Clinicoetiological Pattern and Outcome of Neonates Requiring Mechanical Ventilation: Study in a Tertiary Care Centre.

The clinical and etiological pattern of ventilated newborns, their outcome in relation to morbidity and mortality was studied with 50 ventilated newborns, including outborns. M:f ratio was 2.1:1. The most common gestational age 28-36 weeks (60%) and mostly were appropriate for gestational age (66%). Survival rate 40% (20/50) being directly proportional to the gestational age and intrauterine growth pattern (P < 0.01). Babies by LSCS Lower Segment Cessarian Section survived more than born by normal vaginal delivery (46.7% vs. 37.1%). More outborn survival could be related to their advanced gestational age on presentation. The initial assessment of APGAR score of >7 had a better outcome (56.3%; P < 0.03). The most common indication of ventilation was hyaline membrane disease (19/50) but the survival rate best in babies with meconium aspiration syndrome (54.5%). The most prevalent complication was sepsis (survival rate 60%) while conditions such as shock, intraventricular hemorrhage, disseminated intravascular coagulation, air leak syndrome, and pulmonary hemorrhage had 100% mortality. Thus, the outcome as survival is constrained by many factors; newborn's profile, conditions at birth, and postnatal resuscitation.

In silico Identification of Ergosterol as a Novel Fungal Metabolite Enhancing RuBisCO Activity in Lycopersicum esculentum.

RuBisCO (EC 4.1.1.39), a key enzyme found in stroma of chloroplast, is important for fixing atmospheric CO2 in plants. Alterations in the activity of RuBisCO could influence photosynthetic yield. Therefore, to understand the activity of the protein, knowledge about its structure is pertinent. Though the structure of Nicotiana RuBisCO has been modeled, the structure of tomato RuBisCO is still unknown. RuBisCO extracted from chloroplasts of tomato leaves was subjected to MALDI-TOF-TOF followed by Mascot Search. The protein sequence based on gene identification numbers was subjected to in silico model construction, characterization and docking studies. The primary structure analysis revealed that protein was stable, neutral, hydrophilic and has an acidic pI. The result though indicates a 90 % homology with other members of Solanaceae but differs from the structure of Arabidopsis RuBisCO. Different ligands were docked to assess the activity of RuBisCO against these metabolite components. Out of the number of modulators tested, ergosterol had the maximum affinity (E = -248.08) with RuBisCO. Ergosterol is a major cell wall component of fungi and has not been reported to be naturally found in plants. It is a known immune elicitor in plants. The current study throws light on its role in affecting RuBisCO activity in plants, thereby bringing changes in the photosynthetic rate.

Ocular chemical injuries and their management.

Chemical burns represent potentially blinding ocular injuries and constitute a true ocular emergency requiring immediate assessment and initiation of treatment. The majority of victims are young and exposure occurs at home, work place and in association with criminal assaults. Alkali injuries occur more frequently than acid injuries. Chemical injuries of the eye produce extensive damage to the ocular surface epithelium, cornea, anterior segment and limbal stem cells resulting in permanent unilateral or bilateral visual impairment. Emergency management if appropriate may be single most important factor in determining visual outcome. This article reviews the emergency management and newer techniques to improve the prognosis of patients with chemical injuries.

Falciparum malaria masquerading as appendicitis.

The incidence of falciparum malaria is very high in India. Falciparum malaria is a multiorgan disease which can present with extremely varied presentations. The severity of the disease and difficulty in its diagnosis require a keen sense of suspicion on the part of the treating physician to diagnose it. Here is an unusual case of falciparum malaria presenting as acute appendicitis. This case did not respond to artemether therapy and that also points towards drug resistance emerging in malaria. The child was operated upon and appendix was found to be inflamed. After a tumultuous postoperative course with symptoms suggestive of acute renal failure, a diagnosis of falciparum malaria was made and quinine started. Recovery was uneventful thereafter.

