A Comparative Study on Predictive Validity of Modified Shock Index, Shock Index, and Age Shock Index in Predicting the Need for Mechanical Ventilation among Sepsis Patients in a Tertiary Care Hospital.

Introduction: The shock index (SI), modified shock index (MSI), and age multiplied by SI (ASI) are used to assess the severity of shock. They are also used to predict the mortality of trauma patients, but their validity for sepsis patients is controversial. The aim of this study is to assess the predictive value of the SI, MSI, and ASI in predicting the need for mechanical ventilation after 24 h of admission among sepsis patients. Methods: A prospective observational study was conducted in a tertiary care teaching hospital. Patients with sepsis (235) diagnosed based on systemic inflammatory response syndrome criteria and quick sequential organ failure assessment were included in the study. The need for mechanical ventilation after 24 h is the outcome variables MSI, SI, and ASI were considered as predictor variables. The utility of MSI, SI, and ASI in predicting mechanical ventilation was assessed by receiver operative curve analysis. Data were analyzed using coGuide. Results: Among the study population, the mean age was 56.12 ± 17.28 years. MSI value at the time of disposition from the emergency room had good predictive validity in predicting mechanical ventilation after 24 h, as indicated by the area under the curve (AUC) of 0.81 (P < 0.001), SI and ASI had fair predictive validity for mechanical ventilation as indicated by AUC (0.78, P < 0.001) and (0.802, P < 0.001), respectively. Conclusion: SI had better sensitivity (78.57%) and specificity (77.07%) compared to ASI and MSI in predicting the need for mechanical ventilation after 24 h in sepsis patients admitted to intensive care units.

Epigenetic and immunological indicators of IPEX disease in subjects with FOXP3 gene mutation.

BACKGROUND: Forkhead box protein 3 (FOXP3) is the master transcription factor in CD4+CD25hiCD127lo regulatory T (Treg) cells. Mutations in FOXP3 result in IPEX (immune dysregulation, polyendocrinopathy, enteropathy, X-linked) syndrome. Clinical presentation of IPEX syndrome is broader than initially described, challenging the understanding of the disease, its evolution, and treatment choice. OBJECTIVE: We sought to study the type and extent of immunologic abnormalities that remain ill-defined in IPEX, across genetic and clinical heterogeneity. METHODS: We performed Treg-cell-specific epigenetic quantification and immunologic characterization of severe "typical" (n = 6) and "atypical" or asymptomatic (n = 9) patients with IPEX. RESULTS: Increased number of cells with Treg-cell-Specific Demethylated Region demethylation in FOXP3 is a consistent feature in patients with IPEX, with (1) highest values in those with typical IPEX, (2) increased values in subjects with pathogenic FOXP3 but still no symptoms, and (3) gradual increase over the course of disease progression. Large-scale profiling using Luminex identified plasma inflammatory signature of macrophage activation and TH2 polarization, with cytokines previously not associated with IPEX pathology, including CCL22, CCL17, CCL15, and IL-13, and the inflammatory markers TNF-α, IL-1A, IL-8, sFasL, and CXCL9. Similarly, both Treg-cell and Teff compartments, studied by Mass Cytometry by Time-Of-Flight, were skewed toward the TH2 compartment, especially in typical IPEX. CONCLUSIONS: Elevated TSDR-demethylated cells, combined with elevation of plasmatic and cellular markers of a polarized type 2 inflammatory immune response, extends our understanding of IPEX diagnosis and heterogeneity.

SARS-CoV-2 Infection Presenting as Acute Chest Syndrome in a Child With Hemoglobin SD-Los Angeles Disease: A Case Report and Review of Literature.

