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India has a high share in the global burden of chronic terminal illnesses. However, there is a lack of a uniform system in providing better end-of-life care (EOLC) for large patients in their terminal stage of life. Institutional policies can be a good alternative as there is no national level policy for EOLC. This article describes the important aspects of the EOLC policy at one of the tertiary care institutes of India. A 15 member institutional committee including representatives from various departments was formed to develop this institutional policy. This policy document is aimed at helping to recognize the potentially non-beneficial or harmful treatments and provide transparency and accountability of the process of limitation of treatment through proper documentation that closely reflects the Indian legal viewpoint on this matter. Four steps are proposed in this direction: (i) recognition of a potentially non-beneficial or harmful treatment by the physicians, (ii) consensus among all the caregivers on a potentially non-beneficial or harmful treatment and initiation of the best supportive care pathway, (iii) initiation of EOLC pathways, and (iv) symptom management and ongoing supportive care till death. The article also focuses on the step-by-step process of formulation of this institutional policy, so that it can work as a blueprint for other institutions of our country to identify the infrastructural needs and resources and to formulate their own policies.
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Background: Aim of the study was to evaluate prospectively the outcomes of laparoscopic floppy Nissen fundoplication in cohort of patients with typical symptoms of gastroesophageal reflux disease (GERD) and hiatus hernia without pre-operative 24 hours oesophageal pH and manometry study. Methods: Thirty-four patients with typical symptoms of GERD, from March 2009 to November 2019, were studied. The study was limited to patients with positive findings on upper GI endoscopy done by operating surgeon with typical symptoms (heartburn, regurgitation, and dysphagia) of GERD and hiatal hernia. Laparoscopic Nissen’s fundoplication was performed when clinical assessment suggested adequate oesophageal motility and length. Only 1 patient, who had negative endoscopic findings, underwent a 24-hour pH-monitoring before surgery. Outcome measures included assessment of the relief of the primary symptom responsible for surgery in the early postoperative period; the patient's evaluation of outcome and quality of life after surgery.Result: Laparoscopic Nissen’s fundoplication is an effective long-term treatment for GERD and may be performed in patients with typical symptoms of GERD and hiatus hernia and endoscopic findings suggestive of reflux esophagitis and patient who wants to get rid of life long proton-pump inhibitors (PPI) and antacids medication.Conclusions: Preoperative oesophageal manometry and 24-hour pH monitoring are not mandatory for laparoscopic fundoplication if the patient selection is appropriate but may be required in selected patients with atypical symptoms.
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Anaemia is a common clinical condition in elderly commonly associated with increased morbidity and mortality, increased hospitalization, decreased physical performance, loss of mobility and disability at higher rates than those people without anaemia. The present study was undertaken to assess the aetiological profile of anaemia in elderly. METHODSA cross sectional study was done among elderly patients with anaemia admitted in general medicine department and / or attending general medicine OPD, IGIMS, Patna, Bihar. 100 consecutive patients were selected as per inclusion and exclusion criteria. The patients were subjected to a thorough clinical examination and investigation, and data was analysed. RESULTSAnaemia is more common in males with a male to female ratio of 2.84:1. Maximum numbers of cases was in the age range of 61 to 70 comprising 70 % followed by 23 % in 71 to 80 years age group and 6 % in 81 to 90 years age group. Weakness was the most common presentation comprising 74 % cases. Comorbidities in patients along with anaemia were solid malignancy in 5 %, diabetes mellitus (DM) in 7 %, hypertension (HT) in 6 %, chronic kidney disease (CKD) in 5 %, cor pulmonale in 3 % and hypothyroidism in 1 %. 48 % patients were having moderate anaemia and 45 % patients were having severe anaemia. Morphologically most common variety of anaemia was normocytic normochromic contributing 57 % of the patients. Bone marrow examination done in 62 cases revealed hyper cellular marrow in 27, normocellular in 24, hypo cellular marrow in 6 and mildly hyper cellular to normocellular in 5 cases. Aetiological distribution showed 14 % of anaemia of chronic disease (ACD) and 14 % due to vitamin B12 deficiency. This was closely followed by iron deficiency anaemia (IDA) in 13 % cases. CONCLUSIONSAnaemia in elderly is a common clinical condition commonly presenting with nonspecific symptom. Normocytic normochromic anaemia is the most common morphological type of anaemia with various underlying treatable aetiologies.
