A comparative study between intrathecal fentanyl and intrathecal buprenorphine as adjuvants to 0.5% hyperbaric bupivacaine in females undergoing lower segment caesarean section under spinal anesthesia: a randomized and double blinded study

Background: Double blinded study involving intrathecal hyperbaric bupivacaine (1.5 ml) with adjuvants as Fentanyl and Buprenorphine Methods: Sixty-six females posted for lower segment caesarean section under spinal anesthesia were randomized into two groups-A and B. Group A received 1.5 ml of hyperbaric Bupivacaine and 0.5 ml (75 µg) of Buprenorphine. Group B received 1.5 ml of hyperbaric Bupivacaine and 0.5 ml (25µg) of Fentanyl. Sensory blockade, motor blockade and duration of analgesia were evaluated. Randomization was done using randomization.com program with GraphPad Quick Cals. Statistical analysis was performed with Statistical Package for the Social Sciences (SPSS) statistics version 28 software. Results: There is no statistical difference in the demographic profiles of both groups. Duration of analgesia(minutes) in group A=255.37±34.63 and in group B=175.43±23.58 with p<0.001. Conclusions: A significant drop in mean arterial pressure in both groups from preoperative values throughout surgery, (p<0.05) with the exception of MAP at 50 minutes in B (p=0.139). A significant increase in heart rate at 2 and 4 minutes in group A when compared with baseline HR (p<0.05). In group B, a significant increase only at 2 minutes post spinal anesthesia, p=0.002. Forty-three patients had hypotension (28 vs. 15), p=0.008. Nausea is higher in Group A than B (26 vs. 4). The difference in sensory level of blockade is statistically insignificant, p=0.62. The difference in time of onset of motor blockade of Bromage score 1 was statistically insignificant, p=0.093. Duration of analgesia (minutes) in group A=255.37±34.63 and in group B=175.43±23.58 with p<0.001.

Distribution of pathogenic Leptospira in environmental water and soils of selected recreational forests in Perak, Malaysia

@#Leptospirosis is an emerging zoonotic disease endemic in tropical regions. Aiming at assessing the potential infection risks via recreational exposure, the molecular prevalence of pathogenic Leptospira in 14 amenity forests in five selected districts of the state of Perak was determined. Water and soil samples along streams and waterfalls were subjected to culture of leptospires and the pathogenic Leptospira spp. was detected by lipL32-based polymerase chain reaction (PCR). Twenty out of 154 samples (13%) that tested positive for leptospires were mostly soils and still water recorded with tolerable temperatures (22.226.5°C) and pHs (5.73-6.70). The localised prevalence was highly varied among eight positive forests (6.7-41.7%), particularly higher in Kampar and Kinta districts which are the more populated urban areas. The importance of public health surveillance should not be underrated given the high prevalence of Leptospira spp. in forests in close proximity to indigenous settlements, even where the places are clean. Overall, this study discovered a wide distribution of pathogenic Leptospira spp. in recreational areas.

Enhanced arsenic removal from aqueous medium by arsenic tolerant groundwater fungi

Aim: Arsenic concentration in groundwater above the acceptable level is of global concern due to its serious human health effects. Application of certain fungi, due to their amazing skill to remove arsenic from arsenic contaminated water has received attention in recent years. The main aim of this study was to isolate arsenic tolerant fungi from arsenic-contaminated groundwater and assess their ability for arsenic removal from the aquatic system in-vitro.Methodology: Fungi were isolated from arsenic-contaminated groundwater (44.9–161.1 mg l-1). An experiment on bioremediation/ removal of arsenic by selected highly arsenic tolerant fungi was conducted by culturing them in arsenic supplemented medium and measuring the arsenic contents in initial and after incubation with fungi using Hydride Generation Atomic Absorption Spectroscopy (HG-AAS) to find out the arsenic removal percentage. Results: In all, ten out of forty-five fungi obtained from highly arsenic-contaminated groundwater (44.9–161.1 mg l-1) were able to remove high arsenic contents (>80%) from liquid medium with >85% arsenite (by 6 fungal isolates) and >85% of arsenate (by 9 fungal isolates). In arsenic tolerance assay, all 10 test fungi grew readily in liquid medium enriched with either arsenate (10 and 20 g l-1) or arsenite (2 g l-1) under laboratory conditions (27±2°C). These fungi showed log phase between 5 to 10 days with stationary phase of 11-15 days. High arsenite concentration (4 g l-1) however, completely inhibited the growth of 50% of these fungal isolates. Five of these isolates showed high tolerance index pattern (0.97- 0.91) as compared to others (0.22–0.13). These fungi greatly altered the pH of arsenic supplemented liquid medium (10 mg l-1) as compared to the control when they were individually cultured. These arsenic tolerant fungal isolates may effectively be used for the bioremediation of arsenic from groundwater. Interpretation: The study suggested that 10 fungal isolates were able to tolerate high arsenic concentrations (20 g l-1 of arsenate and 2 g l-1 of arsenite) and were able to enhance arsenic removal (more than 80%) in liquid medium at neutral pH (7.0) and 27°C temperature.