Hemoglobin D-Los Angeles is a variant of hemoglobin that can polymerize in the deoxygenated state. When co-inherited with Hemoglobin S (HbSD-Los Angeles disease) a severe sickling syndrome similar to HbSS can result. Corona virus infectious disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome-corona virus-2. It has been associated with acute chest syndrome (ACS) in individuals with sickle cell disease (SCD), but this complication has not previously been reported in patients with HbSD-Los Angeles. Dexamethasone has been shown to improve outcomes in non-SCD patients with severe acute respiratory syndrome-corona virus-2 pneumonia or acute respiratory distress syndrome; however, its use in SCD patients with ACS is controversial due to a reported increased risk of complications including vaso-occlusive painful episodes. Herein, we reported a patient with HbSD-Los Angeles and COVID-19-associated ACS whom we treated with dexamethasone without transfusion. The patient experienced a rapid recovery without sequelae from steroid use. To further evaluate the use of steroids, we conducted a literature review focusing on the management of pediatric SCD patients with COVID-19-associated ACS. We identified a total of 39 pediatric patients with SCD and COVID-19, of whom 21 (54%) had ACS. Packed red blood cell transfusion (n=11), exchange transfusion (n=4), or a combination of exchange transfusion and packed red blood cell transfusion (n=4) were the most frequently reported treatment, with hydroxychloroquine (n=5), remdesivir (n=1), and tocilizumab (n=1) also being reported. Three patients were treated with dexamethasone. All patients recovered and no adverse outcomes from steroid use were reported. Even though transfusion is considered the standard of care for children with ACS and steroids are not routinely recommended, our experience suggested that COVID-19-associated ACS may be an important exception, especially for patients who refuse transfusion or are in resource-poor nations where blood transfusions may not be readily available. Further studies are warranted to confirm these observations.

Clinical profile and outcomes in cervical cancer: An audit from a tertiary cancer center.

Background: Carcinoma cervix contributes to a major proportion of cancer treatment in tertiary oncology centers. The outcomes are dependent on multiple factors. We conducted an audit to establish the pattern of treatment practiced for carcinoma cervix at the institute and suggest changes thereof to improve the quality of care. Methodology: A retrospective observational study of 306 diagnosed cases of carcinoma cervix was carried out for the year 2010. Data was collected with regards to diagnosis, treatment, and follow-up. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 20. Results: Out of 306 cases, 102 (33.33%) patients received only radiation therapy and 204 (66.66%) patients received concurrent chemotherapy. The most common chemotherapy used was weekly cisplatin 99 (48.52%), followed by weekly carboplatin 60 (29.41%) and three weekly cisplatin 45 (22.05%). Disease-free survival (DFS) at 5 years was 36.6% with patients of overall treatment time (OTT) of <8 weeks and >8 weeks showing DFS of 41.8% and 34% (P = 0.149), respectively. Overall survival (OS) was 34%. Concurrent chemoradiation improved overall survival by a median of 8 months (P = 0.035). There was a trend towards improved survival with three weekly cisplatin regimen, however, insignificant. Stage correlated with improved overall survival significantly with stage I and II showing 40% and stage III and IV showing 32% (P < 0.05) OS. Acute toxicity (grade I-III) was higher in the concurrent chemoradiation group (P < 0.05). Conclusion: This audit was a first of its kind in the institute and threw light on the treatment and survival trends. It also revealed the number of patients lost to follow-up and prompted us to review the reasons for it. It has laid the foundation for future audits and recognized the importance of electronic medical records in the maintenance of data.

Dosimetric comparison of manual forward planning with uniform dwell times versus volume-based inverse planning in interstitial brachytherapy of cervical malignancies.

