Conscious Sedation for Cataract Surgery done Under Retrobulbar Block: A Comparative Study Evaluating the Effects of Midazolam and Dexmedetomidine

NEED FOR THE STUDY: 1. Cataract surgeries were carried out under local anesthesia, 2. A comfortable co-operative stationary patient is a key to achieve good result with these patients, 3. Hence in this study conscious sedation supplemented with Peribulbar block has been carried out and results were observed for; • better patient cooperation, • anxiolysis and patient comfortness, • surgeons satisfaction, • Stable hemodynamics, • Lack of complication, AIM AND OBJECTIVES: 1. To study the effects of conscious sedation in cataract surgery. 2. In this study we compare the effect of midazolam with dexmedetomidine and with that of control group. Method of Collection of Data: Prospective randomised double blind clinical control trial METHODOLOGY: 1. After obtaining informed written consent, patients will be randomly divided into 3 groups by draw of lots. 2. Group M-patients receiving midazolam, Loading dose-0.03mg/kg, Maintenance dose-0.05mg/kg/hr. 3. Group D-patients receiving dexmedetomidine, Loading dose-0.3mcg/kg over ten min, Maintenance dose-0.3mcg/kg/hr. 4. Group C-control. Loading dose – plain 0.9% N.S, Maintenance dose- plain 0.9% N.S. 5. Loading dose is followed by peri bulbar block after 10 min. 6. Maintenance dose is given in infusion throughout the procedure and infusion is stopped at the end of surgery. 7. Supplemental oxygen will not be provided except in case of desaturation (SPO2-95%). PARAMETERS MONITORED: Baseline B.P, Pulse rate, SPO2. Blood pressure, pulse rate, SPO2, R.S, S every 2 min from the time of loading dose to the time the surgery was started. Wong Baker Facial pain rating scale at the time of retrobulbar block. Intra op vitals-B.P, pulse rate, E.C.G, SPO2 every 5 min Ramsay sedation score every 1 min from the time of loading dose till they attain the Ramsay sedation score of 3 and every 5 min there after Patient movement scale during surgery. Aldrete recovery score every min after the end of surgery and time to attain the score of 10 was recorded. Patient was shifted to recovery room after they attain a Aldrete recovery score of 10. Likert like verbal rating of surgeon’s satisfaction at the end of surgery. Patient will be asked whether they were aware of ‘unpleasant intraoperative events’ in the post operative period. Post op vitals and Ramsay sedation score every 10 min for 2hrs in the post op period. RESULTS: We found that conscious sedation was safe and effective in the case of cataract surgery and was associated with greater patient’s comfort and surgeon’s satisfaction when compared to the surgeries which was done only with retro bulbar block alone. Midazolam in a loading dose of 0.05mg/kg and in a maintenance dose of 0.03mg/kg was equally effective to dexmedetomidine in the aspect of patient’s co- operation during retro bulbar block and during surgery which was assessed by facial pain scale, patient movement scale and surgeon satisfaction scale and recall of intra op events. Midazolam was slightly better to dexmedetomidine in the aspect of better hemodynamic profile. However mean time to reach RSS of 3 was rapid with dexmedetomidine when compared to midazolam. But time to reach Aldrete recovery score 10 was prolonged in dexmedetomidine when compared to midazolam. Both the drugs had no significant complications in the peri operative period. CONCLUSION: We conclude that conscious sedation is safe and effective to practise in the case of cataract surgeries and is associated with better patient co operation and surgeon comfort when compared to the surgeries which are done with retrobulbar block alone. Midazolam and dexmedetomidine are equally effective in the aspects of patient co operation and surgeon’s comfort but midazolam is slightly superior to dexmedetomidine in the aspect of better hemodynamic profile

Mucin glycoarray in gastric and gallbladder epithelia

<p>Abstract</p> <p>Background</p> <p>Mucins are critical cytoprotective glycoproteins and alterations of epithelial gastric mucins have been described in different pathological conditions. The purpose of the present study was to evaluate the putative usefulness of mucins in understanding the progression of gastric cancer and gallstone formation in a better perspective.</p> <p>Methods</p> <p>Formalin-fixed paraffin-embedded gastric biopsy specimens and surgically resected gallbladder tissue samples were sectioned. Alcian Blue (AB) staining was performed to identify sialomucins (staining blue at pH 2.5) and sulfomucins (staining brown at pH 1.0) and then Periodic acid-Schiff's (PAS) staining to visualize the neutral mucins (staining magenta).</p> <p>Results</p> <p>In normal gastric and gallbladder mucosae, we found that neutral mucins were predominant, whereas in intestinal metaplasia, gastric carcinoma and stone-containing gallbladder, a significant increase of acidic mucins was found.</p> <p>Conclusion</p> <p>We suggest that the sulfomucins have a greater role in gallstone formation than the neutral mucins and also that the sialomucins and sulfomucins play an important role in cancer progression and metastasis. Our results challenge the glycobiologists to delve deeper in elucidating the role of mucins in gastric malignancy and in gallstone formation.</p

