Coagulation Abnormalities in Severe Scrub Typhus and Their Association with Complications

Aim: To describe coagulation abnormalities and their association with complications in patients with severe scrub typhus. Materials and methods: A cohort study was conducted among all patients of severe scrub typhus [immunoglobulin M (IgM) positive] who reported to this facility from 1st August 2019 to 31st July 2020 and met our inclusion criteria. We estimated the incidence of severe thrombocytopenia (<50,000/µL) and overt disseminated intravascular coagulation (DIC) (DIC score of ?5). We determined the association [risk (RR) ratios] of these abnormalities with complications of scrub typhus, namely—septic shock, multiple organ dysfunction syndrome (MODS), and septic shock with MODS. Results: In total, 71 patients were studied with a mean age of 50 ± 15.5 years, of which 45 (63.4%) were females. On presentation, fever 70 (98.5%), myalgias 22 (31.0%), loose stools 13(18.3%), cough, vomiting, headache 11 (15.5%), altered sensorium 10(14.1%), and pain abdomen 9 (12.7%) were main symptoms. On examination, hypotension 31 (43.7%), eschar 25 (35.2%), icterus 17 (23.9%), and rash 16 (22.5%) were noted. The d-dimer (>0.5 µg/mL) levels were increased in all (100%) patients. Thrombocytopenia (91.5%) was the commonest hematological abnormality and 31 (43.6%) of them had severe thrombocytopenia, 25 (35.2%) patients had low fibrinogen levels (<200 mg/dL) and prothrombin time (PT >16.7 seconds) was prolonged in 20 (28.1%). A total of 42 (59.1%) patients developed MODS, 33 (46.4%) developed septic shock, 24 (33.8 %) had MODS with septic shock, 17 (23.9%) developed overt DIC, and eight (11.2%) died. Severe thrombocytopenia (p = ?0.028) and overt DIC (p = 0.045) were significantly associated with septic shock development. Conclusion: In the patients admitted with severe scrub typhus; thrombocytopenia was the commonest hematological abnormality. The development of septic shock was significantly associated with severe thrombocytopenia and overt DIC.

Evaluation of Recurrence and Hearing Outcome for Inactive Squamosal Disease after Cartilage Strengthening Tympanoplasty

Abstract Introduction Inactive squamosal disease is unique for having a conflicting treatment protocol, with an age-old debate between early surgical intervention or keeping patients in a long-term follow-up. The shifting paradigm is early intervention to prevent further progress into active disease and improve hearing outcome in its nascent stage. Objective To evaluate recurrence and hearing outcome in cases of inactive squamosal disease after cartilage strengthening tympanoplasty. Methods The study was conducted on 50 patients with inactive squamosal disease. Detailed examination was done to grade the retraction. All patients underwent autologous conchal cartilage tympanomastoidectomy with temporalis fascia grafting. Recurrence and hearing evaluations were done by pure tone audiogram at regular intervals for one year. Results Hearing loss was the most common presenting symptom. Isolated pars tensa retractions were more common (54%) than pars flaccida (12%), or those involving both (34%). Ossicular status was normal in only 14% of the cases, and the most common ossicular damage was to the lenticular process of the incus (52%). Three of the patients (6%) had residual perforation at the 3rd month of follow-up. Subjective improvement in hearing was reported by 42% patients. Hearing improvement greater than 10 dB was found in 24 patients (48%). Air-bone gap reduced from 25.16 ± 8.15 dB preoperatively to 12.90 ± 6.20 at 1 year of follow-up. Recurrence was seen in three patients (6%). Conclusion Early intervention by cartilage strengthening of weakened tympanic membrane and ossicular reconstruction not only offers better hearing results, but also prevents progress to active disease.

