Effect of Clinician-directed Technical Specifications on Entrance Skin Doses in Neonates

Objectives: To compare the entrance skin doses (ESD) before and after implementation of a radiation safety policy in neonates (RSN), which focused on clinician-directed technical specifications on the digital X-ray machine. Methods: Prospective observations included two sets of X-rays: Before (BRSN) and after (ARSN) implementation of RSN (documented indication for Xray/expected posttest findings, settings of 40 kVp, 0.5 mAs, film-focus distance 100 cm, gonadal-shield, optimal collimation, and post-shoot image-enhancement). Results: 33 and 32 X-rays were analyzed in respective groups. Mean (SD) of calculated and machine-quantified ESD (µGy/m2) was higher in BRSN group as compared to ARSN group (P <0.001). All ARSN X-rays were interpretable for expected post-test findings. Conclusion: Clinicians’ cognizance of ability to make consequential bedside technical specifications, can reduce ESD without affecting interpretability. These single observations could have a larger impact in sick neonates, where multiple X-rays are done.

Cardiorespiratory Adverse Events after First Vaccination in Preterm Neonates With Gestational Age ?30 Weeks

Objectives: To document the adverse cardiorespiratory events following first routine immunization in preterm neonates. Methods: We retrieved records of neonates with gestational age ?30 weeks, and included those who developed cardiorespiratory events after first vaccines before discharge. Our Unit’s protocol is to administer Bacillus Calmette-Guerin (BCG), hepatitis B vaccine to those discharged at <8 weeks postnatal age. Hexavalent, BCG, pneumococcal vaccine and rotavirus vaccines are given at 8 weeks of age, if hospital stay is predicted to be longer. Unit compliance to vaccination administration at appropriate ages were also measured. Results: Data of 161 neonates ?30 weeks (17.4% <27 week) who completed care in the unit was studied. Cardio-respiratory adverse events were reported in 21(13.7%). None of these required initiation of invasive ventilation. High flow nasal cannula therapy and caffeine restart were required for these events in 14 (9.3%) and 6 (3.9%) neonates, respectively. Lower gestational age, bronchopulmonary dysplasia and sepsis were significant risk factors on univariate analysis. On multivariate analysis, continued need for respiratory support at 4 weeks of age (P=aOR 14.5 (95% CI 5-59.1) was the only independent risk factor for post-vaccination cardiorespiratory adverse events. Of 38 who were not vaccinated at recommended ages by unit policy, 25 were missed opportunities, the rest were deemed unstable for vaccinations at that age by the clinical team. Conclusion: Adverse cardiorespiratory events were uncommon after first vaccinations in very preterm neonates. Administering vaccines in this group before discharge would allow monitoring for these events, especially for those who require long-term respiratory support.

Incidence of Metabolic Bone Disease After Implementation of Bone Protective Nutritional Strategies: A Prospective Cohort Study

Background: Metabolic bone disease (MBD) is a morbidity of multifactorial etiology with a high incidence in very preterm infants. We planned to study the incidence of MBD after implementation of bone health focussed nutritional strategy (BNS) in those <30 weeks gestation at birth. Methods: This prospective cohort study including preterm newborns (<30 weeks) who received nutrition that incorporated (a) Early initiation of intravenous potassium phosphate; (b) Early enteral supplementation with multicomponent human milk fortifier at enteral feed tolerance of 40 mL/kg/day feeds itself; and (c) Weekly phosphorus measurements with optimization of enteral intakes. Incidence of MBD at 4 weeks of postnatal age and beyond were analyzed. Other relevant safety and clinical outcomes were measured. Results: Of the 67 included neonates receiving BNS, 20.9% were classified as MBD. There was a low rate of hyperphosphatemia (4.5%) and hyperkalemia (2.9%). Full enteral feeds were achieved by median (IQR) of 6 (5,7) postnatal days. Conclusion: In preterm newborns (24-30 weeks) MBD incidence was 20.9% after BNS was implemented. Intravenous potassium salt of phosphorus and early use of HMF were safe and feasible.

