A potent antibiotic-loaded bone-cement implant against staphylococcal bone infections.

New antibiotics should ideally exhibit activity against drug-resistant bacteria, delay the development of bacterial resistance to them and be suitable for local delivery at desired sites of infection. Here, we report the rational design, via molecular-docking simulations, of a library of 17 candidate antibiotics against bone infection by wild-type and mutated bacterial targets. We screened this library for activity against multidrug-resistant clinical isolates and identified an antibiotic that exhibits potent activity against resistant strains and the formation of biofilms, decreases the chances of bacterial resistance and is compatible with local delivery via a bone-cement matrix. The antibiotic-loaded bone cement exhibited greater efficacy than currently used antibiotic-loaded bone cements against staphylococcal bone infections in rats. Potent and locally delivered antibiotic-eluting polymers may help address antimicrobial resistance.

Isolated myocardial abscess cavity: An incidental finding on intraoperative transesophageal echocardiography.

Myocardial abscess is a suppurative infection of myocardium, endocardium, native or prosthetic valves, perivalvular structures and cardiac conduction system. It develops in about 20% of patients with infective endocarditis. Due to avascular and fibrous structures, valvular regions are commonly involved. More precisely, aortic valve (AV) rings area; native or prosthetic valve is usually affected. Occurrence of myocardial abscess within free wall of the left ventricle (LV) without any evidence of infective endocarditis is a rare phenomenon; and infrequently reported in medical literature. We report a case of myocardial abscess cavity within the anterior wall of the LV, in a patient who underwent open heart surgery for severe AV stenosis. This was an incidental intraoperative transesophageal echocardiography (TEE) finding without any other evidence of infective endocarditis. The stenotic AV was replaced, along with surgical drainage and closure of the cavity. Postoperatively, patient was managed on empirical antibiotics according to infective endocarditis guidelines.

State-level COVID-19 outbreak and stock returns.

We use state-level data to evaluate the connection between outbreaks of COVID-19 and stock returns over the period January-June 2020. We show that daily increases in the number of infected cases, hospitalized cases, and deaths are negatively associated with next day stock returns of firms headquartered in the same state. The relationship is weaker among states with high levels of medical resources and states that are likely to get support from the federal government. In addition, we find that the negative effect is reduced for firms that report an expectation that an outbreak will increase revenues and for firms with a strong corporate social responsibility practice. We believe our study is the first paper to assess cross-sectional stock price reactions to COVID-19 as a function of the state-level impact of the pandemic outbreak.

Bioactive compounds of Aegle marmelos L., medicinal values and its food applications: A critical review.

Aegle marmelos L. (bael) is a fruit tree of Rutaceae family, widely grown all over the world. This plant is gaining popularity because of its nutrient-rich fruits and immense traditional medicinal usage and pharmacological properties. The health promotive and protective effect of bael fruit is accounted by fibers, carotenoids, phenolics, terpenoids, coumarins, flavonoids, and alkaloids. The curative relevance of these compounds has been assessed by various in vivo and in vitro studies. Fruit shows numerous possible health benefits, namely, radio-protective effects, peroxidation, antibacterial, inhibition of lipid, antidiarrheal, gastroprotective, antiviral, antidiabetic, anti-ulcerative colitis, cardioprotective, free-radical scavenging (antioxidant) and hepatoprotective effects. The health benefits of bael are not only limited to edible portion (fruit), but it also extends to nonedible portion (root, trunk, bark, leaf, flower and seed) having comparable biologically active compounds. Increasing awareness about the role of diet among health-conscious consumers for human well-being has increased the interest in functional foods thereby exploration of the functional attributes of various underutilized plants is being reaffirmed and various sources are emerged out as suitable food material for processing industry. The various scientific reports collected from different bibliometric sources suggested that A. marmelos and its bioactive constituents could play a vital role in the prevention of several chronic and degenerative diseases associated with oxidation stress. This review emphasis on recent scientific evidences on nutrition and bioactive profile of A. marmelos, health benefits along with clinical and nonclinical trials of various phytoconstituents and A. marmelos potential in food processing industry for various food products. Our study suggests that this plant does indeed have pharmacological properties of interest, however, further extensive research is needed to establish a potential strategy that can balance the pharmacological and toxic effects of bael.

Bioactive compounds, nutritional benefits and food applications of colored wheat: a comprehensive review.

