Multidrug Resistant Bacteria Causing Nosocomial Urinary Tract Infection in Neurology/ Neurosurgical Unit of a Tertiary Care Hospital

Introduction: Nosocomial infections with the multidrug resistant microorganisms remain the major concern in the hospitalized patients. Due to the underlying illness, trauma, various neurosurgeries, patients admitted to neurology/ neurosurgery units become more vulnerable to acquire device associated infections during their hospital stay. Objectives: To study the spectrum of uropathogens and their antimicrobial susceptibility pattern among patients admitted to the neurology/neurosurgery unit. Material and methods: A prospective study was conducted in the bacteriology laboratory, Department of Microbiology over a period of 4 months. Urine samples from the patients admitted to neurology and neurosurgical unit (ward and ICU) were processed and identified as per the standard protocol. The antimicrobial susceptibility testing was done using Kirby- Bauer method as per CLSI 2014 guideline. Results: Majority of the urinary isolates belonged to Enterobacteriaceae family in both ward and ICU patients. Among these, 91 out of 106 (86%) isolates in the ward and 43 out of 51 (84%) isolates in ICU were found to be multi drug resistant. Nitrofurantoin was observed to be resistant in more than 75% of both ward and ICU isolates. Conclusion: Majority of nosocomial uropathogens were found to be multidrug resistant. This study emphasizes the emergence of MDR isolates and nitrofurantoin resistance among the nosocomial uropathogens

Effect of molybdenum trioxide nanoparticle-mediated seed priming on the productivity of green gram (Vigna radiata L.)

A field experiment was undertaken in the post-Rabi season of 2019-2020 to reveal the response of greengram (Vigna radiata L.) to seed dressing and seed priming with nano molybdenum trioxide (MoO3). The experiment was laid out in randomized block design (RBD) consisting of 10 different treatments i.e., M0 (no seed treatment with Mo); M1 (seed dressing with Sodium molybdate @ 400 ppm); M2, M3, M4, and M5 (seed dressing with nano Molybdenum trioxide-MoO3 @ 50, 100, 200 and 400 ppm, respectively); and M6, M7, M8 and M9 (seed priming with nano MoO3 @ 50, 100, 200 and 400 ppm, respectively). Inoculation of greengram seeds cv. Shreya (IPM 2-14) with Rhizobium sps. was undertaken in all treatments as per the recommended practice, except in M0 (control). The MoO3 nanoparticles (NPs) synthesized from Ammonium molybdate through calcination at 600 0C for 5 hours indicated globular-shaped NPs of 68.55 nm in TEM and XRD. Nanopriming with MoO3 @ 200 ppm (M8) was most promising in recording significantly superior growth and yield attributing parameters and yield, whereas Mo (control) produced the least. Crop height, number of branches, root length, shoot dry matter, pods/plant and seeds/plant and root nodulation at harvest in M8 were 39.4% and 22.6%; 39% and 5.6%; 23% and 9.3%; 43.9%, and 16.3%; 28.2% and 5.3%; 28.1% and 0.8%, and 73.3% and 36.5% higher than M0 (control) and M1 (farmers’ practice), respectively. Superior growth and yield attributing characters in M8 treatment produced the highest grain and stover yield of 0.88 and 3.74 t/ ha that was 32.53% and 8.37%, and 35.5% and 14.7% higher than M0 (control) and M1 (farmers’ practice), respectively. Seed priming with nano MoO3 @ 400 ppm (M9) and seed dressing with nano MoO3 @ 400 ppm (M5) were of second and third order in recording grain and stover yield but M0 recorded the lowest among all the treatments

