Perioperative management of a parturient with VACTERL association for a caesarean section.

A parturient with VACTERL association (vertebral defects, anal atresia, cardiac defects, trachea-oesophageal fistula, renal abnormalities and limb abnormalities) was listed for an elective caesarean section. She had a short neck with reduced cervical extension and flexion. Magnetic resonance imaging of her whole spine was performed which showed failure of cervical spine segmentation and cervical stenosis. Neuraxial blockade could have resulted in unpredictable spread of local anaesthetic due to the low volume of the spinal canal, and could have caused myelopathic changes within the spinal cord due to cerebrospinal fluid pressure changes. A general anaesthetic using a rapid sequence induction was also predicted to be challenging due to her fixed, unstable neck and severe cervical spine stenosis. After a multidisciplinary discussion Including neurosurgeons, we planned for awake tracheal intubation followed by general anaesthesia. However, before the date of her planned delivery, she required an urgent caesarean section due to severe preeclampsia. This was performed under general anaesthesia following uncomplicated awake tracheal intubation.

Assessment of groundwater salinity using principal component analysis (PCA): a case study from Mewat (Nuh), Haryana, India.

In the present study, principal component analysis (PCA) is used to investigate the processes controlling groundwater salinity in the Mewat (Nuh) district, Haryana, India. Twenty groundwater samples were collected from salinity-affected areas in the March-April months of years 2018 and 2019 and were analyzed for chemical variables pH, EC, Ca2+, Mg2+, Na+, K+, [Formula: see text], Cl-, SO42-, [Formula: see text], TDS, and total hardness. Three principal components were selected based on the eigen value, which explains 79.58% and 85.08% of the total variation in the years 2018 and 2019, respectively. The first principal component (PC-1) is identified with salinity, the second principal component (PC-2) with alkalinity, and the third principal component (PC-3) described the pollution. When the yearly comparison was made, the samples collected in 2019 were found to have an increased salinity compared to 2018, which shows an increased vulnerability to the aquifer of Mewat on account of the decline in rainfall recharge. It was also evident that declining recharge also triggered the recharge from other sources; thus, the impact of pollution is more pronounced in 2019 compared to 2018.

Swarm motility of Salmonella enterica serovar Typhimurium is inhibited by compounds from fruit peel extracts.

UNLABELLED: Controlling spread of human pathogens on fresh produce is a top priority for public health reasons. Isolation of compounds from agricultural waste that would control spread of human pathogens was explored using Salmonella enterica serovar Typhimurium as a model organism. In the environment, micro-organisms migrate as a 'community' especially when they move on moist surfaces. This type of motility is characterized as swarming motility. We examined extracts from agricultural waste such as soya bean husk, peels of orange, pineapple, avocado and pomegranate for antiswarming activity. Avocado and pineapple peels showed moderate (~40%) inhibition of swarming motility while pomegranate peel extract had high antiswarming activity (~85% inhibition) and was examined in further detail. Although the pomegranate peel extract was acidic, swarm-inhibitory activity was not due to low pH and the peel extract did not inhibit growth of Salmonella. Among the key swarm motility regulatory genes, class II (fliF, fliA, fliT and fliZ) and class III (fliC and fliM) regulators were downregulated upon exposure to pomegranate peel extract. Pomegranate peels offer great potential as a bioactive repellent for pathogenic micro-organisms on moist surfaces. SIGNIFICANCE AND IMPACT OF THE STUDY: Controlling the spread of food-borne pathogens in moist environments is an important microbial food safety issue. Isolation of compounds from agricultural waste (such as fruit peels) that would control spread of human pathogens was explored using Salmonella enterica serovar Typhimurium as a model organism. Pomegranate peels offer great potential as a bioactive repellent for pathogenic micro-organisms.

Dopaminergic gene polymorphisms and cognitive function in a north Indian schizophrenia cohort.

