Salivary Cortisol Estimation to Assess Adrenal Status in Children with Fluid Unresponsive Septic Shock.

We evaluated the adrenal status by estimating baseline and ACTH stimulated salivary cortisol in 51 children with fluid unresponsive septic shock at 30 and 60 minutes, and basal salivary cortisol (9-11 am) in 79 healthy children. The baseline salivary cortisol (median,IQR) among patients (19.8, 7.2-42.4 nmol/L) was higher than healthy children (2.6, 1.3-7.6 nmol/L) (P=0.001). Non-survivors and those with catecholamine refractory shock had higher baseline cortisol level, though difference was statistically insignificant. Absolute adrenal insufficiency (baseline salivary cortisol <1.3nmol/L) was diagnosed in 8 (15.7%) patients. Relative adrenal insufficiency (rise in cortisol level above baseline value after stimulation <25nmol/L) was observed in 68.6% of all patients; 71.9% among non-survivors, and in 71.4% patients with catecholamine refractory shock. Salivary cortisol estimation appears to be feasible in children with septic shock. Relative adrenal insufficiency is common in these children.

Induced phytoremediation of metals from fly ash mediated by plant growth promoting rhizobacteria.

A study was carried out to observe the impact of a consortium of bacteria isolated from the fly ash on the metal accumulation by T. latifolia. When a consortium of bacteria Bacillus endophyticus NBRFT4 (MTCC 9021), Paenibacillus macerans NBRFT5 (MTCC 8912) and Bacillus pumilus NBRFT9 (MTCC 8913) was bioaugmented into the rhizosphere of T. latifolia, it enhanced the metal concentration in root, stem and leaves of the plants through increased bioavailability of metals Fe, Cd, Pb, Cr, Ni, Cu and Zn in the fly ash. Besides, these bacteria also promoted the plant growth perhaps due to utilization of ACC, synthesis of phytoharmones and solubilisation of essential metals found in fly ash. As compared to fly ash alone, the accumulation of Fe was maximally enhanced by 164%, 196%, and 251%, followed by Ni by 92%, 44% and 56%, Zn by 82%, 57% and 91%, Cu by 71%, 53% and 60%, Cr by 96%, 80% and 105 %, Pb by 119%, 87% and 140%, Cd by 80%, 109% and 115% in root, stem and leaves, respectively in fly ash with bacteria. Thus, an increased solubilisation of metals coupled with enhanced plant growth stimulated the phytoextraction of metals by T. latifolia from fly ash.

High Frequency Oscillatory Ventilation versus Synchronized Intermittent Mandatory Ventilation in Preterm Neonates with Hyaline Membrane Disease: A Randomized Controlled Trial.

This randomized controlled study was conducted to compare the efficacy and safety of High frequency oscillatory ventilation (HFOV) and Synchronized intermittent mandatory ventilation (SIMV) in preterm neonates with hyaline membrane disease requiring ventilation. The ventilation strategy in both the groups included achieving optimal lung recruitment and targeted blood gases. 49 patients received HFOV and 61 SIMV. The baseline characteristics were similar in both the groups. HFOV group demonstrated better early oxygenation, enabled reduction in oxygenation index (OI) within 24 h of ventilation (difference in mean OI at 1, 6, & 24 h of ventilation: P=0.004 in HFOV, and 0.271 in SIMV group). Duration of hospital stay was shorter in HFOV group (P=0.003). The complication rate and survival were similar in two groups.

NDM-1 Resistance: Fleming’s predictions become true.

Bacteria, beside other microorganisms are mainly responsible for human sufferings beside their beneficial effects. After discovery of Penicillin bacterial diseases were controlled to a much extent. The name ‘antibiotic’ makes us feel that we, humans are superior at least from microorganisms. Serious infections caused by bacteria that have become resistant to commonly used antibiotics have become a major global healthcare problem in the 21st century. Resistance to antibiotics shows that they can fight back and challenge our knowledge and intellect. Discovery of New Delhi metallo-1 make us feel that this is the result of our own ignorance. Indiscriminate, irrational and illogical use of antibiotics is helping bacteria to fight against us. What objections are being raised at the Govt. level, and how research community defends us, keeping that apart, the question is to realize and resolve the threat rather than to overlook it. Our outlook need to be changed and health policies and guidelines need to be reevaluated and overhauled timely.

Light-emitting Diodes versus Compact Fluorescent Tubes for Phototherapy in Neonatal Jaundice: A Multi-center Randomized Controlled Trial.

