Nanofiltration-based diafiltration process for solvent exchange in pharmaceutical manufacturing

Commercially available solvent stable polymeric nanofiltration membranes were used to study the nanofiltration and diafiltration operations in the context of the pharmaceutical industry. Experimental results are presented for a two-step operation involving the preconcentration of a feed solution via nanofiltration followed by the replacement of the first stage solvent with a second solvent via diafiltration in two stages. Membranes MPF-50 and MPF-60, having molecular weight cut-offs of 700 and 400 respectively, were used in the present study. A solution of erythromycin (MW 734) in ethyl acetate was preconcentrated via nanofiltration followed by replacement of ethyl acetate with methanol via batch diafiltration. The experiments were carried out at 440 psig (3033.8 kPa) and room temperature. Membrane compaction, during the initial period of each operation, affected the solute rejection and permeate flux. High erythromycin rejection (96 % ±) was achieved with the MPF-60 membrane. During the diafiltration operations the membranes exhibited no selectivity for the solvent mixture, irrespective of the feed concentration. Ethyl acetate concentration was reduced to less than 4 % over two batch diafiltration runs

Diabetic foot ulcer and its surgical management

Background: Almost 80% population of diabetic foot are from low to middle income countries like India, a country with second largest number of diabetic populations. Prevalence of diabetes mellitus in India is 9.3%. Lower extremity diseases, including peripheral neuropathy, peripheral arterial disease, and foot ulceration, is twice common in diabetic subjects. the most feared consequence of diabetic foot ulcer is limb amputation, which is seen 10 to 30 times more often in person with diabetes. The objective of this study concentrates on surgical management of diabetic foot ulcer.Methods: This is an observational prospective study of 100 cases for evaluation of diabetic foot ulcer and its surgical management at P.D.U. Hospital, Rajkot from January 2017 to November 2018.Results: The average age of presentation is 55.70 year. The male to female ratio was 1.27:1. Most of the patients are from lower middle class and upper lower class according to modified kuppuswamy socioeconomic classification. Most of the patients have duration of diabetes more than 5 years.  Most common microorganism grown from culture was Staphylococcus aureus. This study has higher rate of amputations of 74% due to late presentation and neglected disease due to peripheral neuropathy causes decreased pain sensation. There was no mortality in this study.Conclusions: Management of diabetic foot ulcer is by multimodal approach with conservative and surgical approaches. Preventive measures, early diagnosis and timely surgical intervention prevents limb amputations in diabetic foot ulcer

Review of code blue system and audit

Background: Code Blue systems are communication systems that ensure the most rapid and effective resuscitation of a patient in respiratory or cardiac arrest. Code blue was established in Bharati Hospital and Research Centre in Sept 2011 in order to reduce morbidity and mortality in wards. The aim of the study was to evaluate the current code blue system and suggest possible interventions to strengthen the system.Methods: It was retrospective observational descriptive study. The study population included all consecutive patients above the age of 18 years for whom code blue had been activated. Data was collected using code blue audit forms. The data was analysed using SPSS (Statistical Package for social sciences) software.Results: A total of 260 calls were made using the blue code system between September 2011 to December 2012. The most common place for blue code activation was casualty. The wards were next, followed by dialysis unit and OPD. The indications for code blue team activation were cardio-respiratory arrest (CRA) (88 patients, 33.84%), change in mental status (52 patients, 20%), road traffic accidents RTA (21, 8.07%), convulsions (29 patients 11.15%), chest pain (19 patients, 8.46%), breathlessness (18 patients,6.92%) and worry of staff about the patient (17 patients, 6.53%), presyncope (10 patients, 3.84%), and others (6 patients, 2.30%). The average response time was 1.58±0.96 minutes in our study. Survival rate was more in medical emergency group 46.15% than in CRA group 31.61%. Initial success rate was 35.2% and a final success rate was 34.6%.Conclusions: Establishment of code blue team in the hospital enabled us to provide timely resuscitation for patients who had “out of ICU” CRA. Further study is needed to establish the overall effectiveness and the optimal implementation of code blue teams. The increasing use of an existing service to review patients meeting blue code criteria requires repeated education and a periodic assessment of site-specific obstacles to utilization

Comparative study of chlorhexidine dressings versus simple gauze dressings in midline laparotomy wound

