A Study of the Effectiveness of Lidocaine to Treat Severe Pulmonary Vascular Constriction induced by Protamine

Background: Protamine neutralises heparin a?er separa?on from cardiopulmonary bypass. This study aimed to evaluate the effects of lidocaine on protamine induced pulmonary vascular constric?on in paediatric cardiothoracic surgery. Methods: This was a single-centre, prospec?ve, double-blind and randomised study conducted among eighty pediatric pa?ents with acyano?c congenital cardiac disease, scheduled for elec?ve on-pump cardiac surgery under general anaesthesia. In the study, the par?cipants were divided into four groups: Group NPHL- nonpulmonary hypertension with lidocaine precondi?oning, group NPHS- nonpulmonary hypertension with normal saline (as placebo), group PHL- pulmonary hypertension with lidocaine precondi?oning, and group PHS- pulmonary hypertension with normal saline (as placebo). Results: Pulmonary vasoconstric?on occurred in 11.25% of cases a?er protamine administra?on. Both the NPHS and PHS groups exhibited an increase in mean airway pressure (Paw), Respiratory index (RI), alveolar-arterial oxygen difference (A-aDO2), pulmonary artery pressure (PAP) and decreased dynamic pulmonary compliance (Cydn) and oxygen index (OI) a?er protamine administra?on. However, these changes were not observed in the NPHL and PHL groups with lidocaine precondi?oning. Plasma levels of TXB2 in the NPHS and PHS groups were higher than the NPHL and PHL groups, but 6-keto-PGF1 alpha levels were lower in the NPHS and PHS groups than in the NPHL and PHL groups. Conclusion: In congenital heart disease, repair without cardiopulmonary bypass is not possible in most cases. Prior to reversing heparin with protamine, precondi?oning lidocaine reverses protamine-induced pulmonary vasoconstric?on and improves lung func?on.

Idiopathic multilocular thymic cyst-an incidental anterior mediastinal mass

Acquired thymic cyst are multilocular and they occur de novo or in association with mediastinal neoplasm, systemic autoimmune diseases and trauma. Here, we report a case of acquired multilocular thymic cyst due to non-specific inflammatory etiology in a 42-year old gentleman and our approach to diagnosis and management of anterior mediastinal mass. With no specific clinical symptom, he was diagnosed with anterior mediastinal mass incidentally by imaging studies. Definitive diagnosis of multilocular thymic cyst was obtained by tissue diagnosis of the anterior mediastinal mass resected during the surgery.

Study on prevalence of peripheral neuropathy among patients on hemodialysis

Background: The incidence and prevalence of Chronic Kidney Disease is increasing slowly. Peripheral Neuropathy among CKD patients is the most common neurological complication of uremia, but still it is an under estimated problem adversely affecting the patient’s quality of life. It is more often a silent burden for the patient, progressively affecting his/her quality of life. Hence, this study aimed at analyzing and elaborating the diverse manifestations of CKD and establish the prevalence of peripheral neuropathy among patients with CKD undergoing hemodialysis in our Hospital. Materials and methods: This was a cross sectional study done on patients with CKD undergoing hemodialysis at Government Vellore Medical college and Hospital for a duration of 6 months from July 2017 to December 2017. After obtaining informed consent, the participants satisfying the inclusion criteria were asked detailed history and clinical examination was performed according to the well-designed proforma cited below. The presence of neuropathy was assessed using Michigan Neuropathy Screening Instrument (MNSI) Scores. Results: The mean age of the study subjects was 47.87 years. Most of the patients belonged to the age group 40-70 years. Out of 60 cases, there were 35 (58.0%) males and 25 (42.0%) females. The Male to Female sex ratio was 1.38:1. The prevalence of clinical Uremic distal symmetrical sensory-motor peripheral neuropathy assessed by MNSI in the CKD on HD population was 71.66%. The smallest MNSI score obtained in the study population was 2 and the largest score was 7. Conclusion: Uremic neuropathy is the most common neurological complication in patients with uraemia. MNSI physical assessment could be used as a simple bed side examination to determine the presence or absence of uremic peripheral neuropathy

