General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multi-centre observational study

There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients' (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16-22) and failed intubation in 1 in 312 (95%CI 1 in 169-667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%)

GCMS Profiling Analysis of Five Different Solvent Leaf Extracts of Eupatorium Triplinerve Vahl

<p>Medicinal plants are more crucial in the field of pharmacology as most pharmaceutical industries; it may depend on medicinal plants for their raw materials. Eupatorium Triplinerve Vahl belongs to Asteraceae family, it is also known as "Ayapana" used for various medicinal properties. The present study was carried out to identify the phytoconstituents in the different solvents of the plant leaf extract. In this investigation, Gas Chromatography-Mass Spectrometry GC-MS) screening was performed to evaluate the phytocompounds and their biological activity. The GC-MS analysis provided  peaks area 20.4% of 1-ISOPROPYL-2,5-DIMETHOXY- 4-METHYLBENZENE in ethanol leaf extract, 2H-1-  BENZOPYRAN-2-ONE, 7-METHOXY (peak area  7.07%) in methanol leaf extract, 3-Oxabicyclo[4.2.0]oct- 5-ene (peak area 19.47%) in acetone leaf extract  respectively. The GC-MS profiling of different leaf extracts revealed the presence of bioactive compounds. There are 90 chemical compounds that have new potential sources of medicines for the treatment of various diseases and are responsible for their therapeutic effects. The results show that Eupatorium Triplinerve contains various bioactive compounds and is recommended as a plant of phytopharmaceutical importance.</p><p>Keywords:- Pharmacology, Phytoconstituents, Ayapana, Phytocompounds</p&gt

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Not AvailableSugarcane (Saccharum officinarum L.) is an important commercial crop cultivated worldwide for sugar and in recent years, it also serves as an important resource of biomass, bioethanol and bioplastic. Red rot caused by the fungal pathogen Colletotrichum falcatum Went (Teleomorph: Glomerella tucumanensis [Speg.] Arx and Muller) is a devastating threat for sugarcane cultivation in India. The disease progression is characterized by reddish lesions along the stalk tissue and the lethal effects of the disease leave the sugarcane stalk vulnerable for further sugar recovery. Inspite of the disease’s impact, locating any specific trait in sugarcane is difficult because of its complex polyploidy. To understand and elucidate the initial defense mechanisms in a resistant variety of sugarcane after pathogen inoculation, two suppression subtractive hybridization (SSH) cDNA libraries were constructed with the cDNA of resistant variety at 12 and 36 h. At the end, 141 ESTs specifically upregulated in red rot resistant variety after pathogen challenge was obtained. Annotation of the ESTs revealed that they belong to the categories pertaining to recognition and signal transduction, defense and programmed cell death, oxidative stress, redox maintenance, secondary metabolite biosynthesis, energy and photosynthesis, membrane trafficking and transport, cell/nuclear structure, nucleic acid metabolism, protein metabolism and processing, ubiquitin-26S proteasome system, carbohydrate metabolism, lipid metabolism and unknown categories. Based on the transcripts profile, a hypothetical pathway was generated and it clearly revealed that recognition and signal transduction as the first level of host defense which further activates defense gene expression and causes a global change in sugarcane transcriptome at the molecular level. To further confirm the expression level of defense-associated ESTs, the gene expression of 24 of them were studied in a quantitative real-time PCR (qRT-PCR) at 6, 12, 24, 36, 48 and 72 h after C. falcatum inoculation with 25SrRNA as the endogenous control. In all the ESTs studied, the expression level was found to be high in 72 h after C. falcatum. Further, the sugarcane gene expression at 72 h after C. falcatum was validated by Affymetrix GeneChip SugarCane Genome Array. Genes belonging to the functional categories: signal transduction, defense, energy and metabolism were upregulated. This is the first detailed work on red rot resistance in sugarcane at the molecular level. This study also established that C. falcatum infection causes a global change in sugarcane at the molecular and basal level which finally leads to defense against the fungal pathogen.Not Availabl

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Not AvailableA high throughput analyses of interaction between sugarcane and Colletotrichum falcatum, the hemibiotrophic pathogen causing red rot, was made by comparing transcriptomes of compatible and incompatible interactions in a tropical sugarcane cultivar Co7805 exhibiting differential reaction to the pathotypes Cf94012 and Cf87012, respectively. Suppression subtractive hybridization (SSH) combined with Illumina 2000 high throughput sequencing was used to identify the differential transcripts in resistance response library (RRL) and susceptible response library (SRL). After processing and filtering the raw reads from Illumina 2000 high throughput sequencing of subtracted products, we obtained 10,038 and 4,022 high quality transcripts, from RRL and SRL, respectively. Based on the transcripts mapping to KEGG-KASS database, the presence of a CEBiP receptor and the signals ROS, Ca2+, BR, JA and ABA were identified in both the responses. However, MAPK, ET, PI signals and JA amino conjugation were found only in the incompatible interaction and expression of 10 transcripts involved in these pathways was validated using qRT-PCR. Our study concludes that perception of PAMPs occurs in both systems, but downstream signaling through MAPK, ET, PI and JA amino conjugation and activation of R genes occurs only in the incompatible interaction. This is the first detailed transcriptomic analysis of compatible and incompatible interactions in sugarcane with two different C. falcatum pathotypes through SSH and the next generation sequencing (NGS) platform.Not Availabl