The consumers' demands have changed from energy providing diet to a diet with a balanced nutrient profile along with metabolic, physiological and functional health benefits. They are seeking colorants derived from natural sources to enhance the nutritional and antioxidant value of foods. Colored wheat (Triticum aestivum) contains many phytochemicals, responsible for numerous health benefits. Colored wheat (blue, black, purple and red) contains a good amount of anthocyanins and carotenoids that are primarily located in the outer aleurone layer. Food regulatory and safety authorities and food processing industries are trying to minimize the usage of synthetic food colorants and dyes. Colored wheat is imperative for food processing industries as high-value pigments present in the bran layer (milling industry co-product) can easily be extracted and utilized as functional foods and natural colorants. The extracted pigments such as anthocyanin can replace synthetic dyes currently used in food, drug and cosmetics. Additionally, natural additives improve the nutritional value, appearance, texture, flavor, and storage properties of food products. This review presents a brief knowledge of the nutritional composition of colored wheat including phytochemicals and bioactive compounds like flavonoids, phenolic compounds, their health benefits, methods and technologies used for processing and extraction as well as the effects of processing on these compounds.

Physicochemical characteristics, bioactive compounds and industrial applications of mango kernel and its products: A review.

Mango (Mangifera indica L.) is a fruit plant of family Anacardiaceae, widely grown all over the world, and is a very popular fruit in the world market. Mango fruit is the second most traded tropical fruit and fifth in terms of production globally. Large quantities of mango processing coproducts are generated (peels and seeds), which usually are discarded as waste, yet are a potential source of fat, protein, carbohydrate, and certain bioactive compounds. Mango kernel is a remarkably rich source of macronutrients and micronutrients including calcium, potassium, magnesium, phosphorus, and vitamins A, E, K, and C. Phytochemicals with a notable therapeutic potential such as tocopherols, phytosterols, carotenoids, polyphenols (gallotannins, flavonols, benzophenone derivatives, mangiferin, homomangiferin, isomangiferin, anthocyanins, kaempferol, and quercetin), and phenolic acids (4-caffeoylquinic acids, caffeic, coumaric, ellagic, gallic, and ferulic acid) are reported. The phytochemicals have high antioxidant, antimicrobial, anticancer, and, antiproliferation activities and could be used for food, cosmetic, and pharmaceutical applications. The nutritional composition of mango kernel constitutes 32.34% to 76.81% carbohydrate, 6% to 15.2% fat, 6.36% to 10.02% protein, 0.26% to 4.69% crude fiber, and 1.46% to 3.71% ash on a dry weight basis. The nutritional profile of the kernel suggests its usability as a food ingredient in the development of value-added products such as mango kernel oil, mango kernel butter, mango kernel flour, and biofilms among other diverse products. This comprehensive systematic review explores mango kernel as a potential and novel food ingredient to meet the needs of a health-conscious population. The review also provides a remedy to waste management and environmental pollution.

Novel oil extraction technologies: Process conditions, quality parameters, and optimization.

Conventional techniques of extracting oil using organic solvents pose health, safety, and environmental concerns. In modern extraction methods, green solvents such as water, ethanol, ethyl acetate, carbon dioxide, ionic liquids, and terpenes are currently gaining prominence. These green solvents present no signs of pollution and remain in liquid form over a temperature range of 0 to 140 °C. Other techniques covered in this review include microwave-assisted enzymatic extraction, ultrasound-assisted extraction, supercritical fluid technology, high pressure-assisted extraction, and pulse electric field-assisted extraction. These techniques are considered environmentally friendly because they exhibit less hazardous chemical synthesis, use renewable feedstock, and reduce the chemical load and emissions generated by organic solvents. Aqueous enzymatic extraction is a novel technique that uses enzymes as the medium for extraction of oil. Selection of the enzymes solely depends on the structure of the oilseed and the composition of the cell wall. Studies reveal an enzyme to substrate ratio of 1% to 8%, the temperature of 40 to 55 °C, and a pH of 4 to 8 to be typical for enzymatic extraction of oil from different oilseeds. Microwave-assisted extraction has proven to impart significant effects on mass transfer and offers high throughput and extraction efficiency. A microwave power of 275 to 1,000 W and a temperature range of 30 to 60 °C are noticed in the different studies. The review presents a comprehensive account of the modern extraction techniques, the parameters responsible for yield and quality, and their industrial applications. Besides, the review highlights the optimized parameters for oil extraction from different oil-bearing materials.

