoring(Silverman Anderson Score) . Chest X–ray and routine investigations were done in all neonates. Duration of CPAP and difference in mortality between the two groups was analysed. Outcome : In the present study, preterm neonates born at 28–32 weeks of gestation who were started on early labour room CPAP vs control group outcome is assessed in relation to need for mechanical ventilation and duration of hospital stay and mortality. Results: It is observed that 16 (29.63%) cases required mechanical ventilation whereas 28 (50.91%) preterm neonatesin the control group needed mechanical ventilation. There was a statistically significant difference between the two groups (p < 0.05). The duration of stay in NICU in neonates with early CPAP was significantly less when compared to the controlled group. 30(76.9%) neonates were discharged within 14 days among cases and 16 (48.48%) neonates among control group. There is no difference in mortality between the 2 groups. Conclusions : The following conclusions could be drawn out of the present study on preterm neonates. 1. The early administration of CPAP in the delivery room in preterm neonates developing respiratory distress decreases the need for mechanical ventilation. 2. The duration of stay in NICU in neonates with early CPAP was significantly less. 3. There is no difference in mortality between the two groups.

Langer’s Axillary Arch and Its Clinical Implications.

Introduction: The axillary arch muscle of Langer is the most common anatomical variant of axillary musculature which is of clinical and surgical importance. It may lead to neurovascular compression syndrome in the cervicoaxillary region and can be misinterpreted while examining axilla and also impairs movements of shoulder joint. Observation: During routine dissection of axilla for undergraduate teaching, an unusual muscular slip in the left axilla was observed .The muscular slip was extending from lattisimus dorsi muscle to undersurface of pectoralis major muscle, arching over axillary vessels and cords of brachial plexus. Conclusion: The axillary arch may cause obstruction to axillary vessels and nerves and may be involved in thoracic outlet syndrome and shoulder instability. The knowledge of this muscular variant could help to minimize intraoperative complications related to surgeries in or nearby axilla such as mastectomy, breast reconstruction and axillary lymphadenectomy or lymph node biopsy.

Comparative assessment in enzyme activities and microbial populations during normal and vermicomposting.

Changes in extracellular enzyme activities and microbial populations were studied during the normal composting and vermicomposting of fruitpulp, vegetable waste, groundnut husk and cowdung. The microbial numbers and their extracellular enzyme profiles showed relative variation and were found increasingly more abundant in vermicompost than in normal compost leading to the conversion of agricultural waste into value added product. In vermicompost, the maximum enzyme activities (cellulase, amylase, invertase, protease and urease) were observed during 21-35 days. The cellulase, amylase and protease activities of vermicompost reached the maximum values by 28th day of 1175, 825 µg reducing sugar g-1 hr-1 and 28 µ mol of aminoacid g-1 hr-1 of vermicompost samples respectively. Similarly the invertase and urease activities reached to peak values of 876 µg reducing sugar g-1 hr-1 and 197 µg -N g-1 ha-1 sample on 35th day respectively. Most of the enzymes showed correlation with change in number and types of different microbial groups like bacteria, fungi and actinomycetes during vermicomposting with maximum number of 126 x 106, 28 x 104 and 93 x 105 CFU g-1 sample respectively. In contrast delayed greatest enzyme activities were observed on 42-49th day i.e., last days of normal composting. Earthworms stimulated biochemical activity and nutrient cycling by 40-45% contributing to the reduction of period of degradation of agricultural wastes resulting in maturation of vermicompost by 28th day.

Evidence for presence of female produced pheromone components in male scent brush extract of castor semi-looper moth Achaea janata L.

Hexane extract of male terminalia (along with scent brushes) of castor semi-looper moth, Achaea janata L, elicited significant olfactory responses in both male and female insects by electroantennogram recording technique. However, male extract in the wind tunnel evoked noticeable behaviour responses in the female insects only. Orientation response of the males to the male extract was not evident in wind tunnel experiments. Two electrophysiologically-active compounds were identified from the male extract. Based on GC retention times and mass spectrometry the two compounds were confirmed as (Z,Z)-9,12-octadecadienal and (Z,Z,Z)-3,6,9-heneicosatriene. These two compounds are also constituents of female produced four-component blend of A. janata.

Bacteriological spectrum of cholecystitis and its antibiogram.

Bile Cultures for aerobic and anaerobic bacteria were carried out on 125 samples from patients with chronic cholecystitis with cholelithiasis. Cultures grew 71(56.8%) aerobes and 17(13.6%) anaerobic microorganisms. Polymicrobial infection was seen in 7(16.2%) cases. E. coli (45.07%) and Klebsiella (25.35%) were predominant among the aerobes and Bacteroides fragilis (58.82%) was predominant among the anaerobes. Highest incidence of the disease was observed in the fourth decade of life and females predominated in this study.