Anaesthesia Management of Case of Atrial Septal Defect (Cardiac Disease) for Proximal Humerus Fracture (Non-Cardiac Case)

Atrial Septal Defect is most common congenital developmental acyanotic cardiac anomaly. There is left to right shunt of blood in normal compensated state. In decompensated state, the shunt is reversed and flow is from right to left side causing heart failure and thrombo-embolic event. Here, we report a case of Humerus fracture with large ASD, managed under General Anaesthesia with Interscalene block without any deleterious effects like Venous Air Embolism, Spontaneous Reversal of Shunt etc. As patient was in Beach chair position

Anesthetic Considerations in a Case of Peumatocele Following Chest Trauma: A Case Report

Pneumatocele is a lung bulla or rather an air filled cavity present within the lung parenchyma. It has various causes of origin. The bullous area is void of bronchoalveolar oxygenation and that certainly could result in dyspnea, hypoxia, symptomatic chest pain or even hemoptysis. This can result in spontaneous pneumothorax, pneumothorax provoked by mechanical ventilation or infection. We present a case of a 47yr old gentleman, who presented with a pneumatocele following trauma to chest. Prior to induction, thoracic epidural was inserted at T6-T7 and then he was intubated with the single lumen tube rather than the conventional double lumen tube for bullectomy. Post-operative pain relief using ropivacaine 0.375% and dexmedetomidine was effective. We discuss the anesthetic management and considerations in such a case

Anaesthetic Management of Pediatric Patient with Osteogenesis Imperfecta Posted for Radius Ulna Nailing: A Case Report

Osteogenesis Imperfecta is a collagen disorder of autosomal dominant type caused by mutation of type COLIA-1 and COLIA-2 genes. Orthopaedic surgery in paediatric patient patients of OI is challenging mainly due to difficult airway and risk of malignant hyperthermia. Here we report, a paediatric case of OI with similar family history posted for radius ulna nailing which was managed with total intravenous anaesthesia and supraclavicular brachial plexus block

Both N- and C-terminal domains of galectin-9 are capable of inducing HIV reactivation despite mediating differential immunomodulatory functionalities

BackgroundThe shock-and-kill strategy for HIV cure requires the reactivation of latent HIV followed by the killing of the reactivated cellular reservoir. Galectin-9, an immunomodulatory protein, is shown to induce HIV reactivation as well as contribute to non-AIDS- and AIDS-defining events. The protein is prone to cleavage by inflammatory proteases at its linker region separating the N- and C-terminal carbohydrate-binding domains (N- and C-CRDs) which differ in their binding specificities. It is important to study the activity of its cleaved as well as uncleaved forms in mediating HIV reactivation and immunomodulation in order to understand their role in HIV pathogenesis and their further utilization for the shock-and-kill strategy.MethodologyThe PBMCs of HIV patients on virally suppressive ART (n = 11) were stimulated using 350 nM of the full-length protein and N- and C-CRDs of Gal-9. HIV reactivation was determined by analyzing gag RNA copies using qPCR using isolated CD4 cells and intracellular P24 staining of PBMCs by flow cytometry. Cytokine responses induced by the full-length protein and N- and C-CRDs of Gal-9 were also assessed by flow cytometry, Luminex, and gene expression assays. Changes in T helper cell gene expression pattern after the stimulation were also determined by real-time PCR array.ResultsBoth N- and C-CRDs of galectin-9 induced HIV reactivation in addition to the full-length galectin-9 protein. The two domains elicited higher cytokine responses than the full-length protein, possibly capable of mediating higher perturbations in the immune system if used for HIV reactivation. N-CRD was found to induce the development of Treg cells, whereas C-CRD inhibited the induction of Treg cells. Despite this, both domains elicited IL-10 secretory response although targeting different CD4 cell phenotypes.ConclusionN- and C-CRDs were found to induce HIV reactivation similar to that of the full-length protein, indicating their possible usefulness in the shock-and-kill strategy. The study indicated an anti-inflammatory role of N-CRD versus the proinflammatory properties of C-CRD of galectin-9 in HIV infection

