Evaluation of the accuracy of vibration sense with VibraTip™ as a tool to determine the level of anesthesia following subarachnoid block and its correlation with the pinprick sensation.

BACKGROUND AND AIMS: Assessment of level of anesthesia after subarachnoid block (SAB) is essential. We aimed to evaluate the efficacy of vibration sense as a criteria to determine the level of surgical anesthesia. METHOD AND MATERIALS: The study included patients, scheduled for various surgeries under SAB. The baseline values of vibration sense perception using VibraTip™, motor power using the modified Bromage scale, and sensory block by pinprick method were recorded preoperatively and at 5 and 7 min after administration of SAB. The correlation between vibration sense, loss of pinprick sensation, and level of anesthesia were assessed. RESULTS: The concordance correlation coefficient between the pinprick and vibration sense at 5 min and 7 min showed poor strength of agreement with Pearson ρ (precision) being 0.4192 at 5 min and 0.4701 at 7 min. CONCLUSION: Vibration sense serves as a reliable indicator to assess the level of surgical anesthesia following SAB. Vibration sense testing with VibraTip™along with motor power assessment can be used as a tool for assessment of level of block. There is a poor correlation between level of vibration sense and pinprick.

Basic Concepts and Clinical Outcomes of Drug-Eluting Balloons for Treatment of Coronary Artery Disease: An Overview.

The technology of percutaneous coronary intervention for atherosclerotic coronary artery disease has evolved considerably since its inception. Though Drug-Eluting Stent (DES) reduces the rate of restenosis, long-term safety outcomes and persistent restenosis in complex lesion subset remain area of concern. Recently, Drug-Eluting Balloon (DEB) represents a novel treatment strategy for atherosclerotic coronary artery disease. DEB demonstrated its added value in preclinical studies. Inspired by these results, several clinical trials particularly in complex lesion subsets have been started to explore the value of this novel treatment strategy in a broader range of lesions. This review would summarise material compositions and different characteristics and clinical outcomes of currently available DEB.

A Post-Marketing Surveillance Study to Evaluate Performance of the EXIMO™ Blood Glucose Monitoring System.

INTRODUCTION: The performance of Blood Glucose Monitoring System (BGMS) is critical as the information provided by the system guide the patient or health care professional in making treatment decisions. However, besides evaluating accuracy of the BGMS in laboratory setting, it is equally important that the intended users (healthcare professionals and patients) should be able to achieve blood glucose measurements with similar level of high accuracy. AIM: To assess the performance of EXIMO™ (Meril Diagnostics Pvt. Ltd., Vapi, Gujarat, India) BGMS as per International Organization for Standardization (ISO) 15197:2013 section 8 user performance criteria. MATERIALS AND METHODS: This was a non-randomized and post-marketing study conducted at a tertiary care centre of India. A total of 1005 patients with diabetes themselves performed fingertip blood glucose measurement using EXIMO™ BGMS. Immediately after capillary blood glucose measurement using the blood glucose monitoring system, venous blood sample from each patient was obtained by a trained technician which was assessed by reference laboratory method- Cobas Integra 400 plus (Roche Instrument Centre, Rotkreuz, Switzerland). All the blood glucose measurements assessed by EXIMO™ were compared with laboratory results. Performance of the system was assessed as per ISO 15197:2013 criteria using Bland-Altman plot, Parkes-Consensus Error Grid (CEG) and Surveillance Error Grid analyses (SEG). RESULTS: A total of 1005 patients participated in the study. Average age of the patients was 44.93±14.65 years. Evaluation of capillary fingertip blood glucose measurements demonstrated that 95.82% measurements fulfilled ISO 15197:2013 section 8 user performance criteria. All the results lie within clinically non-critical zones; Zone A (99.47%; n=1000) and Zone B (0.53%; n=05) of the CEG analysis. As per SEG analysis, majority of the results fell within "no-risk" zone (risk score 0 to 0.5; 90.42%). CONCLUSION: The result of the study confirmed that intended users are able to obtain accurate glucose measurements when operating EXIMO™ BGMS, given only the instructions and training materials routinely provided with the system, in clinical practice.

A rare malady with a rarer complication.

