Accordion Effect During Percutaneous Coronary Intervention (Pci)

Pseudo lesions appear in a coronary artery during intervention due to guide wire manipulation are referred as “accordion phenomenon” and are infrequent occurrences during percutaneous coronary intervention of tortuous coronary arteries. Occurrence of pseudo lesion or accordion phenomena puts a diagnostic challenge to the interventionist and might leads to unnecessary intervention. The differential diagnosis includes coronary dissection, thrombus and its spasm. Ischemia & hemodynamic compromise are possible complications. The common method to overcome this situation is pulling the guide wire out of the affected segments and leaving aside only the floppy segment. Pseudo lesion at times response to intracoronary nitro-glycerine however, sometimes they are refractory. We hereby report a case of Accordion phenomenon during PCI of right coronary artery & technical challenges it imposed on

Estimation and quantification of liver iron concentration by magnetic resonance imaging

Background: Liver iron overload is considered to be the histological hallmark of genetic hemochromatosis. The accurate estimation of iron overload is important to establish the diagnosis of hemochromatosis. The aim of the present study was to estimate T2* liver value, quantify liver iron concentration (in milligram of iron per gram dry weight) and find out the appropriate therapy for patients with iron overload according to severity index.Methods: A cross-sectional observational study was carried out in Department of Radio Diagnosis, at B.Y.L. Nair Hospital and medical college, Mumbai from June 2017 to August 2018. A total of 50 cases were enrolled for the present study.Results: Male predominance (66.0%) was seen. Mean duration of disease among the studied cases was 10.52±6.06 years, with minimum and maximum duration of disease of 1 and 26 years respectively. Eight percent had compliance to visit and treatment among the enrolled cases.Conclusions: MRI was concluded to be potentially useful non-invasive method for evaluating liver iron stones in a wide spectrum of haematological and liver diseases

FORMULATION DEVELOPMENT AND EVALUATION OF ALMOND GUM BASED SUSTAINED RELEASE MATRIX TABLET OF INDOMETHACIN

Objective: The aspiration of the current research involves employing various concentrations of polymer and filler to develop indomethacin sustained release (SR) matrix tablets. The objective of this research work is to reduce dosing frequency thereby increasing patients compliance and enhanced therapeutic activity.Methods: Polymers such as Almond gum (AG), polyvinylpyrrolidone (PVP), and starch at different concentrations were used for formulating SR polymeric matrix tablets. Evaluation of pre-compression and post-compression parameters was done for both granules and formulated tablets.Results: Results obtained from pre-compression parameters and post-compression parameters suggested that all the parameters are within the prescribed limits, demonstrating that formulated granules had shown better flow properties. The morphological characteristics of the developed tablet were observed by employing scanning electron microscope where the surface of the tablet was found to be smooth from the in vitro dissolution study, combination of AG (30 mg) with PVP (30 mg), and starch used as a filler has sustained the release of drug up to 10 h.Conclusion: Therefore, developed polymeric matrix tablet exhibited enhanced potency over a conventional tablet by exhibiting an excellent dissolution profile for a period of 10 h

To study the existing system of surgical safety for cataract surgery at tertiary care ophthalmic centre to implement WHO surgical safety checklist

