ABSTRACT
Background:Drug utilization evaluation(DUE)is defined by the World Health Organization(WHO)and focuses on the medical,social,and economic consequences of pharmaceutical marketing,distribution,prescribing,and usage in society.The WHO recommends a physician to every 1 000 people.According to the recent data from the Health Ministry in 2019,in which 1.16 million doctors are of active population with just 80%,or 0.9 million,practicing.As a result,a ratio of 0.68 doctors for every 1 000 people,which is much below as per the WHO reports.This article describes history,types,WHO guidelines,need and purpose of DUE.Objective:The main aim of this paper is to provide information about the rational use of medication in outpa-tient and inpatient department with special emphasis of DUEs.It also provides awareness directly to healthcare professionals,researchers,academicians,pharmacist and nurses to reduce the irrationality of medicines.Methods:The method used to compile this review information gathered from websites,Google scholar,PubMed,Research gate,and studies published on DUE from July 20 to Oct 22 were included as source of information.Results:We studied more than 35 published study on DUE,that reveals most of the physicians prescribed branded drugs not generic drugs,but WHO prescribing indicator allows to prescribe generic drugs in the hospital pharmacy to maintain better inventory control.It may also help to prevent pharmacist misunderstanding during dispensing.Conclusion:The use of generic prescription names avoids the possibility of medication product duplication and lowers patient costs.It is important to remember that incorrect medication prescriptions have impact on both patients and their family members.WHO indicators identify irrational prescribing behaviours to make therapy more rational and cost-effective.
ABSTRACT
Aims: Thymectomy specimens are uncommon in routine histopathology practice. However, awareness of various pathologic entities and definite reporting of these specimens is paramount to optimal patient management. Our objective was to determine the histomorphologic spectrum of thymectomy specimens spanning the non-neoplastic, benign to malignant spectrum. Methods and Results: Thymectomies received over an 8-year period were retrospectively analyzed by reviewing clinical details and histologic findings in detail, incorporating the latest World Health Organization (WHO) 2015 histologic classification. A total of 303 thymectomy specimens (179 males/124 females, mean age 45.3 years [3–84 years]) were included. Around 51.2% (n = 155) patients had associated myasthenia gravis (MG), while 17.5% (n = 53) had incidentally detected anterior mediastinal mass (AMM). Non-neoplastic and benign pathologies comprised 31% (n = 94) cases and showed stronger association with MG (P = 0.009). Thymic follicular hyperplasia (TFH) was the commonest non-neoplastic pathology (n = 32), while the benign tumor group included thymic hemangioma/lymphangioma, thymolipoma, and ectopic parathyroid adenoma. Thymic epithelial tumors (TETs) comprised 64.7% cases, with majority being thymomas (185/303; 61.1%). Thymoma type B2 was the commonest histologic subtype and Stage I/T1 was the most frequent stage. Type A and AB thymomas affected older patients (P = 0.005) and were in lower stage (both Masaoka and American Joint Committee on Cancer [AJCC]) than type B thymomas (P = 0.007). No significant association between MG and thymoma subtype, patient sex or Masaoka stage was seen (P > 0.05). Thymic carcinomas comprised 11 cases and showed no association with MG (0/11, P < 0.001); squamous cell carcinoma was the commonest histologic type (8/11; 72.7%). Conclusion: TETs are the commonest thymic lesions; however, a diverse spectrum of pathologic processes can affect the thymus.
ABSTRACT
The objective of this research work is related to the fact that the source of isolation and acclimatization process influences the microorganism’s potential for the decolorization of various substances. Some of the widely used anthraquinone vat dyes decolorization by the pure bacterial strain is a significant aspect that will assist in the in-situ bioremediation of the ecosystem.The present study is to evaluate the enhanced decolorization of Vat Brown R by an isolated bacterium, Pseudomonas aeruginosa NCH, from textile dye wastewater under aerobic conditions. The effect of pH, temperature, and inoculum size was optimized using response surface methodology with the box-behnken experimental design. The strain NCH showed maximum decolorization efficacy under optimum conditions at pH9.76, temperature 34.69?C, and an inoculum size of 9.51% (v/v), respectively. A decolorization of 90.34% was observed with 100 mg L?1of Vat Brown R within 18h under these conditions. Confirmatory experiments have verified the optimum combination of the three variables predicted by RSM. Kinetics study was carried out using various approaches: Michaelis-Menten (Vmax = 29.1 mg L?1 h?1 and Km = 25.2 mg L?1), Lineweaver-Burk (Vmax = 30.12 mg L?1 h?1 and Km = 26.91 mg L?1), and Eadie-hofstee model (Vmax = 30.23 mg L?1h?1and Km = 27.29 mg L?1), and the results showed that the degradation followed a first-order reaction kinetics. The subsequent degradation of the dye and the formation of metabolites were studied using analytical techniques such as UV-vis spectroscopy and FT-IR analysis. UV-vis spectroscopy validated the detoxification of the dye and confirmed that Pseudomonas sp. NCH overcomes this decolorizing activity through biodegradation. This study investigated the highest decolorization efficiency of strain NCHused in the biodegradation of wastewaters containing anthraquinone dyes.