A comparative study of postoperative intraocular pressure changes in small incision vs conventional extracapsular cataract surgery.

AIMS: To compare short- and long-term IOP changes in small incision cataract surgery (SICS) vs conventional extracapsular cataract surgery (CECS). METHODS: A total of 232 eyes of as many patients undergoing cataract surgery were randomized to SICS or CECS. Sixteen eyes had to be excluded out of the study. IOP was recorded preoperatively and postoperatively on day 1, 2, and 7; and then after 1, 3, and 6 months. Only 160 eyes remained under 6-month follow-up, out of which 48 had CECS and remaining 112, SICS. Results were analysed statistically (repeated measure ANOVA, multiple comparisons). RESULTS: A significantly higher IOP was observed on day 1, 2, and 7 in both types of surgeries as compared to mean preoperative IOP. Variation in rise was more pronounced in CECS (nearly twofold) than in SICS (P<0.05). Maximum decrease in IOP occurred during the first week and it was more rapid in SICS than CECS. At 3 months, IOP was significantly higher than baseline in CECS but significantly lower in SICS. From 3 to 6 months, there was no further decrease in IOP in either type of surgery. CONCLUSIONS: IOP rises significantly on day one in CECS and SICS and thereafter comes down slightly by day 2 and rapidly by day 7. IOP rise is more pronounced in CECS than in SICS. After 1 week to 3 months, IOP decline is very gradual and thereafter ceases to decrease.

Lantadenes and their esters as potential antitumor agents.

Lantadenes are pentacyclic triterpenoids of the weed Lantana camara. Five new lantadenes (14-18) and their methyl esters (20-24) were synthesized, characterized, and screened for cytotoxicity against four human cancer cell lines. The parent compound (1) and the four most active compounds (15, 16, 21, and 22) were further studied for their in vivo tumor inhibitory potential on squamous cell carcinogenesis in Swiss albino mice induced by 7,12-dimethylbenz[a]anthracene (DMBA) and promoted by 12-O-tetradecanoylphorbol-13-acetate (TPA). These results were supported by histopathological studies and discussed in terms of structure-activity relationships. The results inferred the importance of the groups attached to C-22 and C-17 in relation to the antitumor activity of these compounds.

Chemopreventive activity of lantadenes on two-stage carcinogenesis model in Swiss albino mice: AP-1 (c-jun), NFkappaB (p65) and P53 expression by ELISA and immunohistochemical localization.

Lantadenes are pentacyclic triterpenoids isolated from leaves of Lantana camara L. and have antitumor activity. Lantadene A (LA) and methyl ester of LA (LAM) were earlier studied in the author's lab for their chemopreventive effect on 7,12-dimethylbenz(a)anthracene (DMBA) followed by 12-O-tetradecanoylphorbol-13-acetate (TPA) induced squamous cell carcinoma incidence in Swiss albino mice. The present study was specially designed to initiate the involvement of the molecular targets in chemopreventive activity of these compounds. Skin lesions were induced by twice-weekly topical application of DMBA (100 nmol/100 microl of acetone) for 2 weeks followed by TPA (1.7 nmol/100 microl of acetone) on depilated back of mice for 20 weeks. LA and LAM were administered orally at a dose of 50 mg/kg body weight twice weekly, 1 week before DMBA application and continued for 20 weeks thereafter. A significant decrease in the incidence of number of lesions in mice was obtained in LA/LAM treated groups as compared to DMBA/TPA alone. Significant increase in the protein levels of c-jun, p65, and p53 by ELISA were observed in DMBA/TPA treated mice tumors whereas less expression was observed in LA and LAM treated tumors. Further immunohistochemical localization of transcription factors was studied which also showed less localization of c-jun, p65, and p53 in LA and LAM treated tumors as compared to localization in DMBA/TPA treated tumors. It can be inferred that LA and LAM chemopreventive activity may be linked to the deregulation of above molecular targets which warrants further studies in that direction.