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Not AvailableTo understand red rot resistance mechanisms, suppression subtractive hybridization (SSH) has been used in this study to identify the early events during sugarcane and C. falcatum interaction. A resistant variety Co 93009 and a highly susceptible variety CoC 671 were used for construction of SSH cDNA libraries. The resistant Co 93009 was used as tester and susceptible CoC 671 was used as driver. At the end of subtraction, cloning and sequencing the ESTs were classified into various functional categories based on homology search. A total of 317 annotatable ESTs were obtained from both the libraries, 146 corresponded to sugarcane response triggered at 12h after C. falcatum inoculation and 171 corresponded to sugarcane response triggered at 36h after C. falcatum inoculation. In both the libraries, several signal transduction genes were commonly expressed. Secondary metabolism plays a vital role in plant cells as a defense response which synthesizes secondary metabolites which are lethal for pathogens. S-adenosyl methionine (SAM) synthetase, involved in polyamine biosynthesis was expressed in 12h response library and dehydroquinate dehydratase involved in phenyl propanoid pathway was induced in the other library. Dirigent protein which is widely known for conifer defense and which is involved in dictating stereochemistry of lignin biosynthesis was found to be expressed in both the libraries but the transcript level was 15 in 36 h response libraries. The expression of a dirigent protein in response to C. falcatum challenge in sugarcane is a novel outcome which interlinks the architecture and molecular evolution of sugarcane and conifers. Apart from these, many transcripts involved in general metabolism, energy metabolism, transport and several transcription factors were expressed in both the libraries. In conclusion, this study identified key transcripts, several of which are not reported in sugarcane resistance response. Functional validation and gene silencing studies of key enzymes/transcripts makes them a suitable candidate for transgenic approaches or breeding programmes. Our studies are in progress to functionally validate candidate transcripts through qRT-PCR and to standardize gene silencing strategies.Not Availabl

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Not AvailableRed rot caused by the fungus Colletotrichum falcatum Went is a destructive disease of sugarcane in India and other Asian countries. The pathogen infects the economically valuable stalk tissue which results in severe yield loss and impaired juice quality. Visible symptoms of the disease appear in the pathogen inoculated cane tissue after 72h as reddish tissue discoloration. However, early molecular events that occur between the host and the pathogen before 72h are poorly understood. To understand the molecular defense responses between sugarcane and C. falcatum interaction before phenotyphic symptom expression, we employed suppression subtractive hybridization (SSH) in sugarcane stalk tissue samples collected at 12h and 36h after pathogen inoculation in a red rot resistant cultivar. RNA samples of red rot resistant cv. Co 93009 collected at 12h and 36h after C. falcatum inoculation were used as a tester and the corresponding RNA samples of red rot susceptible cv.CoC 671 collected at 12h and 36h after pathogen inoculation and mock samples of cv. Co 93009 were used as drivers for the two individual subtractions. At the end of subtractive hybridization and sequencing, a total of 139 EST’s were obtained from the two libraries which were functionally categorized as belonging to recognition and signal transduction, oxidative stress, redox maintenance, membrane trafficking and transport, defence and programmed cell death, energy and photosynthesis, metabolism, secondary metabolite biosynthesis, cell/nuclear structure and unknown categories. In 12h response library (12hRL), the abundance of recognition and signal transduction ESTs were high whereas in 36h response library (36hRL), ESTs homologous to nucleic acid metabolism were high. Further gene expression of a set of 12 candidate ESTs was validated by quantitative real-time PCR (qRT-PCR) in the same set of red rot resistant and susceptible cultivars. This study identified a network of early defence responses and associated signals for the first time in a red rot resistant sugarcane cultivar in response to C. falcatum infectionNot Availabl

Rapid emergence of day-care anaesthesia: A review

The number of day-care surgeries is increasing every day. The boundaries of day-care surgeries are being redefined on a continual basis. Multi-dimensional benefits to the patient, hospital and national economy are the driving forces behind the changing scenario on the horizon of day surgery. The literature search included Google, medlinx, pubmed and medline. We have attempted to look at the controversies in patient selection with comorbidities, pre-operative assessment and an acceptable ASA grade of patients. An attempt is also made to look at suitable surgical procedures, a pathway of introducing procedures, which are still complex and specialist procedures in challenging environment. The techniques of general anaesthesia, central neuraxial blocks, regional nerve blocks with indwelling catheters and monitoring techniques are deliberated upon. Finally the most important post-operative issues of discharge criteria, including recovery after spinal anaesthetic, oral fluid intake, voiding and travel after day surgery, are considered