Objective: To evaluate whether light-emitting diode (LED) phototherapy is as efficacious as compact fluorescent tube (CFT) phototherapy for the treatment of nonhemolytic jaundice in healthy term and late preterm neonates. Study design: Multi-centre open-label randomized controlled trial. Setting: Four tertiary care neonatal units. Subjects: Healthy term and late preterm neonates with nonhemolytic jaundice. Intervention: Single-surface LED or CFT phototherapy. Primary outcome variable: Duration of phototherapy. Results: A total of 272 neonates were randomized to receive LED (n=142) or CFT (n=130) phototherapy. The baseline demographic and biochemical variables were similar in the two groups. The median duration of phototherapy (IQR) in the two groups was comparable (26 (22-36) h vs. 25(22-36) h; P=0.44). At any time point, a similar proportion of neonates were under phototherapy in the two groups (log-rank test, P=0.38). The rate of fall of serum total bilirubin (STB) during phototherapy and the incidence of ‘failure of phototherapy’ were also not different. An equal proportion of neonates had a rebound increase in STB needing restarting of phototherapy. Side effects were rare, comparable in the two groups and included hypothermia, hyperthermia, rash, skin darkening and dehydration. Conclusions: LED and CFT phototherapy units were equally efficacious in the management of non-hemolytic hyperbilirubinemia in healthy term and late-preterm neonates.

Body composition & cardiovascular functions in healthy males acclimatized to desert & high altitude.

BACKGROUND & OBJECTIVES: Several physiological changes affecting physical fitness occur in humans whenever they are exposed to extremes of environments such as heat, cold and high altitude (HA). The present study was undertaken to evaluate effect of stay in desert and HA on physical fitness and body composition of physically active individuals. METHODS: Study was conducted on three groups of male soldiers (n=30 in each group) at different climatic conditions i.e., temperate (plains of north India), hot desert (Rajasthan), and HA (3600 m) in Western Himalayas. Subjects were acclimatized to hot and HA environments and had similar BMI (body mass index). Body fat, lean body mass, haemoglobin levels were determined along with, blood pressure and physical fitness index (PFI). RESULTS: The body fat of subjects at temperate, desert and HA was found to be 15.4, 12.8 and 16.9 per cent respectively. The resting heart rate and blood pressure were higher in altitude group in comparison to others. PFI score of volunteers at temperate, desert and HA were found to be 97.4 +/- 10.3, 92.4+/- 14.4 and 83.8 +/- 6.2 respectively. INTERPRETATION & CONCLUSION: A combination of different factors i.e., higher resting pulse rate, increased blood pressure and body fat may be responsible for lower PFI at HA. The observed differences in body fat content of different groups could be an adaptive feature to the environment.

The efficacy and safety of low dose epidural butorphanol on postoperative analgesia following cesarean delivery.

Butorphanol is considered an effective and safe analgesic after cesarean delivery but is associated with profound dose-dependent sedation. Somnolence may cause hindrance in early mother-baby interaction. This study was designed to assess the analgesic efficacy and to monitor side-effects of low doses (0.5 mg and 0.75 mg) of epidural butorphanol with bupivacaine compared to bupivacaine alone in parturients following cesarean delivery. One hundred and twenty parturients (American Society of Anesthesiologists physical status 1 and 2) undergoing cesarean delivery were allocated into three groups: group 1 received epidural 0.125% bupivacaine while group 2 and 3 received an additional 0.5 mg and 0.75 mg butorphanol respectively. A combined spinal, epidural technique was used. Spinal anaesthesia was used for surgery. The epidural route was used for postoperative analgesia with the study drug. Onset, duration and quality of analgesia, lowest visual analogue scales (VAS) score, and side effects were noted. The onset and duration of analgesia in group 2 (4.1+/-2.6 min and 202.4+/-62.8 min) and group 3 (4.0+/-2.5 min and 192.3+/-69.1 min) were significantly different (P<0.01) from group 1 (6.6+/-2.7 min and 145.7+/-89.6 min). The quality of analgesia in terms of time to first independent movement and satisfactory VAS were statistically better (P<0.01) in group 2 (3.9+/-0.3 hour and 8.1+/-0.1 mm) and group 3 (3.8+/-0.4 hour and 8.1+/-0.9 mm) than in group 1 (5.2+/-0.4 hour and 6.3+/-1.3 mm). The incidence of sedation was 5% in all the three groups. A lower dose of epidural butorphanol with bupivacaine produces a significantly earlier onset, longer duration and better quality of analgesia than bupivacaine does.

Small-cell neuroendocrine tumor of larynx: a rare presentation.

Neuroendocrine tumors of the larynx are extremely rare and represent < 1% of all primary laryngeal tumors. We report a case of a 55-year-old man who presented to us with laryngeal tumor, histopathological evaluation of which revealed it to be a neuroendocrine tumor. Diagnosis is based mostly on light microscopy and may be supported by special histochemical stains in some instances.