Isolated ventricular noncompaction (IVNC) is an unclassified cardiomyopathy characterized by prominent intraventricular trabeculations separated by deep intertrabecular recesses. Although microvascular dysfunction is known, myocardial infarction is rare and usually seen as a consequence of coincidental coronary artery disease. We report the case of a 19-year-old male patient who presented to us with symptoms and signs of heart failure. Echocardiography revealed IVNC with severe left ventricular dysfunction. He was put on medical treatment including oral anticoagulants. Six months later, he came to our emergency department with anterior wall STEMI. Coronary angiogram revealed thrombotic occlusion of distal LAD, which resolved completely with tirofiban and heparin. Coronary thromboembolism due to blood stasis in the left ventricular cavity has not been previously documented in IVNC.

A rapid method for authentication of Buffalo (Bubalus bubalis) meat by Alkaline Lysis method of DNA extraction and species specific polymerase chain reaction.

Buffalo (Bubalus bubalis) meat is a major item of export from India but export of beef i.e. meat from cattle (Bos indicus) is prohibited. Also, adulteration of buffalo meat with that of beef (meat from cattle) is a common fraudulent practice because of prohibition on cow slaughter in most states of India. Food analysts require precise identification techniques to implement such regulations. In the present study, a method of DNA extraction by Alkaline lysis from meat samples and speciation of buffalo meat using species specific Polymerase Chain Reaction (PCR) has been reported. Alkaline lysis technique is a rapid method which involves triturating meat with four volumes of 0.2N NaOH, dilution of resultant liquid extract with eight volumes of 0.2N NaOH, heating the mix 75 °C for 20 min followed by neutralization with eight volumes of 0.04N Tris HCl. Entire procedure of DNA extraction takes less than 30 min and it is economical as it involves less expensive chemicals. Method was successfully applied in animal byproducts also viz., liver, heart and kidney. For authentication of buffalo meat, pair of primers was designed based on mitochondrial D loop gene nucleotide sequence. PCR amplification using the designed primers gave amplicon of size 482 bp in buffalo and no amplification was detected in closely related species viz., cattle, sheep and goat meat samples. Results of the assay were highly repetitive and reliable. An export sample referred by export regulation authorities was also analyzed by using the Alkaline lysis method of DNA extraction and species specific PCR which enabled authentication of meat within 5 h.

Effect of ammonium hydroxide on ultrastructure and tenderness of buffalo meat.

This study was conducted with an objective to improve the tenderness of tough buffalo meat using ammonium hydroxide. Buffalo meat chunks from Biceps femoris muscle were marinated with distilled water (control), 0.1%, 0.5% and 1.0% solution of ammonium hydroxide for 48 h at 4±1 °C and subjected to various physico-chemical analysis and ultrastructural studies. Ammonium hydroxide increased (P<0.05) the pH, water holding capacity (WHC), collagen solubility, total and salt soluble protein extractability and cooking yield. Reduction (P<0.05) in Warner-Bratzler shear force values were observed in all ammonium hydroxide treated samples compared to non-treated control. Electrophoretic pattern of muscle proteins exhibited reduction in the intensity and number of certain protein bands for 0.1% and 0.5% ammonium hydroxide treated samples compared to control. Scanning and transmission electron microscopy also revealed breakdown of endothelium layers surrounding muscle fibers and weakening of Z-discs respectively, in treated samples compared to controls. These results suggest that ammonium hydroxide might be used to tenderize tough buffalo meat.

Protective effect of ginger against alcohol-induced renal damage and antioxidant enzymes in male albino rats.

Superoxide dismutase, ascorbic acid, glutathione and uric acid levels were decreased and xanthine oxidase, glutathione-s-transferase activities were increased in alcohol treated (2 g/kg body weight, once daily for 30 days) group. However, treatment with ethanolic extract of ginger (100 mg/kg, 200 mg/kg body weight, po, once daily for 30 days) these parameters came to normalcy showing the antioxidant effect of ginger. The antioxidant compounds of ginger may modulate the oxidative stress parameters. The biochemical findings were supplemented by histopathological examination of the kidney. Severe congestion and degenerative changes in tubules in alcohol treated rats were restored by ginger extract treatment. The results confirm the renal protective effect of ginger in alcohol treated rats.

The age-specific clinical and anatomical profile of mitral stenosis.