AIM: Dosimetic comparison of manual forward planning(MFP) with inverse planning(IP) for interstitial brachytherapy(ISBT) in cervical carcinoma. BACKGROUND: Brachytherapy planning by MFP is more reliable but time-consuming method, whereas IP has been explored more often for its ease and rapidness. The superiority of either is yet to be established. METHODOLOGY: Two plans were created on data sets of 24 patients of cervical carcinoma who had undergone ISBT, one by MFP with uniform dwell times and another IP on BrachyVision 13.7 planning system with a dose prescription of 600 cGy. Isodose shaper was used for improving conformity & homogeneity. Dosimetric parameters for target and organs at risk (OARs) were recorded. Conformity index (COIN), dose homogeneity index (DHI), overdose index (OI), Coverage index (CI) and dose nonuniformity ratio (DNR) were calculated. RESULTS: Mean high risk clinical target volume: 73.05(±20.7)cc, D90: 5.51 Gy vs. 5.6 Gy (p = 0.017), V100: 81.77 % vs. 83.74 % (p = 0.002), V150: 21.7 % vs. 24.93 % (p = 0.002), V200: 6.3 % vs. 6.4 % (p=0.75) for IP and MFP, respectively. CI: 0.81(IP) and 0.83(MFP) (p = 0.003); however, COIN was 0.79 for both plans. D2cc of OARs was statistically better with IP (bladder 54.7 % vs. 56.1 %, p = 0.03; rectum 63 % vs. 64.7 %, (p = 0.0008). CONCLUSION: Both MFP and IP are equally acceptable dosimetrically. With higher dose achieved to the target, for a similar OAR dose, MFP provides greater user flexibility of dwell positions within the target as well as better optimization. Isodose shaper may be carefully used for fine tuning. Larger sample sizes and clinical correlation will better answer the superiority of one over the other.

A new species of mealybug (Hemiptera: Coccomorpha: Pseudococcidae) from Tectona grandis L.f. (Lamiaceae) in southern India.

A new species of mealybug, Formicococcus tectonae Joshi, Bindu Gullan sp. n., is described and illustrated based on adult females collected from teak, Tectona grandis (Lamiaceae), in plantations in Thrissur district, Kerala, southern India. The mealybug lives in tunnels made by the teak trunk borer, Cossus cadambae (Moore) (Lepidoptera: Cossidae). Ants of a Tapinoma species were found in the tunnels, tending the mealybugs. The new mealybug is most similar morphologically to F. polysperes Williams and F. robustus (Ezzat McConnell) comb. rev. A key to adult females of all the Formicococcus species recorded from India is provided.

Study of 5-Fluorouracil Loaded Chitosan Nanoparticles for Treatment of Skin Cancer.

BACKGROUND: The purpose of this study was to formulate, characterize and in-vitro cytotoxicity of 5-Fluorouracil loaded controlled release nanoparticles for the treatment of skin cancer. The patents on nanoparticles (US8414926B1), (US61654404A), (WO2007150075A3) etc. helped in the selection polymers and method for the preparation of nanoparticles. METHODS: In the present study nanoparticles were prepared by simple ionic gelation method using various concentrations of chitosan and sodium tripolyphosphate (TPP). Several process and formulation parameters were screened and optimized using 25-2 fractional factorial design. The prepared nanoparticles were evaluated for particle size, shape, charge, entrapment efficiency, crosslinking mechanism and drug release study. RESULTS: The optimized 5-Fluorouracil loaded nanoparticle were found with particle size of of 320±2.1 nm, entrapment efficiency of 85.12%± 1.1% and Zeta potential of 29mv±1mv. Scanning electron microscopy and dynamic light scattering technique revealed spherical particles with uniform size. The invitro release profile showed controlled release up to 24 hr. Further study was carried using A375 basal cell carcinoma cell-line to elucidate the mechanism of its cytotoxicity by MTT assay. CONCLUSION: These results demonstrate that the possibility of delivering 5-Fluorouracil to skin with enhanced encapsulation efficiency indicating effectiveness of the formulation for treatment of basal cell carcinoma type of skin cancer.

Effect of Dopant Precursor Solutions on the Structural and Optical Properties of ZnS:Cu Nanophosphors.