A Cross Sectional Study to Assess the Levels of Depression and Anxiety in Patients with Chronic Obstruction Pulmonary Disease in a Tertiary Care Hospital

Background: Objective: In the present study, demographic profile, knowledge and motivation of COPD patients attending tertiary hospital, the level of anxiety and depression is assessed. Methods: This cross - sectional study was carried out on consecutive patients with COPD during their routine out - and in - patient visits in the tertiary care hospital during 4 months (April 2019 to July 2019). Physician confirmed cases of more than 1 - year duration were included in the study. Thus 194 COPD patients were admitted in the ward. They were interviewed by using HADS scale and Modified Morisky scale. The diagnosis of COPD was confirmed by Chest X - ray and Spirometery tes t and a history of exacerbation or hospitalization over past 6 months was also obtained. The chi square - test, t - test and one - way analysis of variance were used in the univariate analyses, whilst regression was used in the multiple variable analyses. Result s: A total of 194 COPD individuals, 124 Males and 70 Females were enrolled in the study. The mean age of the respondents was 49.16 ± 8.20 (25 - 62) years. The mean scores for anxiety and depression were 19.12± 2.38 and 11.54± 2.50 respecti vely. Both anxiety and depression scores were statistically significant between the gender. Among males 70 % cases were having no comorbid conditions; however, 57.10 % females were having more than two comorbid conditions. Conclusion: Pres ent study illustrates that anxiety and depression are common in patients with COPD, furthermore, patients with depressive disorders have more comorbidities in comparison with patient with anxi

Vitamin D and autoimmune thyroiditis in children – A prospective case–control study

Background: The deficiency or insufficiency of Vitamin D has been widely reported to be linked with autoimmune thyroid diseases. Several studies were evaluated the immunomodulatory effects of 25 hydroxyvitamin D (25(OH)D) and its counterparts in autoimmune diseases especially in autoimmune thyroiditis. Aim and Objectives: The aim of the study was to assess the Vitamin D status in children with autoimmune thyroiditis at tertiary care hospital, Sangareddy, Telangana. Materials and Methods: A source of 80 newly diagnosed cases with autoimmune thyroiditis and similar volume of age and sex matched control subjects between ?6 and 12 years were included in the study. Parameters such as thyroid function tests, serum calcium, serum phosphorus, serum alkaline phosphatase, 25(OH)D, and antithyroid antibodies levels were assessed. The antithyroid antibodies levels were assessed through chemiluminescence assay. Results: The 25(OH)D levels were 14.98ng/ml in cases and 17.46 ng/ml in control subjects. The mean levels of 25(OH)D, serum calcium, and alkaline phosphatase were statistically significant (P < 0.05). Conclusion: The levels of Vitamin D and four groups of antithyroid peroxidase antibody and antithyroglobulin antibody among cases and control subjects were not significant (P > 0.05). The estimation of Vitamin D in high-risk group may be helpful in designing the treatment strategies to decrease the morbidity.

Study of Inflammatory Markers in Chronic Obstructive Pulmonary Disease

Introduction: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the sudden worsening of symptoms of COPD like shortness of breath, increased quantity and color of sputum, and systemic inflammation, and has a significant impact on survival. Biomarkers such as high-sensitivity C-reactive protein (hsCRP) and procalcitonin have been studied in AECOPD patients as prognostic markers. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are two new inflammatory markers and play a significant role in prognosis in patients with AECOPD. NLR and PLR are easily available and cost-effective markers and have the potential for helping in the risk stratification of hospitalized AECOPD patients. Aim: Study of inflammatory markers in COPD and their correlation with clinical outcome. Methods: A prospective observational comparative study was conducted on 100 patients of COPD at the Department of General Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, and all necessary investigations were done. Results: A total of 100 patients of COPD were taken, 50 patients were in a stable state (controls) and the same number of patients were in an acute exacerbation state (cases). Mean levels of NLR, hsCRP, and procalcitonin in cases were significantly higher as compared to controls whereas levels of PLR in cases and controls were comparable with no significant difference between them. Levels of both of these inflammatory markers (NLR and PLR) were positively correlated with levels of hsCRP and levels of procalcitonin. Of the total 50 patients, 23 (56.00%) patients needed mechanical ventilation and 11 (22%) needed inotropic support. Only 6 out of 50 patients (12.00%) died. Levels of NLR and PLR were positively correlated with the duration of hospitalization. Levels of NLR and PLR were not significantly associated with the need of inotropic support and mortality, levels of NLR were also not significantly associated with the need of mechanical ventilation whereas levels of PLR were significantly higher in patients who required mechanical ventilation. Conclusion: Levels of NLR were raised in patients with AECOPD (cases) than stable state COPD patients (controls). So levels of NLR can be used as a marker to predict acute exacerbation and there was a positive correlation of NLR and PLR with levels of hsCRP and procalcitonin.

