Co-Relation of Risk Factors for Surgical Site Infection in Patients Undergoing Surgery For Carcinoma of Breast

Background: Breast malignancy is one of the highest ranked malignancy occurring among Indian females, overall incidence being 25 per 1, 00,000 females varying across different states. Breast cancer surgeries are one of the commonest surgeries being conducted which is considered to be a clean procedure pretending to be at lower risk of complications. However it is has been observed that patient develops surgical site infection at an increased rate approximately 19% which leads to poor quality of life, increased hospital stay and delay in commencement of adjuvant therapies. The aim is to Co-relate risk factors for surgical site infection in patients undergoing surgery for carcinoma of breast. The objective of this study was to observe the relation of surgical site infection and its associated risk factors in the patient undergoing surgery for carcinoma breast.Material & Methods:We analyzed 50 patients diagnosed with carcinoma breast and operated for the same in Teerthanker Mahaveer Medical College & Research Centre, Moradabad, Uttar Pradesh. Patients were divided into two groups, Group A who develop surgical site infection and Group B who don抰 develop surgical site infection. All the predisposing factors including age, BMI, Addiction, co morbidity, Neo-adjuvant therapy, preoperative total leucocyte count were recorded. An observation was done with above mentioned risk factors and correlated with development of surgical site infection.Results:In our study we found that the risk factors associated with surgical site infection post breast cancer surgeries were age, BMI, co morbidity, Addiction and Neo-adjuvant therapy.Conclusions:Patients of Age more than 50years or who underwent Mastectomy or having associated co-morbidity with co-relation to Smoking & BMI more than 30, with Increased TLC count or who have received Neo-adjuvant chemotherapy are associated with increased risk of SSI following breast surgery which has led to increased hospital stay. There are many other studies who also concluded the relation of above factors with development of SSI post breast surgery, however further research is needed to elucidate the effect of prior manipulation and radiation therapy in development of SSI.

Lefamulin: novel pleuromutilin drug for community acquired bacterial pneumonia

The advent and spread of antimicrobial resistance has led to a global public health emergency necessitating development of new antimicrobial drugs. Community acquired bacterial pneumonia (CABP) contributes a major portion of societal burden with increasing morbidity due to evolution of drug resistant strains. Lefamulin is a novel pleuromutilin antibiotic with unique mechanism of action through inhibition of protein synthesis by binding to the peptidyl transferase center of the 50s bacterial ribosome. The drug displays activity against Gram positive and atypical organisms associated with CABP (i.e., Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumonia, Legionella pneumophila, and Chlamydophila pneumoniae), with an expanded Gram-positive spectrum including Staphylococcus aureus (i.e., methicillin-resistant, vancomycin-intermediate, and heterogeneous strains). Lefamulin is available in both intravenous (IV) and per oral (PO) formulation, exhibits high nonlinear plasma protein binding with low unbound concentrations, higher concentrations in lung epithelial lining fluid (ELF) than in plasma, and a half-life of approximately 10 hour. The recommended IV dose is 150 mg twice daily over 1 hour or a PO dose of 600 mg twice daily. Most common adverse drug reactions injection site reactions, hepatic enzyme elevation, nausea, diarrhoea, hypokalemia, insomnia, and headache. Clinical trials for lefamulin have been positive and Phase 3 data suggest similar efficacy when compared to moxifloxacin with or without linezolid in CABP. Also, the documented resistance and cross-resistance with other Gram-positive antibacterials remains low. With Nabrivia Pharmaceuticals having already received US FDA approval in August 2019, lefamulin may soon be a new addition to the mounting armoury of drugs against CABP.