Nanoparticles of ZnS doped with Cu (ZnS:Cu) were prepared at room temperature by wet chemical method without any capping agent using two dopant precursor solutions-aqueous: (i) Copper acetate [ZnS:CA] and (ii) Copper nitrate [ZnS:CN] solutions. The characterization of the samples was carried out for the structural, surface morphological and optical properties. XRD analysis results revealed the formation of cubic structure ZnS:Cu particles with an average size of 2.5 nm. From diffuse reflectance spectral (DRS) studies the band gap was found to be higher than bulk due to quantum confinement effect. In Photoluminescence (PL) spectra a sulphur vacancy related blue emission around 432 nm and a green emission from the recombination between the shallow donor level and the t2 level of Cu were observed. The ZnS:CN nanoparticles showed enhanced luminescence property compared with that of ZnS:CA nanoparticles.

Formulation, Characterization and In vitro Cytotoxicity of 5-Fluorouracil Loaded Polymeric Electrospun Nanofibers for the Treatment of Skin Cancer.

BACKGROUND: The purpose of this study was to formulate, characterize and conduct in vitro cytotoxicity of 5-fluorouracil loaded polymeric electrospun nanofibers for the treatment of skin cancer. The patents on electrospun nanofibers (US9393216B2), (US14146252), (WO2015003155A1) etc. helped in the selection of polymers and method for the preparation of nanofibers. METHODS: In the present study, the fabrication of nanofibers was done using a blend of chitosan with polyvinyl alcohol and processed using the electrospinning technique. 5-fluorouracil with known chemotherapeutic potential in the treatment of skin cancer was used as a drug carrier. 24-1 fractional factorial screening design was employed to study the effect of independent variables like the concentration of the polymeric solution, applied voltage (kV), distance (cm), flow rate (ml / hr) on dependent variables like % entrapment efficiency and fiber diameter. RESULTS: Scanning electron microscopy was used to characterize fiber diameter and morphology. Results showed that the fiber diameter of all batches was found in the range of 100-200 nm. The optimized batch results showed the fiber diameter of 162.7 nm with uniform fibers. The tensile strength obtained was 190±37 Mpa. Further in vitro and ex vivo drug release profile suggested a controlled release mechanism for an extended period of 24 hr. The 5-fluorouracil loaded electrospun nanofibers were found to decrease cell viability up to ≥50% over 24 hr, with the number of cells dropping by ~ 10% over 48 hr. As the cell viability was affected by the release of 5-fluorouracil, we believe that electrospun nanofibers are a promising drug delivery system for the treatment of Basal Cell Carcinoma (BCC) skin cancer. CONCLUSION: These results demonstrate the possibility of delivering 5-Fluorouracil loaded electrospun nanofiber to skin with enhanced encapsulation efficiency indicating the effectiveness of the formulation for the treatment of basal cell carcinoma type of skin cancer.

Fresh Fruit Juice of Opuntia dillenii Haw. Attenuates Acetic Acid-Induced Ulcerative Colitis in Rats.

The present study aimed to evaluate the protective effect of fresh fruit juice of Opuntia dillenii Haw. (FJOD) on acetic acid-induced ulcerative colitis in rats. Fresh FJOD (2.5 and 5 ml/kg) and sulfasalazine (100 mg/kg) were given orally for seven consecutive days prior to colitis induction on the eighth day by intrarectal acetic acid (4% v/v) administration. Macroscopic, clinical activity scoring, biochemical, and histopathological examinations of colon were used to assess colonic damage. FJOD and sulfasalazine treatment significantly attenuated the macroscopic damage, clinical activity score, and wet weight of the colon when compared to disease control and further showed significantly reduced levels of myeloperoxidase, malondialdehyde, and serum lactate dehydrogenase and enhanced colonic levels of reduced glutathione. The protective effect of FJOD may be attributed to its antioxidant and anti-inflammatory activities in ulcerative colitis. The observed effects may be due to the presence of phenolics, flavonoids, and betalains in the fruit juice of Opuntia dillenii.

Predictors of Postoperative Ventilation in Scoliosis Surgery: A Retrospective Analysis.