Role of Itolizumab in the Treatment of COVID-19 Patients, Admitted to ICU at a Tertiary Care Hospital

Background: Clinical studies have correlated severe deterioration of COVID-19 patients due to excessive and uncontrolled production of cytokines. There is a pressing need to explore therapies, which could prevent the cytokine storm rather than terminating it. Aims and objectives: The aim of the study is to evaluate the effect of itolizumab on clinical outcomes of patients with moderate-severe COVID-19 disease admitted to ICU. The primary aim of the current study is to find out any mortality benefit in 14 days. The secondary aim is to assess the morbidity outcomes in terms of reduction in inflammatory markers and also the duration of hospital stays to assess the prognostication. Materials and methods: It is a retrospective case-control study in which laboratory-confirmed COVID-19 patients admitted to ICU were taken. A total of 62 patients were recruited, 31 patients received itolizumab (cases/treatment group) and 31 patients didn’t receive itolizumab (designated as controls). Results: Among the total patients recruited, 68% of the study population was male and 32% were female. A total of 12 patients expired among cases and 13 expired among controls. Overall mortality in both groups was noted to be almost similar. The control group showed mortality at lower computed tomography (CT) scores compared to the cases. There is a significant reduction in inflammatory markers, like interleukins-6 (IL-6) and D-dimer in cases compared to the control group. Conclusion: In conclusion, treating patients with cytokine storms before they require intubation/mechanical ventilation is crucial to preventing deaths. Itolizumab has shown no clinical benefit in critically ill COVID-19 patients, however, timely initiation of itolizumab therapy may serve as a key therapeutic option in preventing the mortality and morbidity outcomes in moderate-severe COVID-19 patients.

Student perceptions of an online surgical teaching programme during the COVID-19 pandemic at the University of KwaZulu-Natal: A short report

Background. The COVID-19 pandemic has led to an unprecedented global health crisis, with impacts on many facets of the health system, including lack of access to regular training wards and the need for social distancing, which posed particular challenges to undergraduate teaching. Objectives. To explore the perceptions of students of the online surgical programme at the University of KwaZulu-Natal (UKZN). Methods. An online survey was administered to 258 final-year students. Data were collected on student demographics, the impact of COVID-19 restrictions on the teaching programme, engagement and learning from live Zoom sessions, overall perceptions about the module and general feedback on students' experience of the programme. Results. Most students (84%, 77/91) supported the need to change to the virtual programme. The module was perceived as well-structured (89%, 81/91). Most students (87%, 79/91) regarded the online resource materials as beneficial. Analysis of open-ended responses showed that asynchronous delivery allowed students to review and revisit resources in their own time. Student challenges included poor internet connectivity, difficulty in concentrating where live sessions exceeded an hour, and lack of clinical exposure. Conclusion. Online teaching in medical education is a feasible option for remote learning. However, it cannot replace the benefits gained during clinical exposure. Findings from this study will help to set a benchmark for online surgical training at UKZN and develop best practices for blended teaching models. As we adapt to a new normal in the era of COVID-19, the disruptions and results of innovative teaching methods have the potential to change the future of medical education