ABSTRACT
Objective: To document morbidities in adolescents with cystic fibrosis (CF) from India. Methods: Details of children with cystic fibrosis surviving beyond 15 years of age were extracted from hospital records, and analyzed. Results: 43 children [Median (IQR) age 18.7 (17, 20.6) years, were enrolled. Median (IQR) body mass index was 15.82 (13.5, 19.05) kg/m2. Pseudomonas species were isolated from respiratory specimens of 34 (79%) adolescents. Allergic bronchopulmonary aspergillosis (ABPA) and Cystic fibrosis-related diabetes (CFRD) were seen in 12 (28%) and 11 (26%) patients, respectively. Conjugated hyperbilirubinemia and distal intestinal obstruction syndrome (DIOS) were diagnosed in 15 (35%) and 6 (14%) children, respectively. Pseudomonas species colonization (P=0.04) and multiple pulmonary exacerbations in last one year (P<0.001) were significant predictors of FEV1% predicted. Conclusion: Malnutrition, chronic airway colonization, ABPA, CFRD, conjugated hyperbilirubinemia and DIOS are morbidities observed in adolescents with CF in India. The data support the need for early screening of CF-associated morbidities.
ABSTRACT
Ascertaining the genetic variability and its relationships among valuable genetic resources is important for crop improvement programme. Here, we assessed the response of eleven wheat (Triticum aestivum L.) genotypes using cluster and principal component analysis (PCA) based on morphophysiological data and yield under nine different environments. Wheat genotype WH 1080 maintained higher photosynthetic efficiency under individual stress of 50% water deficit (drought) and 100 mM NaCl (salt), whereas under interactive stresses KRL 370 and KRL 283 were found to be the best genotypes. The highest value of Na+/K+ ratio in shoots was recorded for WH 1080 (1.167) and lowest in KRL 283 (0.612) under combined stresses. Proline accumulation was maximum in KRL 330 (3.17 mg g-1 FW) and minimum in KRL 283 (2.8 mg g-1 FW). Significantly higher reduction (73.4%) was observed in HD 2009 for grain weight/plant at 100 mM NaCl + 50% WD stress treatment whereas minimum reduction of 39.18% was recorded in KRL 370 in comparison to the control treatment. The PCA showed that the first three components comprising about 91% of the total variation for which the variables were analyzed. AMMI model revealed KRL 210 to be stable genotype as being close to center on biplot. E5 environment (100 mM NaCl) was most stable followed by E9 (50% WD + 100 mM NaCl). HD 2888, C-306, HD 2851 and HD 2009 were having positive interaction with E1 (Control) whereas WH 1080 had positive interaction with water deficit environments i.e. E2 and E3 (25 and 50% WD) while KRL 433 had highest positive interaction with combined water deficit and salt stress environments E6, E7, E8 and E9, followed by KRL 370. Similarly, KRL 283, KRL 330, KRL 210 and Kharchia 65 had high positive interaction with saline environments E4 and E5. Findings of the experiment would be beneficial to wheat breeders, specifically the location-specific promising genotypes could possibly be used to develop/breed MAGIC populations to tag genes/alleles conferring drought and salinity tolerance.