Background: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, named after the first President of India, was established on the 10th of March, 1967 as a National centre for ophthalmic science, to provide state of the art patient care, expand human resources for medical education and undertake research to find solutions to eye health problems of national importance. Average numbers of cataract surgeries performed per month are 700 to 1000.Methods: Anticipating implementation in 50% cases hundred cases of cataract surgery were observed to study the existing system of surgical safety followed at Dr. R.P. Center and gap analysis done, against the WHO surgical safety checklist for cataract surgery. Modified WHO surgical safety checklist for cataract surgery was developed and implemented in the centre. Barriers in implementation of surgical safety checklist were also identified, and remedial measures suggested.Results: Significant improvement was noticed in all the parameters after introduction of modified checklist.  The additional points which were added in modified surgical safety checklist were implemented in almost all the cases by the nursing staff. Overall mean compliance percentage before implementation of modified surgical safety check list at Dr. R.P.C was 37%±10.1 (P=0.001).  While after introduction of modified surgical safety check list the mean compliance has improved to 62.7%±10.3, Wilcoxon rank sum test/Independent test is applied for each domain.Conclusions: Cataract procedure is the most common surgical procedure performed in the population in India. High volume and high turnover increase the potential for errors. Compliance to surgical safety check list before intervention was 32%. After intervention in form of a focus group discussion and introduction of modified surgical safety check list has resulted in increase in the compliance rate to 67%. This study revealed that changes or additional work is not happily accepted by the staff. After six months of intervention of modified surgical safety checklist compliance rate was still high, this suggests that constant supervision and monitoring by senior staff can sustain the compliance rate.

A comparative study for efficacy and safety of low doses of clonidine for hemodynamic stability in patients undergoing laparoscopic cholecystectomy

Background: This randomized prospective double-blind study was designed to evaluate the efficacy and side effects of low doses clonidine for perioperative haemodynamic stability and postoperative recovery.Methods: Patient’s with ASA grade I–II undergoing laparoscopic cholecystectomy were randomized into three groups of 30 patients each. All patients received either normal saline 10 ml (Group I) or 0.8 µg/kg (Group II) or 1 µg/kg (Group III) over duration of 180 seconds, 10 min prior to laryngoscopy and intubation. Anaesthesia was induced with 1% propofol (2 mg/kg) and maintained with nitrous oxide 60% in oxygen and isoflurane. The parameters assessed at various time intervals were heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and sedation score.Results: Both doses of clonidine proved to be effective in perioperative haemodynamic stability. Clonidine 0.8 mcg/kg was as effectve and safer to Clonidine 1 mcg/kg for attenuatíon of the hemodynamíc responses to laparoscopy. There were no significant differences in the parameters of recovery between groups.Conclusions: Significant hemodynamic derangements can occur during laproscopic cholecystectomy at intubation, pneumoperitoneum and extubation. These were effectively attenuated by premedication with 0.8 mcg/kg and 1 mcg/kg of intravenous clonidine. Dose of 1 mcg/kg though found to be effective but produced adverse effects in form of hypotension and bradycardia

Clinical Management of Food Allergy

Food allergies have become a growing public health concern. Currently the standard of care focuses on avoidance of trigger foods, education, and treatment of symptoms following accidental ingestions. Here we provide a framework for primary care physicians and allergists for the diagnosis, management, and treatment of pediatric food allergy

Improved Enzymatic Hydrolysis of Pilot Scale Pretreated Rice Straw at High Total Solids Loading

Enzymatic hydrolysis at high solids loading has the potential to reduce both capital and operational expenditures. Here, pretreatment of rice straw (PRS) with dilute acid was carried out at a pilot scale (250 kg per day) at 162°C for 10 min and 0.35% acid concentration, followed by enzymatic hydrolysis at different total solids loadings. It showed that although the total sugar concentration increased from 48 to 132 g/l, glucan conversion reduced by 27% (84–66.2%) with increasing solids from 5 to 20% in batch mode. Therefore, two different fed-batch approaches were evaluated to improve the glucan conversion by the sequential addition of a substrate and/or enzyme. At 20% solid loadings and a 3 filter paper units/g enzyme dosage, the highest glucan conversion obtained was 66% after 30 h of hydrolysis in batch mode. However, in an optimized fed-batch approach, the glucan yield was improved to 70% by simply dividing the substrate feeding into three batches, that is, 50% at 0 h, 25% each after 4 h, and 8 h of hydrolysis reaction. The addition of surfactant (Ecosurf E6) further improved the conversion to 72% after 30 h. The role of critical factors, that is, inhibitors, enzyme–lignin binding, and viscosity, was investigated during the course of hydrolysis in the batch and fed-batch approaches. This study suggests a sustainable approach for improved hydrolysis at high solids loadings by fine-tuning a simple process