BACKGROUND: Patients undergoing corrective surgery for scoliosis may require postoperative ventilation for various reasons. AIM: The aim was to study the correlation of preoperative (pulmonary function test [PFT], etiology, and Cobb's angle) and intraoperative factors (type of surgery, number of spinal segments involved, blood transfusion, and temperature at the end of surgery) on postoperative ventilation following scoliosis surgery. SETTINGS AND DESIGN: patients' medical records of scoliosis surgery at a tertiary care center during 2010-2016 were retrospectively analyzed. MATERIALS AND METHODS: We studied retrospectively 108 scoliosis surgeries done in our institute during this period by the same group of anesthetists using standardized anesthesia technique. We analyzed preoperative (etiology, preoperative PFT, and Cobb's angle) and intraoperative factors (type of surgery, number of spinal segments involved, blood transfusion, and temperature) influencing postoperative ventilation. STATISTICAL ANALYSIS: For all the continuous variables, the results are either given in mean ± standard deviation, and for categorical variables as a percentage. To obtain the association of categorical variables, Chi-square test was applied. RESULTS: Patients with Cobb's angle above 76° and spinal segment involvement of 11 ± 3 required postoperative ventilation. Forced expiratory volume in 1 s (FEV1%) <38 and forced vital capacity (FVC%) <38.23 of the predicted could not be extubated. Increased blood transfusion and hypothermia were found to affect postoperative ventilation. CONCLUSION: Preoperative factors such as etiology of scoliosis, Cobb's angle, spirometric values FEV1% and FVC% of predicted and intraoperative factors like number of spinal segments involved, affect postoperative ventilation following scoliosis surgery. Increased blood transfusion and hypothermia are the preventable factors leading to ventilation.

Geriatric Patients with Hip Fracture: Frailty and Other Risk Factors Affecting the Outcome.

BACKGROUND: Hip fracture is a devastating health-care problem in a geriatric patient, leading to high mortality and morbidity. Preoperative risk assessment in the geriatric patient is often inexact because of the difficulty in measuring their poor physiologic reserves. AIMS: The primary objective was to find the association of modified frailty index (MFI) with 90-day mortality in geriatric patients who received anesthesia for fractured hip. Secondary objectives were to assess the association of preoperative waiting time with the 90-day mortality and the correlation of preexisting medical conditions with poor functional outcome among the survivors. SETTINGS AND DESIGNS: This prospective, observational study was conducted at a tertiary care institution. SUBJECTS AND METHODS: In this prospective observational study, done over a period of 1 year, 60 geriatric patients aged ≥65 years who received anesthesia for fractured hip and fulfilled selection criteria were recruited. The association of MFI with 90-day mortality and the correlation of preexisting comorbidities with poor functional outcome among the survivors were assessed. STATISTICAL ANALYSIS USED: Independent sample t-test, Mann-Whitney test, and odds ratio were used as applicable. RESULTS: Total 60 patients were available for analysis as two patients dropped off from final 62 on follow up, fifty three patients survived after 90 days. MFI and 90-day mortality showed a significant direct correlation with P < 0.0001. However, no association was found between the preoperative waiting time and 90-day mortality. Preexisting medical conditions showed a significant association of dementia with total dependence afterward with a P = 0.02. CONCLUSION: There is significant statistical correlation of MFI with the 90-day mortality in the geriatric hip-fractured patients undergoing surgery.

Stereoselective HPLC separation of alvimopan on cellulose-based immobilized polysaccharide as a chiral stationary phase.

Chiral separation by normal phase high performance liquid chromatography is one of the most powerful technique to quantify the chiral purity of the compounds. In this study, a novel, simple, and specific analytical method was proposed to ascertain the chiral purity of alvimopan (ALV). The normal phase HPLC method was developed based on cellulose tris (3,5-dichlorophenylcarbamate) stationary phase. The separation of ALV isomers achieved by using column CHIRALPAK IC (250 × 4.6 mm, 5 µm), mobile phase n-hexane: isopropyl alcohol: ethanol: diethylamine (650:200:150:5 v/v), column oven temperature 30°C, flow rate 1.0 mL min-1 , injection volume was 10 µL, chromatographic response monitored at 273 nm. The developed method was validated as per the ICH guidelines and found precise, accurate, and linear. The advantage of the method is a good separation of ALV isomers within 35 minutes of the analysis time. Therefore, this method is suitable for routine determination of chiral purity of ALV active pharmaceutical ingredient.

