Predictionof Environmental FateandToxicityofInsecticidesUsing Multi-Target QSAR Approach.

Ecotoxicological risk assessments form the foundation of regulatory decisions for industrial chemicals used in various sectors. In this study, a multi-target-QSAR model established by a backpropagation neural network trained with the Levenberg-Marquardt (LM) algorithm was used to construct a statistically robust and easily interpretable Mt-QSAR model with high external predictability for the simultaneous prediction of the environmental fate in form of octanol-water partition coefficient (LogP), (BCF) and acute oral toxicity in mammals and birds (LD50rat ) and (LD50bird ) for a wide range of chemical structural classes of insecticides. Principal component analysis was performed on descriptors selected by the SW-MLR method, and the selected PCs were used for constructing the SW-MLR-PCA-ANN model. The developed well-trained model (RMSE=0.83, MPE=0.004, CCC=0.82, IIC=0.78, R2 =0.69) was statistically robust as indicated by the external validation parameters (RMSE=0.93, MPE=0.008, CCC=0.77, IIC=0.68, R2 =0.61). The AD of the developed Mt-QSAR model was also defined to identify the most reliable predictions. Finally, the missing values in the dataset for the aforementioned targets were predicted using the constructed Mt-QSAR model. The proposed approach can be used for simultaneous prediction of the environmental fate of new insecticides, especially ones that haven't been tested yet.

Effectiveness of Video-Assisted Educational Program Regarding Prevention of Oral Mucositis among Patients Receiving Radiotherapy.

Objectives: Oral mucositis refers to erythematous and ulcerative lesions in the oral mucosa observed in patients with head and neck cancer receiving radiotherapy (RT). It is an acute complication or side effect of RT. The aim of the study was to assess the effectiveness of video assisted educational program regarding the prevention of oral mucositis in terms of knowledge and reported practices among patients receiving RT. Materials and Methods: A quantitative approach, pre-experimental one group pre-test post-test design was used among 50 head and neck cancer patients coming to the radiation unit by non-probability purposive sampling technique. Structured knowledge interview schedule tools, that is, socio-demographic variables, knowledge MCQ's and reported practices rating scale were used. Data analysis was performed using Statistical Package for the Social Sciences version 20. Results: The study findings reveal that there is a significant improvement in the level of knowledge of patients (t = 4.54, P < 0.05) and reported practices of patients (t = 6.08, P < 0.05) which proves that video-assisted educational program on oral mucositis prevention was effective in improving the knowledge and practices of head and neck cancer patients. The result shows a significant association of pre-test reported practices with the occupation of the patient. There is a moderately positive correlation (0.54) between knowledge and reported practices in pre-test and a strong positive correlation (0.76) between knowledge and reported practices in post-test. Conclusion: The present study reveals that video-assisted educational program regarding the prevention of oral mucositis was effective in improving the knowledge and reported practices among head and neck cancer patients receiving RT.

Burnout Syndrome Assessment Scale for Nurses Working in Intensive Care Units: Development and Validation.

Background: Stress at workplace keep individual at extreme pressure and leads to exhaustion and inability to deal with stressful situation which causes burnout. Continuous stress on workplace causes multiple physical as well as psychological manifestations. Due to more demanding job nurses are more prone to burnout syndrome at workplace. Early assessment and timely interventions to overcome burnout are key for more productive work output. The objective of the present study was to develop Burnout Syndrome Assessment Scale (BOSAS) for nurses. Materials and Methods: A methodological design was carried out to develop BOSAS in different phases. Modified Delphi technique used for content validity. Reliability was calculated in terms of internal stability and stability of scale. Validity was measured in terms of face, content, criterion, and construct validity. Results: There were a total of 20 items in the final draft. Internal consistency was checked by Cronbach's alpha which was 0.94. Test-retest reliability of scale was found 0.93. Pearson's correlation was used to check inter-item correlation which was found between 0.20 and 0.40. The content validity index was 0.93. Concurrent criterion validity of scale was 0.82. Construct validity was analyzed by factor analysis, all items were loaded in 5 factors and accounted for 64.95% of variance. Conclusion: BOSAS has good validity and reliability and it can be used to assess and identify burnout among nurses.