Clinico Etiological Profile of Pancytopenia and Bicytopenia In Pediatric Population Aged 1 Month-12 Years at Tertiary Care Centre

BACKGROUND: Cytopenia can be defined as the reduction in any one of the three cellular components of blood, i.e., white blood cells, red cells, or platelets. If any of the above two cell lines are reduced it is called as bicytopenia. If all three types of cell lines are reduced then it is called as pancytopenia. The etiologies of bicytopenia and pancytopenia differ vastly in pediatric population, ranging from infiltration of marrow by malignant cells to a bone marrow suppression by any viral infection. Presence of marked overlapping between the etiologies of bicytopenia and pancytopenia is noted. Peripheral smear becomes a necessary investigation if the exact etiology of bicytopenia and pancytopenia wasn’t evident from the clinical history or routine examination. The next investigation which is a bone marrow biopsy/aspiration is warranted. Clinically anemia may lead to dyspnoea, fatigue and cardiac manifestations. Thrombocytopenia may lead to easy bruising/bleeding gums and leucopenia may lead on to increased liability to infection. OBJECTIVES: 1. Study the etiological distribution of both pancytopenia and bicytopenia in pediatric population 2. Define the clinical spectrum of pancytopenia & bicytopenia in pediatric population. MATERIALS AND METHODS: We conducted this study to assess the clinico-etiological profile in pediatric population presenting with bicytopenia or pancytopenia in our hospital. This research helps us to know about the usual etiologies and clinical spectrum of bicytopenia and pancytopenia in our population. All bicytopenia and pancytopenia cases were followed up every fortnight with clinical examination and complete blood count in our hematology outpatient clinics on Saturday. During follow up we tried to find out the time interval between onset of cytopenia and diagnosis of leukemia or lymphoma i.e., we tried to find out the time duration of bicytopenia and pancytopenia before it manifests as leukemia/lymphoma/aplastic anemia. We also assesed the short term outcome of bicytopenia and pancytopenia i.e., recovered or relapsed or treatment failure/death. RESULTS: Bicytopenia is more common than pancytopenia in our locality. Both bicytopenia and pancytopenia have slight male predominance. Most of the children with bicytopenia and pancytopenia presented with fever. Infections were the most common etiology in children admitted with bicytopenia and pancytopenia. Dengue fever was the commonest cause of bicytopenia in our study. In a child with fever, if leucopenia and thrombocytopenia also present, probable etiology could be dengue fever, enteric fever and septicemia. In a child with fever, if anemia and thrombocytopenia also present, probable etiology could be acute leukemia. In our study, most common cause of pancytopenia was septicemia, caused by coagulase negative staphylococcus aureus and klebsiella pneumonia. In all children admitted with pancytopenia, blood cultures should be sent before first dose of antibiotics. In our study the other common causes of pancytopenia are aplastic anemia and acute lymphoblastic leukemia. So in all children with pancytopenia bone marrow aspiration should be done to rule out acute leukemia and aplastic anemia. So in a child with fever if pancytopenia also present, probable etiology could be septicemia followed by aplasticanemia, ALL. CONCLUSION: In children with clinical features of sepsis, if bicytopenia and pancytopenia present, it is associated with high mortality. Although bicytopenia& pancytopenia look ominous, this study showed the common causes were infections. High index of suspicion was necessary for early diagnosis and initiation of appropriate treatment will have an impact on prognosis, as most of the causes were treatable and curable. Despite infections being the common cause of bicytopenia& pancytopenia, high index of suspicion is needed and prompt bone marrow aspiration studies should be done to rule out leukemias

SCREENING OF ANTI-OXIDANT ACTIVITY OF METHANOLIC EXTRACT OF GRACILARIA FERGUSONII J.AG. (RED SEAWEED) IN HARE ISLAND, THOOTHUKUDI, TAMIL NADU, INDIA