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Introduction: Urinary tract infection is one of the most common types of bacterial infection in patients with diabetes mellitus.Aim: The aim of the study was to assess the prevalence of urinary tract infection among hospitalized diabetic patients.Materials and Methods: A hospital-based prospective study was carried out from June 2018 to May 2019. A total of 100 patientsof diabetes mellitus with urinary tract infection were included in this study.Results: Of 100 patients, 54 were male and 46 were female, the most common age group was 46–55 years. Most patientshad a fever with rigor (48%) followed by dysuria (22%), suprapubic pain (20%), increased frequency of urine (18%), flank pain(10%), pyuria (6%), and hematuria (4%). Urine culture analysis revealed that Escherichia coli (29%) was the most commonorganism responsible of urinary tract infection. The majority of isolated organisms were sensitive to antimicrobial agents suchas amikacin, nitrofurantoin, and levofloxacin.Conclusion: Urinary tract infection is frequent in diabetic patient and the urine culture should be performed in all hospitalizedpatients with diabetes mellitus. Early diagnosis, knowledge of common predisposing factors, and appropriate clinical managementare important to improve prognosis.
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Birth weight is considered as one of the most important factors that affect the neonatal mortality in both developing and developed countries. In addition, it is a significant determinant of post neonatal mortality, infant and childhood mortality and morbidity. This study was conducted to evaluate the various factors influencing anthropometric measurements of neonates at birth.METHODSThis is a hospital based cross sectional study consisting of neonates and their respective mothers delivered at Darbhanga Medical College, Laheriasarai, Bihar, during the period April 2018 to September 2019. Neonates were divided into three groups < 2500 gms, 2500-3500 gms, >3500 gms and these groups were studied in relation to the determining factors of mothers.RESULTSAmong 1000 babies, 56.3% were male and 43.7% were female. Mean birth weight was 2596.90 ± 542.79 gms ( ± SD). Mean birth weight was higher in males and LBW rate was higher in males. 37.3% of babies were LBW babies. Duration of gestation determines birth weight and other anthropometric parameters proportionately increase with birth weight. In the present study, 15.7% were preterm babies, and 1.8% of babies were post term babies. Factors like maternal age, weight, pregnancy weight gain, socio economic status, Muslim religion, maternal literacy, birth order (2nd onwards), male sex, singleton pregnancy, non-anaemic status, higher period of gestation and spacing had positive correlation with birth weight and negative correlation with LBW incidence. 1/3rd of LBW babies were preterm and 2/3rd were IUGR babies. In this study, anaemia and diabetes was 79.9% and 3% respectively. Maternal diabetes mellitus is an important risk factor for macrosomia.CONCLUSIONSBy avoiding teenage pregnancies, adapting family planning methods, providing good quality antenatal care, improving maternal nutrition, spacing of more than three years, correcting anaemia, early recognition of obstetric complications and timely intervention will reduce percentage of LBW babies, increase the mean birth weight and increase the other newborn anthropometric parameters at birth, which will lower the infant mortality and improve the survival.
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Dead and damaged spermatozoa cells present universally in the ejaculates of all eutherian mammals exert toxic effect on contemporary healthy cells mostly through generation of excessive free radicals. This is much more evident during extended period of processing, resulting in poor ejaculate quality. The solution lies in depletion of dead/damaged spermatozoa from the neat ejaculates itself. Thus the objective of the study was to evaluate the efficiency of the protocols such as discontinuous PercollTM density gradient centrifugation (PDGC) and glass wool filtration (GWF) for depletion of dead/damaged spermatozoa from fresh semen in buffalo. Random ejaculates (n=6) of Murrah buffalo bulls were divided into two aliquots after quality assessment: PDGC and GWF protocols (Group I and II, respectively). At the end of the purification protocol, efficiency of the protocols in depleting dead/damaged spermatozoa as reflected by certain quality parameters were evaluated. The mean efficiency (%) of purification protocols based on recovery of spermatozoa was 44.68 and 40.02% for PDGC and GWF, respectively. Moreover significantly (p<0.05) greater values for quality parameters was observed in the Group II (26.4+6.8 vs 68.8+4.4 for acrosome integrity (%); 12.68+6.6 vs 57.7+7.5 for functional plasma membrane integrity (%); 20.3+5.8 vs 80.75+6.7 for viability (%) in Group I and II, respectively). It was concluded that GWF is a better technique than PGDC to filter out dead/damaged spermatozoa from fresh semen with improvement in semen quality and can be a valuable tool in assisted reproductive technology