Leptospirosis among the self-supporting convicts of Andaman Island during the 1920s - the first report on pulmonary haemorrhage in leptospirosis.

Several researchers had carried out investigations on the possibility of existence of Weil’s disease in Andaman Islands during early 20th century. The first report of a series of confirmed cases of leptospirosis that occurred during1929 was published in 1931.There were several reports during 1995 to 2009 that described detailed account of leptospirosis including various clinical syndromes. The possibility of pulmonary involvement in leptospirosis being a manifestation historically overlooked rather than newly emerged during the past two decades is examined in this review in the context of Andaman Islands. Two case series of leptospirosis, one occurred in 1929 and the other in 1996-1997 were reviewed with special emphasis on pulmonary involvement and haemorrhagic manifestations. The similarities and differences in the clinical profile of patients of the two case series were analysed. The review shows that respiratory system involvement and pulmonary haemorrhage as evidenced by presence of haemoptysis as a complication of leptospirosis was occurring during 1920s in Andaman Islands. The incidence of pulmonary involvement, however, rose from 9.4 per cent during 1929 to 52 per cent in 1996-1997. The case fatality ratio in patients with pulmonary involvement, which was 50 per cent during 1929 and 42.9 per cent during 1996-1997, was higher than that in cases without pulmonary involvement.Fever, conjunctival congestion, jaundice, vomiting, diarrhoea, hepatomagaly, haemoptysis, haematemesis and subconjunctival haemorrhage were common in both series. The case series in Andaman Islands in 1929 was probably the first report of pulmonary haemorrhage as a manifestation of leptospirosis. The increase in the incidence of pulmonary involvement in leptospirosis in the recent past is probably due to the increase in the density and diversityof its animal vectors,the broadening of the range of circulating serovars and the interactions between the vector and the agent. An increased virulence of Leptospira through gene acquisition and loss on an evolutionary time scale and the resulting change in the gene content, gene order and gene expression cannot be ruled out.

Laparotomy for post chemotherapy residue in ovarian germ cell tumors.

BACKGROUND: Primary conservative surgery and cisplatin-based chemotherapy have resulted in high cure rates in malignant ovarian germ cell tumors. A significant proportion of advanced tumors may have post-chemotherapy residue and it is important to distinguish necrosis or fibrosis without viable tumor from persistent viable tumor and teratoma. AIMS: To evaluate the role of laparotomy in assessing the nature of post-chemotherapy residue in ovarian germ cell tumors. MATERIALS AND METHODS: Eighty-three patients with malignant ovarian germ cell tumors seen at Cancer Institute, Chennai between 1992 and 2002 were studied. Sixty-eight patients completed combination chemotherapy with cisplatin regimes, of whom 35 had radiological residual masses. Twenty-nine out of these 35 patients underwent laparotomy to assess the nature of the residue. RESULTS: On laparotomy, three patients had viable tumor, seven immature teratoma, three mature teratoma and 16 only necrosis or fibrosis. None of our patients with dysgerminoma, embryonal carcinoma, absence of teratoma element in the primary tumor and radiological residue of < 5 cm had viable tumor whereas all patients with tumors containing teratoma component initially had residual tumor. Absence of viable disease was higher in patients who had normalization of serum markers by two cycles of chemotherapy. CONCLUSION: Our study suggests that patients with absence of teratoma element initially, radiological residue of< 5 cm and normalization of serum markers after two cycles of chemotherapy do not require surgery to assess the nature of post-chemotherapy residue. However, laparotomy should be performed in patients with tumors that initially contain teratoma element and in those with sluggish tumor marker response after two cycles of chemotherapy since they have a high chance of having viable post chemotherapy residue.