A Comprehensive Overview on Pathogenesis and Management of Osteoarthritis vis-a-vis Sandhigatavāta

The most common joint condition encountered in clinical practice is osteoarthritis (OA) of the knee, which is a primary source of impairment in the elderly. It is a multifactorial chronic degenerative condition characterised by loss of articular cartilage, enlargement of bone at the borders, subchondral sclerosis, and a variety of biochemical and morphological changes to the synovial membrane and joint capsule. OA clinically similar to Sandhigatavāta of Ayurveda is one of the eighty types of Nānātmaja Vātavyādhi. The aetiopathogenesis, symptoms, and treatment of Sandhigatavāta found in a very concise format in classical texts. The authors have tried to put an emphasis on OA related to its prevalence, aetiology and pathogenesis based on Sadkriyākāla along with management by incorporating the knowledge of literary and data base resources in order to establish a guideline for the rational use of treatment modalities. The present approach may be useful for clinicians and researchers to plan appropriate strategy of management and research in the field of OA

MANAGEMENT OF PRESSURE URTICARIA (SH?TPITTA) THROUGH VIRECANA : A CASE REPORT

Introduction: A 32 years old female patient consulted for the following complaints- frequent episodes of papular, pinkish red rashes on whole body on applying pressure or scratching, associated with marked itching and burning sensation since one and a half month. She was clinically diagnosed as acute case of Sh?tpitta that can be correlated with urticaria (pressure urticaria: due to pressure). Material and Methods: Ayurvedic ?odhana (Virecana) and ?amana treatment were used to successfully manage this condition. The goal of this case study is to illustrate how ?odhana (bio-purification treatments) and ?amana (palliative) therapy might be beneficial in the treatment of allergic disorders such as urticaria. Result and Conclusion: After receiving Virecana and oral medication, the patient's symptoms considerably improved. Although contemporary medicine offers a variety of treatment options for urticaria and other allergic skin conditions, recurrence is typical even after medication. This case study shown that Ayurvedic management (Virecana as ?odhana therapy and ?amana ?usadha) may be useful in the treatment of skin issues.

Morpho-toxicology of chlorpyrifos to prolactin cells of a freshwater catfish, Heteropneustes fossilis / Morfotoxicologia de clorpirifos para as células de prolactina de bagre de água doce Heteropneustes fossilis

In the present study, an organophosphorus compound Coroban (active ingredient chlorpyrifos ­ E.C. 20%) was used. In short-term exposure the fish were subjected to 0.8 of 96h LC50 value of chlorpyrifos (1.76 mg L-1) for 96h. In long-term exposure the experiment was performed for 28 days by using 0.2 of 96h LC50 value of chlorpyrifos (0.44 mg L-1). Fish were killed on each time intervals from control and experimental (chlorpyrifos) groups after 24, 48, 72, and 96h in short-term exposure and after 7, 14, 21, and 28 days in long-term experiment. Blood samples were collected and sera were analyzed for calcium. Pituitary glands were fixed for histological studies and stained with Herlant tetrachrome and Heidenhain's azan techniques. Short-term exposure of chlorpyrifos caused decrease in the serum calcium levels. No change was noticed in the prolactin cells of chlorpyrifos treated fish. Long-term treatment with chlorpyrifos provoked hypocalcemia. The prolactin cells of treated fish exhibited slight degranulation after 21 days whereas the nuclear volume remained unchanged. After 28 days, the prolactin cells exhibited further degranulation and the nuclear volume recorded an increase. Cytolysis and vacuolization were also visible.

No estudo presente, o composto organofosforo Coroban (ingrediente ativo clorpirifo ­ E.C. 20%) foi usado. Na exposição a curto prazo os peixes foram submetido a 0,8 de valor LC50 de 96h de clorpirifo (1,76 mg L-1) durante 96h. Na exposição a longo prazo o experimento foi executado durante 28 dias usando 0,2 de valor LC50 de 96h de clorpirifos (0,44 mg L-1). Os peixes foram mortos a cada intervalo dos grupos controle e experimental (clorpirifos) após 24, 48, 72, e 96h em exposição a curto prazo e após 7, 14, 21, e 28 dias no experimento a longo prazo. As amostras de sangue foram colhidas e o soro foi analisado para cálcio. As glândulas pituitárias foram fixadas para estudos histológicos e colorido por tetracromo de Herlant e por técnicas de azan do Heidenhain. A exposição a curto prazo do clorpirifo diminuiu os níveis de cálcio no soro. Nenhuma mudança foi observada nas células de prolactina nos peixes tratados com clorpirifo. O tratamento a longo prazo com clorpirifo causou hipocalcemia. As células de prolactina dos peixes tratados mostraram uma leve degranulação após 21 dias ao passo que o volume nuclear permaneceu inalterado. Depois de 28 dias, as células de prolactina mostraram mais degranulação e o volume nuclear registrou um aumento. Citólise e vacuolização também eram visíveis.