A REVIEW ARTICLE ON THERAPEUTIC POTENTIAL OF GARLIC

Garlic or Lashun is the member Liliaceae family, is use as spice in food cooking as well as medicine to treat various ailments. Garlic is also acting as a flavoring agent for the cooking, and however it has also been used as a drug from very ancient and modern times in all over the world, it is used to inhibit and cure the vast range of ailments and disorders. Allicin found in the garlic is the chemically active substance of fresh garlic extract, possess the capacity of readily permeable through phospholipid membranes which contributes to its possible pharmacological activity and also contain sulfur compounds, which are believed to bring some of the health benefits. Currently, garlic is broadly used for different diseases related with the systemic circulation and heart, which includes atherosclerosis, HDL, LDL & heart attack, coronary heart disease, and hypertension. Garlic is also reported to treat the lung cancer, and various other cancers such as colon cancer& skin diseases too, it also has hypolipidemic, immunomodulator, aphrodisiac, & Antifungal actions. This article reviews the importance of garlic (Allium sativum), and, their active constituents to show whether or not can be further used as potential natural sources for the development of any novel drug formulations.

Organ Weights and Intestinal Morphology of Broiler Chickens Fed Diets Containing Different Supplements

The present study was evaluated the effect of dietary inclusion of various feed supplements and their combination on the performance index, glucose and serum cholesterol for 6 weeks. Day-old broiler chicks (n=252) were randomly assigned to seven treatment groups, each with 3 replicates. The first treatment was designated as control (T0) in which no supplement was added to the feed, while in treatments T1; organic mineral mixture (Organomin forte), T2; organic mineral mixture (Vannamin), T3; probiotics (Microguard), T4; enzyme (Brozyme -XPR) and probiotics, T5; emulsifier (Lipigon) were provided through feed. In the T6 group, 3 percent less energy was given through feed. The weight of vital organs viz. heart, liver, gizzard, and spleen were significantly (P<0.05) increased by the feed supplements of which were in the normal range. The gut morphology was also favorably altered due to feed supplementations. This indicates that the organic mineral mixtures, probiotics, enzymes and emulsifiers, and their combinations can be used as a growth promoter in broiler diets and can improve gut health. These products show promising effects as alternatives for antibiotics as pressure to eliminate growth-promoting antibiotic use increases

Assessment of Livestock Production Technologies and Package of Practices through Multivariate Typology: A Case of Maharashtra, India

The study was carried out in four different agro-climatic zones of Maharashtra. A typology was developed applying multivariate statistical techniques i.e. Cluster analysis (CA) to classify groups of farm households with similar farm characteristics into four homogenous clusters, (i) households possessing small landholding, a larger high yielding dairy stock with small goat flock size (37.5%), (ii) households having small landholding with a small stock of high yielding dairy animal and small goat flock size (39%), (iii) households having large landholding with large high yielding dairy stock and small flock size (13.5%) and (iv) households possessing small landholding with small high yielding dairy stock and large flock size (10%). An assessment in terms of awareness, knowledge and adoption of dairy technologies and goat production practices were carried out across the clusters which was found significantly high within the household of cluster 3 and 4. The overall adoption index was found to be 65.16 per cent across the whole clusters. Multiple regression analysis revealed that total SAU, flock size, occupation, innovative proneness, scientific orientation, awareness of technology and knowledge of technology contribute positively (P<0.01, P<0.05) to the adoption of technology. The coefficient of determination was found (R2 =0.66) across the whole clusters

Application of Thyroid Peroxidase (TPO) and Hector Battifora Mesothelial-1 (HBME-1) immunohistochemical markers in the diagnosis of papillary thyroid carcinoma of the thyroid