BACKGROUND: Associations of polymorphisms from dopaminergic neurotransmitter pathway genes have mostly been reported in Caucasian ancestry schizophrenia (SZ) samples. As studies investigating single SNPs with SZ have been inconsistent, more detailed analyses utilizing multiple SNPs with the diagnostic phenotype as well as cognitive function may be more informative. Therefore, these analyses were conducted in a north Indian sample. METHODS: Indian SZ case-parent trios (n = 601 families); unscreened controls (n = 468) and an independent set of 118 trio families were analyzed. Representative SNPs in the Dopamine D3 receptor (DRD3), dopamine transporter (SLC6A3), vesicular monoamine transporter 2 (SLC18A2), catechol-o-methyltransferase (COMT) and dopamine beta-hydroxylase (DBH) were genotyped using SNaPshot/SNPlex assays (n = 59 SNPs). The Trail Making Test (TMT) was administered to a subset of the sample (n = 260 cases and n = 302 parents). RESULTS: Eight SNPs were nominally associated with SZ in either case-control or family based analyses (p < 0.05, rs7631540 and rs2046496 in DRD3; rs363399 and rs10082463 in SLC18A2; rs4680, rs4646315 and rs9332377 in COMT). rs6271 at DBH was associated in both analyses. Haplotypes of DRD3 SNPs incorporating rs7631540-rs2134655-rs3773678-rs324030-rs6280-rs905568 showed suggestive associations in both case-parent and trio samples. At SLC18A2, rs10082463 was nominally associated with psychomotor performance and rs363285 with executive functions using the TMT but did not withstand multiple corrections. CONCLUSIONS: Suggestive associations with dopaminergic genes were detected in this study, but convincing links between dopaminergic polymorphisms and SZ or cognitive function were not observed.

Association study of neuregulin-1 gene polymorphisms in a North Indian schizophrenia sample.

BACKGROUND: Neuregulin-1 (NRG1) gene polymorphisms have been proposed as risk factors for several common disorders. Associations with cognitive variation have also been tested. With regard to schizophrenia (SZ) risk, studies of Caucasian ancestry samples indicate associations more consistently than East Asian samples, suggesting heterogeneity. To exploit the differences in linkage disequilibrium (LD) structure across ethnic groups, we conducted a SZ case-control study (that included cognitive evaluations) in a sample from the north Indian population. METHODS: NRG1 variants (n=35 SNPs, three microsatellite markers) were initially analyzed among cases (DSM IV criteria, n=1007) and controls (n=1019, drawn from two groups) who were drawn from the same geographical region in North India. Nominally significant associations with SZ were next analyzed in relation to neurocognitive measures estimated with a computerized neurocognitive battery in a subset of the sample (n=116 cases, n=170 controls). RESULTS: Three variants and one microsatellite showed allelic association with SZ (rs35753505, rs4733263, rs6994992, and microsatellite 420M9-1395, p≤0.05 uncorrected for multiple comparisons). A six marker haplotype 221121 (rs35753505-rs6994992-rs1354336-rs10093107-rs3924999-rs11780123) showed (p=0.0004) association after Bonferroni corrections. Regression analyses with the neurocognitive measures showed nominal (uncorrected) associations with emotion processing and attention at rs35753505 and rs6994992, respectively. CONCLUSIONS: Suggestive associations with SZ and SZ-related neurocognitive measures were detected with two SNPs from the NRG1 promoter region in a north Indian cohort. The functional role of the alleles merits further investigation.

Comparison of seven Oxethazaine containing antacids available in the Indian market.

OBJECTIVE: This in-vitro study was designed to measure the quantity of acid neutralized by a suspension of a commercial antacid available in Indian markets at a labeled dose and to test the concept of the relative effectiveness of 7 different commercial antacids containing Oxethazaine. METHODS: A simple back titration methodology was used to determine the acid neutralization capacity (ANC) of antacids. RESULTS: It was observed that different antacids vary widely in their in vitro ANC. There was also a batch to batch variation noted for each brand of antacid. The analysis indicated that there was a significant difference of ANC in favor of AD versus other antacids studied. CONCLUSION: Comparison of relative effectiveness indicates that AD has highest ANC in vitro amongst other antacids. However, the present study being in vitro, the effects of antacid may vary in vivo, as individual variations also contribute to the ultimate effectiveness of an antacid.

Prediction of ruminal volatile fatty acid proportions of lactating dairy cows based on milk odd- and branched-chain fatty acid profiles: new models, better predictions.

The volatile fatty acids (VFA) produced in the rumen and the proportions in which they are produced are important determinants of a ruminant's metabolism, but their monitoring requires rumen-fistulated animals, which is not feasible under practical conditions or in experimental setups at herd level. An alternative approach was suggested earlier, consisting of predicting the VFA proportions from measured odd- and branched-chain fatty acid concentrations in the milk with a linear model. Here, we have improved this strategy through the development and application of 2 new model structures: the quadratic model, containing quadratic terms and interactions, and the rational model, consisting of a ratio of linear expressions. Both were found to improve prediction accuracy significantly compared with the linear model. Although the quadratic model achieved the best prediction accuracy, the rational model has the interesting property that it takes the dependence of the 3 predicted VFA into account and guarantees that the 3 proportions add up to 1. Adding a study effect to correct for a possible study bias in the multi-study data improved prediction substantially for all 3 methods. Our results demonstrate the potential of using milk odd- and branched-chain fatty acid concentrations to predict rumen VFA proportions.