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Not AvailableA suppression subtractive hybridization (SSH) technique was used to identify differentially expressed genes in sugarcane in response to Colletotrichum falcatum, the fungal pathogen causing red rot in sugarcane. Messenger RNA (mRNA) samples collected from red rot resistant cv. Co 93009 at 6, 12, 24 and 48h after pathogen challenge were pooled together and used as tester population. mRNA samples collected from red rot susceptible cv. CoC 671 at 6, 12, 24 and 48h after pathogen challenge and control of samples of cv. Co 93009 and cv. CoC 671 were pooled together and used as the driver population. A forward subtraction enriched for differentially expressed ESTs in the resistant cultivar was carried out. At the end of subtraction, cloning and sequencing, 136 EST sequences were assembled into 10 clusters/contigs. Based on TIGR homology search, the clusters were found to be involved in reactive oxygen species (ROS) signaling, defense and the secretory pathway of plant innate immunity associated with hypersensitive response (HR) - mediated programmed cell death (PCD). Temporal gene expression pattern of the EST clusters by quantitative real time PCR (qRT-PCR) revealed that, resistant cultivar had a higher level of gene expression than the susceptible cultivar in all the clusters till 48h after pathogen inoculation. In conclusion, this study identified for the first time a set of differentially expressed EST clusters in red rot resistant sugarcane cultivar in response to C. falcatum infectionNot Availabl

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Not AvailableColletotrichum falcatum is an intriguing hemibiotroph, causing red rot in sugarcane, which caused significant loss to sugarcane production for more than a century in the country. To comprehensively understand the molecular interaction among different components of disease resistance mechanism in sugarcane against C. falcatum, detailed studies were conducted on transcript profiling, induction of 3-deoxyanthocyandin phytoalexins and proteomics. A set of sugarcane varieties varying in red rot resistance were challenged with the pathogen and tissue samples were harvested at different time intervals for the analyses. In subtractive libraries ESTs associated with Ca2+ signalling such as calmodulin-like protein, calnexin, putative calcium dependent protein kinase (CDPK) and ethylene (ET) induced calcium binding protein were upregulated in response to pathogen challenge in resistant varieties. Here, ROS and calcium signals emerge at early intervals in response to C. falcatum, thus putatively involved in signalling and defense response in the host tissues. To circumvent the damage caused by ROS, L-ascorbate peroxidase, class III peroxidase and superoxide dismutase were upregulated in the resistant cultivar. Further, transcriptional induction of cysteine and serine proteases is associated with H2O2 mediated-hypersensitive response (HR) cell death at the pathogen infection site. Besides that, MAPK7/MAPK4 and Avr9/Cf9 proteins were upregulated in response to C. falcatum at the early intervals in resistant interaction. We also found up-regulation of ESTs associated with secretory pathway include coatomer subunit, putative coatomer protein complex subunit β 2, signal recognition particle 9 kDa protein and a putative polyphosphoinositide binding protein. ESTs associated with ubiquitin proteasome system (UPS) system namely putative small zinc finger-related protein, 26S proteasome ATPase subunit Rpt6 and putative cullin 1 were upregulated in this study. These molecules may have a direct role to target and recycle several proteins during C. falcatum pathogenesis in the sugarcane tissues. Interestingly, SAM synthetase 1 and a radical SAM domain-containing protein were upregulated in response to the pathogen possibly leading to phytoalexin biosynthesis. The magnitude of synthesis and phytoalexin accumulation proximal to the pathogen infected region is likely to determine the red rot resistant phenotype of sugarcane cultivars. , Incompatible interactions maintained a higher induction of phytoalexins than the compatible ones as observed in the HPLC assays, wherein, upregulation of chalcone synthase 8 and SAM synthetase 1 involved in phytoalexin biosynthesis pathway was also found.Not Availabl

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Not AvailableYellow leaf (YL) caused by Sugarcane yellow leaf virus (SCYLV) is a serious viral disease affecting production and productivity in many ruling sugarcane varieties in India. Usually the characteristic disease symptoms appear during maturity phases of the crop; also many of the infected varieties don’t exhibit disease symptoms and disease expression is influenced by virus titre and other factors including prevailing climate. The present study was taken up to quantify and compare SCYLV in meristem derived tissue culture raised in vitro plantlets and asymptomatic sugarcane plants in RT-qPCR by relative standard curve method. The standard curve was prepared with serial dilutions of plasmid standards from 3x107 to 3x103 copy numbers of virus target gene. In this assay, copy number of virus population in in vitro plantlets and asymptomatic plants was estimated from 20,314.58 to 4,330.87 and from 8.96 to 0.27 million copy of viruses, respectively. Relative expression level of the virus between in vitro plantlets and asymptomatic plants was in the ratio of 73.7:243393.1 based on 2^ (-(ΔΔCt)). The results clearly established that meristem derived tissue culture significantly reduced SCYLV population and it is concluded that the relative standard curve method efficiently detect the copy numbers of target virus in different sugarcane samples.Not Availabl