Potential applications of lactic acid bacteria and bacteriocins in anti-mycobacterial therapy

Tuberculosis (TB) is a communicable disease caused by Mycobacterium tuberculosis (M. tuberculosis). WHO estimated that 10.4 million new (incident) TB cases worldwide in year 2016. The increased prevalence of drug resistant strains and side effects associated with the current anti-tubercular drugs make the treatment options more complicated. Hence, there are necessities to identify new drug candidates to fight against various sub-populations of M. tuberculosis with less or no toxicity/side effects and shorter treatment duration. Bacteriocins produced by lactic acid bacteria (LAB) attract attention of researchers because of its 'Generally recognized as safe' status. LAB and its bacteriocins possess an effective antimicrobial activity against various bacteria and fungi. Interestingly bacteriocins such as nisin and lacticin 3147 have shown antimycobacterial activity in vitro. As probiotics, LAB plays a vital role in promoting various health benefits including ability to modulate immune response against various infectious diseases. LAB and its metabolic products activate immune system and thereby limiting the M. tuberculosis pathogenesis. The protein and peptide engineering techniques paved the ways to obtain hybrid bacteriocin derivatives from the known peptide sequence of existing bacteriocin. In this review, we focus on the antimycobacterial property and immunomodulatory role of LAB and its metabolic products. Techniques for large scale synthesis of potential bacteriocin with multifunctional activity and enhanced stability are also discussed.

Chromatographic Separation and in Vitro Dissolution Assessment of Tenofovir disoproxil fumarate, Emtricitabine and Nevirapine in a Fixed Dose Combination of Antiretrovirals.

A rapid, economic and robust stability indicating HPLC method was developed and validated to quantify Tenofovir disoproxil Fumarate (TDF), Emtricitabine (EMT) and Nevirapine (NVP) simultaneously at single wavelength (254 nm) in order to assess the in vitro drug release profile from tablet formulations. Chromatographic separation was performed with a gradient elution of samples on a 4.6 mm x 150 mm, 5 μm, Inertsil ODS-2 column with buffered mobile phase containing solvent A (10 Mm ammonium acetate buffer, pH 4.6) and solvent B ( acetonitrile) at a flow rate of 1.0 mL/min). In dissolution studies, the sink condition was optimized based on quantitative solubility of TDF, EMT and NVP standards in different dissolution medium as recommended by USP. The proposed HPLC method and dissolution test condition were validated as per ICH guidelines. The results obtained meet the regulatory criteria thereby confirming that the method is suitable for routine quality control analysis and in vitro dissolution studies.

Isolation of colicinogenic E. coli, optimization of colicin production and transformation of Col plasmid.

An attempt was made for the isolation of colicinogenic E. coli from cow and sheep dung samples. Total of 112 E. coli isolates were collected from sheep and cow dung samples in which 63 isolates are from cow dung and 49 isolates are from sheep dung samples. In the screening for colicin production, two E. coli isolates C22 and C51 from cow dung sample and one isolate S39 from sheep dung sample showed activity against the pathogenic strain E. coli O157:H7. Colicin production by all the three E. coli isolates was found to be enhanced by 0.25mg/l of mitomycin-c and three hours of incubation at 370C. Plasmid DNA was isolated from colicinogenic E. coli strains by alkali lysis method and their molecular weight was found to be 6.5 kb. The transformation experiment carried out with the standard strain E. coli DH5 confirmed that the plasmids were col-plasmids. The three colicinogenic E. coli strains isolated in this study will be a candidate to develop as probiotic for veterinary applications.

Burkholderia pseudomallei infection in a healthy adult from a rural area of South India.