Identification of Forced Degradation Products of Itopride by LC-PDA and LC-MS.

Degradation products of itopride formed under different forced conditions have been identified using LC-PDA and LC-MS techniques. Itopride was subjected to forced degradation under the conditions of hydrolysis, photolysis, oxidation, dry and wet heat, in accordance with the International Conference on Harmonization. The stress solutions were chromatographed on reversed phase C18 (250×4.6 mm, 5 µm) column with a mobile phase methanol:water (55:45, v/v) at a detection wavelength of 215 nm. Itopride degraded in acid, alkali and oxidative stress conditions. The stability indicating method was developed and validated. The degradation pathway of the drug to products II-VIII is proposed.

Forearm IVRA, using 0.5% lidocaine in a dose of 1.5 mg/kg with ketorolac 0.15 mg/kg for hand and wrist surgeries.

AIM: Local anesthetic toxicity remains one of the most dreaded complications of the intravenous regional anesthesia (IVRA) technique. It results from the sudden release of a large amount of local anesthetic (LA) into the systemic circulation. This release can occur when the tourniquet deflates accidentally during the procedure or when it is deflated intentionally at the end of the procedure to terminate the anesthesia. The forearm tourniquet IVRA technique may offer distinct advantages over the conventional upper arm tourniquet IVRA technique. Use of a forearm tourniquet allows the dosage of local anesthetic to be decreased to almost half of what is required with an upper arm tourniquet, and the incidence of tourniquet pain has been reported to be less with forearm tourniquet. In this study, authors assessed the clinical efficacy of administering IVRA with lidocaine plus ketorolac using either a forearm or upper arm tourniquet. METHODS: Upper arm IVRA was established using 0.5% lidocaine at a dose of 3 mg/kg with ketorolac at 0.3 mg/kg. Forearm IVRA was established using 0.5 % lidocaine at a dose of 1.5 mg/kg with ketorolac at 0.15 mg/kg. Quality of surgical anesthesia, onset, duration of sensory block and postoperative surgical pain and analgesic use were recorded and assessed. The incidence of local anesthetic toxicity and local complications due to the tourniquet were also recorded. RESULTS: Surgical anesthesia was assessed as excellent or good (grade 0/1) in all 20/20 patients who received IVRA using an upper arm tourniquet and in 19/20 patients who received IVRA using a forearm tourniquet (P=1.00). Onset as well as regression of sensory block was similar in both the groups. Post operative VAS scores at 30 min and 60 min were statistically comparable between the two groups, as was the analgesic use in the first 24 h. CONCLUSIONS: In conclusion, forearm IVRA provides effective perioperative anesthesia and analgesia. The technique results in a similar clinical profile as upper arm IVRA while using half the dose of both lidocaine and ketorolac.

A novel use of esophageal tracheal airway: the control of torrential oral bleeding.

Combitube has been included in the American Society of Anesthesiologists (ASA) difficult airway algorithm for the emergency management of patients who can be neither intubated nor ventilated. The main advantages of the Combitube are minimal training required for its use and blind insertion with 90% success rate upon first attempt. The authors report a case of torrential oral bleeding in which the airway was secure and isolated by Combitube. The pharyngeal cuff of the Combitube was overinflated so as to create a tamponade effect to control otherwise uncontrollable and inaccessible oral bleeding.

Fresh-cut lettuce in modified atmosphere packages stored at improper temperatures supports enterohemorrhagic E. coli isolates to survive gastric acid challenge.

Incidences of foodborne outbreaks involving enterohemorrhagic Escherichia coli strains with mutations in a key regulatory gene, rpoS, have been reported. Incentives, if any, for losing this regulatory function are not clear since the RpoS regulator is required for the expression of several environmental stress tolerance genes. RpoS also positively regulates 2 of the 3 acid-resistance systems of E. coli under aerobic growth conditions and enables the pathogen to survive gastric acid challenge. We selected 7 enterohemorrhagic E. coli isolates, 6 of which are known to carry defective rpoS gene, and then analyzed resistance to synthetic gastric juice after the strains were inoculated on fresh-cut lettuce and stored under modified atmosphere packaging (MAP) conditions. Subatmospheric oxygen partial pressures in MAP enabled all 6 rpoS-defective isolates to induce acid resistance over the 8-d storage period if the temperature was >or= 15 degrees C. No acid resistance was induced for MAP-stored lettuce left at temperatures

Indo Heart Survey on latent abnormal glucose regulation in patients with coronary artery disease without diabetes across India.