Clinical signs, lethal dose and histopathological lesions in grass carp, Ctenopharyngodon idella experimentally infected with Edwardsiella tarda.

An experiment was conducted to study the lethal dose (LD50-96h) and histopathological changes occurring in several organs of grass carp challenged with different concentrations of Edwardsiella tarda. The healthy grass carps were challenged with the bacterial suspension of 106,107, 108, 109 and 1010 CFU ml-1. The study demonstrated that the lethal dose (LD50-96h) of E. tarda for grass carp is 1.3 × 109 CFU ml-1. The infected fish showed abnormal swimming behavior, slower movements, skin necrosis, hemorrhages, and open lesion on the fontanelle of the frontal bone of the skull during the initial phase of infection. About 60% of the fish which received the bacterial suspension of 1010 CFU ml-1 died within 24 h of infection. The histopathological examination of the infected tissue section demonstrated the severe damages in the internal organs. In gills, oedema, secondary lamellae fusion, and hyperplasia of basal epithelial lining between secondary lamellae were reported. The microscopic observation showed the disruption of submucosa to the mucosa, which finally led to degenerative changes in the intestine, necrosis of hepatocytes and infiltration of red blood cells in the liver. The tubular disintegration in kidney and loss of capsular boundary of red pulp in spleen were also reported. In conclusion, the result indicates that the infection caused by E. tarda can cause severe damages and alterations in grass carp tissues and potential mass mortality. Moreover, The bacteria isolated from the mobribund fish was characterized by biochemical tests and expression of five critical virulence genes like citC, fimA, gadB, mukF and gyrB were detected from the microorganism. The study aims to provide a research foundation for further studies on the susceptibility and pathological changes of grass carp induced by E. tarda infection.

Airway management of palatoglossal bands - A challenge to an anaesthesiologist.

Palatoglossal bands are one of the very rare congenital anomaly with very few documented cases worldwide. They can present with respiratory distress which requires immediate surgical intervention, or with feeding difficulties. The management of such a patient is a challenge to any anaesthesiologist because of inability to perform conventional laryngoscopy and associated cardiac or digital anomalies. We discuss here the management of such an infant who presented at 18 months with feeding difficulties.

A Comparative Study of Intrathecal Bupivacaine and Bupivacaine with Different Doses of Clonidine in Lower Limb Surgeries.

BACKGROUND: Intrathecal clonidine is a very safe, nonopioid adjuvant to local anesthetics to prolong the duration of analgesia without any major side effects. OBJECTIVE: The purpose of the present study was to evaluate the efficacy of clonidine in two different doses as an adjuvant to bupivacaine intrathecally in lower limb surgeries. MATERIALS AND METHODS: A total of 75 adult patients scheduled to undergo lower limb surgeries were randomly allocated into either of three groups of 25 patients. Group I received 12.5 mg bupivacaine, Group II patients received bupivacaine 12.5 mg with clonidine 15 µg, and patients in Group III received bupivacaine 12.5 mg with clonidine 30 µg intrathecally. A total volume of 3 ml was made in all groups using normal saline. The hemodynamic parameters, onset, and duration of sensory block, highest dermatomal level of sensory block, motor block onset, time to complete motor block recovery, and mean time to request of the first analgesic were recorded. Side effects or any other complications were noted. RESULTS: The mean time of onset of sensory block and motor block was less in clonidine groups. The mean duration of sensory block was significantly prolonged in clonidine groups as compared to study group. The duration of motor block (in minutes) was significantly prolonged in Group III (171.60 ± 38.20) as compared to Group I (113.20 ± 35.79) and Group II (115.20 ± 38.41). The time of analgesic request in Group I was 148.16 ± 43.99 min, 190.60 ± 38.08 in Group II, and 200.80 ± 59.85 min in Group III. CONCLUSIONS: The addition of intrathecal clonidine 15 µg to small dose bupivacaine increased the spread, duration of analgesia, and produced effective spinal anesthesia with stable hemodynamics and did not prolong postoperative motor block.