Dynamics of Hot QCD Matter -- Current Status and Developments

The discovery and characterization of hot and dense QCD matter, known as Quark Gluon Plasma (QGP), remains the most international collaborative effort and synergy between theorists and experimentalists in modern nuclear physics to date. The experimentalists around the world not only collect an unprecedented amount of data in heavy-ion collisions, at Relativistic Heavy Ion Collider (RHIC), at Brookhaven National Laboratory (BNL) in New York, USA, and the Large Hadron Collider (LHC), at CERN in Geneva, Switzerland but also analyze these data to unravel the mystery of this new phase of matter that filled a few microseconds old universe, just after the Big Bang. In the meantime, advancements in theoretical works and computing capability extend our wisdom about the hot-dense QCD matter and its dynamics through mathematical equations. The exchange of ideas between experimentalists and theoreticians is crucial for the progress of our knowledge. The motivation of this first conference named "HOT QCD Matter 2022" is to bring the community together to have a discourse on this topic. In this article, there are 36 sections discussing various topics in the field of relativistic heavy-ion collisions and related phenomena that cover a snapshot of the current experimental observations and theoretical progress. This article begins with the theoretical overview of relativistic spin-hydrodynamics in the presence of the external magnetic field, followed by the Lattice QCD results on heavy quarks in QGP, and finally, it ends with an overview of experiment results.Comment: Compilation of the contributions (148 pages) as presented in the `Hot QCD Matter 2022 conference', held from May 12 to 14, 2022, jointly organized by IIT Goa & Goa University, Goa, Indi

Which method is best for the induction of labour?: A systematic review, network meta-analysis and cost-effectiveness analysis

Background: More than 150,000 pregnant women in England and Wales have their labour induced each year. Multiple pharmacological, mechanical and complementary methods are available to induce labour. Objective: To assess the relative effectiveness, safety and cost-effectiveness of labour induction methods and, data permitting, effects in different clinical subgroups. Methods: We carried out a systematic review using Cochrane methods. The Cochrane Pregnancy and Childbirth Group’s Trials Register was searched (March 2014). This contains over 22,000 reports of controlled trials (published from 1923 onwards) retrieved from weekly searches of OVID MEDLINE (1966 to current); Cochrane Central Register of Controlled Trials (The Cochrane Library); EMBASE (1982 to current); Cumulative Index to Nursing and Allied Health Literature (1984 to current); ClinicalTrials.gov; the World Health Organization International Clinical Trials Registry Portal; and hand-searching of relevant conference proceedings and journals. We included randomised controlled trials examining interventions to induce labour compared with placebo, no treatment or other interventions in women eligible for third-trimester induction. We included outcomes relating to efficacy, safety and acceptability to women. In addition, for the economic analysis we searched the Database of Abstracts of Reviews of Effects, and Economic Evaluations Databases, NHS Economic Evaluation Database and the Health Technology Assessment database. We carried out a network meta-analysis (NMA) using all of the available evidence, both direct and indirect, to produce estimates of the relative effects of each treatment compared with others in a network. We developed a de novo decision tree model to estimate the cost-effectiveness of various methods. The costs included were the intervention and other hospital costs incurred (price year 2012–13). We reviewed the literature to identify preference-based utilities for the health-related outcomes in the model. We calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit. We represent uncertainty in the optimal intervention using cost-effectiveness acceptability curves. Results: We identified 1190 studies; 611 were eligible for inclusion. The interventions most likely to achieve vaginal delivery (VD) within 24 hours were intravenous oxytocin with amniotomy [posterior rank 2; 95% credible intervals (CrIs) 1 to 9] and higher-dose (≥ 50 μg) vaginal misoprostol (rank 3; 95% CrI 1 to 6). Compared with placebo, several treatments reduced the odds of caesarean section, but we observed considerable uncertainty in treatment rankings. For uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best three treatments, whereas vaginal misoprostol (≥ 50 μg) was most likely to increase the odds of excessive uterine activity. For other safety outcomes there were insufficient data or there was too much uncertainty to identify which treatments performed ‘best’. Few studies collected information on women’s views. Owing to incomplete reporting of the VD within 24 hours outcome, the cost-effectiveness analysis could compare only 20 interventions. The analysis suggested that most interventions have similar utility and differ mainly in cost. With a caveat of considerable uncertainty, titrated (low-dose) misoprostol solution and buccal/sublingual misoprostol had the highest likelihood of being cost-effective. Limitations: There was considerable uncertainty in findings and there were insufficient data for some planned subgroup analyses. Conclusions: Overall, misoprostol and oxytocin with amniotomy (for women with favourable cervix) is more successful than other agents in achieving VD within 24 hours. The ranking according to safety of different methods was less clear. The cost-effectiveness analysis suggested that titrated (low-dose) oral misoprostol solution resulted in the highest utility, whereas buccal/sublingual misoprostol had the lowest cost. There was a high degree of uncertainty as to the most cost-effective intervention

Anaesthesia for neurosurgical procedures in paediatric patients

Recent advances in neurosurgery, neuromonitoring and neurointensive care have dramatically improved the outcome in patients affected by surgical lesions of central nervous system (CNS). Although most of these techniques were applied first in the adult population, paediatric patients present a set of inherent challenges because of their developing and maturing neurological and physiological status, apart from the CNS disease process. To provide optimal neuroanaesthesia care, the anaesthesiologist must have the knowledge of basic neurophysiology of developing brain and effects of various drugs on cerebral haemodynamics apart from the specialised training on paediatric neuroanaesthesia. This article highlights on the perioperative management of paediatric neurosurgical patients

Alleviating Stress Response to Tracheal Extubation in Neurosurgical Patients: A Comparative Study of Two Infusion Doses of Dexmedetomidine

Background: Tracheal extubation is almost always associated with increase in sympathoadrenal activity may result in hypertension, tachycardia, and arrhythmias. Attempts have been made to oppose the pressor response by the use of various drugs. Dexmedetomidine decreases norepinephrine which reduces the blood pressure and the heart rate (HR). We hypothesize that the infusion of dexmedetomidine may produce more stable hemodynamics during extubation as compared to boluses. Materials and Methods: Ninety adult patients aged 18–65 years, the American Society of Anesthesiologists Grade I–II undergoing intracranial surgeries for various neurologic problem at All India Institute of Medical Sciences were enrolled in this randomized controlled trial. Primary Objectives: (1) To observe the hemodynamic changes (HR and mean arterial pressure [MAP]) and airway responses during tracheal extubation following two infusion doses of dexmedetomidine. Secondary Objectives: (1) Time to emergence and time to tracheal extubation, (2) Early postoperative complications such as laryngospasm and bronchospasm, and (3) adverse effects of the study drug. Patients were assigned into three groups – (1) Group D0.2 – 0.2 μg/kg/h diluted to 50 ml, (2) Group D0.4 – 0.4 μg/kg/h diluted to 50 ml and Group P (Placebo) – 0.9% NS 50 ml. The hemodynamics including the HR and MAP were recorded just before the loading dose of the study drug and then were recorded every 5 min till the infusion was stopped at tracheal extubation and every 1 min till 10 min postextubation. In addition, the airway, respiratory and cardiovascular complications along with postoperative nausea and vomiting, shivering, cough grading, Aldrete score, Ramsay sedation scale, and intraoperative awareness were recorded. Statistical Analysis: Continuous variables such as HR and MAP were analyzed using analysis of variance and categorical variables were analyzed using the Chi-square test. Results: Patient demographics were comparable between the three groups. There was a significant reduction in HR and MAP just before extubation and up to 10 min post extubation in the D0.2 and D0.4 groups as compared to placebo (P < 0.001) but the difference among the dexmedetomidine groups were not significant. Patients belonging to D0.2 group emerged faster than D0.4 group, however, the results were comparable with placebo group. 73.3% patients of the placebo group had tachycardia and hypertension at emergence as compared to only 3.3% patients in the D0.4 group (P < 0.001). Eighty percentage patients of D0.2 and 100% patients of D0.4 group had a significant reduction in cough as compared to placebo (P < 0.001). No patient in either groups had intraoperative awareness, any respiratory complications, or allergic reactions to the study drug. Modified Aldrete scoring and Ramsay sedation scale were comparable in all the three groups. Conclusion: Dexmedetomidine suppresses cough and hemodynamic responses (HR and MAP) to tracheal extubation significantly without delaying emergence

Blood groups systems

International Society of Blood Transfusion has recently recognized 33 blood group systems. Apart from ABO and Rhesus system, many other types of antigens have been noticed on the red cell membranes. Blood grouping and cross-matching is one of the few important tests that the anaesthesiologist orders during perioperative period. Hence, a proper understanding of the blood group system, their clinical significance, typing and cross-matching tests, and current perspective are of paramount importance to prevent transfusion-related complications. Nonetheless, the knowledge on blood group system is necessary to approach blood group-linked diseases which are still at the stage of research. This review addresses all these aspects of the blood groups system