A study of serum bilirubin in neonates in relation to the maternal age.

A comparative study of neonatal serum bilirubin levels was done in neonates of different age groups of mothers. A total 122 healthy, new borns were selected for the study, born at Queen Mary's Hospital, Lucknow. Mothers were divided into two groups i.e. < 30 years and > 30 years of age. Samples of blood were collected thrice, first on day 1 from cord blood, 2nd and 3rd on days three and five of life from neonates by heel prick method, using small bore capillaries for blood collection, serum bilirubin estimation were done by the method of Malloy & Evelyn and Mean +/- SD were calculated. P-Value was observed between different age groups. In both the groups of mothers i.e. < 30 years and > 30 years serum bilirubin levels in their neonates raised to highly significant levels on day 3 (P-Value < 0.001) as compared to their cord blood serum bilirubin levels. On comparing serum bilirubin levels in neonates of both the maternal groups, it was observed that there is no significant difference between two groups on day of birth and day day 5 but statistically significant difference was observed on day 3 (P < 0.05), serum bilirubin levels were higher in neonates of younger age group mothers.

Clinico-epidemiological study of hospitalized cases of severe leptospirosis.

In an attempt to understand the clinical spectrum and pathological and biochemical abnormalities and their prognostic importance in leptospirosis, a prospective study was carried out in Port Blair during September 1996 to August 1997. Out of 80 patients suspected to have leptospirosis, 58 were proved to have current leptospiral infection using serological tests and among these, 14 died giving a case fatality rate of 24.1 per cent. The incidence of the disease showed two separate peaks roughly coinciding with the paddy sowing and harvesting season and the majority of the patients had history of exposure to wet and water logged environment prior to the attack of the disease. The disease presented as two separate clinical syndromes--the hepato-renal form and the pulmonary form though some degree of overlap was present. Hepatic and renal complications occurred in 30 patients each with 26 of them having both. These generally occurred late in the course of the disease and the mortality rate was relatively low. In contrast pulmonary complication occurred quite early and the case fatality rate in those patients was very high (6.7% vs 42.9%). The other complications encountered in the current series of cases were refractory hypotension probably due to myocarditis in 40 per cent and neck stiffness and altered sensorium due to central nervous involvement in 12.1 per cent of the patients. The chances of the patients developing complications were considerably low if treated early and very few of them developed any complications after 2 days of hospitalized treatment. The early occurrence of pulmonary complications indicates a pathogenesis totally different from that responsible for the other complications.

Prevalence & spectrum of congenital malformations in a prospective study at a teaching hospital.

A prospective survey for congenital malformations at birth, at a teaching hospital, over a period of two and half years on 9405 consecutive single births has shown that prevalence of major congenital malformations in live births was 1.6 per cent and in still births 16.4 per cent. There was no significant difference in the prevalence of congenital malformations between Hindus (2.0%) and Muslims (2.7%) but amongst Muslims with consanguinity the prevalence of congenital malformation was 4.6 per cent compared to 2.3 per cent in non-consanguineous Muslim spouses (P less than 0.05). Open neural tube defect was the single most common anomaly (31.7% of all malformations) occurring at a rate of 4.7 per 1000 single births, with equal prevalence of anencephaly and meningomyelocoele. Case control study showed that history of concomitant medical illness, drug intake during the first trimester, threatened abortion, hydramnios and pre-eclamptic toxaemia in the current pregnancy were significantly associated with the occurrence of congenital malformations.

A monomeric protein with hemagglutinating activity from seeds of Vigna mungo (Phaseolus mungo).

Black gram (Vigna mungo) seeds are shown to contain a lectin with certain unusual features. The lectin agglutinates only trypsinized red cells, and its sugar specificity is complex as none of the common sugars, oligosaccharides or complex polysaccharides exhibit any affinity for the lectin. The purified lectin has a molecular weight of 58 kDa and is a monomer. Unlike other plant lectins, antibodies to the P. mungo lectin do not exhibit any immunological cross reactivity. The clot forming ability of the lectin is unusual in that the clot once formed is rapidly disaggregated indicated that it induces, as yet undefined, certain membrane alterations.