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Background: Bronchial Asthma is a common cause of mortality and morbidity in the developing world like India. Objective: The purpose of the present study was to establish a nomogram for PEFR in 6-12 yrs age group in relation to height in Eastern India, a first of its kind study from Eastern India. Setting: 1003 randomly selected healthy school children in Kolkata. Study Design: Prospective cross sectional study. Methods: Mini Wright peak flow meter was used to measure PEFR in resting condition and standing position. The best value of three attempts was recorded and compared to height, weight, sex and age separately. Multiple regression analysis was used to determine the influence of various variables. Results: Height ranged from 95 cm to155 cm and PEFR ranged from 115 L/min to 335 L/min irrespective of sex. Mean PEFR was 241.5 L/min in all sexes whereas the median, 25th percentile and 75th percentile values were 244.1 L/min, 186 L/min and 290 L/min respectively. PEFR values increased in a linear pattern with increase in height in both sexes. Using multiple regression analysis we can estimate the PEFR values with height alone in both sexes with more than 95% accuracy. Conclusion: PEFR values depend on height, weight, age and sex, the former being the most important parameter
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Hypertension is an important worldwide public-health challenge because of its high frequency and concomitant risks of cardiovascular, cerebrovascular and kidney disease. This study was designed to compare total and ionized calcium levels between patients with newly detected essential hypertension and normotensive controls. The ionized serum calcium levels are significantly lowered in newly detected essential hypertensive patients when compared to normotensive controls. The total serum calcium levels are not significant and levels are found to be same in the hypertensive as well as the normotensive patients. The total and ionized serum calcium levels have a significant negative correlation with the level of systolic blood pressure and with the diastolic blood pressure in newly detected essential hypertensive patients. The total and ionized serum calcium levels showed no significant difference with age, sex, BMI, life style, smoking, alcohol, family history of hypertension in newly detected essential hypertensive patients
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Introduction: Major aetiology of acute undifferentiated fevershows wide variation, especially in developing countriesincluding India. Acute undifferentiated fever poses a diagnosticand therapeutic challenges to health care workers, particularlyin limited resources. It is one of the commonest presentingproblem in hospital. It is necessary to know the cause, whichwill be useful to give proper treatment to the patients. Thisstudy was aimed to find out the acute undifferentiated feveraetiologies and clinical pattern.Material and Methods: This study was conducted onhundred patients of acute undifferentiated fever, admittedin Indira Gandhi institute of Medical Science, Patna fromFebruary 2018 to January2019.Result: Acute undifferentiated fever affected all age groupbut most common in 26 to 35 years of age group (29%).One hundred patients were included, 78male and 22female.In this study, Typhoid (41%) was leading cause of acuteundifferentiated fever followed by Malaria (23%), DengueFever (20%), Leptospirosis (5%), Scrub Typhus (3%) andChikungunya (1%). Common symptom was fever (100%),Headache (64%), Vomiting (48%), Rigor and chills (42%)whereas common sign was hepatosplenomegaly (55%).Typhoid fever (41%) was the commonest cause of acuteundifferentiated fever followed by malaria (23%), denguefever (20%), urinary tract infection (5%), scrub typhus (3%)and chikungunya (1%).Conclusion: It is important to know the aetiology andclinical pattern of acute undifferentiated fever for theirproper management and it will help to prevent morbidity andmortality.
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Eco-friendly biosynthetic approach for silver nanoparticles production using plant extracts is an exciting advancement inbio-nanotechnology and has been successfully attempted in nearly 41 plant species. However, an established model plantsystem for systematically unraveling the biochemical components required for silver nanoparticles production is lacking.Here we used Arabidopsis thaliana as the model plant for silver nanoparticles biosynthesis in vitro. Employing biochemical, spectroscopic methods, selected mutants and over-expressor plants of Arabidopsis involved in pleotropicfunctions and sugar homeostasis, we show that carbohydrates, polyphenolics and glyco-proteins are essential componentswhich stimulated silver nanoparticles synthesis. Using molecular genetics as a tool, our data enforces the requirement ofsugar conjugated proteins as essentials for AgNPs synthesis over protein alone. Additionally, a comparative analysis ofAgNPs synthesis using the aqueous extracts of some of the plant species found in a brackish water ecosystem (Gracilaria,Potamogeton, Enteromorpha and Scendesmus) were explored. Plant extract of Potamogeton showed the highest potentialof nanoparticles production comparable to that of Arabidopsis among the species tested. Silver nanoparticles production inthe model plant Arabidopsis not only opens up a possibility of using molecular genetics tool to understand the biochemicalpathways and components in detail for its synthesis.
