Weeds infesting Wheat crop in Rohtak, Haryana

Multiple field visits were performed to investigate weed flora of wheat fields in Rohtak district of Haryana, conducted during 2018 which revealed infestation of 28 weed species comprising 15 families of grasses and broadleaf weeds. The weeds were identified with the help of available literature and through comparison with the already identified weed species. Poa annua, Polypogon monspeliensis and broadleaf weeds Chenopodium album, Rumex retroflex, Coronopus didymus were the pre-dominant weeds in moist region, whereas Cynodon dactylon, Fumaria parviflora, Chenopodium album, Polypogon monspeliensis in light soil with low salinity. There was a greater variety of weeds in Bohar and Kharawar villages and the least was found in village Sheria and Garnavati from vegetative to fully grown stage. Maximum number of species were of family Poaceae and Asteraceae. This study will be helpful as an additional tool in maintaining the floristic composition of District Rohtak as well as in controlling the weed problem

Categorization of patients with abnormal uterine bleeding according to PALM-COEIN FIGO classification

Background: Abnormal uterine bleeding is a common problem of the women in the reproductive age group and leads to the frequent visits of women in hospitals to health care providers. In an effort to create a universally accepted system of nomenclature to describe uterine bleeding abnormalities in reproductive-aged women, an alternative classification system polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified, known by the acronym PALM-COEIN developed.Methods: It is a retrospective study on 200 patients of abnormal uterine bleeding to categorize them on the basis of PALM-COEIN classification. Patient grouped under these categories after detailed history, examination, investigations and histopathological reports.Results: Ovulatory dysfunction was the most common cause of AUB in patients presenting to the gynecology outpatient department (n=60, 30%). It was followed by leiomyoma (n=48, 24%) and endometrial causes (n=38, 19%) and were the top three etiologies for AUB respectively. Adenomyosis (n=26, 13%), not classified (n=12, 6%), iatrogenic (n=8, 4%), polyp (n=4, 2%) and malignancy and coagulopathy each (n=2, 1%) contributing least to the PALM-COEIN classification as an etiology for AUB.Conclusions: PALM-COEIN classification is a universally accepted and consistent method of knowing exact etiology following investigations, so the proper treatment can be done for AUB.

Efficacy and superiority of an innovative method (IM) of intravenous (IV) fluid drip drop rate calculation using IV set and its comparison with conventional methods (CM)

Background: Almost every indoor patient requires some form of intravenous (IV) fluids and its infusion rate should be proper as recommended for best treatment outcomes. To overcome the same, a simple, quick and easily applicable new method for drip drop rate calculation is proposed, which is user-friendly at bedside and doesn’t require mathematical skills or help.Methods: Author compared this novel innovative method (IM) of IV fluid drip drop rate method for both regular macro and micro drop infusion set against conventional mathematical calculation method (MC) of infusion in various IV fluid indoor orders and assessed for time-to-initiation of treatment (TI) required and its accuracy. Ten resident doctors and ten nursing staff participated to grade both conventional and novel methods by using pre-printed forms of various parameters like time consumption, comfort level, accuracy and applicability in ward and these both methods were scored on a scale of 1 to 10.Results: Conventional method (CM) required 14.23±1.10seconds, while novel method (IM) required average 3.63±0.73seconds for calculation of drop rate. Average grading for conventional method was 3.63±0.49 and for novel method was 7.84±0.6 out of 10.Conclusions: Novel method of IV fluid drip drop rate formula is easy, quick and superior in comparison to conventional method and it doesn’t require any additional instrumental help. It is good alternative to conventional formula for IV drip drop rate calculation in absence of infusion pump.

Impact of coronary artery disease on augmentation index as measured by estimated central blood pressure: A case control study in Asian Indians

Aims We compared various components of blood pressure and arterial stiffness of healthy control with those of coronary artery disease (CAD) patients using BP+ machine™. Methods In this prospective, case-control study, total 585 individuals of both the genders were enrolled. The study population consisted of 277 controls (healthy siblings of diseased subjects not having CAD – group A) and 308 CAD patients (group B). Age and sex adjusted regression and receiver operative curve (ROC) analysis was performed to assess the strength of association of these parameters. Results We found that mean systolic blood pressure (SBP) (137.14 ± 22.49 vs. 129.26 ± 19.86), central systolic blood pressure (CSBP) (130.78 ± 21.89 vs. 117.53 ± 17.98), augmentation index (AI) (108.55 ± 44.98 vs. 49.38 ± 21.03) and pulse rate variability (98.82 ± 231.09 vs. 82.86 ± 208.77) were significantly (p < 0.05) higher in CAD population as compared to healthy counterparts. Left ventricular contractibility as measured by dP/dt was significantly lower in CAD patients. All these parameters were significantly abnormal in CAD as compared to healthy control population irrespective of the gender of the patient except for SBP in females. Both – odds ratio (1.108; 95% CI: 1.081–1.135; p < 0.0001) and ROC analysis (AUC: 0.937; 95% CI: 0.919–0.956; p < 0.0001) showed AI as the strongest predictor of CAD, closely followed by CSBP. Conclusion Central aortic blood pressure parameters such as AI and CSBP measured noninvasively with BP+ machine could be the effective predictors of CAD in Asian Indians.

Ebstein's anomaly: "The one and a half ventricle heart"

Abstract Objective: Ebstein's anomaly remains a relatively ignored disease. Lying in the 'No Man's land' between congenital and valve surgeons, it largely remains inadequately studied. We report our short-term results of treating it as a 'one and a half ventricle heart' and propose that the true tricuspid annulus (TTA) 'Z' score be used as an objective criterion for estimation of 'functional' right ventricle (RV). Methods: 22 consecutive patients undergoing surgery for Ebstein's anomaly were studied. Echocardiography was performed to assess the type and severity of the disease, tricuspid annular dimension and its 'Z' score. Patients were operated by a modification of the cone repair, with addition of annuloplasty, bidirectional cavopulmonary shunt (BCPS) and right reduction atrioplasty to provide a comprehensive repair. TTA 'Z' score was correlated later with postplication indexed residual RV volume. Results: There was one (4.5%) early and no late postoperative death. There was a significant reduction in tricuspid regurgitation grading (3.40±0.65 to 1.22±0.42, P<0.001). Residual RV volume reduced to 71.96±3.8% of the expected volume and there was a significant negative correlation (rho −0.83) between TTA 'Z' score and indexed residual RV volume. During the follow-up of 20.54±7.62 months, the functional class improved from 2.59±0.7 to 1.34±0.52 (P<0.001). Conclusion: In Ebstein's anomaly, a higher TTA 'Z' score correlates with a lower postplication indexed residual RV volume. Hence, a complete trileaflet repair with offloading of RV by BCPS (when the TTA 'Z' score is >2) is recommended. The short-term outcomes of our technique are promising.

Management of pulmonary alveolar proteinosis with whole lung lavage using extracorporeal membrane oxygenation support in a postrenal transplant patient with graft failure.

Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by accumulation of excessive lung surfactant in the alveoli leading to restrictive lung functions and impaired gas exchange. Whole lung lavage (WLL) is the treatment modality of choice, which is usually performed using double lumen endobronchial tube insertion under general anesthesia and alternating unilateral lung ventilation and washing with normal saline. It may be difficult to perform WLL in patients with severe hypoxemia wherein patients do not tolerate single lung ventilation. Extracorporeal membrane oxygenation support (ECMO) has been used in such patients. We report a patient with autoimmune PAP following renal transplant who presented with marked hypoxemia and was managed by WLL under ECMO support.