Lung Ultrasound and Blood Gas-Based Classification of Critically Ill Patients with Dyspnea: A Pathophysiologic Approach.

INTRODUCTION: The objective of this study was to classify dyspneic patients and to evaluate outcome variables on the basis of lung ultrasound (LUS) and arterial blood gas (ABG) findings. METHODS: We performed a retrospective chart-based review in which we included patients with dyspnea admitted to our intensive care unit (ICU) between March 2015 and August 2016. On the basis of LUS (presence of A-lines/B-lines) and ABG (hypoxia/hypercarbia), patients were classified into six groups: (i) metabolic defect (dry lung, no hypoxia); (ii) perfusion defect (dry lung, hypoxia); (iii) ventilation defect (dry lung, hypoxia, and hypercarbia); (iv) ventilation and alveolar defect (wet lung, hypoxia, and hypercarbia); (v) alveolar defect-consolidation ([wet lung] hypoxia, no echocardiographic [ECG] abnormality); (vi) alveolar defect-pulmonary edema (wet lung [usually bilateral], hypoxia, ECG abnormality). The patient's demographic data, sequential organ failure assessment (SOFA) score, need for intubation, vasopressors, form of mechanical ventilation, ICU outcome, and length of stay were noted. RESULTS: A total of 244 out of 435 patients were eligible for inclusion in the study. The median age was 56 years. 132 patients (54.1%) required mechanical ventilation, and median SOFA score was 7. Noninvasive ventilation was required in 87.5% of patients with ventilation defect as compared to 9.2% with alveolar defect-consolidation (P < 0.0001). We had 21.7% mortality in patients with alveolar defect-consolidation, 10.8% mortality in patients with metabolic defect, and 8.7% mortality in patients with alveolar defect-pulmonary edema (P < 0.0001). CONCLUSION: This classification gives an organized approach in managing patients with dyspnea. It predicts that patients with alveolar defect-consolidation are most sick of all the groups and need immediate intervention.

A cat has 9 lives: The dilemma of diagnosing non hodgkin's lymphoma in intensive care unit.

Non hodgkins lymphoma is a common haematological malignancy characterized by abnormal clonal proliferation of T-cells, B-cells or both. The incidence of non hodgkins lymphoma is rapidly rising. The diagnosis and management of NHL presents as a challenge in developing countries like India due to high prevalence of tuberculosis, cost and poor patient compliance. We describe an unusual case of a patient who presented as a diagnostic dilemma and took 8 diagnosis before finally being confirmed as a case of NHL. A suspicion for NHL should always be kept in mind in a patient presenting with pneumonia, bilateral pulmonary infiltrates and eosinophilia.

Comparative evaluation of different doses of intrathecal neostigmine as an adjuvant to bupivacaine for postoperative analgesia.