Duplication of inferior vena cava and coagulation mutations with left-sided iliofemoral venous thrombosis.

Duplication of the inferior vena cava (IVC) with coagulation mutations in the form of factor V Leiden and MTHFR mutations represents an unusual subset of patients. We are reporting a case of a 43-year-old man who presented with left iliofemoral deep venous thrombosis diagnosed on duplex ultrasound scan. At the time of catheter-directed thrombolysis with prophylactic IVC filter placement, a duplicated IVC system was observed. After thrombolysis, a stenotic lesion in the left common iliac vein and IVC was stented. IVC filters were retrieved after 6 weeks. On thrombophilia profile testing at 3 months, he was also found to have factor V Leiden and MTHFR mutations. After 12 months of follow-up, the patient is asymptomatic with a patent iliocaval venous system and is receiving lifelong anticoagulation.

Acute ST-segment elevation myocardial infarction: a rare initial presentation of previously undiagnosed essential thrombocythemia.

Essential thrombocythemia (ET) is a myeloproliferative disorder characterized by hemorrhagic and thrombotic complications. We describe a rare case of ST-segment elevation myocardial infarction (STEMI) in a patient with previously undiagnosed ET, confirmed by gene mutation. A 68-year-old man presented with severe acute chest pain and was diagnosed with STEMI. Primary coronary angiography showed severe stenosis with thrombus in the proximal left anterior descending coronary artery. Percutaneous aspiration thrombectomy was performed with no residual stenosis. The patient was discharged on antiplatelet agents, aspirin, and clopidogrel. Further investigations for intracoronary thrombus with no underlying atherosclerotic disease revealed positive Janus kinase 2 (JAK2) V617F gene mutation, and this was consistent with a diagnosis of ET with elevated platelet count. This case describes a rare initial presentation of previously undiagnosed ET with acute STEMI and highlights the potential importance of secondary workup for non-atherosclerotic causes of STEMI with isolated intracoronary thrombus otherwise normal coronary vasculature with no focal atherosclerosis.

Myocardial protection with isoflurane during off-pump coronary artery bypass grafting: a randomized trial.

OBJECTIVES: To analyze the hemodynamic effects and myocardial injury using troponin-T and creatine phosphokinase (CPK-MB) with isoflurane and compare it with a control group in patients undergoing off-pump coronary artery bypass (OPCAB) surgery. DESIGN: This prospective, randomized study was performed in patients scheduled for elective OPCAB surgery during February 2007 to February 2009. SETTING: Tertiary care, university teaching hospital. PARTICIPANTS: Forty-five patients undergoing elective OPCAB surgery. INTERVENTIONS: Patients were randomly allotted to receive either isoflurane (inspired concentration between 1.0% and 2.5%) or propofol (1.5 to 3.5 mg/kg/h) during OPCAB surgery. The concentration of these agents was titrated such that the BIS value was maintained between 50 and 60. MEASUREMENTS AND MAIN RESULTS: The hemodynamic data were measured and recorded after induction of anesthesia (baseline), during the distal anastomosis of each coronary artery, and 5 and 30 minutes after giving protamine. In addition, blood samples for troponin-T and CPK-MB were obtained after induction (baseline), after 6 hours and 24 hours postoperatively. The cardiac index was significantly higher in the isoflurane group at all stages, except during distal anastomosis of the diagonal branch of the left anterior descending artery (p < 0.05). There was a significant increase in troponin-T levels at 6 and 24 hours after surgery in the propofol group (from 0.037 ± 0.013 ng/mL to 0.098 ± 0.045 ng/mL and 0.081 ± 0.025 ng/mL, respectively, p < 0.05). Significant increases in the troponin-T levels were observed at 6 hours (from 0.033 ± 0.011 ng/mL to 0.052 ± 0.025 ng/mL, (p < 0.05) in the isoflurane group, and the levels in the propofol group were significantly higher than the isoflurane group at 6 and 24 hours after surgery (p < 0.05). The CPK-MB levels increased in both groups, but were not statistically different. CONCLUSIONS: Isoflurane provides protection against myocardial damage in a clinically used dosage as documented by lower levels of troponin-T in patients undergoing OPCAB surgery.