Background: Thyroid cancer is the most common endocrine malignancy accounting for >90% of malignancies of endocrine glands. The inter and intraobserver variation in the histomorphological diagnosis of Papillary Thyroid Carcinomas may sometimes pose a diagnostic difficulty. Application of IHC biomarkers may play an active or complementary role in their accurate classification. Aim: The present study was conducted to evaluate if HBME-1 and TPO immunohistochemical analysis can reliably differentiate papillary carcinomas from other thyroid lesions. Material and Methods: 50 cases of benign and malignant thyroid lesions were taken. Immunohistochemical staining for HBME-1 and TPO was performed. HBME-1 and TPO score was interpreted as absent and positive. Medical records were retrieved and their clinical data, surgical treatment, and pathological findings were noted. Results: Out of 50 cases, 19 (73.1%) cases were diagnosed PTC, 4 (15.4%) cases were FTC, 3(11.5%) cases were of MTC and 24 cases of benign thyroid lesions. TPO expression was found positive in 91.7% of cases of Benign thyroid lesions. In malignant thyroid lesions, negative expression of TPO was seen in 63.16%, 0% and 33.33% of PTC, FCT, and MCT respectively. HBME-1 showed negative expression in 83.3% of cases of benign thyroid lesions. Whereas, in malignant thyroid lesion HBME-1 expression was positive in 78.95%, 50% and 0% cases of PTC, FCT, and MCT respectively. Conclusion: Testing for expression of HBME-1 has been shown to improve the diagnostic accuracy for thyroid malignant nodules. The combination of HBME-1, and TPO may contribute to an accurate diagnosis of papillary thyroid carcinoma.

Bulk segregant analysis identifies SSR markers associated with Alternaria blight resistance in linseed (Linum usitatissimum L.)

Aim: Alternaria blight caused by Alternaria lini is one of the major diseases of linseed which severely affects the yield and productivity. Here, we utilizes F2 mapping population derived from a resistant (JRF-4) and a susceptible (Chambal) genotypes of linseed and SSRs to identify the markers associated with Alternaria blight resistance using bulk segregant analysis approach. Methodology: A population consisting of 154 F2 individuals was developed from the cross between JRF-4 (resistant) and Chambal (susceptible). All 154 F2 individuals were screened with 100 polymorphic SSRs to identify extreme phenotype. Two bulk of extremes phenotypes (disease resistant and disease susceptible) from F2 mapping population were used for the bulked segregant analysis. The SSR primers that distinguished the parental lines were used to amplify the DNA from two bulks and banding pattern was observed to identify the SSRs that can differentiate the resistant and susceptible phenotypes bulk for Alternaria blight. Markers validation was carried out by amplifying DNA from individual plants of each bulk. Results: Out of 100, only 10 markers showed polymorphism among the bulks and of which only three markers viz., LUSc 898_3_12, Lu 2472 and Lu 3078 were able to differentiate the disease resistant and susceptible individuals from F2 population. Further, single marker linear regression approach was used to validate the association of selected polymorphic markers with the disease. The markers LUSc 898_3_12 and Lu 2472 showed significant regression which confirmed their linkage with Alternaria blight resistance. Interpretation: The two markers having significant regression can be used for diseases resistance breeding during marker assisted selection.

Conceptual And Applied Aspect Of Agnikarma In The Purview Of Cauterization

In Ayurveda, Shalyatantra is one of the eminent branches based on six major methods of management among which Agnikarma is boon for local Vata and Kaphaja Vyadhi. Its effect can be assessed as Sthanik Karma (local action), Saarvadaihik Karma (Action throughout the body) and Vishista Karma (Special actions). Based on amount of Agni needed, the condition and site of disease, Dahanupakarana are used to produce therapeutic burns during Agnikarma Chikitsa. It can be classified according to Dravya used, site, disease, Akritiand Dhatu to be cauterized. Based on the Dagdha (Burn), it is again of four type viz. scorched burn, blistered burn, superficial burn and deep burn. Its indication is in all seasons except in summer and autumn. Indications and contraindications are well expounded in classics with detail information on Purva Karma, Pradhana Karma and Paschat Karma during Agnikarma as it is superior to every other procedure used in Ayurveda Surgery. In modern medicine, there is no use of therapeutical burn i.e., Samyak Dagdha Chikitsa but its use is in other form eg., Cauterization is used for coagulation and tissue destruction. Agnikarma is considered as the best therapy to pacify Kaphanubandha Vata Dosha because Agni possesses Ushna, Tikshna, Sukshma, Aashukari Gunas, which have anti Vataja and anti Kaphaja properties. It is done by red hot Shalaka. It gives quick relief to the patient and hence is termed as best therapy.