OBJECTIVE: To study the efficacy and safety of intrathecal neostigmine at dose of 50 µg and 150 µg as an adjuvant to bupivacaine for postoperative analgesia under spinal anesthesia. MATERIALS AND METHODS: 75 patients of either sex, belonging to American Society of Anesthesiologists (ASA) physical status I and II in the age group of 30-65 years scheduled to undergo lower abdominal and lower limb surgeries were allocated randomly into 3 groups of 25 each. Spinal anesthesia was administered in Group I (control group) with 12.5 mg (2.5 ml) of 0.5% hyperbaric bupivacaine, in Group II (50 µg group) with 12.5 mg (2.5 ml) of 0.5% hyperbaric bupivacaine and 50 µg (0.1 ml) of neostigmine methylsulphate and in Group III (150 µg group) with 12.5 mg (2.5 ml) of 0.5% hyperbaric bupivacaine and 150 µg (0.3 ml) of neostigmine methylsulphate. Hemodynamic parameters, onset and level of sensory block were recorded. Postoperative analgesic assessment was made in terms of total Visual Analogue Scale-Pain (VAS-P) scores in 24 hrs, duration of analgesia (time to requirement of first analgesic) and total number of rescue analgesic (diclofenac sodium 75 mg intramuscularly) consumption in 24 hours. Side effects were recorded. RESULTS: The total VAS-P score in group I was 23.12 ± 3.21, which was higher than the VAS-P score in group II (18.4 ± 2.92) and group III (16.24 ± 1.85). The total duration of analgesia was significantly prolonged in neostigmine groups (224.40 ± 23.28 min in group I, 367.60 ± 42.15 min in group II and 625.60 ± 87.70 min in group III). In group I, the patients required 2.48 ± 0.51 number of analgesics in 24 hours, which was much higher than required in group II (1.92 ± 0.64) and group III (1.32 ± 0.47). The incidence of nausea and vomiting was more with 150 µg neostigmine group compared to 50 µg neostigmine. CONCLUSIONS: The administration of intrathecal neostigmine in dose of 50 µg as an adjuvant to bupivacaine produces hemodynamically stable analgesia with minimal side effects.

Tracheobronchial Injury caused by Blunt Trauma: Case Report and Review of Literature.

Tracheobronchial injuries are rare cases requiring skillful airway management. We report a challenging case of tracheobronchial injury in a young adult who was run over by a tractor and was referred to us from a peripheral hospital with endotracheal tube in situ. He was severely hypoxaemic on initial presentation. Diagnostic work up showed high suspicion for right bronchial transection along with left lung upper lobe contusion. Due to deteriorating clinical condition of the patient and despite immediate unavailability of fibreoptic bronchoscope, patient was immediately taken up for right posterolateral thoracotomy and double lumen tube was inserted. The position of the tube was confirmed clinically. As soon as the fibreoptic bronchoscope arrived, it was again used to confirm the position of double lumen tube. Patient's clinical condition improved after repair of the injured right bronchus and he was later extubated the next day.

Probiotic lactobacilli: an innovative tool to correct the malabsorption syndrome of vegetarians?

Vegetarians may have subtle nutritional deficiencies which have been related to the occurrence of an unrecognized malabsorption syndrome. The excess phytate content in cereals, nuts, legumes and oilseeds which represent the mainstay of their food intake, seems to play a central role in the pathogenesis of this malabsorption syndrome as an inverse relationship has been shown to link the phytate content of the diet with the intestinal absorption of trace minerals and proteins. We postulate that manipulating the endogenous digestive microflora of subjects on a vegetarian diet through administering probiotic lactic bacteria would represent an innovative tool to counteract the occurrence of the malabsorption syndrome dependent on the high phytate content of their diet. Even though there are no data about the composition of endogenous digestive microflora in subjects on a vegetarian diet, we expect that probiotic lactobacilli can interact with or affect distinct yet interrelated components within the intestinal milieu, such as epithelial cells, enteric flora, and/or mucosal immune cells. This would ultimately translate into the correction of the unregulated mechanisms implicated in the altered intestinal absorption of trace metals and proteins commonly seen in vegetarians. Clinical experience with probiotic therapy of patients with inflammatory bowel disease fully agrees with this view. One additional point of interest is that probiotic lactobacilli, and other species of the endogenous digestive microflora as well, are an important source of the enzyme phytase which catalyses the release of phosphate from phytate and hydrolyses the complexes formed by phytate and metal ions or other cations, rendering them more soluble ultimately improving and facilitating their intestinal absorption. The regular intake of probiotic preparation, may represent a cheap and safe tool in order to convert a diet with a low potential for bioavailability of trace minerals and proteins, such as the vegetarian diet, into a diet with a high bioavailability potential. The benefit of such an approach would not be restricted to vegetarians.