Qualitative Phytochemical Screening of Three Indigenous Medicinal Plants

ABSTRACT Many modern medicines had their origin in medicinal plants. The present study was undertaken in three common plants viz; Mangifera indica (Mango), Azadiracta indica (Neem) and Lantana camara which are found to have anti diabetic and other medicinal properties. Pytochemical analyses of the active components of the plants by using different solvents were carried out. The fresh leaves of mango, neem and lantana were collected from the campus of Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Tathawade, Pune. Methanol, petroleum ether and water extracts of fresh and dry leaves of all the three plants were obtained by standard procedure. Filtered extracts were concentrated and were subjected to qualitative phytochemical analysis for various secondary metabolites like alkaloids, glycosides, steroids, triterpenoids, tannins, saponins and flavonoids. Phytochemical analysis indicated the presence of these constituents in these plants whereas variable results were observed with different solvents used. Phytochemical screening can serve as a basis for proper identification, collection and investigation of the plants. These parameters will be useful in the preparation of the herbal monograph of these plants

New Physics in b --> s bar(s) s Decay

We perform a model-independent analysis of the data on branching ratios and CP asymmetries of $B\to\phi K$ and $B\to\eta^{(')} K^{(*)}$ modes. The present data is encouraging to look for indirect evidences of physics beyond the Standard Model. We investigate the parameter spaces for different possible Lorentz structures of the new physics four-Fermi interaction. It is shown that if one takes the data at $1\sigma$ confidence level, only one particular Lorentz structure is allowed. Possible consequences for the $B_s$ system are also discussed.Comment: 9 pages, 3 encapsulated figures, minor changes in the text, conclusions unchanged, a few references added, version to appear in PL

Association of Vegetable and Animal Flesh Intake with Inflammation in Pregnant Women from India

In pregnant women, studies are lacking on the relationship of vegetable and animal flesh (poultry, red meat and seafood) intake with inflammation, especially in low- and middle-income countries. We conducted a cohort study of pregnant women receiving antenatal care at BJ Medical College in Pune, India. The dietary intake of pregnant women was queried in the third trimester using a validated food frequency questionnaire. Twelve inflammatory markers were measured in plasma samples using immunoassays. Only 12% of the study population were vegetarians, although animal flesh intake levels were lower compared to Western populations. In multivariable models, higher intakes of total vegetables were associated with lower levels of the T-helper (Th) 17 cytokine interleukin (IL)-17a (p = 0.03) and the monocyte/macrophage activation marker soluble CD163 (sCD163) (p = 0.02). Additionally, higher intakes of poultry were negatively associated with intestinal fatty-acid binding protein (I-FABP) levels (p = 0.01), a marker of intestinal barrier dysfunction and Th2 cytokine IL-13 (p = 0.03), and higher seafood was associated with lower IL-13 (p = 0.005). Our data from pregnant women in India suggest that a higher quality diet emphasizing vegetables and with some animal flesh is associated with lower inflammation. Future studies should confirm these findings and test if modulating vegetables and animal flesh intake could impact specific aspects of immunity and perinatal health

Randomized Clinical Trial of High-Dose Rifampicin With or Without Levofloxacin Versus Standard of Care for Pediatric Tuberculous Meningitis: The TBM-KIDS Trial

Background. Pediatric tuberculous meningitis (TBM) commonly causes death or disability. In adults, high-dose rifampicin may reduce mortality. The role of fluoroquinolones remains unclear. There have been no antimicrobial treatment trials for pediatric TBM. Methods. TBM-KIDS was a phase 2 open-label randomized trial among children with TBM in India and Malawi. Participants received isoniazid and pyrazinamide plus: (i) high-dose rifampicin (30 mg/kg) and ethambutol (R30HZE, arm 1); (ii) high-dose rifampicin and levofloxacin (R30HZL, arm 2); or (iii) standard-dose rifampicin and ethambutol (R15HZE, arm 3) for 8 weeks, followed by 10 months of standard treatment. Functional and neurocognitive outcomes were measured longitudinally using Modified Rankin Scale (MRS) and Mullen Scales of Early Learning (MSEL). Results. Of 2487 children prescreened, 79 were screened and 37 enrolled. Median age was 72 months; 49%, 43%, and 8% had stage I, II, and III disease, respectively. Grade 3 or higher adverse events occurred in 58%, 55%, and 36% of children in arms 1, 2, and 3, with 1 death (arm 1) and 6 early treatment discontinuations (4 in arm 1, 1 each in arms 2 and 3). By week 8, all children recovered to MRS score of 0 or 1. Average MSEL scores were significantly better in arm 1 than arm 3 in fine motor, receptive language, and expressive language domains (P < .01). Conclusions. In a pediatric TBM trial, functional outcomes were excellent overall. The trend toward higher frequency of adverse events but better neurocognitive outcomes in children receiving high-dose rifampicin requires confirmation in a larger trial. Clinical Trials Registration. NCT02958709

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts