Surgical approach of bentall procedure in a patient of pectus excavatum

A middle-aged man diagnosed case of Marfan syndrome associated with pectus excavatum presented with chest pain and dyspnea. Chest X-ray, transthoracic echocardiography and Computed tomography (CT) of heart and aorta revealed severe Aortic regurgitation with dilated aortic root, sinotubular junction and ascending aorta with normal size arch and descending aorta. Patient was taken for surgery. Pectus excavatum creates difficulties for heart exposure and cannulation for cardiopulmonary bypass. We planned for femoro-femoral bypass to carry out ahesiolysis and Bentall procedure without much difficulties. Postoperative stay of the patient was uneventful and followed up in regular interval

An intensive audit on 250 patients of advanced ovarian cancer to improve quality of care in a tertiary referral oncology centre in India

Background: A clinical audit provides the framework to improve the quality of patient care in a systematic way. In this study, we intensively audited our 250 advanced epithelial ovarian cancer (EOC) patients aiming to improve our patient care.Methods: Ambispective study of 250 patients of advanced EOC was done from our prospectively maintained computerized database in the department of surgical oncology, AIIMS, New Delhi from 2013 to 2020.We audited the demographic profile, treatment patterns, perioperative and survival outcomes in different subgroups.Results: In this study, 83.6% stage III and 16.4% stage IV A. There was 62 (24.8%) upfront, 112 (44.8%) interval and 76 (30.4%) secondary group. 126 underwent cytoreductive surgery (CRS) and 124 CRS and hyperthermic intraperitoneal chemotherapy (HIPEC). There was 24.8% early and 8.4% late postop complications. Median follow up 50 months. Overall, the median disease-free survival (DFS) 39 months. PFS was 12 months among 68 patients with recurrence. Attrition rate 4%. In the upfront setting, the median DFS 44 months in CRS only group and DFS not reached (p=0.032) in CRS and HIPEC group still. In the interval setting, the median DFS 39 months in CRS only group and 44 months in CRS and HIPEC group (p=0.06). In recurrent setting, the median DFS 14 months in CRS group and 23 months in CRS and HIPEC group (p=0.02)Conclusions: Audit is an integral part of any clinical practice. It teaches us to improve the quality of care and thereby better outcomes. We recommend 6 monthly clinical audits in any cancer treatment for better outcomes in future

Engraftment Syndrome: A Retrospective Analysis of the Experience at a Tertiary Care Institute

Engraftment syndrome (ES) is a clinical syndrome that occurs in the early neutrophil recovery phase following hematopoietic stem cell transplant (HSCT). Although also described for allogenic HSCT, it is basically diagnosed in the context of autologous HSCT. We retrospectively reviewed 171 consecutive HSCTs performed between January 2013 and January 2015 in our Bone Marrow Transplant (BMT) unit and analyzed all cases of noninfectious fever and strong clinical features suggestive of ES in the peri-engraftment period for up to 7 days. We observed the incidence of ES to be 12.3% (16/130) in the autologous and 4.8% (2/41) in the allogeneic cohort. Among plasma cell disorders, which constitute 50% of our study population, the incidence of ES was 19.7%. Among the ES cases of autologous transplants, 81.2% (13/16) patients satisfied the Maiolino criteria (MC) and 87.5% (14/16) patients the Spitzer diagnostic criteria (SC). A total of 68.7% (11/16) patients satisfied both MC and SC, and two patients (12.5%) did not satisfy either (MC− SC−). There was no significant difference in days of hospitalization and usage of supportive care between ES and non-ES patients, and there was no mortality due to ES. On univariate analysis, female patients (p < 0.013) and those with diagnosis of a plasma cell disorder (p < 0.03) had higher risk of ES. In conclusion, the incidence of ES in our study population is consistent with that of many others, but severity evaluation needs exploration in larger cohorts with pragmatically modified diagnostic criteria

Antibacterial efficacy of Jackfruit rag extract against clinically important pathogens and validation of its antimicrobial activity in Shigella dysenteriae infected Drosophila melanogaster infection model

513-522Exploration of alternative sources of antibacterial compounds is an important and possibly an effective solution to the current challenges in antimicrobial therapy. Plant derived wastes may offer one such alternative. Here, we investigated the antibacterial property of extract derived from a part of the Jackfruit (Artocarpus heterophyllus Lam.) called ‘rag’, generally considered as fruit waste. Morpho-physical characterization of the Jackfruit rag extract (JFRE) was performed using Gas-chromatography, where peaks indicative of furfural; pentanoic acid; and hexadecanoic acid were observed. In vitro biocompatibility of JFRE was performed using the MTT assay, which showed comparable cellular viability between extract-treated and untreated mouse fibroblast cells. Agar well disc diffusion assay exhibited JFRE induced zones of inhibition for a wide variety of laboratory and clinical strains of Gram-positive and Gram-negative bacteria. Analysis of electron microscope images of bacterial cells suggests that JFRE induces cell death by disintegration of the bacterial cell wall and precipitating intracytoplasmic clumping. The antibacterial activity of the JFREs was further validated in vivo using Shigella dysenteriae infected fly model, where JFRE pre-fed flies infected with S. dysenteriae had significantly reduced mortality compared to controls. JFRE demonstrates broad antibacterial property, both in vitro and in vivo, possibly by its activity on bacterial cell wall

Experimental investigations of vibration and acoustics signals in milling process using kapok oil as cutting fluid

Vegetable oils are found as the feasible alternative for conventional minerals oils. There has been many environmental and health issues which are spotted with the use of conventional cutting fluids. There has been a great demand for developing new environmentally friendly vegetable based cutting fluids to reduce these harmful effects. In this present study, vegetable based kapok oil is used as a cutting fluid during milling to study its consequences over other conventional oils. The process parameters such as spindle speed, depth of cut and feed rate were optimized with respect to the flank wear (Vb) and surface roughness (Ra) respectively with the use of central composite design in response surface methodology (RSM). Further an attempt has been made to monitor the tool condition by measuring the cutting force, vibration and sound pressure simultaneously. Three different tool conditions such as dull, fresh and working were analyzed and their consequences were also reported. Also, the performance of the kapok oil is compared with the palm oil and mineral oil (SAE 20W 40). The feed rate has the major contribution for surface roughness and flank wear. It is found that the cutting force (F), sound pressure (p) and vibration (V) increases with the tool wear

Seleno-Nucleobases and Their Water-Soluble Ruthenium-Arene Half-Sandwich Complexes: Chemistry and Biological Activity

Half-sandwich organometallic ruthenium complexes of seleno-nucleobases, 3 and 4, were synthesized and characterized. The structures of both complexes were determined by X-ray crystallography and are the first crystal structures of ruthenium complexes with seleno-nucleobases. Interestingly, 3 self-assembles aided by adventitious water in DMF to give a tetranuclear square 3a center dot 6H(2)O. Complex 4 is active against Jurkat and Molt-4 cell lines but inactive against the K562 cell line, whereas 3 is completely inactive against all three cell lines. The free ligand 6-selenopurine (1) and 6-selenoguanine (2) are highly active against these cell lines. Compound 2, like its thio analogue, is unstable under UVA light, whereas 4 is stable under similar conditions, which suggests that the ruthenium complex could reduce problems associated with the instability of the free ligand, 2, under irradiation