Dynamometer based hand grip strength as a clinical tool for objective assessment of post-operative residual muscle weakness.

Background and Aims: Residual neuromuscular block continues to be a significant postoperative complication despite neuromuscular monitoring. This study aims to determine the applicability of a hand-held forced dynamometer for hand grip strength assessment as an objective measure of residual muscle weakness. Methods: The study included patients undergoing surgery under general anaesthesia. A demonstration was given to the patient on the usage of a dynamometer for handgrip strength and a peak expiratory flow meter for peak expiratory flow rate (PEFR) and baseline values were recorded. The parameters were monitored at 15 minutes post-extubation and again at intervals of 15 minutes until one hour, half-hourly until four hours, and hourly until six hours post-operatively. Paired t-test was used for comparison of baseline muscle strength and PEFR with the parameters at different time points. Association between muscle strength and PEFR was tested with the Pearson-correlation test. Results: Muscle strength was 50 to 60%, 75% and 100% of baseline at 15, 45 and 210 minutes after extubation, respectively. PEFR was 50 to 60%, 75% and 100% of baseline at 15, 60 and 180 minutes after extubation. The Pearson-correlation test established a positive correlation between handgrip strength and PEFR (correlation-coefficient 0.86). Conclusion: A significant reduction in the postoperative muscle strength can be detected using an objective forced dynamometer to measure handgrip strength even when train of four count has returned to unity and even when there are no clinical signs of muscle weakness. The residual muscle weakness is significant enough to affect the PEFR in the postoperative period.

Effectuation of International Academy of Cytology Yokahama Reporting System of Breast Cytology to Assess Malignancy Risk and Accuracy.

INTRODUCTION: Recently the International Academy of Cytology (IAC) proposed a new Yokahama reporting system for breast fine-needle aspiration cytology (2019) in order to standardize reporting pattern and to link cytology reporting to management algorithms. AIMS AND OBJECTIVES: To categorize the samples according to the newly proposed IAC Yokahama reporting system of breast cytology and to assess diagnostic accuracy and corresponding risk of malignancy (ROM) for each category. MATERIALS AND METHODS: This is a retrospective study of breast cytology cases done at Department of Pathology. The slides are retrieved from pathology archives and classified using a recently proposed IAC, Yokahama reporting system of breast cytology into five categories. The risk of malignancy, sensitivity, specificity, and diagnostic accuracy were estimated on the basis of the final histopathological diagnosis. RESULTS: Of the 386 cases of breast FNAC, 226 (55.55%) had the corresponding histological diagnosis. The respective ROM for each category was 22.22% for category 1 (insufficient material), 5.32% for category 2 (benign), 26.31% for category 3 (atypical), 100% for category 4 (suspicious for malignancy), and 100 % category 5 (malignant). Malignant cases were considered only when positive tests, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 89.66%, 100%, 100%, 90.2%, and 94.69%, respectively. CONCLUSIONS: The present study showed statistically significant sensitivity, specificity, and diagnostic accuracy, especially with malignant cases. Hence, using the IAC Yokahama reporting system of breast cytology is effective to standardize the reporting in various institutes and provide clear guidelines to clinician for further management.

Designing and Screening of New Schiff Bases of Isatins for Antibacterial Activity by In Silico Methods and Docking Studies.

Isatin or tribulin is an indole derivative; the compound was first obtained by Erdmann [1] and Laurent [2] and Erdmann in 1841 as a product from the oxidation of indigo dye by nitric acid and chromic acids. The compound is found in many plants, such as Isatis tinctoria, Calanthe discolor, and Couroupita guianensis. Schiff bases of isatin are investigated for their pharmaceutical properties. Isatins have been found to have various activities such as antiviral, antibacterial, anti-inflammatory, analgesic, anticonvulsan, antidepressant anti-HIV, fungicidal, etc. In this study, we focus on isatin derivatives for antibacterial activity. Isatin derivatives are docked on two targets, glucoseamine-6-phosphate synthase (PDB ID:2VF%) and dihydropteroate synthase (PDB ID: 1AJ0) enzymes that are potential targets for antibacterial and antifungal agents. The in silico results and docking scores of the isatin derivatives were compared with standard drugs.