Hemodynamic Responses and Safety of Sedation Following Premedication with Dexmedetomidine and Fentanyl during Fiberoptic-assisted Intubation in Patients with Predicted Difficult Airway.

BACKGROUND: Awake fiberoptic intubation (AFOI) is the gold standard for the management of predicted difficult airway, and inappropriate sedation is a major cause leading to its failure. AIMS: The primary objective was to compare the heart rate (HR) changes that accompany AFOI following sedation with dexmedetomidine and fentanyl. Secondary objectives included comparison of changes in blood pressure, patient comfort, ease of intubation, and degree of sedation. SETTINGS AND DESIGNS: This prospective double-blinded randomized study was conducted in a tertiary care institution. SUBJECTS AND METHODS: Forty patients with anticipated difficult airway requiring AFOI were included in the study. Group A received dexmedetomidine 1 µg/kg whereas Group B received fentanyl 2 µg/kg. After topical anesthesia of the airway, AFOI was performed. STATISTICAL ANALYSIS USED: Fisher's exact test, independent two-sample t-test, and Mann-Whitney U-test were used as applicable. RESULTS: The hemodynamic parameters were comparable in both the groups except at 1 min postintubation when fentanyl group had significantly higher HR. There were lower alertness and muscle tone scores in dexmedetomidine group. Total comfort score was significantly higher in fentanyl group. Though more patients in dexmedetomidine group showed that no reaction to intubation and more patients in fentanyl had slight grimacing, the difference was insignificant. The ease of intubation was similar in both the groups. CONCLUSION: Though dexmedetomidine1 µg/kg and fentanyl 2 µg/kg premedication results in comparable hemodynamics and ease of intubation, in view of enhanced patient comfort, dexmedetomidine premedication is advantageous in patients with anticipated difficult airway undergoing AFOI.

Predictors and Outcomes of Postoperative Pulmonary Complications following Abdominal Surgery in a South Indian Population.

BACKGROUND: Postoperative pulmonary complications (PPC) following abdominal surgery are associated with increased morbidity and poorer outcomes. We prospectively examined risk factors associated with the development of PPC in patients undergoing abdominal surgery. AIMS: The primary outcome was to determine the association of predefined risk factors in the prediction of PPC after abdominal surgery. Secondary outcomes were evaluation of outcomes of PPC. SETTING AND DESIGN: This was a prospective study conducted in the gastrosurgical and urological units of a tertiary care referral hospital in patients undergoing abdominal surgery over a period of 6 months (November 2015-April 2016). MATERIALS AND METHODS: Relevant preoperative and intraoperative variables were recorded by the anesthesiologist in a pro forma provided. Postoperatively, data from the Intensive Care Unit (ICU) were collected from data sheets. PPC were defined according to preset criteria and outcomes of the patients including ICU stay, hospital stay, and mortality were noted. STATISTICAL ANALYSIS: Chi-square test was used to find the association of risk factors of PPC. Mann-Whitney test was used for continuous variables and McNemar's test for postoperative respiratory variables. A final regression analysis was performed with factors with significant association (P < 0.1). RESULTS: One hundred and fifty patients were included, and 24 patients (16%) developed PPC as defined by our criteria. Emergency surgery (44.4% of PPC) and cardiac comorbidity (23.9% of PPC) were significant associations for pulmonary complications. The length of ICU and hospital stay (LOICU, LOHS) and mortality were higher in the group with pulmonary complications (P < 0.001). CONCLUSIONS: Emergent surgery and cardiac comorbidities were independent predictors for the development of PPC. PPC are associated with increased LOHS, LOICU stay, and mortality.