A prospective study assessing feasibility of performing percutaneous nephrolithotomy in chronic kidney disease patients - What factors affect the outcome?

ABSTRACT Objectives To primarily evaluate the functional outcomes of PCNL for bilateral renal calculi/calculi in solitary functioning kidney with Chronic Kidney Disease(CKD). To identify factors affecting the renal replacement therapy following PCNL. Materials and Methods Patients with bilateral renal calculi/calculi in solitary kidney and CKD (eGFR<60/s.creatinine>2) and Good Performance Status [Eastern Cooperative Oncology Group (ECOG): 0-2] were included in the study. Results A total of 60 patients with CKD who had bilateral renal calculi/calculi in solitary functioning kidney underwent PCNL. At 6 months, eGFR improved or stabilized in 45 (75%) patients, while in 15 (25%) patients eGFR deteriorated. A total of 5 (14.28%) and 2 (25%) patients of CKD stage 4 and 5 respectively had improvement in eGFR as well as CKD stage. Fourteen (82.35%), 21 (60%), 3 (37.5%) patients of CKD stage 3, 4, 5 had improvement in eGFR but not significant enough to cause stage migration. Again 3 (17.65%) , 9 ( 40%) and 3 (37.5%) patients of CKD stage 3, 4, 5 had reduction in eGFR but not significant enough to cause stage migration. None of the patients had worsening of CKD stage. Preoperative CKD stage and eGFR were compared with measurements made at the final follow up visit (6 months). Conclusion Our results indicate that most patients of renal calculi with CKD show improvement or stabilization of renal function with aggressive stone removal. Improvement is more in patients who have mild to moderate CKD. Aggressive management of comorbidities, peri-operative UTI and complications may delay or avoid progression of CKD status in such patients.

Characterization of glycolipid biosurfactant from Pseudomonas aeruginosa PA 1 and its efficacy against Phytophtora infestans

Aim: The aim of the present study was to identify biosurfactant produced by Pseudomonas aeruginosa and to determine the effectiveness of biosurfactants (rhamnolipid) against P. infestans causing late blight of potato. Methodology: Pseudomonas aeruginosa strains were isolated from soil samples and the potential strain PA 1, selected because of its antagonistic ability, was used to optimize anti-metabolite production and its characterization using HPLC-Mass spectrometry. Rhamnolipid based formulation was developed and its efficacy was tested against late blight disease. Results: The results revealed that four rhamnolipids congeners were identified, among them three were mono-rhamno-di-lipidic congeners and one was di-rhamno-di-lipdic congeners, abundantly present in the crude biosurfactant obtained from P. aeruginosa PA1. The mass spectra of mono-rhamno-di-lipidic Rha-C12-C14 peak value (m/z 584), Rha-C12.1-C10.CH3 peak value (m/z 545), Rha-C12-C-12-CH3 peak value (m/z 575) and di-rhamno-di-lipidic. Rha-Rha-C10-C10 peak value (m/z 651) were also detected. Rhamnolipid-based formulation was developed and evaluated at different concentration ranging from 0.012 and 0.3% in detached leaf test. Significant reduction in lesion area was recorded at 0.2% concentration (lesion area 0.06 cm2 as against 9.8 cm2 on 5th day of inoculation). Interpretation: Microbial produced rhamnolipid based formulation at 0.2% concentration was found effective against late blight of potato in detached leaf test. Further, it could be used in field study as green chemical which would help in replacing application of chemicals in agriculture.