Assessment of genetic divergence of mango genotypes using multivariate techniques

Aim: The study was carried out to assess the overall genetic variability of 60 mango (Mangifera indica) genotypes for important fruit quality and yield characteristics to select better parents for mango breeding programme. Methodology: A total of 17 variables were scored and subjected to multivariate analysis. ANOVA, descriptive statistics, cluster analysis and principal component analysis were used to investigate variability among the genotypes for the selected traits. Results: Significant phenotypic variability was observed for studied traits. Cluster analysis classified all genotypes into two major groups according to shared similarity. Principal component analysis revealed that traits like fruit weight, fruit diameter, pulp content and pulp: stone ratio contributed positively, while fruit shape index, TSS:acid ratio, stone and peel traits contributed negatively for a large proportion of the observed variability. Interpretation: Pusa Arunima, Pusa Shresth, Pusa Lalima, Mallika, Ramkela, Amrapali, Extreema, Neelum, Gulab Jamun, S.B. Alibagh, Tommy Atkins, Primor-de-Amoreira genotypes were found unique for fruit and yield attributing traits, thus making them potential donor parent for fruit weight, fruit color, fruit diameter, fruit shape, pulp and pulp: stone traits in mango hybridization programme.

Anatomical variations of coronary artery and frequency of median artery: A cadaveric study from Northern India.

Introduction: Clinicians and anatomists have been examining coronary artery variations for a long time. However, there is still no consensus on the normality or abnormality of coronary arteries. The present survey was therefore conducted to find out the variations in left coronary artery (LCA) and right coronary artery (RCA) branches, the existence and occurrence of the median artery in northern Indian population.Material and methods: The present study was planned and conducted during March 2012 to September 2014 at Department of Anatomy, Major S. D. Singh Medical College, Fatehgarh; a tertiary care teaching hospital. The hearts of 40 adult northern Indian cadavers fixed with 10% formaldehyde were used. To determine the dominant circulation, the artery that supplies the posterior inter ventricular sulcus was investigated. Dissections were performed under a dissection microscope and photographed. Results: LCA branched out of the aortic sinus in all the hearts and had an average diameter of 4.44 ± 1.79 mm. In 45% hearts, the LCA was separated into the anterior inter ventricular branch and the circumflex branch (bifurcation). In 42.5% hearts, in addition to the anterior inter ventricular branch and the circumflex branch; there was a median artery that coursed on the front wall of the left ventricle (trifurcation). In 10% hearts, branching occurred as in trifurcation but with two median arteries emerging from the LCA (quadrifurcation). Myocardial bridges were found on the LCA branches in 19 of the 24 hearts in which the median artery existence of the median artery and myocardial bridges. The median artery might be important as it may not result in any clinical symptom for many years in a large number of subjects. Knowledge of individual and racial variations in coronary arteries is essential for the diagnosis and treatment of coronary artery patients.

Colobronchial fistula: A rare cause of chronic cough.

We report a colobronchial fistula in a middle-aged woman. She had been having cough with expectoration of sputum with a faeculent odour since the age of 7 years. Imaging revealed a fistulous connection between the hepatic flexure and the right bronchial tree, which was successfully repaired surgically.

Trace elements in nungsham, the red edible algae of Manipur.

Energy Dispersive X-ray Fluorescence (EDXRF) technique was used for the determination of trace elements in wild red edible algae. The elements so far detected were discussed for their importance in the food item in addition to the monitoring the pollution levels of the fresh water where they grew as algae is one of the best bioaccumulator of heavy elements.

Impact of rhizobacteria on growth and chromium accumulation in Scirpus lacustris L. grown under chromium supplementation.