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Chronic Obstructive Pulmonary Disease (COPD) is major cause of mortality & morbidity all over the world significantly affecting Quality of life of all the affected individuals and it also causes economic as well as social burden on society. COPD at present is the 4th leading cause of death worldwide, and is suspected to become 3rd leading cause of death worldwide by 2020. COPD diagnosis is confirmed by post bronchodilator FEV1 / FVC ratio < 0.70. In the present study, we wanted to examine the relationship between the history, clinical indices and spirometry in patients of COPD. Methods: Study was done in the department of pulmonary medicine on 50 patients of COPD, randomly selected after taking inclusion and exclusion criteria under consideration. Results: >80% of the patients were in age group of 40-70 years and mean age of presentation was 57.6 years. Smoking was present as risk factor in 62%. Most of the patients (42%) were under GOLD stage 3 followed by stage 4 (36%), stage 2 (22%) and no patients in stage 1. Duration of illness among patients ranged from 1 month to 40 years, with a mean of 7.4 years. As per new GOLD 2019 grouping criteria, maximum participants were in group B (78%), followed by group D (20%) and group A (2%). 24 out of 50 patients were in 19-25 BMI (normal) group, followed by 20 patients under <19 (low BMI) group and then 6 in >25 BMI group. We found statistically significant correlations between: FEV1/FVC ratio, MEF 25-75 and Age; between FVC and sexual difference;FEV1, FVC and MMRC Grading. Conclusion: PFT is an important tool for measuring degree of involvement of lung parenchyma in cases of COPD. It is affected by various factors, therefore a thorough history is important for assessment of level of involvement as well as for planning further management of patients.
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Background: Despite being preventable and curable, TB is the leading cause of HIV associated mortality. It is the most common opportunistic infection among HIV positive individuals with CD4 cell count <500/ mm3. Worldwide the number of people infected with both HIV & TB is rising. The objective of the study was to describe the socio-demographic profile of HIV-TB co-infected patients and to assess the adherence of HIV TB Co-infected patients to anti tubercular treatment (ATT) attending ART Centre, RIMS, Ranchi.Methods: It was a hospital based prospective study done at Rajendra Institute of Medical Sciences (RIMS), Ranchi. Duration of study was 14 months. A total of 117 patients were registered during the study period and were followed up for adherence to ATT.Results: Out of 117 patients 4 were excluded. Among 113 patients, mostly were male (74.3%) and from rural background (69.9%). Majority (94.7%) of the patients came for regular follow up and took medicines as advised. Adherence was significantly associated with education (p=0.025).Conclusions: In this study it was concluded that education significantly affected adherence to ATT among HIV-TB Co-infected patients of ART Centre of RIMS, Ranchi.
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Background:Antenatal check up (ANC) is imperative for the timely diagnosis and treatment of pregnancy related morbidities.Good and timely ANC is a vital component for the safe motherhood and child survival. The study aims to describe the socio demographic prole & to assess the ANC Status and degree of acceptance of different services given in ANC among pregnant women.Methods: This was a cross sectional hospital based study done in Obs. &Gynae. department of RIMS, Ranchi for a duration of 3 months. All pregnant women admitted for delivery in Obs. & Gynae. department, RIMS, Ranchi during our data collection period were selected randomly from ve units. Total sample size during this period came out to be 163. Templates were generated in MS excel sheet and data analysis was done using SPSS software (version20.0).Results: After analysis of 163 subjects, it was found that about half (50.6%) of the patients were from rural background with non tribal ethnicity (68.11%). ANC registration was found in 98.1% of women and 34.4% women have more than four ANC visits. Conclusions: Majority of the women were taking ANC visits and getting iron supplementation with TTinjection.