ABSTRACT
Adamantinoma of the long bones is an exceedingly rare and slow-growing tumor that affects the diaphysis of long bones, particularly the tibia. Based on the pattern of the epithelial cell component and the presence or absence of the osteofibrous dysplasia-like element, several histological variants have been described, such as (i) tubular (the most frequent), (ii) basaloid, (iii) squamous, (iv) spindle variant, (v) osteofibrous dysplasia -like variant, and (vi) Ewing's sarcoma - like adamantinoma (the least frequent). The diagnosis may be challenging since this tumor may be mistakenly interpreted as carcinoma, myoepithelial tumor, osteofibrous dysplasia, and vascular tumor. We report the case of a 41-year-old male who presented with swelling over the right leg associated with pain. The X-ray showed a lytic lesion of the right-sided tibia. The diagnosis of adamantinoma was made based on the clinico-radiological, histomorphology, and immunohistochemical findings. Histologically, classic adamantinoma is a biphasic tumor characterized by epithelial and osteofibrous components in varying proportions and differentiating patterns. The diagnosis can be confirmed by immunohistochemistry for demonstrating sparse epithelial cell nests when the radiological features are strongly consistent with adamantinoma. This case is highlighted because the epithelial component can lead to a misdiagnosis, particularly when the clinico-radiological features are overlooked. Adamantinoma of long bones has the potential for local recurrence and may metastasize to the lungs, lymph nodes, or other bones. The prognosis is good if early intervention is taken.
Subject(s)
Humans , Male , Adult , Tibia/pathology , Adamantinoma/pathology , DiaphysesABSTRACT
Collision tumors have been reported in various organs like the gastrointestinal tract, lung, skin, adrenals, central nervous system, lymph nodes, uterus, but are rarely seen in the ovary. Collision tumors are two histologically distinct neoplasms in the same organ without any intermixture between them. Here we present a case of a collision tumor of the ovary represented by a mucinous cystadenoma and teratoma. It is imperative for a surgical pathologist to correctly diagnose the collision tumor components and differentiate them from mixed tumors as it will dictate the appropriate treatment based on the individual biological aggressiveness of each component.
Subject(s)
Humans , Female , Adult , Teratoma/pathology , Cystadenoma, Mucinous/pathology , Ovarian Neoplasms/complications , Diagnosis, DifferentialABSTRACT
Total Quality Management (TQM) is a managerial and managemental approach of an organization focused on quality, based on participation of all of its members and while aiming at long term benefits to the organization and consumers health. It is focused on continuous improvement of all processes approached with combined fundamental management techniques and specialized tools under quality systems. TQM is a process of managing the whole organization so that it progress in all the dimensions of products and services that are important to the consumers. It roots from the belief that mistake can be avoided or mininimised and defects can be prevented, with sole objective being the continuous process improvement. The introduction of Hazard Analysis Critical Control Point (HACCP) has signaled a shift in emphasis from resource intensive end product inspection and testing to preventive control of hazards at all the stages of food supply chain. It also identifies and controls hazards that are fundamentals for food safety. The integrated approach to implementation of ISO standards and HACCP concept is vital for management of quality and safety of dairy products hence safeguarding the customer’s requirements, ensuring that certified products conform to minimum standards set internationally. These standards ensure and enhance transparency in the development of food quality and safety procedures, thus helping to upgrade and update food safety systems. ISO laid down guidelines, codes, specifications and requirements to evolve effective TQM system.