Melioidosis is an emerging disease producing protean manifestations, and is more common in alcoholics and diabetics. The disease can be a trivial localized lesion or a fatal septicemia. Early diagnosis and appropriate antimicrobial treatment greatly reduces the mortality rate. We report a case of localized form of the disease in an elderly male with no known predisposing medical disease who responded well to oral amoxycillin-clavulanic acid and cotrimoxazole treatment.

Quality indicators in a mycobacteriology laboratory supporting clinical trials for pulmonary tuberculosis

Documentation of structured quality indicators for mycobacteriology laboratories supporting exclusively controlled clinical trials in pulmonary tuberculosis [PTB] is lacking. To document laboratory indicators for a solid [Lowenstein-Jensen medium] culture system in a mycobacteriology laboratory for a period of 4 years [2007-2010]. The sputum samples, collected from PTB suspects/patients enrolled in clinical trials, were subjected to fluorescence microscopy, culture and drug sensitivity testing [DST]. Data was retrospectively collected from TB laboratory registers and computed using pre-formulated Microsoft Office Excel. Laboratory indicators were calculated and analyzed. The number of samples processed in a calendar year varied from 6261 to 10,710. Of the samples processed in a calendar year, specimen contamination [4.8-6.9%], culture positives [78.4-85.1%] among smear positives, smear positives [71.8-79.0%] among culture positive samples, smear negatives among culture negative samples [95.2-96.7%], and average time to report DST results [76-97 days] varied as shown in parentheses. Values of quality indicators in mycobacteriology laboratories supporting exclusively clinical trials of PTB have to be defined and used for meaningful monitoring of laboratories.

Fluoxetine withdrawal syndrome in the newborn.

A term baby was admitted to our neonatal unit with jitteriness, hypertonia, sneezing and fever. Her mother was on 20 mg of fluoxetine throughout her pregnancy. These symptoms which were possibly due to fluoxetine withdrawal lasted only for a short while. We attempt to look at the reported prevalence of this condition in the literature.

Indirect immunofluorescent antibody test for the rapid diagnosis of melioidosis.

Culture is the only reliable method available at present for the diagnosis of melioidosis. Though serological tests have been described, their value in routine diagnosis is controversial. All indirect immunofluorescent assay (IFA) was therefore evaluated to determine its use in the diagnosis of melioidosis. Whole cell antigen prepared from a laboratory isolate of Burkholderia pseudomallei was used to assay IgG and IgM antibodies. Fourteen of the 22 (63.6%) culture proven cases had IgM antibodies while only 10 (45.5%) had IgG antibodies. Negative predictive value of IgM assay was 92 per cent. Positive predictive value was 100 per cent if both IgM and IgG were considered together. The present study done on a limited number of samples suggests that IFA may be useful in routine diagnosis of melioidosis.

Septicaemic melioidosis in a tertiary care hospital in south India.

BACKGROUND & OBJECTIVES: Melioidosis and the causative organism Burkholderia pseudomallei are being recognized gradually in various centres in India. In the septicaemic form, melioidosis is a serious and life threatening condition which requires early detection and specific treatment to avoid case fatality. A review of patients with septicaemic melioidosis at a tertiary care hospital in south India was carried out with a view to define the clinical features, predisposing conditions, if any, and the outcome. METHODS: A total of 28 patients with culture proven septicaemic melioidosis during December 1993 to December 2002 were included. Information on clinical details and outcome was obtained and antibiotic susceptibility of the isolates studied. RESULTS: Of the 28 patients of blood culture proven septicaemic melioidosis, the organism was also isolated from pus in two patients. The presenting clinical features were varied, most presenting as pyrexia of unknown origin or visceral abscesses, or septic arthiritis. Associated/predisposing conditions were present in 50 per cent of the patients, and diabetes mellitus was the commonest one. mortality was 58 per cent in our series. INTERPRETATION & CONCLUSION: Melioidosis is an emerging infection in India. The magnitude of the problem can only be assessed by increasing awareness, both of its existence in the clinical setting and its identification in the laboratory.