INTRODUCTION: This cross-sectional study on the age-specific clinical and anatomical characteristics of mitral stenosis was conducted at the Department of Cardiology at Kottayam Medical College, South India. METHODS: The clinical profile, laboratory details and transthoracic echocardiographical features of 203 consecutive patients with mitral stenosis were studied. Wilkins score was used to assess the valve morphology and the feasibility of balloon mitral valvotomy (BMV)/closed mitral valvotomy (CMV). Patients were grouped according to age, into Group I (younger than 40 years; 68 cases), Group II (40-65 years; 78 cases) and Group III (older than 65 years; 57 cases) for analysis. RESULTS: The mean age of the patients was 53 years. History of rheumatic fever was less common in Group III (37 percent in Group I vs. 20 percent in Group III, p-value is equal to 0.05). Acute pulmonary oedema occurred commonly in Group III (six percent in Group I vs. 36 percent in Group III, p-value is less than 0.001). Incidence of ischaemic strokes increased with increasing age (three percent in Group I vs. 12 percent in Group II, p-value is equal to 0.05; 12 percent in Group II vs. 25 percent in Group III, p-value is equal to 0.05; and three percent in Group I vs. 25 percent in Group III, p-value is less than 0.001). Prevalence of atrial fibrillation (AF) increased progressively with increasing age (nine percent in Group I vs. 30 percent in Group II, p-value is less than 0.001; 30 percent in Group II vs. 64 percent in Group III, p-value equal to 0.003). Clinical features of pulmonary hypertension was highest among Group I (66 percent in Group I vs. 42 percent and 43 percent in Groups II and III, respectively, p-value is equal to 0.01). The mean duration of exertional dyspnoea, history of paroxysmal nocturnal dyspnoea, mean NYHA class, mean left atrial sizes, mean mitral valve areas and mean mitral valve gradients did not vary significantly among the three groups. Mitral valve scores were prohibitive for BMV/CMV in significant numbers of older patients (seven percent in Group I vs. 38 percent in Group II vs. 80 percent in Group III; p-value is less than 0.001). CONCLUSION: When compared to the trends in developed countries, the mean age at presentation of mitral stenosis is similar, but the degree of valve deformity is higher. Incidence of pulmonary oedema, AF and stroke increases with advancing age in mitral stenosis.

Perturbation in kidney lipid metabolic profiles in diabetic rats with reference to alcoholic oxidative stress.

Diabetes is a major threat to global public health, and the number of diabetic patients is rapidly increasing worldwide. Evidence suggests that oxidative stress is involved in the pathophysiology of diabetic complications and alcoholic diseases. The aim of this study is to find out the impact of alcohol on lipid metabolic profiles in kidney tissue under streptozotocin induced diabetic condition. No study has been reported so far on the effect of alcohol on diabetic condition and also with reference to lipid metabolic profiles. Hence, the present study has been designed to elucidate the impact of alcoholism on diabetic condition. Male wistar strain albino rats were randomly divided into four groups: control (saline treated) NC, alcohol-treated (At), diabetic control (DC), and alcohol-treated diabetic rats (D+At). In alcohol-treated diabetic rats, we observed high levels of MDA, total cholesterol, triglycerides, phospholipids and also high levels of blood glucose than other groups. Moreover, degenerative changes of renal cells in alcohol-treated diabetic group were maximized by administration of alcohol as evinced by histopathological examination. This study suggests that alcohol consumption could be an aggravation factor which contributes for the formation of free radicals in diabetic condition. Therefore, consumption of alcohol during diabetic condition is harmful.

Microalbuminuria in patients with essential hypertension and its relationship to target organ damage: an Indian experience.