Four chromate tolerant rhizobacterial strains viz., RZB-01, RZB-02, RZB-03 and RZB-04 were isolated from rhizosphere of Scirpus lacustris collected from Cr-contaminated area. These strains characterized at morphological and biochemical levels. The most efficient chromate tolerant strain RZB-03 was inoculated to fresh plant of S. lacustris and grown in 2 μg ml -1 and 5 μg ml -1 of Cr +6 supplemented nutrient solution under controlled laboratory condition. The effects of rhizobacterial inoculation on growth and chromium accumulation in S. lacustris were evaluated. The inoculation of rhizobacteria increased biomass by 59 and 104%, while total chlorophyll content by 1.76 and 15.3% and protein content increased by 23 and 138% under 2 μg ml -1 and 5 μg ml -1 concentrations of Cr +6, respectively after 14 d as compared to non-inoculated plant. Similarly, the Cr accumulation also increased by 97 and 75% in shoot and 114 and 68% in root of inoculated plants as compared to non inoculated plants at 2 μg ml-1 and 5 μg ml-1 Cr+6 concentrations, respectively, after 14 d. The chromate tolerant rhizobacteria which play an important role in chromium uptake and growth promotion in plant may be useful in development of microbes assisted phytoremediation system for decontamination of chromium polluted sites.

Chromium (VI) induced phytotoxicity and oxidative stress in pea (Pisum sativum L.): Biochemical changes and translocation of essential nutrients.

Due to widespread industrial use, chromium (Cr) is considered a hazardous environmental pollutant. It is known to inhibit plant growth and development. The present study provides the evidence of the phytotoxicity of this metal on the pea (Pisum sativum L. cv Azad) plants. The plants of pea (Pisum sativum L.) were grown in refined sand under different concentrations i.e. 0.05, 0.1, 0.2, 0.3 and 0.4 mM of Cr (VI) in order to study the effect on growth and yield, photosynthetic pigments, relative water content, non-reducing sugar and protein with activity of certain enzymes like catalase, peroxidase, starch phosphorylase and ribonuclease. The analysis of the results showed that photosynthetic pigments (68.68%), relative water contents (62.77%), non-reducing sugar (66.66%) and protein (81.57%) were decrease along with reduction in plant height (52.69% ) and leaf area (50.81%) of the pea plants. However, in response to various concentration of Cr exposed plants showed significant induction of reducing and total sugars with enzymes like catalase, starch phosphorylase and ribonuclease. The translocation of Cr in various part of pea plant have been found in order of root> stem> leaves>seeds which ranged between 34.8 to 217.3 mg g-1 d.wt. (dry weight) in roots, 6.5 to 173.13 mg g-1 d.wt. in shoot, 4.2 to 74.43 mg g-1 d.wt. in leaves and 0.94 to 8.64 mg g-1 d.wt. in seeds, that is also reflected by the transfer factor of Cr from refined sand to tested species.

Simultaneous appearance of dual malignancies of hematopoietic system-multiple myeloma and acute myeloid leukemia.

We herein report a case of denovo and simultaneous appearance of multiple myeloma and acute myeloid leukemia in a 58-year-old female patient, without prior exposure to chemotherapy or radiotherapy. This case is reported because of its extreme rarity.

Isolation and characterization of chromate resistant bacteria from tannery effluent.

The tannery effluent emanating from Common Effluent Treatment Plant (CETP), Unnao (U.P, India) was found toxic in nature, having high BOD, COD, TDS and Cr content (5.88 mg l(-1)), which supported growth of chromate tolerant bacteria. Several chromate tolerant bacteria have been isolated from these effluent and maximum tolerant four strains (NBRIP-1, NBRIP-2, NBRIP-3 and NBRIP-4) were characterized in this study. These strains showed multiple metal and antibiotic resistances. Growth of these strains was reduced at higher Cr concentration with extention of lag phase. Chromium accumlulation by these isolates may have a great potential in recovery and detoxification of Cr from tannery effluent.

Comparative immunopotentiating properties of saponin and incomplete Freund's adjuvant coupled to affinity purified larval antigen of Hyalomma anatolicum anatolicum.

Comparative immunostimulatory properties of saponin and incomplete Freund's adjuvant (IFA) were studied using affinity purified 39 kDa larval antigen of Hyalomma anatolicum anatolicum. Significant antibody response to 39 kDa antigen was detected in the sera of rabbits immunized with both 39 kDa plus saponin and 39 kDa plus IFA in comparison to their corresponding control animals. Insignificant differences were noted in the antibody response between the animals of two immunized groups. Upon challenge, the animals immunized with 39 kDa plus IFA rejected 76.2 +/- 9.7% of larvae and 45.8 +/- 4.1% of adults while in group of animals injected with 39 kDa plus saponin rejected 80.9 +/- 11.2% of larvae and 47.2 +/- 5.7% of adults.