Background: Wound infections are the most common complication of surgery that adds significantly to the morbidity of the patient and the cost of the treatment. Most of the surgical site infections are preventable. Dressing is an active element of wound management, designed to control infection and promote healing. This study was done to compare clinical efficacy of normal gauze dressings versus chlorhexidine dressings in midline laparotomy wounds.Methods: Patients with midline laparotomy incision were randomized to receive either gauze or chlorhexidine dressings. Bacterial colonization, post- operative fever, frequency of infection, change of dressings, hospital stay and postoperative pain were assessed at the start of treatment and at weekly intervals until full healing occurred.Results: A total of 128 patients were enrolled in the study and divided into 2 groups viz chlorhexidine group (Group A) and Simple gauze group (Group B) with 64 patients each. Wound cultures, change of antibiotics, post-operative soakage, median hospital stay duration, postoperative pain, post- operative wound infection, and follow up visits for wound healing were compared between two groups A and B and statistical significance established.Conclusions: The analysis of wound culture, fever incidence and frequency of infection on Chlorhexidine dressings showed decreasing trends compared to traditional dressings

Triple mesh technique in repair of recurrent lumbar incisional hernia

Lumbar hernias occur infrequently and can be congenital, primary (inferior or Petit type, and superior or Grynfeltt type), post-traumatic, or incisional. They are bounded by the 12th rib, the iliac crest, the erector spinae, and the external oblique muscle. Most postoperative incisional hernias occur in nephrectomy or aortic aneurysm repair incisions for which various surgical method in context of meshplasty are available. In this case 60 yr. male hypertensive patient presented to the outpatient clinic of institute with recurrent left side lumbar incisional hernia, patient was previously operated for left side nephrolithiasis 15 years back and onlay meshplasty 2 years back for incisional hernia. The patient was operated under high risk for recurrent incisional hernia repair by triple layered meshplasties in the same sitting. Lumbar incisional hernias are often diffuse with fascial defects that are usually hard to appreciate. Computed tomography scan is the diagnostic modality of choice with adjuvant clinical findings, which allows differentiating them from abdominal wall musculature denervation atrophy complicating flank incisions. Repairing these hernias is difficult due to the surrounding structures for which our surgical approach included a triple mesh repair consisting of underlay, inlay and onlay meshplasty thereby anticipating further such incidences of incisional hernia

Behavioral Variant Frontotemporal Lobar Degeneration with Amyotrophic Lateral Sclerosis with a Chromosome 9p21 Hexanucleotide Repeat

To determine the genetic basis of familial frontotemporal lobar degeneration (FTLD) with amyotrophic lateral sclerosis (ALS) we performed a clinical and genetic analysis of an affected family. A 51-year-old man with behavioral variant FTLD with ALS had a family history of the disease suggestive of autosomal dominant inheritance with incomplete penetrance. Genetic studies in this patient demonstrated the presence of an amplified hexanucleotide repeat (>30) polymorphism in the chromosome 9 open reading frame 72 (C9ORF72) gene which was previously identified as a cause of FTLD. Five others unaffected from the family were negative (all had less than 11 repeats). Because of the clinical and pathological overlap between FTLD and AD we performed a larger genome-wide association study and did not find association of single nucleotide polymorphisms (SNPs) in the C9ORF72 gene with Alzheimer’s disease (AD) risk. Bioinformatic analysis of C9ORF72 using the Gene Expression Omnibus database showed expression differences in patients with muscular dystrophy, neural tube defects, and schizophrenia. We also report analysis of gene expression in brain regions using the Allen Human Brain Atlas. Defects in this recently reported gene are now believed to be the most common cause of inherited ALS and an important cause of inherited FTLD. Our work suggests that the gene may also be important in other neurological and psychiatric conditions

Triorchidism at orchidopexy: a case report

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Noninvasive detection of graft injury after heart transplant using donor-derived cell-free DNA: A prospective multicenter study

Standardized donor-derived cell-free DNA (dd-cfDNA) testing has been introduced into clinical use to monitor kidney transplant recipients for rejection. This report describes the performance of this dd-cfDNA assay to detect allograft rejection in samples from heart transplant (HT) recipients undergoing surveillance monitoring across the United States. Venous blood was longitudinally sampled from 740 HT recipients from 26 centers and in a single-center cohort of 33 patients at high risk for antibody-mediated rejection (AMR). Plasma dd-cfDNA was quantified by using targeted amplification and sequencing of a single nucleotide polymorphism panel. The dd-cfDNA levels were correlated to paired events of biopsy-based diagnosis of rejection. The median dd-cfDNA was 0.07% in reference HT recipients (2164 samples) and 0.17% in samples classified as acute rejection (35 samples; P = .005). At a 0.2% threshold, dd-cfDNA had a 44% sensitivity to detect rejection and a 97% negative predictive value. In the cohort at risk for AMR (11 samples), dd-cfDNA levels were elevated 3-fold in AMR compared with patients without AMR (99 samples, P = .004). The standardized dd-cfDNA test identified acute rejection in samples from a broad population of HT recipients. The reported test performance characteristics will guide the next stage of clinical utility studies of the dd-cfDNA assay