Persistent microalbuminuria (MA) is the earliest indicator of chronic kidney disease (CKD) in patients with diabetes mellitus and hypertension. Patients with MA have high risk for target organ damage (TOD) resulting in stroke, retinopathy and adverse cardiovascular events. Though the prevalence of hypertension is high in India, the relationship between MA and TOD in hypertension is not well studied. To address this issue, this study was conducted at the Kottayam Medical College, Kerala, South India, between May 2005 and October 2006. The principal aim was to find out the prevalence of MA and its relationship to TOD in patients with essential hypertension. A total of 150 hypertensives without diabetes mellitus and/or other conditions causing MA were studied. Urine albumin-creatinine ratio (ACR) was assessed and MA was defined as albumin excretion between 30-300 mg/day. The relationship of MA with the duration, severity and previous treatment of hypertension, body mass index (BMI), lipid profile and TOD's like left ventricular hypertrophy (LVH), hypertensive retinopathy and stroke was assessed by univariate analysis. Forty patients (26.67%) were found to have MA of whom 24 were males and 16 were females. MA was significantly higher in those with longer duration and greater severity of hypertension (p < 0.001 in each). Older age (p < 0.001), adverse lipid profile (p < 0.01) and higher BMI (p < 0.04) were the other identifiable risk factors for MA. Gender and history of smoking did not pose higher risk for MA. Stroke (OR=3.8), echocardiography-proven LVH (OR=9.42) and hypertensive retinopathy (OR=9.7) were significantly higher in those with MA. In conclusion, the prevalence of MA in essential hypertension is high and patients with MA have high odds for developing TOD like stroke, LVH and hypertensive retinopathy. Early screening of hypertensives for MA and prompt treatment of positive cases might reduce the burden of CKD and cardiovascular disease in the community.

Biochemical and physicochemical changes in spent hen breast meat during postmortem aging.

An experiment was conducted to study the biochemical and physicochemical changes with respect to improvement in tenderness of spent hen breast meat. Breast muscle obtained from freshly slaughtered spent hens (72 wk old) was divided into 5 equal lots and dipped in 1 mM NaN(3) before being packed in low-density poly-ethylene pouches under aerobic conditions and stored at refrigeration temperature (4 degrees C). Lots were removed on 0, 7, 14, 21, and 28 d of storage and analyzed for pH, TBA reactive substances (TBARS), total sulfhydryl content, protein-bound sulfhydryl content, nonprotein-bound sulfhydryl content, perimysial fraction, collagen content, free OH-proline, N, nonprotein N, and proteolysis rate. Shear force value and penetrometer readings were also determined after making patties from the stored muscle samples. Results showed that pH values were gradually decreasing over the storage period. The TBARS values were increasing (P < 0.001), whereas the sulfhydryl content was decreasing (P < 0.001) over the storage period. The TBARS values were negatively (P < 0.05) correlated with total sulfhydryl content. This suggests that sulfhydryl content may prevent further higher oxidation of lipids. The soluble collagen content, collagen solubility, free OH-proline, and proteolysis rate were increasing (P < 0.001) during postmortem aging. These results suggest that collagen degradation into free amino acids occurs postmortem. A gradual decrease (P < 0.001) in shear force value and a gradual increase (P < 0.001) in penetrometer readings were recorded in the patties made from matured breast meat. Therefore, postmortem aging of spent hen breast meat resulted in 23% improvement in tenderness of minced patties on 14 d and 39% on 28 d as evidenced by biochemical and physicochemical changes.

Laryngocele - a case report and review of literature.

This is case report of 35-year old male patient presented with hoarseness and swelling on left side of neck. The swelling was noticed by the patient for 8 months. It has been diagnosed clinically and radiologically as a combined laryngocele. The laryngocele has been successfully excised using and combined approach i.e., external and endoscopic methods. This case has been reported for its rarity at this age.

Efficacy of low dose peginterferon alpha-2b with ribavirin on chronic hepatitis C.

AIM: To assess the efficacy of peginterferon alpha 2b at doses of 50 microg weekly and 80 microg weekly (based on body weight) plus ribavirin in HCV genotype 2 and genotype 3 chronic hepatitis C patients. METHODS: During the study period of Jan 2002 to Dec 2003, all patients diagnosed as chronic hepatitis C or HCV related compensated cirrhosis were treated with peginterferon alpha 2b 50 microg S/C weekly (body weight < 60 kg) or 80 microg S/C weekly (body weight > 60 kg) plus ribavirin 800 mg/d for 24 wk. RESULTS: Overall 28 patients, 14 patients in each group (based on body weight) were treated during the period. Out of 28 patients, 75% were genotype 3, 18% were genotype 2 and 7% were genotype 1. The mean dose of peginterferon alpha 2b was 0.91 microg/kg in group 1 and 1.23 microg/kg in group 2 respectively. The end of treatment and sustained virologic response rates were 82% and 78% respectively. Serious adverse effects were seen in 3.5% patients. CONCLUSION: Low dose peginterferon alpha 2b in combination with ribavirin for 24 wk is effective in HCV genotype 2 and 3 chronic hepatitis C patients.