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Background: Non-alcoholic fatty liver disease (NAFLD) is a distinct hepatic condition characterized by abnormal fat accumulation in liver cells; histologically resembling alcohol induced liver damage. The term NAFLD is used to describe a wide array of fatty liver changes from simple steatosis to steatohepatitis, cirrhosis and hepatocellular carcinoma (HCC), in the absence, of excessive alcohol intake. Methods: 312 suspected patients of NAFLD above the age group of 15 and irrespective of sex were screened during the study. Total 60 patients were selected according to the inclusion and exclusion criteria designed for our study. Further clinical (history, BMI, BP,etc.), biochemical (blood sugar profile, lipid profile, serum transaminases, Serum uric acid etc.), histopathological (liver biopsy) and radiological profiling (USG) was done. Result : Our 60 recruited patients had a mean age of 52.53±11.68 years with 21 (35%) male subjects and 39 (65%) female subjects. We found that fatigue, malaise and abdominal pain were the commonest whereas heart burn as the second commonest complain among the study group. Further clinical examination of 26 (43.3%) patients with RUQ abdominal pain revealed that 14 (53.8%) had abdominal tenderness, 10 (38.5%) had abdominal tenderness with hepatomegaly and 2 (7.7%) had no significant clinical findings. Our study revealed mean BMI to be 27±6.32 kg/m2 with more than half of our patients were pre-obese (33.3%) and obese (28.3%). Lipid profiling revealed 13 (21.7%) patients had hypertriglyceridemia. Serum transaminases revealed 22 (36.7%) and 39 (65%) had raised SGPT/ALT and SGOT/AST levels respectively. Ultrasonographically, 30 (50%) had grade-I, 23 (38.3%) had grade-II and 7 (11.7%) had grade-III fatty liver. Due to low patient compliance, only 3 (5%) had their liver biopsy done which revealed steatosis and dense fibrosis. Conclusion: Current absence of specific treatment further for NASH and NAFL emphasizes the need of healthy diet, yoga and daily exercise in order to control insulin resistance/metabolic syndrome.
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Background: Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycaemia. India alone had 65.1 million diabetics by the year 2013. DM with high BMI & increased central obesity (WHR) have changes in the cardiac geometry evidenced in echocardiography. AIM OF STUDY: Estimation of Body Mass Index (BMI) and Waist Hip Ratio (WHR) & Establish a relationship between obesity, particularly central obesity in type 2 diabetes mellitus patients and cardiac changes with the help of echocardiography. Methods: 30 Subjects with type 2 DM attending the OPD or admitted in Katihar Medical College indoor department & 30 control patients were also be taken from the same, all of age >40 years. The cases and the controls were examined thoroughly with respect to BMI (>30) & WHR (> 0.85 for females and > 0.95 for males) and echocardiography was done. Results: The cases i.e. type 2 diabetes with high WHR and BMI had highly significant alteration in LV geometry as compared to the controls & had significantly high mean LV mass 189.10grams as compared to 134.04 grams of the controls. There was significant early diastolic dysfunction found in the cases group while no significant difference was found in systolic dysfunction between cases & controls. The incidence of changes in left ventricular geometry was higher in female type 2 diabetic subjects with high waist hip ratio and BMI as compared to males. Conclusions: Form the data of the present study it can be concluded that type 2 diabetics with obesity, particularly central type, have an increased predisposition to the development of left ventricular structural or geometrical abnormality. They have significantly higher left ventricular Mass. Obese type 2 diabetics also have higher incidence of diastolic dysfunction. All these abnormalities occur with greater frequency in females. Thus, type 2 diabetics with high BMI and Waist hip ratio have higher risk of development of cardiovascular disease, which is higher for female than males.
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Background: Hematological abnormalities are among the most common complications of HIV. Anaemia is the most common hematological abnormality in HIV patients, and is strongly associated with the progression of the disease, followed by leucopenia and thrombocytopenia. The objective of the study is to find out the magnitude & type of hematological abnormalities and its correlation to CD4 Count. Methods: The study was done on 80 HIV patients, above the age of 15 yrs, including both males and females, attending ART Centre, at Katihar Medical College, Katihar, Bihar. Various haematological parameters were recorded and studied with respect to CD4 count. Results: Among the total patients, 57.5% had anaemia, 23.75% had leucopenia and 12.5% had thrombocytopenia. The magnitude of these abnormalities were directly proportional to low CD4 counts. Results: Among the total patients, 57.5% had anaemia, 23.75% had leucopenia and 12.5% had thrombocytopenia. The magnitude of these abnormalities were directly proportional to low CD4 counts. Conclusions: These hematological parameters can be used to assess the severity and progression of HIV as they are directly associated with CD4 count. Anaemia being the single most independent factor associated with high mortality. Aggressive treatment of these haematological abnormalities can lead to substantial decline in morbidity and mortality associated with HIV patients.