ABSTRACT
Fundamentos: la hipertensión arterial es el cuarto principal factor de riesgo de muerte e incapacidad, así como el responsable de más de 1.6 millones de fallecimientos en la India. Los informes de casos clínicos, los estudios observacionales y los ECA evidencian los efectos de los medicamentos homeopáticos en la hipertensión. Objetivos: los resultados de este estudio se añaden a la evidencia de la eficacia del uso de los medicamentos homeopáticos individualizados en la hipertensión de estadio I. Materiales y métodos: Se ha realizado un ensayo aleatorizado, simple ciego y controlado por placebo entre octubre de 2013 y marzo de 2018. El parámetro primario fue evaluar los cambios en la presión sistólica (PS) y la presión diastólica (PD) mensualmente durante tres meses. 217 pacientes de los 2,127 pacientes examinados cumplieron los criterios de selección y fueron aleatorizados para recibir un medicamento en potencias Q (o potencias LM) más indicaciones para la modificación del estilo de vida (MEV) (116 pacientes) o bien placebo + MEV (101 pacientes). La modificación del estilo de vida incluyó actividad física y dieta como parte de la pauta terapéutica. El análisis fue de intención de tratamiento. Resultados: Las mediciones ANOVA repetidas entre los grupos mostraron una diferencia estadística significativa (Lambda de Wilks 0.85, F=12.12, dF=213, P=0.0001) tanto en la PS como en la PD a favor de la Homeopatía individualizada. La prueba t independiente post hoc mostró una reducción media significativa de la PS [diferencia media 7.12 mmHg, IC del 95%; CI 4.72 a 9.53, P=0.0001] y un descenso medio de la PD [diferencia media 5.76 mmHg, IC del 95%: 4.18 a 7.23, P=0.0001] a favor del grupo con Homeopatía más MEV. Los medicamentos más utilizados fueron: Sulphur (n=24), Natrium muriaticum (n=21), Lycopodium (n=16), Nux vomica (n=12) y Phosphorus (n=10). Conclusiones: Se ha constatado que la Homeopatía individualizada junto con la MEV fue más eficaz que el placebo junto con la MEV en los pacientes que sufren hipertensión en estadio I. Se precisan más ensayos en un marco estricto. (AU)
Background: Hypertension (HTN) is a leading risk factor for death and disability and responsible for over 1.6 million deaths in India. Clinical case reports, observational studies and randomised controlled trials show the effects of homoeopathic medicine in HTN. Objectives: The results of this study will add to the evidence of effectiveness of individualised homoeopathic medicine in Stage I HTN. Methods: A single-blind, randomised, placebocontrolled trial was undertaken from October 2013 to March 2018. The primary outcome measure was to evaluate the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) every month for 3 months. Of 2,127 patients screened, 217 patients who fitted the inclusion criteria were randomised to receive either homoeopathic Q potencies (or LM potencies) plus lifestyle modification (LSM)=116 or placebo + LSM=101. LSM included physical activity and diet as part of the treatment regimen. Analysis was by intention to treat. Results: Repeated-measure ANOVA between the groups showed statistically significant difference (Wilk lambda 0.85, F=12.12, df=213, P=0.0001), in both SBP and DBP favouring Individualised Homoeopathy (IH) along with LSM. Post hoc independent t-test showed a significant mean reduction in SBP (mean difference 7.12 mmHg, 95% confidence interval [CI] 4.72-9.53, P=0.0001) and DBP (mean difference 5.76 mmHg, 95% CI: 4.18-7.23, P=0.0001) favouring Homoeopathy plus LSM group. Sulphur (n=24), Natrum muriaticum (n=21), Lycopodium (n=16), Nux vomica (n=12) and Phosphorus (n=10) were the most useful medicines. Conclusion: IH in LM potency along with LSM was found effective over placebo along with LSM in the patients suffering from Stage I HTN. Further trials in rigorous setting are warranted. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Homeopathic Therapeutics , Homeopathy , Hypertension/therapy , Life StyleABSTRACT
Soil salinization and alkalinization frequently co-occur in nature, but very few studies focus on the interactive effects of mixed salt and alkali stresses on plants. Sporobolus marginatus Hochst. ex A. Rich. (perennial halophytic grass) collected from extreme saline sodic Kachchh plains, Bhuj, Gujarat was analyzed to evaluate the stress specific responses in osmoprotectants, antioxidants, ionic relations and protein profiling under saline, sodic and mixed saline-sodic soils. Osmotic adjustments in terms of total soluble sugars (TSS), glycine betaine, proline content and protein concentration exhibited differential responses to variable stress conditions. Proline content increased 4.8 folds at pH2 10.0, 5.2 folds at ECe 35 dSm-1 and 5 folds at pH2 9.0 + ECe 20 dSm-1. The greater accumulation of proline in Sporobolus, may presumably be one of the factor for tolerance to higher salt. At the same time, superoxide dismutase (SOD) activity in leaves increased with increasing sodicity i.e. 30.73 and 33.55 units g-1 FW at pH 9.5 and pH 10.0, respectively. Gradual increase in peroxidase enzyme (POX) activity was observed under all the stresses. Under control condition, POX activity was 21.67 units g-1 FW in Sporobolus, which increased to 26.56 units g-1 FW at pH 10.0, 27.89 units g-1 FW at ECe 35 dSm-1 and 27.44 units g-1 FW at pH 9.0 + ECe 20 dSm-1. The basal activity of APX increased with increasing stress conditions and was maximum (43.91 units g-1 FW) at pH 10.0. On the other hand, 2 times higher glutathione reductase (GR) activity was obtained under sodic stress of pH 9.5 and pH 10.0. SDS-PAGE revealed that five new polypeptide bands of MW 58.5, 53.7, 39.7, 31.8 and 28.3 kDa were expressed at higher saline level while one polypeptide band of 39.7 kDa disappeared at higher salinity level of 35 dSm-1 which may be due to its degradation at higher salt concentration. Synthesis of common polypeptides of MW 98.1, 69.3, 35.45, 24.89 and 23.3 kDa under all the stress conditions need special mention. Furthermore, the enhanced expression of these proteins, which also existed in the control plants, were specifically increased under stress condition which revealed that these proteins were up-regulated in specific regions of Sporobolus adapted to salt stress. Therefore, further exploration is needed to test the contribution of salt stress related proteins/genes or regulatory factors from the salt tolerant grasses (STGs) for possible utilization in cereal crop improvement.