T helper responses to Japanese encephalitis virus infection are dependent on the route of inoculation and the strain of mouse used.

T helper cytokine and IgG subtype responses were studied in three strains of mice (C57BL/6J, Swiss albino, BALB/c; n=90 per strain) immunized with live Japanese encephalitis virus (JEV) by intraperitoneal (IP), subcutaneous (SC) and peroral (PO) routes. Lymphocytes obtained from the spleens of immunized and control mice were stimulated in vitro with JEV for 48 h and the supernatants were assayed for the presence of the cytokines IL-4 and IFN-gamma. JEV-specific IgG isotypes were also measured in the sera of immunized mice. T helper cytokine responses in mice immunized with JEV were found to be strain- and route-specific in the three species tested. Moreover, they were also dependent on the type of immunogen used (live vs killed virus), as well as the number of doses administered. C57BL/6J and BALB/c mice were more uniform in their T helper responses compared with the outbred Swiss albino mice and induced a good Th1 response (P<0.001). Among the three routes evaluated, the IP and SC routes consistently elicited a Th1 response compared with the PO route (P<0.001), where an initial Th2-type response reverted to a Th1 response after repeated immunization. Live JEV induced a Th1 response while the commercial killed vaccine induced a predominant Th2 profile.

Immune responses of goats against foot-and-mouth disease quadrivalent vaccine: comparison of double oil emulsion and aluminium hydroxide gel vaccines in eliciting immunity.

The epidemiological role of small ruminants in foot-and-mouth disease (FMD) outbreaks has been generally neglected. Although, the disease in these species is sub-clinical in nature, their role as virus carriers represents a reservoir for further infection and spread of disease. Data on the usefulness of polyvalent FMD vaccine (FMDV) in goats is scant. Thus, the present study was undertaken to evaluate the benefits of a highly potent polyvalent FMDV in goats. In the present investigations, FMDV quadrivalent double oil emulsion (Montanide ISA 206) vaccines were tested in goats at reduced doses of 2 ml per animal (antigen payload 3.5 microg per serotype per dose). The oil adjuvant elicited superior immune response at any given period than aluminium hydroxide gel (AGS) vaccine and the rapidity of development of response was quicker. The duration of immunity also appeared to be maintained for long period. The differences in immune response between two adjuvant groups were statistically significant (P<0.05). The differences were apparent even in kinetics of immune response. Unlike cattle, goats were found to be late responders for oil-adjuvanted vaccine. Our results indicate possible universal usage of double oil emulsion vaccines for disease control programs irrespective of species of animals.

B-cell-mediated lysis of cells infected with the neurotropic JHM strain of mouse hepatitis virus.

Cells expressing the spike (S) glycoprotein of the neurotropic JHM strain (JHMV) of mouse hepatitis virus (MHV) are susceptible to lysis by B cells derived from naïve mice, including B cells from perforin-deficient mice. Cytolysis requires interaction of the virus receptor and the viral S glycoprotein, is independent of other viral-induced components, and is not a unique property of B cells. Neutralizing anti-S-protein monoclonal antibodies (mAb) and a mAb specific for the viral receptor inhibit lysis. However, cells infected with an MHV strain unable to induce cell-cell fusion are resistant to lysis and lysis of JHMV-infected cells is inhibited by an anti-S-protein nonneutralizing mAb which prevents S-protein-mediated cell fusion. These data suggest that B cells may function as antibody-independent innate immune response during JHMV infection in vivo.

Impaired T cell immunity in B cell-deficient mice following viral central nervous system infection.

