General anesthesia for cesarean section in the presence of mitral stenosis associated with severe pulmonary hypertension

Rheumatic heart disease (RHD) is the most common cause of cardiac disease during pregnancy in India. A case of severe pulmonary hypertension (pulmonary arterial pressure- 98 mm Hg) secondary to mitral stenosis associated with RHD in a 28-year old woman, is described. She underwent a high risk elective cesarean section under general anesthesia at 36 weeks of gestation. The intraoperative and postoperative course was uneventful. The advantages of general anesthesia over neuraxial blockade during cesarean section are discussed in this report. The management of patients at a high risk of developing pulmonary edema and decompensated heart failure in the perioperative period has been stressed upon. A thorough understanding of the pathophysiology and complications of RHD during pregnancy and cesarean section is required for managing the disease successfully

ASSESSING THE IMPACTS OF CITY SPRAWL ON URBAN FREIGHT TRANSPORT IN DEVELOPING COUNTRIES

Introduction: In the 21st century, cities in developing countries have witnessed faster growth as compared with cities in developed countries. Countries like India, China and Brazil have one of the most densely populated cities in the world. The transport infrastructure in these cities struggles to deal with the increasing population and geographic sprawl. Though some efforts are made to improve the transportation systems in these cities, urban freight transport is largely overlooked as the focus remains on passenger transport. Methods: This study aims to assess the impacts of the city’s geographic sprawl on urban freight transport using the example of the textile industry in Surat, India. The sprawl of the city and its textile industry is measured based on historical maps, Google imagery, and establishment surveys. Changes in urban freight trip lengths are determined using the data of a commercial vehicle drivers’ survey. Results: In the last two decades, the city expanded geographically by almost three times. The relocation of textile manufacturing units led to a 40% increase in trip lengths and additional 56 tons of carbon dioxide generation per year. Due to the city sprawl, the overall efficiency of the urban freight transport system reduced. There is a need for a holistic planning approach towards urban freight movement and related urban infrastructure for sustainable freight flows. This can serve as a policy framework to decide on the location of a logistics hub or as guidelines to allocate manufacturing enterprises in the proximity of the urban area, thus enabling sustainable development of the city

Oseltamivir induced sinus bradycardia: an area of potential concern

Oseltamivir was approved for the prevention and treatment of influenza in 1999 by the USFDA (US Food and Drug Administration). The use of Oseltamivir is increasing rapidly all over the world, especially after the 2009 “Swine Flu” pandemic. Less data is published as far as the cardiovascular side effects of Oseltamivir are concerned, but it could be associated with some serious cardiovascular side effects. This study presented a case series of 5 cases suspected to be suffering from seasonal influenza H1N1 (“Swine Flu”), who developed sinus bradycardia while they were on Oseltamivir therapy

Variants of Tribulus species – a scientific study through DNA RAPD – molecular characterization

Gokshura a well-known drug in Ayurveda which is extensively used in many disease conditions like dysuria, asthma, diabetes, cough, oedema, cardiac disorders etc. Tribulus terrestris (Family – Zygophyllaceae) is an official source of Gokshura as per API. Five species of genus Tribulus are found throughout India with a slight morphological difference. In this study, three different species of Tribulus genus from different regions were subjected for molecular characterization by RAPD method. Analysis showed that three different samples gave clearly similar banding pattern with each of the random primers used and 80% similarity between the three samples were observed when the results were subjected to band scoring and analysis with clustering. Even through the micromorpholgical observations showed differentiating characters in mature carpels and intrastaminal glands of the selected species

Europium-doped cerium oxide nanoparticles for microglial Aβ clearance and homeostasis

Alzheimer’s disease (AD) is the most common neurodegenerative disorder. Pathologically, it is characterized by the deposition of amyloid beta (Aβ) plaques and presence of neurofibrillary tangles. These drive microglia neuroinflammation and consequent neurodegeneration. While the means to affect Aβ plaque accumulation was achieved how it affects disease outcomes remains uncertain. Cerium oxide (CeO2) reduces Aβ plaques, oxidative stress, inflammation, and Alzheimer’s disease (AD) signs and symptoms. Specifically, CeO2 nanoparticles (CeO2NPs) induces free radical scavenging and cell protective intracellular signaling. This can ameliorate the pathobiology of an AD-affected brain. In order to investigate, CeO2NPs affects for microglia neurotoxic responses a novel formulation of europium doped CeO2NPs (EuCeO2NPs) was synthesized. We then tested EuCeO2NPs for its’ abilities to generate cellular immune homeostasis in AD models. EuCeO2NPs attenuated microglia BV2 inflammatory activities after Aβ1–42 exposure by increasing the cells’ phagocytic and Aβ degradation activities. These were associated with increases in the expression of the CD36 scavenger receptor. EuCeO2NPs facilitated Aβ endolysosomal trafficking and abrogated microglial inflammatory responses. We posit that EuCeO2NPs may be developed as an AD immunomodulator

Razvoj metformin hidroklorida za izravnu kompresiju metodom sušenja raspršivanjem