Genome-wide association studies for phenological and agronomic traits in mungbean (Vigna radiata L. Wilczek)

Mungbean (Vigna radiata L. Wilczek) is one of the important warm-season food legumes, contributing substantially to nutritional security and environmental sustainability. The genetic complexity of yield-associated agronomic traits in mungbean is not well understood. To dissect the genetic basis of phenological and agronomic traits, we evaluated 153 diverse mungbean genotypes for two phenological (days to heading and days to maturity) and eight agronomic traits (leaf nitrogen status using SPAD, plant height, number of primary branches, pod length, number of pods per plant, seeds per pod, 100-seed weight, and yield per plant) under two environmental conditions. A wide array of phenotypic variability was apparent among the studied genotypes for all the studied traits. The broad sense of heritability of traits ranged from 0.31 to 0.95 and 0.21 to 0.94 at the Delhi and Ludhiana locations, respectively. A total of 55,634 genome-wide single nucleotide polymorphisms (SNPs) were obtained by the genotyping-by-sequencing method, of which 15,926 SNPs were retained for genome-wide association studies (GWAS). GWAS with Bayesian information and linkage-disequilibrium iteratively nested keyway (BLINK) model identified 50 SNPs significantly associated with phenological and agronomic traits. In total, 12 SNPs were found to be significantly associated with phenological traits across environments, explaining 7%–18.5% of phenotypic variability, and 38 SNPs were significantly associated with agronomic traits, explaining 4.7%–27.6% of the phenotypic variability. The maximum number of SNPs (15) were located on chromosome 1, followed by seven SNPs each on chromosomes 2 and 8. The BLAST search identified 19 putative candidate genes that were involved in light signaling, nitrogen responses, phosphorus (P) transport and remobilization, photosynthesis, respiration, metabolic pathways, and regulating growth and development. Digital expression analysis of 19 genes revealed significantly higher expression of 12 genes, viz. VRADI01G08170, VRADI11G09170, VRADI02G00450, VRADI01G00700, VRADI07G14240, VRADI03G06030, VRADI02G14230, VRADI08G01540, VRADI09G02590, VRADI08G00110, VRADI02G14240, and VRADI02G00430 in the roots, cotyledons, seeds, leaves, shoot apical meristems, and flowers. The identified SNPs and putative candidate genes provide valuable genetic information for fostering genomic studies and marker-assisted breeding programs that improve yield and agronomic traits in mungbean

The state of pediatric asthma in Chicago's Humboldt Park: a community-based study in two local elementary schools

Abstract Background Pediatric asthma is a serious public health problem in Chicago and has been designated a high priority concern by residents of Chicago's Humboldt Park, a diverse community area with a large number of Puerto Rican, African American, and Mexican American families. Methods In May 2009, following the principles of community-based participatory research, a cross-sectional asthma screening survey was administered to adult caregivers of children attending two Humboldt Park elementary schools. Data were analyzed to determine the prevalence of diagnosed and probable asthma as well as the degree of asthma control among affected children; associations between asthma outcomes and mutable triggers were evaluated. Results Surveys from 494 children were evaluated. Physician-diagnosed asthma was reported for 24.9% of children and probable asthma identified in an additional 16.2% of children. Asthma was poorly or moderately controlled in 60.0% of diagnosed children. Smoking occurred inside 25.0% of households and 75.0% of caregivers reported idling of vehicles in their community. Report of general stress among caregivers, stress due to community crime, and/or an inability to cope with everyday life were significantly and positively associated with poor asthma morbidity and control among affected children. Conclusions Despite high prevalence rates and poor asthma morbidity and control in Humboldt Park, the association of these measures with mutable variables is promising. A community-based asthma intervention to address the issues identified in this study is needed to affect positive change.http://deepblue.lib.umich.edu/bitstream/2027.42/112574/1/12887_2010_Article_357.pd