Postoperative Ultrasound Guided Continuous Femoral Nerve Blockade for Unilateral Total Knee Arthroplasty: A Comparison of 0.125% Bupivacaine and 0.2% Ropivacaine.

CONTEXT: Total knee arthroplasty (TKA) is associated with severe postoperative pain which increases morbidity and mortality. AIMS: The aim of the study was to compare the analgesic efficacy and motor blockade of continuous infusion of 0.125% bupivacaine and 0.2% ropivacaine in femoral nerve block following unilateral TKA and to assess the effectiveness of femoral nerve block. SETTINGS AND DESIGN: One hundred and fifty patients undergoing unilateral total knee replacement surgery were included in this prospective observational comparative study. SUBJECTS AND METHODS: Patients are divided into two groups of 75 each. Femoral nerve catheter was placed at the end of surgery using ultrasound. Postoperative analgesia and motor blockade were compared for the next 24 h using visual analog scale (VAS) score, additional analgesic requirement, and Bromage scale. STATISTICAL ANALYSIS: Student's t-test and Chi-square test were applied. RESULTS: There was no statistically significant difference in pain between the two groups though VAS score (during rest and movement) and opioid consumption were lower in bupivacaine group. Nearly 28.6% patients experienced pain and required additional analgesics. Seventy-two percent among them complained of pain in the popliteal region supplied by sciatic nerve. Eight patients excluded from the study also had pain in the popliteal fossa. There was a statistically significant difference in motor blockade between the two groups at 12, 18, and 24 h after starting infusion. Bupivacaine group had a higher percentage of type three blocks compared to ropivacaine group. CONCLUSION: Continuous femoral nerve block (CFNB) with 0.125% bupivacaine infusion provided better analgesia with denser motor blockade compared to 0.2% ropivacaine infusion. CFNB alone is not sufficient to provide adequate analgesia following unilateral TKA.

Efficacy of atomised local anaesthetic versus transtracheal topical anaesthesia for awake fibreoptic intubation.

BACKGROUND AND AIMS: Successful awake fibreoptic intubation (AFOI) depends on adequate topical anaesthesia of the airway. We aimed to compare efficacy of atomised local anaesthetic versus transtracheal topical anaesthesia for AFOI. METHODS: It was a prospective, randomised controlled study of 33 patients with the American Society of Anesthesiologists' physical status 1-3 with anticipated difficult airway requiring AFOI. The primary objective was to compare the patient comfort after topical anaesthesia of the airway using atomiser with transtracheal injection of the local anaesthetic agent for AFOI in patients with anticipated difficult airway. The secondary objectives were to compare the ease of intubation, time required to intubate and the haemodynamic changes during intubation. After topical anaesthesia of nostrils, patients in Group T received transtracheal injection of 4 ml of 4% lignocaine whereas Group A patients received 4-5mL of 4% atomised lignocaine using DeVilbiss atomiser before AFOI. Patient comfort assessed objectively by the anaesthetic assistant during the procedure, ease of intubation assessed using cough and gag reflex score, time taken to intubate and the haemodynamic changes during the procedure were compared. RESULTS: Ease of intubation, patient comfort and the time taken to intubate were significantly better in Group T patients, with P = 0.001, 0.009 and 0.019, respectively, compared with the patients in Group A. There were no significant changes in haemodynamic parameters. CONCLUSION: Topical anaesthesia by transtracheal injection in patients with anticipated difficult airway made AFOI easier and faster with better patient comfort compared to atomiser with no clinically significant untoward side effects.

Efficacy of intranasal dexmedetomidine versus oral midazolam for paediatric premedication.