ABSTRACT
Background: Serum phosphate level correlate with atherosclerosis in both animal models and humans with advanced chronic kidney disease and coronary calcification is a known impact of higher serum phosphate, but whether this relationship exists among individuals with Non-CKD is unknown. we conducted this study to observe role of higher serum phosphate level in cardiovascular comorbidities like MI and CHF in Non-CKD patients.Methods: In this observational study, 300 patients were enrolled, half of the patients having Clinical features or positive biochemical markers (Troponin-I for MI and serum BNP for CHF) suggestive of myocardial infarction and heart failure were taken as case group and half of the subjects were taken as control group with similar baseline characteristics. All participants in this study were consenting and more than 18 years of age.Results: The mean value of serum phosphate level in case group was 4.41±1.40 while in control group was 3.19±1.07 showing statistically significant difference (p-value <0.001). In case group 65% patients were having MI with higher serum phosphate level (4.22±1.40).Conclusion: Higher serum phosphate level is related to increased cardiovascular morbidities even in non-CKD patients.
ABSTRACT
The present study was performed to evaluate haematological and biochemical parameters with response to milk production of dairy cattle at low temperature. Ambient temperature and relative humidity were recorded and the temperature-humidity index (THI) was calculated as indicator of thermal comfort zone for cattle. Lactating crossbred dairy cattle were selected for this study. A significant increase in RBC, Hb, and PCVWBC was recorded in winter. Glucose and aspartate aminotransferase (AST), albumin level showed a significant increase in winter. Milk production level was decrease due to cold stress. These results provided an insight into the haematological and biochemical responses of Jersey crossbred cows to different environmental conditions. Hence, this study will be helpful for the better dairy cattle management in winter seasons for higher production at the cold arid high altitude region
ABSTRACT
Background: Spontaneous bacterial peritonitis is a fatal complication of liver cirrhosis. Ascitic fluid culture is positive in half of the cases. Materials and methods: The present cross-sectional study was conducted upon the patients admitted in Medicine ward of VIMS, Pawapuri. Bacterial examination of ascitic fluid, culture and antibiotic sensitivity was done. Results: 47.2% of SBP cases were culture positive. E. coli (46.2%), Klebsiella (26.9%), Acinetobacter (7.7%) and Pseudomonas aeruginosa (3.8%) were the common organisms isolated. Conclusion: As half of SBP cases have positive culture, ascitic fluid culture and antibiotic sensitivity testing is essential in such cases.