BACKGROUND: The Euro Heart Survey on diabetes and heart has demonstrated high prevalence of latent glucose abnormalities in non-diabetic patients with coronary artery disease (CAD) in the European population. The aim of our survey was to assess the prevalence of latent abnormal glucose regulation in adult non-diabetic CAD patients in India. METHODS AND RESULTS: Seven centers distributed across India recruited 350 patients. The diagnosis of CAD was done by coronary angiography showing >50% stenosis in any major epicardial coronary artery or its branches. Oral glucose tolerance test (OGTT) and fasting glucose levels were used to characterize glucose metabolism. Venous plasma glucose was measured before (fasting) and 2 hours after ingestion of glucose. Impaired fasting glucose (IFG) was defined as OGTT (0 minute)>or=100 mg/dl but <126 mg/dl and OGTT (2 hours)<140 mg/dl. Impaired glucose tolerance (IGT) was defined as OGTT (0 minute)<126 mg/dl and OGTT (2 hours)>or=140 mg/dl but <200 mg/dl. Of the 350 patients studied, 176 (50.28%) had impaired glucose regulation (IFG-28 [8%]; IGT-148[42.28%]) and 75 (21.42%) had newly detected Diabetes. In all 251 (71.7%) patients with CAD had previously undetected abnormal glucose regulation. CONCLUSION: This survey demonstrates the presence of abnormal glucose regulation in almost three quarters of the non-diabetic Indian CAD patients. OGTT should be recommended as routine screening test for detecting latent glucose abnormalities in all CAD patients.

Kinetic studies of Escherichia coli AlkB using a new fluorescence-based assay for DNA demethylation.

The Escherichia coli AlkB protein catalyzes the direct reversal of alkylation damage to DNA; primarily 1-methyladenine (1mA) and 3-methylcytosine (3mC) lesions created by endogenous or environmental alkylating agents. AlkB is a member of the non-heme iron (II) alpha-ketoglutarate-dependent dioxygenase superfamily, which removes the alkyl group through oxidation eliminating a methyl group as formaldehyde. We have developed a fluorescence-based assay for the dealkylation activity of this family of enzymes. It uses formaldehyde dehydrogenase to convert formaldehyde to formic acid and monitors the creation of an NADH analog using fluorescence. This assay is a great improvement over the existing assays for DNA demethylation in that it is continuous, rapid and does not require radioactively labeled material. It may also be used to study other demethylation reactions including demethylation of histones. We used it to determine the kinetic constants for AlkB and found them to be somewhat different than previously reported values. The results show that AlkB demethylates 1mA and 3mC with comparable efficiencies and has only a modest preference for a single-stranded DNA substrate over its double-stranded DNA counterpart.

Rapid detection of Salmonella from hydrodynamic pressure-treated poultry using molecular beacon real-time PCR.

A real-time polymerase chain reaction (PCR) assay was evaluated to detect Salmonella in hydrodynamic pressure (HDP)-treated chicken using molecular beacon probes available as a commercial kit (iQ-Check, Bio-Rad Laboratories). The sensitivity and accuracy of the assay were compared with the conventional USDA microbiological procedure using artificially contaminated minced chicken. Chicken fillets were irradiated at 10 kGy to completely destroy any naturally occurring Salmonella. These fillets were minced and inoculated with as low as 2+/-1 cfu of S. typhimurium per 25 g chicken. The minced chicken samples were vacuum packed in multi-layer barrier bags, heat shrunk, and treated with HDP. Results showed that all inoculated samples (n=36) were detected by the PCR assay and conventional USDA procedure. Similarly, all uninoculated controls (n=11) were negative by both PCR assay and USDA procedure. As few as 2+/-1 cfu could be detected from 25 g HDP-treated chicken following 16-18 h enrichment in buffered peptone water. Real-time PCR proved to be an effective method for Salmonella detection in HDP-treated chicken with high sensitivity and more importantly, a rapid and high-throughput detection in 18 h, compared to 3-8 days for the conventional microbiological methods. HDP treatment, which has been reported to reduce spoilage bacteria in various meats, was unable to kill pathogenic Salmonella in minced chicken.

Ho: Yag laser-assisted lumbar disc decompression: a minimally invasive procedure under local anesthesia.

The morbidity associated with open procedures for lumbar intervertebral disc prolapse has led to the development of minimally invasive techniques. Ho: LADD (Laser-assisted disc decompression) is a very cost-effective minimally invasive procedure. The procedure is carried out under local anesthesia. The patient can be mobilized immediately after the surgery. The study involved 36 cases treated with Ho: LADD for contained lumbar intervertebral disc prolapse. 35 cases were available for follow-up. There was a 91.5% success rate and a minimal complication rate. All cases adhered to strict inclusion and exclusion criteria and were evaluated with the modified Macnab criteria for the assessment of postoperative results.