Anesthetic management for emergency cesarean section and aortic valve replacement in a parturient with severe bicuspid aortic valve stenosis and congestive heart failure.

Asymptomatic women with mild aortic stenosis (AS) and normal left ventricular functions can successfully carry pregnancy to term and have vaginal deliveries. However, severe AS (valve area <1.0 cm2) can result in rapid clinical deterioration and maternal and fetal mortality. So, these patients require treatment of AS before conception or during pregnancy preferably in the second trimester. In suitable patients percutaneous balloon aortic valvotomy appears to carry lower risk. It can also be used as a palliative procedure allowing deferral of aortic valve replacement until after delivery. The present patient had severe critical AS with congestive heart failure that was refractory to medical therapy and the fetus was viable (>28 wks). So, combined lower segment cesarean section and aortic valve replacement were performed under opioid based general anesthesia technique to reduce the cardiac morbidity and mortality.

Acute normovolemic hemodilution is not beneficial in patients undergoing primary elective valve surgery.

The objective of this study was to evaluate the effectiveness of acute normovolemic hemodilution (ANH) as a sole method of reducing allogenic blood requirement in patients undergoing primary elective valve surgery. One hundred eighty eight patients undergoing primary elective valve surgery were prospectively randomized into two groups: Group I (n=100) acted as control and in Group II (n=88) autologous blood was removed (10% of estimated blood volume in patients with hemoglobin (Hb) > 12g% and 7% when the Hb was < 12g%) in the pre-cardiopulmonary bypass (CPB) period for subsequent re-transfusion after protamine administration. The autologous blood withdrawn was replaced simultaneously with an equal volume of hydroxyl-ethyl starch solution. Banked blood was transfused in both the groups when Hb was < or = 6g% on CPB and < or = 8g% after CPB. Platelets were transfused when the count fell to < 100 x 10(9)/L and fresh frozen plasma (FFP) was transfused whenever there was diffuse bleeding with laboratory evidence of coagulopathy. The two groups were comparable as regards demographic data, type of surgical procedures performed, duration of CPB and ischemia, duration of elective ventilation and re-exploration for excessive bleeding. The autologous blood withdrawn in patients with Hb > or = 12g% was 288.3+/-69.4 mL and 244.4+/-41.3 mL with Hb < 12g% (P=NS). The Hb concentration (g%) was comparable pre-operatively (Group I = 12.1+/-1.6, Group II = 12.4+/-1.4), on postoperative day 1 (Group I = 10.3+/-1.1, Group II = 10.6+/-1.2) and day 7 (Group I = 10.9+/-1.5, Group II = 10.4+/-1.5). However, the lowest Hb recorded on CPB was significantly lower in Group II (Group I = 7.7+/-1.2, Group II = 6.7+/-0.9, P < 0.05). There was no difference in the chest tube drainage (Group I = 747.2+/-276.5 mL, Group II = 527.6+/-399.5 mL), blood transfusion (Group I = 1.1+/-1.0 units vs. Group II = 1.3+/-1.0 units intra-operatively and Group I = 1.7+/-1.2 units vs. Group II = 1.7+/-1.4 units post-operatively) and FFP transfusion (Group I = 581.4+/-263.4 mL, Group II = 546.5+/-267.8 mL) in the two groups. We conclude that low volume autologous blood pre-donation does not seem to provide any added advantage as a sole method of reducing allogenic blood requirement in primary elective valve surgery.

Case report: Upper neck pouch sign in the antenatal diagnosis of esophageal atresia.

Prenatal diagnosis of esophageal atresia remains a challenge for the imaging consultant. On antenatal USG, the finding of an absent or small stomach in the setting of polyhydramnios used to be considered suspicious of esophageal atresia. However, these findings have a low positive predictive value. The upper neck pouch sign is another sign that helps in the antenatal diagnosis of esophageal atresia. In this paper, I report a case of esophageal atresia that was diagnosed on USG at 27 weeks of gestation; the diagnosis was confirmed postnatally.

Case report: Antenatal diagnosis of congenital high airway obstruction syndrome - laryngeal atresia.

Congenital high airway obstruction syndrome (CHAOS) is a near fatal condition of multifactorial inheritence, in which the fetus has a dilated trachea, enlarged echogenic lungs, an inverted or flattened diaphagram, and ascites. A case of CHAOS, diagnosed antenatally on USG at 28 weeks of gestation, is being reported here.