Impact of gamma irradiation on growth, yield and physiological attributes of maize

Feeding the increasing global population with adequate supply of cereals for food, particularly with limited agricultural area, is a challenging task. In this context, emphasis on enhancing food producing processes gains attention. Gamma irradiation, up to certain doses, is known to improve crop yield without using chemical fertilizers. Among the cereals, maize is an important crop, which accounts for 9% of total food grain production. Here, we presumed that gamma ray pretreatment to maize seeds would be beneficial and boost the maize productivity and yield. In this study, we conducted field experiments to assess the gamma irradiation induced effect on seedling emergence, plant growth, yield and yield attributes of maize (HQPM-1). Grains of maize were exposed to gamma radiation doses ranging from 0.0025, 0.005, 0.01, 0.05, 0.1, 0.2, 0.3, 0.4 0.50, 1.0 and 2.0 kGy with the help of 60Co γ-radiation source facility available in the Centre. The germination of irradiated seeds was assessed in an incubator chamber and the irradiated seeds were sown in the field during kharif (July-October) 2013 and 2014 seasons at the IARI, New Delhi, research farm. The germination was >90% up to 0.1 kGy dose, beyond which, germination of seeds in the incubator as well as in field condition declined significantly. Few seedlings still came out from relatively higher doses of gamma irradiation (>0.5 kGy). However, these seedlings could not survive more than seven days. Results of present study indicated that plant growth parameters, such as plant height, photosynthetic rate, chlorophyll content, leaf area index at ‘tasseling’ as well as at ‘silking’ stage affected positively at lower doses (<0.2 kGy). The biological yield, grain weight (g) (cob-1), grains (cob-1) and 100 grain weights responded positively to the lower doses (≈ 0.1 kGy) of gamma irradiation. Our results indicated improvement in biological yield by 35.2% at 0.1 kGy as compared to the control (00 kGy). However, maximum reduction (33%) was recorded at 0.5 kGy. Similarly, grain yield (ton ha-1) was improved by 8.3% at 0.1 kGy as compared to the control, but reduced the most by 56.9% at 0.5 kGy compared to the respective control.

Development of species-specific primers for detection of Xanthomonas campestris pv. campestris causing black rot of crucifers

Aim: Black rot of crucifers caused by Xanthomonas campestris pv. campestris (Pammel) Dowson (Xcc) is a major seed-borne disease. The present study aimed to develop a rapid diagnostic protocol for the specific and sensitive detection of this pathogen. Methodology: A specific primer set was designed based on rpf gene and optimization of PCR condition was done for specific detection of Xcc. Sensitivity of PCR for primer set was then determined by diluting the Xcc DNA and cells. Results: Specific primer set was able to amplify a specific band of 304 bp in all 11 isolates of Xcc but failed to amplify other Xanthomonas species and one each of Ralstonia solanacearum, Erwinia caratovora subsp. caratovora, Bacillus subtilis, Pseudomonas fluorescens and P. aeruginosa. The primer set was highly sensitive as it was able to detect 10 pg μl-1 bacterial DNA and up to 3x103 CFU ml-1 corresponding to 12 viable cells of Xcc which were used as template for PCR reaction Interpretation: The results suggest that developed PCR primers are highly specific and sensitive and it can be used to detect the pathogen at an early stage of infection for disease management.