Acute toxicity of azadirachtin to a teleost, Heteropneustes fossilis / Toxicidade aguda da azadiractin para um teleósteo, Heteropneustes fossilis

The acute static renewal test of a botanical pesticide - azadirachtin for the freshwater catfish, Heteropneustes fossilis has been performed to determine the LC50 values at different exposure period. The LC50 values at various exposure periods are 173.06 mg L-1 for 24h; 80.69 mg L -1 for 48h; 58.57 mg L-1 for 72h and 52.35 mg L -1 for 96h. The upper confidence limits were 196.87, 86.91, 79.20 and 70.04 mg L-1 for 24, 48, 72 and 96 h and lower confidence limits were 154.01, 74.24, 37.33 and 33.83 mg L-1, respectively. These results indicate that azadirachtin exposure to the fish caused toxic effects.

A renovação do ensaio estático agudo de um pesticida botânico - azadiractin para o peixe de água doce, Heteropneustes fossilis foi realizada para determinar os valores de LC50 em diferentes períodos de exposição. Os valores de LC50 em diferentes períodos de exposição são 173,06 mg L-1 por 24h; 80,69 mg L-1 por 48h; 58,57 mg L-1 por 72 h e 52,35 mg L-1 por 96h. Os limites de confiança superiores foram 196,87; 86,91; 79,20 e 70,04 mg L-1 para 24, 48, 72 e 96h os limites inferior e confiança foram 154,01; 74,24; 37,33 e 33,83 mg L-1, respectivamente. Estes resultados indicam que a exposição do peixe à azadiractin causou efeitos tóxicos.

Transcanalicular laser dacryocystorhinostomy using low energy 810 nm diode laser

Hypertrophic scarring may be a cause of failure after transcanalicular laser dacryocystorhinostomy [DCR] surgery. This hypertrophic scarring results from tissue charring and excessive coagulation, which may be caused by the high laser energy. We have evaluated the use of low energy settings to prevent hypertrophic scarring, for a successful outcome. To perform and evaluate transcanalicular laser DCR using low energy 810 nm diode laser. Interventional, non-comparative, case series. Patients with nasolacrimal duct obstruction and chronic dacryocystitis, who needed DCR, and were fit for surgery under local anesthesia, were recruited to undergo transcanalicular laser DCR using a 810 nm diode laser. The outcome was measured by the patency of the lacrimal passage, as indicated by the relief in the symptoms and the patency on syringing at the last follow-up. The surgical time and surgical complications were noted. Descriptive analysis. The study included 94 patients. The average age was 30.1 years [range 15 - 69 years]. Seventy [74.4%] patients were female. Eight patients had failed external DCR. Per-operative patency of the passage was obtained in all the patients. Average surgical time was seven minutes [5 - 18 minutes]. At the end of the study period of one year, a successful outcome was seen in 85 patients [90.5%]. There were eight patients of previous failed DCR surgeries, and six of them achieved a cure at the end of follow-up. Transcanalicular Laser DCR can be safely performed using a low power 810 nm diode laser. The surgery is elegant, minimally invasive, allows fast rehabilitation, and has an excellent success rate

Parkinsonism due to isolated substantia nigra involvement in probable Japanese encephalitis

Parkinsonism due to an isolated lesion of the substantia nigra following a febrile illness is a rare entity. Anecdotal reports in the literature implicate substantia nigra as peculiarly susceptible to flaviviruses. Here we report a case of isolated substantia nigra involvement in a probable Japanese encephalitis patient who presented with post-encephalitic parkinsonism