BACKGROUND AND AIMS: Premedication is an integral component of paediatric anaesthesia which, when optimal, allows comfortable separation of the child from the parent for induction and conduct of anaesthesia. Midazolam has been accepted as a safe and effective oral premedicant. Dexmedetomidine is a selective alpha-2 agonist with sedative and analgesic effects, which is effective through the transmucosal route. We compared the efficacy and safety of standard premedication with oral midazolam versus intranasal dexmedetomidine as premedication in children undergoing elective lower abdominal surgery. METHODS: This was a prospective randomised double-blinded trial comparing the effects of premedication with 0.5 mg/kg oral midazolam versus 1 µg/kg intranasal dexmedetomidine in children between 2 and 12 years undergoing abdominal surgery. Sedation scores at separation and induction were the primary outcome measures. Behaviour scores and haemodynamic changes were secondary outcomes. Student's t-test and Chi-square were used for analysis of the variables. RESULTS: Sedation scores were superior in Group B (dexmedetomidine) than Group A (midazolam) at separation and induction (P < 0.001). The behaviour scores at separation, induction and wake up scores at extubation were similar between the two groups. The heart rate and blood pressure showed significant differences at 15, 30 and 45 min in Group B but did not require pharmacological intervention for correction. CONCLUSION: Intranasal dexmedetomidine at a dose of 1 µg/kg produced superior sedation scores at separation and induction but normal behavioural scores in comparison to oral midazolam in paediatric patients.

Evaluation of heavy metal enrichment in Cochin estuary and its adjacent coast: multivariate statistical approach.

Temporal and spatial variations of heavy metals in the Cochin estuary and its adjacent coastline during three seasons were studied to investigate the impact of anthropogenic heavy metal pollution. Total organic carbon, sand, silt, clay and 10 metals (Cd, Pb, Cr, Ni, Co, Cu, Zn, Mn, Mg and Fe) in the surface sediments were analysed. Multivariate statistical analyses like canonical correspondence analysis, principal component analysis and cluster analysis were used for source identification, integration of geochemical data and clustering of stations based on similarities. Enrichment factor, contamination factor and geoaccumulation index were used to assess the contamination level. From the study, it can be understood that estuary and coast are highly polluted especially with Cd, Zn, Pb and Ni. Anthropogenic influence of heavy metals was evidenced from both the principal component analysis and cluster analysis. Finer fractions (mud) of the sediment and the associated Fe oxy hydroxides might be playing major role in the transport of heavy metals in the system. Very high enrichment factor value observed suggested high anthropogenic pressure in the study area. All the stations in the northern part of the estuary showed very high enrichment factors indicating heavy load of Zn and Cd in this area which might have reached from the industrial area lying to the north side of the Cochin estuary. Pollution indices suggested that both the estuary and its adjacent coast were showing low contamination with respect to Cr, Mg, Mn and Fe; all other metals were causing low to extremely high levels of pollution in the study area.

Structural and Optical Properties of White Light Emitting ZnS:Mn(2+) Nanoparticles at Different Synthesis Temperatures.

We report of the synthesis and characterisation of white emitting ZnS:Mn(2+) nanoparticles. The spectroscopic properties and the crystal structure of Mn doped ZnS nanoparticles are studied here to provide a better understanding on how the luminescence emission and the crystalline composition are influenced by the synthesis temperature. The synthesis of the samples were carried out by the simple wet chemical precipitation method. The influence of synthesis temperature on structure and optical properties were studied at constant Mn concentration. The nanoparticles were structurally characterized by X-Ray Diffraction (XRD) and Scanning Electron Microscopy (SEM). The XRD studies show the phase singularity of Mn doped ZnS particles having zinc-blende (cubic) structure at all temperatures. The band gap of the doped samples are red shifted with temperature. Electron Paramagnetic Resonance (EPR) spectra exhibited resonance signals, characteristic of Mn(2+). Incorporation of Mn in the ZnS nanoparticles was confirmed by Inductively Coupled Plasma- Atomic Emission Spectroscopic studies (ICP-AES). The samples show an efficient emission of yellow-orange light centred at 590 nm which is characteristic of Mn(2+) along with a blue emission at 435 nm due to sulfur vacancy. The overall emission is white at all temperatures with CIE co-ordinates in close agreement with achromatic white.