In the present study, anti-oxidant activity of methanol extract of Gracilaria fergusonii J.Ag. collected from Hare Island, Thoothukudi in the south east coast of Tamil Nadu, India was screened. Free radical scavenging activity was evaluated using 1,1-diphenyl-2-picryl hydrazyl (DPPH) free radical and a reducing power by Cupric Reducing Antioxidant Capacity (CUPRAC) assay. The percentage of scavenging activity of DPPH by methanol extract at 100μg, 200μg, 300μg, 400μg and 500μg were 31.35, 45.23, 61.76, 79.54 and 82.93% respectively. At a concentration of 100μg, 200μg, 300μg, 400μg and 500μg of methanol extract, the absorbance were 0.295, 0.302, 0.328, 0.367 and 0.384 respectively. These results similar to those obtained from the DPPH assay in which 500μg showed the highest total anti-oxidant capacity, followed by 400μg, 300μg and 200μg, and lastly 100μg. The results showed that both DPPH scavenging activity and absorbance were increased when the concentration of methanol extract was also increased. Vitamin C, a strong anti-oxidant was also used as control, and the anti-oxidant potential was compared to all tested samples. Keywords: Seaweeds, Gracilaria fergusonii, anti-oxidant, methanolic extract, Hare Island

Phytochemical analysis of methanolic extract of Ulva rigida C.Ag. collected from Koothankuzhi Coast, Tirunelveli district, Tamil Nadu, India

The present study was concentrated to explore the phytochemicals present in the methanolic extract of Ulva rigida C.Ag., collected from Koothankuzhi in the south east coast of Tamil Nadu, India. &nbsp;The phytochemical analysis of methanolic extract was screened using the standard procedure for UV-Visible spectroscopic, HPLC and FTIR. The UV-Visible spectrum showed the compounds separated at the nm of 662, 603, 533 and 400 with the absorption 0.653, 0.331, 0.458 and 2.684 respectively. The qualitative HPLC fingerprint profile displayed fourteen compounds at different retention time of 1.770min, 2.230min, 2.540min, 2.870min, 3.090min, 3.377min, 3.900min, 4.257min, 4.797min, 5.340min, 5.853min, 6.520min, 7.730min and 9.220min. The result of FTIR analysis was found the presence of functional groups such as alkynes, sulfonic acids, carboxylic acids, carboxylic acid salt, aldehydes, aliphatic and unsaturated hydrocarbons. Keywords: Ulva rigida, UV-Visible, HPLC, FTI

Visual cortex neuroanatomical abnormalities in psychosis: neurodevelopmental, neurodegenerative, or both?

BACKGROUND: Idiopathic psychotic disorders, which include schizophrenia, schizoaffective and bipolar disorder with psychosis, are debilitating disorders affecting about 3% of the world’s population. Neurodevelopmental and neurodegenerative hypotheses have been proposed in psychosis, but the literature is mixed in regards to whether psychosis pathogenesis involves one or both of these processes. Since the visual system matures early in development, studying visual pathway abnormalities stratified by disease onset may further inform our understanding of psychosis pathogenesis. OBJECTIVE: The objective of this thesis is to determine whether disease onset, independent of illness duration, has a differential effect on visual cortical abnormalities in psychosis. We examined visual cortical measures for thickness, surface area, and volume using a pseudo-longitudinal study design of first episode psychosis-schizophrenia (FEP-SZ), FEP-non-schizophrenia (FEP-NSZ), early onset psychosis (EOP, 15 and 30 years of age) groups. Relationships between visual cortical metrics and clinical or functional outcomes were performed. METHODS: The FEP sample (n= 102) included healthy controls (n= 44), FEP-SZ (n= 36), and FEP-NSZ (n= 22). The chronic psychosis data included healthy controls (n= 311) and psychosis probands (n=510). Psychosis probands was stratified by disease onset: EOP (n=213), OP (n=257), and LOP (n=40). Propensity matching was performed to match healthy controls (HC) according to age, sex and race. Linear regression models were performed comparing the means of visual cortical measures between groups. Partial Spearman correlations controlling for confounding factors were performed between visual cortical regions and clinical data. For FEP, clinical outcomes were assessed using Clinical Global Impression scale (CGI), Scale of Positive Symptoms (SAPS), and Scale of Negative Symptoms (SANS). For onset groups, clinical and functional outcomes were assessed using Positive and Negative Syndrome Scale (PANSS), Montgomery–Åsberg Depression Rating Scale (MADRS), Brief Assessment of Cognition (BACS), Wecshler Memory Scale (WMS) spatial span, anti-saccade error rates, dot expectancy pattern test, emotion recognition test, and Birchwood Social Functioning Scale (SFS). Multiple comparisons were performed using the Benjamini-Hochberg procedure. RESULTS: FEP-SZ was associated with smaller V1 and V2 areas, higher MT area and lower MT thickness compared to HCs. Lower MT thickness was associated with worse negative symptoms. Compared to HC, patients with chronic psychosis had lower V1, V2, and MT areas, as well as smaller MT thickness. V1 and V2 area and MT thickness were lower in the EOP group in comparison to matched HC. OP and LOP had a thinner MT region compared to matched HC. Of particular note, it was observed that EOP had greater area differences as compared to thickness reductions in the LOP group. Increased hallucinations and delusions were associated with a thinner MT region in the EOP group. CONCLUSION: When stratified by disease onset, FEP, EOP, OP, and LOP appear to have different pathogenic mechanisms and the severity of visual cortex neuroanatomical abnormalities are dependent on when the disease onset occurs. EOP occurs earlier in neurodevelopment resulting in greater severity in symptom and visual cortical measures as compared to OP. On the contrary, LOP appears to have a neurodegenerative mechanism which is evidenced by accelerated visual cortical thinning.2027-05-31T00:00:00