The quality of life of caregivers of children with atopic dermatitis in a South African setting

Background. Atopic dermatitis (AD) is known to adversely affect patients' quality of life (QOL). However, less is known about the extent to which caregivers are affected, particularly in developing countries. Objectives. To investigate factors affecting QOL in caregivers of children with AD in the South African (SA) setting and to document the associated effect of disease severity. Methods. This was a prospective study of 142 AD patients and their caregivers attending Grey's Hospital in KwaZulu-Natal, SA, between May and September 2016. Disease severity was assessed according to the Objective Scoring of Atopic Dermatitis (Objective SCORAD) index. The Dermatitis Family Impact (DFI) questionnaire was used to assess QOL. Results. The study population included 119 (84%) black, 20 (14%) Indian and 3 (2%) coloured patients. Among the group, 44% of cases (n=62) were classified as mild, 53% (n=76) as moderate and 3% (n=4) as severe. The DFI score was significantly associated with the Objective SCORAD index (p<0.0001). QOL factors significantly affected were emotional distress of the caregiver (p<0.0001), tiredness of the caregiver (p<0.0001) and family leisure activities (p<0.0001). Involvement in treatment (p=0.016), food preparation and feeding (p=0.003), the family's sleep (p=0.001) and the caregiver's relationships (p=0.025) were moderately affected. Conclusion. The QOL of caregivers of children with AD in this setting was adversely affected and declined with increasing disease severity. An evaluation of the psychosocial health of caregivers and appropriate referral where necessary are important for holistic management of both the patient and the caregiver and to improve disease outcome

Savitzky-Golay Filter for Denoising Lung Sound

ABSTRACT For computerized analysis of respiratory sounds to be effective, the acquired signal must be free from all the interfering elements. Different forms of noise which can degrade the quality of lung sounds are recording artifacts, power line/Radio Frequency (RF) interferences, ambient acoustic interferences, heart sound interference etc. Such interferences adversely affect the diagnostic interpretations. Powerful denoising techniques are necessary to resolve this issue. A denoising scheme for lung sounds, based on Savitzky-Golay (S-G) filter is proposed in this paper. The order and frame length of the SG filter is determined objectively using the Signal to Noise Ratio (SNR) and computational time as objective function. Maximum SNR is observed when the frame length is nearest to the value just higher than the polynomial order. This observation holds good for different levels of simulated addictive Gaussian noise. The polynomial order of 8 and frame size of 9 are found to be promising with SNR of 10.401db at computation time of 2.1ms.

An evaluation of mini-laparotomy cholecystectomy in the laparoscopic era: a rural experience

Background: Laparoscopic cholecystectomy (LC) is the gold standard for the management of symptomatic cholelithiasis and complications of gallstone disease. Mini laparotomy cholecystectomy (MOC) may be a more appropriate option in the resource constrained rural setting due to its widespread applicability and comparable outcome with LC. The study aimed toprovide an epidemiological analysis of gallstone disease in the rural population and to evaluate the outcome of MOC in a rural hospital.Methods: A retrospective chart analysis of 248 patients undergoing cholecystectomy in a rural regional referral hospital in KwaZulu-Natal from January 2009 to December 2013 was undertaken.Results: Of the 248 patients, the majority were females (n = 211, [85%]). The most frequent indications for cholecystectomy included: biliary colic (n = 115, [46.3%]); acute cholecystitis (n = 80, [32.3%]); gallstone pancreatitis (n = 27, [10.8%]). Forty cases (16.1%) were converted to open cholecystectomy (OC). The median operative time was 40 minutes (range18­57). Twenty-three morbidities (9.3%) occurred including: bile leaks (n = 6, [2.4%]); bleeding from drain site (n = 1, [0.4%]), incisional hernia (n = 8 [3.2%]) and wound sepsis (n = 8 [3.2%]). The median length of hospital stay in patients who underwent MOC was 48 hours (range: 24­72 hours) and the median time to return to work was 10 days (range: 4­14 days). There was one mortality in the entire cohort.Conclusion: MOC is a safe and feasible operation for symptomatic cholelithiasis when cholecystectomy is indicated. The low operative morbidity and mortality in the context of a high risk patient profile and complicated gallstone disease makes this procedure an alternative to LC where LC is inaccessible