Design, Characterization, and Docking Studies of Some Novel Isatin Derivatives for Anticonvulsant and Antidepressant Activity.

Isatin (indoline-2,3-dione) derivatives are derived from plant origin indole derivatives by the Sandmeyer method and characterized by IR, NMR, and mass spectrometric method. Molinspiration is used to calculate the molecular properties of all the synthesized compounds and to generate bioactivity scores (GPCR ligand, ion channel inhibitor, kinase inhibitor, nuclear receptor ligand, protease inhibitor, enzyme inhibitor) of the series of compounds. ADME predicted parameters are lipophilicity, P-gp substrate, GI absorption, bioavailability, lead-likeness, and blood-brain barrier (BBB) permeability by boiled egg model. Molecular docking is performed for the synthesized compounds they compared with the standard drugs.

Autogenous Bone Marrow Aspirate Coated Synthetic Hydroxyapatite for Reconstruction of Maxillo-Mandibular Osseous Defects: A Prospective Study.

PURPOSE: This prospective study was conducted to evaluate the bone regeneration capacity of synthetic hydroxyapatite mixed with autogenous bone marrow aspirate when used as a bone graft substitute in maxillo-mandibular osseous defects. METHODS: This study included nine patients with histopathalogically proven benign osteolytic lesions in maxilla and mandible that were treated with enucleation or marginal resection followed by bone marrow aspirate coated synthetic biphasic hydroxyapatite (hydroxyapatite and beta tricalcium phosphate) graft placement. Incorporation of graft was assessed based on Irwin's radiologic staging. The efficacy of graft to form new bone was radiologically evaluated by observing the sequential changes of density at grafted site using gray scale level histogram which was processed in adobe photoshop 7.0 elements. Clinical assessment of recipient and donor sites was done. RESULTS: Based on Irwin's radiologic staging, at 6 month follow up period, obvious incorporation of graft with new bone was observed. Sequential changes in bone density measured by gray scale histogram revealed initial resorption followed by replacement of BMA coated hydroxyapatite with new bone formation. None of the patients eventually had complications like infection, wound dehiscence, graft loss at recipient sites at 6 months follow up period. CONCLUSION: Autogenous bone marrow aspirate in combination with synthetic hydroxyapatite is an effective option for accelerating bone regeneration in small to moderate sized jaw bone defects. This mixture provides all the three critical elements needed for bone regeneration (osteogenesis, osteoinduction and osteoconduction) with an added advantage of obviating donor site morbidity.

Adverse Drug Reactions in Hospitalized Pediatric Patients: A Prospective Observational Study.

OBJECTIVES: To determine the incidence, pattern, causality, preventability, severity and predictors of adverse drug reactions (ADRs) in pediatric population. METHODS: It was a prospective, observational study that included patients of either sex, of any age treated in the pediatric wards of a tertiary care hospital. Study patients were followed throughout their hospital stay. Whenever an ADR was detected, all the required data was collected and analyzed. Data was analyzed for incidence, causality (by using WHO Probability scale and Naranjo's algorithm), preventability (by using Modified Shumock and Thornton scale), severity (by using Modified Hartwig and Siegel scale) and predictors of ADRs. RESULTS: Of the 1775 children admitted in the pediatrics ward, 1082 patients met study criteria and were enrolled into the study. A total of 64 ADRs were identified from 54 patients. The incidence of ADRs was 4.99 %. Male patients experienced majority (68.52 %) of ADRs. Drugs most commonly implicated in ADRs were amoxicillin + clavulanate (21.87 %) followed by ceftriaxone (20.31 %). Most (51.56 %) of the ADRs reported belonged to the system organ class, gastrointestinal system disorders. Among the ADRs reported, 82.85 % of ADRs were mild. Majority (87.5 %) of the ADRs were of 'probable' causality category and 96.9 % were not preventable. There was a significant association between occurrence of ADRs and the use of ≥4 number of medications, age (infants) and gender (male). CONCLUSIONS: Among the pediatric population, infants, male gender and those receiving ≥4 number of medications are at risk of developing ADRs. Constant monitoring is required to address the safety issue in pediatric population especially in infants and patients receiving ≥4 drugs.