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Obsessive Compulsive Symptoms in Patients with Epilepsy. To find out the prevalence of obsessive compulsive symptoms / disorder among patients of epilepsy. Patients with epilepsy diagnosed clinically at psychiatric out patients department were selected for the study. Yale-Brown Obsessive Compulsive Scale was applied to find out the prevalence and nature of obsessive compulsive symptoms. A total of 93 patients were participated and it was found that 20.4 % of epilepsy patients had obsessive compulsive symptoms. The prevalence of obsessive compulsive symptoms among the patients of epilepsy was found to be 20.4%.
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Background: Objective: our study was to observe the risk factors in different age group of patients with ischemic stroke. Methods: A total of 120 patients of ischemic stroke were considered on the basis of detail clinical history, laboratory findings and CT Scan/MRI. Results: Data was analyzed by using MS-Office software. Conclusion: Major risk factors associated with ischemic stroke was hypertension, smoking, alcohol consumption, diabetes mellitus, dyslipidemia and obesity.
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Background: Pseudomonas aeruginosa is an important pathogen isolated from various clinical infections. The occurrence of multidrug-resistant (MDR) Pseudomonas aeruginosa strains is increasing worldwide and limiting our therapeutic options resulting in high mortality. We aim to study the incidence of multidrug resistant Pseudomonas aeruginosa in inpatients from various departments along with rate of nosocomial infections. Methods: A cross sectional study from January 1, 2013 to December 31, 2013. A total of 167 Pseudomonas aeruginosa were isolated from 764 clinical specimens. The isolates were identified by standard microbiological techniques. The antibiotic susceptibility was done by Kirby Bauer method. Results: The highest number of isolates were from pulmonary samples n=90 (53.89%) followed by pus n=48 (28.74%). Overall, 39 (23.36%) isolates were nosocomial. The nosocomial isolates were mainly isolated from department of surgery, orthopaedics, obstetrics & gynaecology followed by others. Among 167 isolates screened, 53 (31.73%) were found to be MDR (resistant to ≥3 classes of antipseudomonal agents). The resistance was most against cephalosporins [Cefepime (65.26%), cefotaxime (60.47%)], fluoroquinolones [Ciprofloxacin (46.1%), levofloxacin (31.87%)] aminoglycosides [Amikacin (37.72%), gentamicin (31.13%)] followed by ureidopenicillins and carbepenems. About 56.75% isolates were suspected Metallo β lactamases producers. Conclusion: The study suggests that the incidence of nosocomial infection by multidrug resistant Pseudomonas aeruginosa is increasing globally especially the Metallo Beta lactamases producing strains. So there is a continuous need of conduction of surveillance programmes to formulate rational treatment strategies to combat this emerging challenge.
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The acute static renewal test of a botanical pesticide - azadirachtin for the freshwater catfish, Heteropneustes fossilis has been performed to determine the LC50 values at different exposure period. The LC50 values at various exposure periods are 173.06 mg L-1 for 24h; 80.69 mg L -1 for 48h; 58.57 mg L-1 for 72h and 52.35 mg L -1 for 96h. The upper confidence limits were 196.87, 86.91, 79.20 and 70.04 mg L-1 for 24, 48, 72 and 96 h and lower confidence limits were 154.01, 74.24, 37.33 and 33.83 mg L-1, respectively. These results indicate that azadirachtin exposure to the fish caused toxic effects.
A renovação do ensaio estático agudo de um pesticida botânico - azadiractin para o peixe de água doce, Heteropneustes fossilis foi realizada para determinar os valores de LC50 em diferentes períodos de exposição. Os valores de LC50 em diferentes períodos de exposição são 173,06 mg L-1 por 24h; 80,69 mg L-1 por 48h; 58,57 mg L-1 por 72 h e 52,35 mg L-1 por 96h. Os limites de confiança superiores foram 196,87; 86,91; 79,20 e 70,04 mg L-1 para 24, 48, 72 e 96h os limites inferior e confiança foram 154,01; 74,24; 37,33 e 33,83 mg L-1, respectivamente. Estes resultados indicam que a exposição do peixe à azadiractin causou efeitos tóxicos.