Metformin hydrochloride exhibits poor compressibility during compaction, often resulting in weak and unacceptable tablets with a high tendency to cap. The purpose of this study was to develop directly compressible metformin hydrochloride by the spray drying technique in the presence of polymer. Metformin hydrochloride was dissolved in solutions containing a polymer, namely polyvinylpyrrolidone (PVP K30), in various concentrations ranging from 0-3 % m/V. These solutions were employed for spray-drying. Spray-dried drug was evaluated for yield, flow property and compressibility profile. Metformin hydrochloride spray-dried in the presence of 2 % PVP K30 showed an excellent flow property and compressibility profile. From the calculated Heckel’s parameter (Py = 2.086), it was demonstrated that the treated drug showed better particle arrangement in the initial compression stage. Kawakita analysis revealed better packability of the treated drug compared to the untreated drug. Differential scanning calorimetry and Fourier transform infrared spectroscopy experiments showed that the spray-dried drug did not undergo any chemical modifications. Tablets made from the spray-dried drug (90 %, m/m) were evaluated for crushing strength, friability and disintegration time and the results were found satisfactory.Metformin hidroklorid se teško komprimira zbog čega nastaju slabe tablete neodgovarajuće kvalitete s velikom tendencijom kalanja. Cilj ovog rada je prirediti metformin hidroklorid za izravnu kompresiju metodom sušenja raspršivanjem u prisutnosti polimera. Metformin hidroklorid je otopljen uz dodatak različitih količina (03 % m/V) polivinilpirolidona (PVP K30). Dobivene otopine sušene su raspršivanjem, a tako pripravljenom metformin hidrokloridu određivano je iskorištenje, tečnost i kompresibilnost. Metformin hidroklorid pripravljen u prisutnosti 2 % PVP K30 ima izvrsnu tečnost i kompresibilnost. Izračunati Heckelovi parametri (Py = 2,086) pokazuju da tako obrađeni metformin hidroklorid tvori veće čestice na početku kompresije. Analiza po Kawakiti ukazuje na to da se obrađeni lijek bolje preša od neobrađenog. Diferencijalna pretražna kalorimetrija (DSC) i Fourierova transformirana infracrvena spektroskopija (FTIR) pokazuju da sušenje raspršivanjem nije uzrokovalo nikakve kemijske promjene. Iz obrađenog metformina izrađene su tablete (90 % m/m) sa zadovoljavajućom lomljivošću, drobivošću i vremenom dezintegracije

SHock-INduced Endotheliopathy (SHINE): A mechanistic justification for viscoelastography-guided resuscitation of traumatic and non-traumatic shock

Irrespective of the reason for hypoperfusion, hypocoagulable and/or hyperfibrinolytic hemostatic aberrancies afflict up to one-quarter of critically ill patients in shock. Intensivists and traumatologists have embraced the concept of SHock-INduced Endotheliopathy (SHINE) as a foundational derangement in progressive shock wherein sympatho-adrenal activation may cause systemic endothelial injury. The pro-thrombotic endothelium lends to micro-thrombosis, enacting a cycle of worsening perfusion and increasing catecholamines, endothelial injury, de-endothelialization, and multiple organ failure. The hypocoagulable/hyperfibrinolytic hemostatic phenotype is thought to be driven by endothelial release of anti-thrombogenic mediators to the bloodstream and perivascular sympathetic nerve release of tissue plasminogen activator directly into the microvasculature. In the shock state, this hemostatic phenotype may be a counterbalancing, yet maladaptive, attempt to restore blood flow against a systemically pro-thrombotic endothelium and increased blood viscosity. We therefore review endothelial physiology with emphasis on glycocalyx function, unique biomarkers, and coagulofibrinolytic mediators, setting the stage for understanding the pathophysiology and hemostatic phenotypes of SHINE in various etiologies of shock. We propose that the hyperfibrinolytic phenotype is exemplified in progressive shock whether related to trauma-induced coagulopathy, sepsis-induced coagulopathy, or post-cardiac arrest syndrome-associated coagulopathy. Regardless of the initial insult, SHINE appears to be a catecholamine-driven entity which early in the disease course may manifest as hyper- or hypocoagulopathic and hyper- or hypofibrinolytic hemostatic imbalance. Moreover, these hemostatic derangements may rapidly evolve along the thrombohemorrhagic spectrum depending on the etiology, timing, and methods of resuscitation. Given the intricate hemochemical makeup and changes during these shock states, macroscopic whole blood tests of coagulative kinetics and clot strength serve as clinically useful and simple means for hemostasis phenotyping. We suggest that viscoelastic hemostatic assays such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are currently the most applicable clinical tools for assaying global hemostatic function—including fibrinolysis—to enable dynamic resuscitation with blood products and hemostatic adjuncts for those patients with thrombotic and/or hemorrhagic complications in shock states

Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial

Background Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population. Methods AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921. Findings Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, patients in the fluoxetine group had more falls (20 [3%] vs seven [1%]; p=0·018), bone fractures (19 [3%] vs six [1%]; p=0·014), and epileptic seizures (ten [2%] vs two [<1%]; p=0·038) at 6 months. Interpretation Oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and epileptic seizures. These results do not support the use of fluoxetine to improve functional outcome after stroke