Some unusual and severe forms of adverse drug reactions: a call for setting adverse drug reaction monitoring centres.

Thirty four patients aged 14 to 65 years (18 males and 16 females) admitted to the University Hospital with various unusual and severe forms of adverse drug reactions were studied. It comprised of toxic epidermal necrolysis in 8 patients, systemic vasculitis in 7 of which 3 patients had gangrene of fingers and/or toes, severe erosive gastritis in 9 patients, Stevens-Johnson syndrome in 7 patients, thrombocytopenic purpura in 2 patients and generalised convulsions in 1 patient. Various drugs responsible for causing these adverse drug reactions included antibacterials, antimalarials, anticonvulsants, antituberculars and nonsteroidal anti-inflammatory drugs. Most of the patients recovered. However, 5 of the 8 patients having toxic epidermal necrolysis died of which 2 patients had developed tetanus as a preterminal event. In view of ongoing addition of newer drugs to the therapeutic armamentarium and an increasing incidence of various unusual and severe forms of adverse drug reactions, it is our contention that a separate adverse drug reaction monitoring cell should be established in every hospital setting.

A pilot study of polyunsaturated phosphatidyl choline in fulminant and subacute hepatic failure.

Present pilot study was conducted to evaluate efficacy and safety of polyunsaturated phosphatidyl choline (PPC) in a phase III clinical trial in patients of fulminant and subacute hepatic failure over one year period in a prospective randomised blinded controlled design. We found that in patients of fulminant hepatic failure, recovery period from encephalopathy was faster and mortality rate lower in the test group of patients who received PPC in a dose of 350 mg thrice daily for 6 to 8 weeks as compared to the control groups who did not receive it. In the patients of subacute hepatic failure, recovery from encephalopathy was faster, mortality rate lower and regression of ascites was significantly higher (P = 0.0022) in test group of patients who received PPC as compared to the control group. However, as the number of patients in the present pilot study is small, we propose that larger clinical trials are warranted in this direction to prove the efficacy and safety of PPC in fulminant and subacute hepatic failure.

The value of sonography for estimation of liver volume by using a simple geometric formula ascertained in cadaveric livers.

Accurate assessment of liver size and its volume are important. However, as the clinical methods do not produce reliable results especially when the liver is shrunken, and the previous attempts to accurately assess liver volume by radio-isotopes, CT scans and computer assisted ultrasonography have not gained popularity due to high cost and complex techniques, the need to devise a simpler technique for estimation of liver volume continues. In doing so, we estimated volume of 10 cadaveric livers by water displacement technique to serve as the reference value. Thereafter, assuming the shape of liver like a right-angled pyramid, we calculated its volume by a simple geometric formula of '1/2 abc'. However, a reduction of 15% was made from this to compensate for depression on the inferior surface of liver. This method was subsequently implemented to assess liver volume of 14 healthy individuals and 20 patients of fulminant hepatic failure (FHF) by using ultrasonography. Our findings revealed smaller liver volume in Indians as compared to the reported Western figures, and a significantly smaller liver volume in females as compared to males. The liver volume of 6 FHF patients who died was significantly smaller (696.5 +/- 143.5 cm3) as compared to that of the 14 FHF patients who survived (1083 +/- 365.3 cm3). Moreover, mortality rate was 100 per cent in 3 patients of FHF who showed markedly shrunken globular liver with a liver volume of less than 500 cm3. Thus, a markedly reduced liver size in FHF patients suggests a poor prognosis. However, since the number of FHF patients in the present series is small, it is our contention that a larger series is mandatory to confirm the findings of the present study.