Use of RAPD fingerprinting for delineating populations of hilsa shad Tenualosa ilisha (Hamilton, 1822)

RAPD was used to delineate the hilsa populations sampled from the Ganga, Yamuna, Hooghly, and Narmada Rivers at six different locations. Six degenerate primers were used to generate the fragment patterns from the samples collected. All primers were highly polymorphic and generated high numbers of amplification products. Nei's genetic distances were calculated between locations. The overall average genetic distance among all the six locations was 0.295. The Fst value within the Ganga was 0.469 and within the Hooghly it was 0.546. The overall Fst value for the six populations analyzed was 0.590. The UPGMA dendrogram clustered the hilsa into two distinct clusters: Ganga and Yamuna populations and the Hooghly and Narmada populations.

Comparative study of complex spina bifida and split cord malformation.

OBJECTIVE: To see the difference in clinical profiles, radiological findings and surgical outcome of the group 1 split cord malformation and meningomyelocele (SCM with MMC) from group 2 (SCM without MMC). METHODS: 46 patients of SCM were selected from a total of 138 cases of spinal dysraphism. They were divided into two groups, based on presence or absence of MMC. Group I (SCM with MMC) n =19 patients and Group II (SCM without MMC) n=27 patients. A detail clinical evaluation and MR screening of whole spine of all cases was performed. All patients underwent surgical detethering of cord. After an average follow-up of 1.7 years, the operative results were clinically assessed and statistical significance was calculated. RESULTS: Male to female ratio was 1:09. Mean age of presentation was 3.6 years. Cutaneous markers like tuft of hair, cutaneous haemangioma, etc, had a higher incidence in group II in comparison to group I (50% vs 10.5%). The incidence of motor deficits was significant in group I in comparison to group II (63% vs 40%). The incidences of sensory loss, trophic ulcers, sphincteric dysfunction and muscle atrophy were relatively more common in group I patients, while neuro-orthopedic deformities such as congenital telepes equinovarus (CTEV), scoliosis and limb shortening were more frequent (67%) in group II children as compared to group I (53%). Type I SCM has higher incidence in group I children. Low lying conus were found in 47% patient of group I, while in group II it was noticed in 69%. The associated cranial anomalies like hydrocephalus, ACM and syrinx, were slightly higher in group I patients. At surgery, dysgenetic nerve roots, neural placode, arachnoid bands and atrophic cord were seen mainly in group I. Postoperative complications like, CSF leak, pseudomeningocele and meningitis were more commonly encountered in group I patients. The patients of group II showed better operative outcome compared to group I cases. CONCLUSION: Incidence of SCM with MMC amount to 41% of total SCM cases. Progressive neurological deficit was higher in this group (SCM with MMC) in comparison to the group harboring SCM without MMC. In view of a significant association of SCM in MMC cases, associated with other craniospinal anomalies, a thorough screening of neuraxis (by MRI) is recommended to treat all treatable anomalies simultaneously for desired outcome.

Effect of hypoxia on the circulating levels of essential mineral elements in rats.

Changes occurring in concentrations of certain trace metals and electrolytes viz. chromium, copper, zinc, sodium, potassium, calcium, magenesium and chloride in plasma of rats exposed to intermittent hypobaric hypoxia were evaluated. Batches of Sprague-Dowley rats (12 in each group) were exposed for 1, 7,14 and 21 days to a simulated altitude 7,620 m for 6 h per day and one group of unexposed animals was kept as control. There was a significant rise of 153% in plasma chromium levels of 1 day exposed group in comparison to the unexposed group which tends to normalise on subsequent exposure. There was a gradual increase in plasma copper levels of 9.0, 28.2, 62.6 and 65.6% respectively in 1,7,14 and 21 days exposed rats in comparison to unexposed rats. On the other hand plasma zinc levels were seen to be decreasing during entire exposure. Plasma sodium levels decreased initially in 1 and 7 day exposed rats and increased in later groups whereas plasma potassium levels of exposed groups remained low in comparison to unexposed group. Chloride levels were found to be elevated in 14 and 21 day exposed groups.The plasma calcium and magnesium levels were higher in all exposed groups over unexposed groups. Changes in chromium, copper and zinc observed in the present study during exposure to hypoxic stress may be responsible for the hyperglycemia and anorexia encountered during intial phase of high altitude acclimatisation.

A probability model for the number of births in an equilibrium birth process.

A probability model for the number of complete conceptions (that is, live births) taking into account foetal wastages, occurring in a couple during a specified period of time (T0, T0+T) is developed assuming that the data was collected starting a long time after marriage. A method of estimating some of the underlying parameters is given. The model is applied to data obtained in a Varanasi Survey in 1969 -70.