Microbial Lipid production from potato processing waste water and simultaneous nutrient removal using oleaginous fungi

Microbial lipids can be used as a feedstock for biodiesel production, and use of biowastes as the substrate for microbial lipid production can reduce its production cost. The aims of this research include: (i) isolation and identification of local oleaginous species from Irish soils; (ii) feasibility of oleaginous fungi for microbial lipid production from potato processing wastewater, in addition with nutrient removals from wastewater; and (iii) microbial lipid production using pure carbon sources for comparison. Local oleaginous fungi were isolated from Irish soils with the aim of producing microbial lipids with low cost starch substrates. 30 cultures were oleaginous with glucose as the carbon substrate; the maximum lipid content in biomass (44.3%) was observed in the isolate I16-3. When the isolates were grown on starch medium, 19 cultures among 30 cultures were able to accumulate lipids. The maximum lipid content (39%) was observed in I16-3. The isolate was identified as Aspergillus flavus. This study also explored the amylase secretion capability of isolated cultures and the maximum yield (34 IU/mL) was observed in the isolate I16-3. Identification of isolated fungi with molecular techniques revealed a number of non mucaraceous fungi including Aspergillus sp., Penicillum sp., Tricoderma sp., and Aceremonium sp. along with mucaraceous fungi zygomycetes sp., Mortierella sp. and Umbliopsis sp. These non mucaraceous oleaginous fungi would be of future interest in generation of the second generation biodiesel. Potential use of potato processing wastewater for microbial lipid production was studied under various conditions. Using Aspergillus oryzae, diluting the wastewater by adding 25% of tap water achieved the maximum lipid yield of 3.5 g/L. It was observed that phosphate limitation may be the mechanism to stimulate microbial lipid production. At this dilution ratio, total soluble starch was utilized by 99% and the fungi secreted amylase of 53.5 IU/mL. Nutrient removal from potato processing wastewater was examined; at this dilution ratio, removals of chemical oxygen demand, total soluble nitrogen, total soluble phosphorus, ammonium nitrogen, orthophosphate and sulphate of 91%, 98%, 97%, 100%, 100% and 30% were achieved. Lipids of A.oryzae contained major fatty acids like palmitic acid (12.6%), palmitolic acid (4.3%), stearic acid (14.5%), oleic acid (22.5%), linolenic acid (5.5%), and linoleic acid (6.5%). When external nutrients were added to raw potato processing wastewater for lipids and gamma - linolenic acid (GLA) production using two oleaginous fungi, Aspergillus flavus I16-3 and Mucor rouxii, the lipid and GLA yields were enhanced; 3.5 and 4.2 g/L of lipids, and 100 and 140 mg/L of GLA were produced by Aspergillus flavus I16-3 and Mucor rouxii, respectively. In addition, the wastewater was efficiently treated, when external nutrients were added to raw wastewater, with total soluble chemical oxygen demand removals of 60% and 90%, total soluble nitrogen removals of 100% and 98%, total soluble phosphorus removals of 92% and 81% by Aspergillus oryzae I16-3 and Mucor rouxii, respectively. In the study with pure glucose, starch and cellulose as the carbon substrate, Mucor rouxii was cultured at an initial C/N ratio of 60. The highest lipids yield of 4.9 g/L was found with glucose as the carbon substrate. The lipid content in biomass for starch was less than for glucose. The maximum lipid yield was increased when the starch concentration was increased to 60 g/L and 5.8 g/L of lipids was produced. Cellulose supported M.rouxii biomass growth but did not support the lipid production. Significant quantities of a-Amylase (0.5 and 1.2 IU/mL) and cellulase (0.19 IU/mL) were produced by M.rouxii to hydrolyze the complex carbon sources. Microbial lipids comprised oleic, palmitic, stearic, linolenic and GLA fatty acids. On the whole, this research has found non mucaraceous oleaginous fungi for low cost lipid production on starchy wastes. Isolated indigenous fungi have been proven to be efficient in microbial lipid production from potato processing wastewater. Our research also demonstrates the potential use of potato processing wastewater for microbial lipid production with simultaneous wastewater treatment