Sodium bicarbonate use and the risk of hypernatremia in thoracic aortic surgical patients with metabolic acidosis following deep hypothermic circulatory arrest.

Objective: Metabolic acidosis after deep hypothermic circulatory arrest (DHCA) for thoracic aortic operations is commonly managed with sodium bicarbonate (NaHCO3). The purpose of this study was to determine the relationships between total NaHCO3 dose and the severity of metabolic acidosis, duration of mechanical ventilation, duration of vasoactive infusions, and Intensive Care Unit (ICU) or hospital length of stay (LOS). Methods: In a single center, retrospective study, 87 consecutive elective thoracic aortic operations utilizing DHCA, were studied. Linear regression analysis was used to test for the relationships between the total NaHCO3 dose administered through postoperative day 2, clinical variables, arterial blood gas values, and short‑term clinical outcomes. Results: Seventy‑five patients (86%) received NaHCO3. Total NaHCO3 dose averaged 136 ± 112 mEq (range: 0.0–535 mEq) per patient. Total NaHCO3 dose correlated with minimum pH (r = 0.41, P < 0.0001), minimum serum bicarbonate (r = −0.40, P < 0.001), maximum serum lactate (r = 0.46, P = 0.007), duration of metabolic acidosis (r = 0.33, P = 0.002), and maximum serum sodium concentrations (r = 0.29, P = 0.007). Postoperative hypernatremia was present in 67% of patients and peaked at 12 h following DHCA. Eight percent of patients had a serum sodium ≥ 150 mEq/L. Total NaHCO3 dose did not correlate with anion gap, serum chloride, not the duration of mechanical ventilator support, vasoactive infusions, ICU or hospital LOS. Conclusion: Routine administration of NaHCO3 was common for the management of metabolic acidosis after DHCA. Total dose of NaHCO3 was a function of the severity and duration of metabolic acidosis. NaHCO3 administration contributed to postoperative hypernatremia that was often severe. The total NaHCO3 dose administered was unrelated to short‑term clinical outcomes.

Surgical technique for excisional bleb revision using a rotational conjunctival flap for a large conjunctival defect

Bleb dysesthesia is a common but under recognized late complication of trabeculectomy, sometimes requiring surgical revision if conservative measures fail. We describe in detail a surgical technique for closure of a large conjunctival defect following bleb excision for refractory dysesthesia. Two subconjunctival 5-fluorouracil injections were given to improve bleb function. Eight months post-operatively, the intraocular pressure is well controlled on two agents, and the patient has had resolution of dysesthesia

High genetic diversity in the coat protein and 3 untranslated regions among geographical isolates of Cardamom mosaic virus from south India.

A survey was conducted to study the biological and genetic diversity of Cardamom mosaic virus (CdMV) that causes the most widespread disease in the cardamom growing area in the Western Ghats of south India. Six distinct subgroups were derived based on their symptomatology and host range from the sixty isolates collected. The serological variability between the virus isolates was analysed by ELISA and Western blotting. The 3 terminal region consisting of the coat protein (CP) coding sequence and 3 untranslated region (3 UTR) was cloned and sequenced from seven isolates. Sequence comparisons revealed considerable genetic diversity among the isolates in their CP and 3 UTR, making CdMV one of the highly variable members of Potyviridae. The possible occurrence of recombination between the isolates and the movement of the virus in the cardamom tract of south India are discussed.

Significance of HBV DNA by PCR over serological markers of HBV in acute and chronic patients.

A study was undertaken to determine Hepatitis B virus DNA (HBV DNA) by PCR in acute and chronic hepatitis B infection and to correlate it with serological markers. Three hundred and forty-five serum samples of patients from all over India were categorized into different groups according to their serological profile. HBV DNA was detected upon amplification in 166/263 patients in group A, 3/14 patients in group B, and 2/32 patients in group C, and was not detected in groups D and E. The presence of HBV DNA in 49 patients with non-replicative HBV disease, as defined by the absence of HBeAg, suggests low levels of viremia which is also supported by the abnormal liver function tests (LFTs) in these patients. In addition, HBV DNA was detected in small proportion of individuals with past HBV infection. This data suggests that, detection of HBV DNA by amplification technique serves as an important supplementary tool besides serology in a number of clinical settings, especially in determining low levels of viremia in patients with non-replicative HBV disease and chronic hepatitis, and also in a few patients with past HBV infection and who could be asymptomatic carriers of HBV infection.

Nucleic acid reactive antibodies—Specificities and applications.

The specificities of nucleic acid reactive antibodies and their applications in cell biology and molecular biology are reviewed.

Cytokinin binding proteins from mammalian sera.

A cytokinin-binding protein fraction was isolated from normal rabbit sera by affinity chromatography. The protein fraction bound tritium labelled N6- (Δ2-risopentenyl) adenosine and the order of inhibition of this binding by competing non-radioactive compounds was, N6-(Δ2-isopentenyl) adenosine >N6-benzyIadenosine >zeatin-riboside >N6-(Δ2-isopentenyl) adenine >kinetin riboside >adenosine. The protein fraction showed broad specificity, the prefered cytokinin being N6-(Δ2-isopentenyl) adenosine. This is the first report of the isolation of cytokinin binding proteins from mammalian sources.