A review of the toxicosis and biological properties of the genus Eupatorium.

Eupatorium genus grows wild in many parts of the world. A number of species of Eupatorium are toxic to grazing animals. Milk sickness in humans is caused by ingestion of milk of the animals reared on the pastures infested with Eupatorium rugosum (white snakeroot). While some information is available on the toxins in various species of Eupatorium, ambiguities still persist in extrapolation of the data to field incidence of toxicosis. Eupatorium genus has been used for its medicinal properties for many decades. A number of bioactive natural products have been reported in the extracts of Eupatorium spp. and the genus is a promising bioresource for preparation of drugs and value-added products.

Isolated bilateral paralysis of the soft palate in an adult.

A case of bilateral paralysis of the soft palate occurring in a 42-year-old patient is presented. Idiopathic paralysis of the soft palate as an isolated clinical entity was first described by Edin et al. 1976. Since then 22 similar cases have been reported, all in children and all unilateral. A search of the English language literature has not revealed a case of bilateral palatal palsy in an adult.

Comparison of lantadenes content and toxicity of different taxa of the lantana plant.

Three taxa of the lantana plant (Lantana camara var.Aculeata) I (white-pink), II (yellow-pink), and III (yellow-red)-differed in the content of lantadenes and compounds X, Y, and Z. Lantadene A, lantadene B, and lantadene C were the major lantadenes of taxon III. It contained small amounts of lantadene D. Taxa I and II contained very small amounts of lantadene A and lantadene B. Compounds X, Y, and Z were the major constituents of taxa I and II, and they constituted 59% and 92% of the total constituents in these taxa, respectively. Ingestion of lantana leaf powder of taxon III by male guinea pigs caused severe hepatotoxicity. Taxon I elicited mild hepatotoxicity in one out of six animals while taxon II was nontoxic. The biological and ecological significance of the presence of high amounts of compounds X, Y, and Z in taxa I and n is not known.

Hemiplegia as a manifestation of acute mountain sickness.

A young mountaineer who developed right sided hemiplegia with aphasia at high altitude is reported. This is an uncommon nervous system manifestation in acute mountain sickness.

Falciparum malaria.

We analysed cases of hematologically proved cases of Plasmodium falciparum malaria encountered from July 1984 to Dec 1985 in a military hospital. The age range was 3 days to 10 years. Majority presented with classical symptom of fever (92.7%). Others presented with gastrointestinal (7.3%), hepatic (4.5%), central nervous system (7.3%) and respiratory (3.6%) symptoms. Anemia was found in 36.4%. Hepatosplenomegaly was present in majority of the cases. The rare findings were polyarthritis, rash, urticaria and cerebellar features. All cases responded to chloroquine or quinine. No resistance to drugs was found and there was no mortality.

Dosimetric aspects of the therapeutic photon beams from a dual-energy linear accelerator.

Parameters of the photon beams (6 and 20 MV) from a dual-energy linear accelerator (Mevatron-KD, Siemens Medical Laboratories, CA) are presented. The depth dose characteristics of the photon beams are dmax of 1.8 and 3.8 cm and percentage depth dose of 68% and 80% at 10-cm depth and 100-cm source-surface distance for a field size of 10 X 10 cm2 for 6 and 20 MV, respectively. The 6 and 20 MV beams were found to correspond to nominal accelerating potentials of 4.7 and 17 MV, respectively. The stability of output is within +/- 1% and flatness and symmetry are within +/- 3%. These figures compare favorably with the manufacturer's specifications.

Swimming with grommets.

A controlled prospective study was designed to find the relation of otorrhoea with swimming in ears with grommets. The children were allowed to swim in swimming pools without any precautions. They were advised not to swim during an upper respiratory infection. The results show that the incidence of otorrhoea among swimmers and non-swimmers after first 6 weeks post-operatively was remarkably similar.