ABSTRACT
Background Simple and mucopurulent chronic bronchitis (SMCB) is characterized by recurrent mucoid or mucopurulent expectoration in absence of localized suppurative disease. This observational open label study was undertaken to evaluate the effects of homeopathic medicine in SMCB. Methods 1902 patients were screened from 07 centres out of which 1305 were excluded. 597 patients were enrolled as per the inclusion and exclusion criteria. A total of 14 pre-defined homeopathic medicines were shortlisted for prescription after repertorizing the pathological symptoms of SMCB. Outcomes were assessed through chronic bronchitis symptom scale (CBSS) and FEV1/ FVC ratio with spirometry for over a period of two years. Appearance of any change (relief/ worse)/ status quo was immediately followed by placebo/ change in dilution/ change in remedy. Statistical analysis was done using SPSS version 20. Results: 532 patients were analyzed based on the intention to treat principle using last observation carry forward method. Mean CBS score reduced from 29.86±4.5 at baseline to 12.33±7.6 at completion of 2 years. Repeated measures ANOVA, at time points 0 (baseline), 3, 6, 9, 12 ,15, 18, 21 and 24 months, showed significant reduction in CBS scores [Wilk's Lambda 0.104, F=564, df 524; p=00001]. The FEV1 and FEV1/FVC was maintained within normal limits. 86% prescriptions included Lycopodium, Arsenicum album, Pulsatilla, Phosphorus, Stannum metallicum, Calcarea carbonica, Silicea, Bryonia alba. Conclusion: The result suggests effectiveness of homeopathic treatment in early years of SCMB patients. Controlled trials are warranted. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Bronchitis, Chronic/therapy , Homeopathy , Pulsatilla nigricans/therapeutic use , Arsenicum Album/therapeutic use , Calcarea Carbonica/therapeutic use , Lycopodium clavatum/therapeutic use , Silicea Terra/therapeutic use , Stannum Metallicum/therapeutic use , BryoniaABSTRACT
Soil salinization and alkalinization frequently co-occur in nature. However, only few studies have focused on the interactive effects of mixed salt and alkali stresses on plants. To find supplementary feed source under arid and semiarid conditions, Dichanthium (Forsk.) Stapf. seeds and root cuttings were collected from extreme saline sodic Kachchh plains, Bhuj (Gujrat), and established at ICAR-Central Soil Salinity Research Institute, Karnal. The experiment was designed in RBD having nine different treatments i.e. control (pH2: 7.1; ECe: 0.43), alkaline (pH2: 9.5 and 10.0), saline (ECe: 15, 25 and 35 dS m-1) and saline-alkaline (pH2 9.0 with ECe: 10, 15 and 20 dS m-1). Under alkaline conditions, Dichanthium maintained their plant height but reduction was observed in chlorophyll concentration at both the stresses. Highest photosynthetic rate (Pn) was recorded in control treatment i.e. 36.05 μmol CO2 m-2 s-1 which was decreased with the intensified stress. Reductions were also noticed in the rates of stomatal conductance (gS) and transpiration rate (E) under different stress levels. Dichanthium restrict Na+ accumulation (mean Na+ 0.27%) in root zone whereas in shoots, mean Na+ was 4.58%. Dichanthium maintained or increased shoot K+ concentration under saline and mixed stress condition to mitigate the injurious effect of high Na+ concentration. Among fodder quality parameters, Dichanthium contained 5.15% mean crude protein (CP). Stress treatment caused 10-25% reduction in the CP content over all the stress treatments. Alkalinity, salinity and mixed saline sodic stress caused reduction in neutral detergent fiber (NDF) content but maximum reduction was observed under salinity stress condition. ADF (Acid detergent fiber) content was higher in control (47.44%) and decreased with increasing salt stress. ADL followed the same the trend as shown by ADF.
ABSTRACT
Hemorrhagic septicemia (HS) is a major disease of cattle and buffaloes characterized by an acute, highly fatal septicemia with high morbidity and mortality. Sporadic cases are more difficult to diagnose clinically and hence diagnosis at an early stage is required for control of the disease. The present study was conducted to compare the temporal sensitivity of multiplex PCR and bacterial isolation to diagnose hemorrhagic septicemia due to Pasteurella multocida at an early stage i.e. before the appearance of clinical signs in mice. Multiplex-PCR (mPCR)was evaluated for simultaneous as well as temporal detection and identification of P. multocida at type level for early and accurate diagnosis of hemorrhagic septicemia (HS). Swiss albino mice were experimentally infected with 100 colony forming units (CFU) of the bacteria P. Multocida TypeB:2 Strain P52. Heart blood samples were collected, 2, 4, 8, 12 and 24 h post infection for bacterial isolation as well as detection and identification by mPCR. The P. multocida was isolated from the heart blood sample collected as early as 8 h post infection while mPCR detected the bacterial DNA as early as 4 h post infection before the appearance of clinical signs hence mPCR for P. multocida Type B:2 was found to be more sensitive than the bacterial isolation for diagnosis of HS.
ABSTRACT
Resection and reconstruction of the SVC is a challenging Intraoperative situation owing to the potential complications after clamping a patent vessel. Hemodynamic imbalance and neurological effects of SVC clamping can be life threatening. These complications can be prevented by careful intraoperative monitoring and management. Anaesthesiologist must be aware of different options to manage such challenging situations.