CD8(+) T cells are required to control acute viral replication in the CNS following infection with neurotropic coronavirus. By contrast, studies in B cell-deficient (muMT) mice revealed Abs as key effectors in suppressing virus recrudescence. The apparent loss of initial T cell-mediated immune control in the absence of B cells was investigated by comparing T cell populations in CNS mononuclear cells from infected muMT and wild-type mice. Following viral recrudescence in muMT mice, total CD8(+) T cell numbers were similar to those of wild-type mice that had cleared infectious virus; however, virus-specific T cells were reduced at least 3-fold by class I tetramer and IFN-gamma ELISPOT analysis. Although overall T cell recruitment into the CNS of muMT mice was not impaired, discrepancies in frequencies of virus-specific CD8(+) T cells were most severe during acute infection. Impaired ex vivo cytolytic activity of muMT CNS mononuclear cells, concomitant with reduced frequencies, implicated IFN-gamma as the primary anti viral factor early in infection. Reduced virus-specific CD8(+) T cell responses in the CNS coincided with poor peripheral expansion and diminished CD4(+) T cell help. Thus, in addition to the lack of Ab, limited CD8(+) and CD4(+) T cell responses in muMT mice contribute to the ultimate loss of control of CNS infection. Using a model of virus infection restricted to the CNS, the results provide novel evidence for a role of B cells in regulating T cell expansion and differentiation into effector cells.

Protective immune response to 16 kDa immunoreactive recombinant protein encoding the C-terminal VP1 portion of Foot and Mouth Disease Virus type Asia 1.

Recombinant protein of Foot and Mouth Disease Virus (FMDV) type Asia 1 corresponding to the C-terminal half of VP1 was expressed in Escherichia coli. As an alternative to the synthetic peptide, this selected C-terminal region was used as a protein vaccine in guinea pigs in order to study the immune response with various adjuvant formulations: immune stimulatory complexes (ISCOMs), Montanide ISA 206, Freund's incomplete adjuvant (FIA), lipopolysaccharide (LPS) and cytokine mixture. A primary dose of 40 microg/animal followed by a booster of the same dose was injected after a 21-day interval. The sera were collected at intervals of 21, 42 and 63 days after the booster. The humoral response to vaccine was monitored by sandwich enzyme-linked immunosorbent assay (ELISA) and a serum neutralization test (SNT). The guinea pig sera showed high titers both in ELISA and SNT, which could be protective. Further, irrespective of the adjuvant preparation used, the vaccine conferred protection against the challenge virus 105 days post-vaccination in 13 of 15 animals (86%). The results indicated that a combination of recombinant protein ISCOMs and Montanide ISA 206 would be a better choice for achieving early protective titers and longer lasting immunity and that the C-terminal half of the VP1 protein may be tried as a safe vaccine for secondary immunization.

Oral immunisation of mice with live Japanese encephalitis virus induces a protective immune response.

This study was undertaken to evaluate the efficacy of oral immunisation of mice with live Japanese encephalitis virus (JEV). Swiss albino mice were immunised with JEV by the peroral (p.o.), intraperitoneal (i.p.) and the subcutaneous (s.c.) routes on days 0, 7 and 14 using either mouse brain derived immunogen (MBDI) or cell culture derived immunogen (CCDI). Oral immunisation of mice evoked high anti-JEV antibody titres by ELISA (Geometric mean titres of 5065 with CCDI and 8854 with MBDI). Moreover, the orally immunised mice showed 76.7% protection with MBDI and 70% with CCDI against intracerebral challenge with a lethal dose of JEV. This study demonstrates for the first time that oral immunisation of mice with live JEV generates a brisk, protective immune response. The results of this study suggest that oral immunisation with JEV holds promise for the future.

Biodegradation of slop oil from a petrochemical industry and bioreclamation of slop oil contaminated soil.

Slop oil, i.e. waste oil from a petrochemical complex, contains at least 240 hydrocarbon components, of which 54% are from C5 to C11 and the rest from C12 to C23. Of 22 isolated bacterial cultures that were able to degrade slop oil, seven could each degrade about 40% of the slop oil, and a mixture of all seven could degrade ≤50% in liquid medium. Bioaugmentation of soil contaminated with slop oil with the mixed bacterial culture gave up to 70% degradation of slop oil after 30 days. This compares with 40% degradation without bioaugmentation. Bioaugmentation led to a significant increase in counts of bacteria able to degrade slop oil. Wheat sown on bioaugmented soil germinated and grew better than on non-augmented soil and led to increased degradation of slop oil (up to 80%). This indicates the potential of mixed culture for bioremediation.