Assessing Diastolic Hypertension in Patients of Primary Hypothyroidism among Adults Visiting a Tertiary Care Hospital in North India

Background: Elevation of diastolic BP has been shown in few studies among patients with hypothyroidism. However, the evidence is still obsolete when it comes to Indian settings. This study intends to evaluate association between hypertension and primary hypothyroidism in North Indian population.Methodology: One hundred primary hypothyroid patients (TSH level >5.5) were subjected to a cross-sectional comparative study in a tertiary care hospital in North India from August 2015 to June 2017. Patients had no thyroid complications and were unknown of their blood pressure status. Sociodemographic profile andclinical and laboratory status was evaluated which included blood pressure measurements; lipid profile, kidney function tests, and other vitals were recorded.Results: Individuals with diastolic and overall hypertension had significantly less serum T3 values and high TSH and serum creatinine values as compared to non-hypertensive individuals. Pearson test showed a significant correlation between serum TSH levels with both systolic and diastolic BP.Conclusion: This study showed that both systolic and diastolic blood pressure increased linearly with increasing TSH. Despite the differing estimated prevalence of hypertension in hypothyroidism, there seems to be a positive association of thyroid with BP

Comparison of Eplerenone and Spironolactone in Treatment of Patients with Congestive Heart Failure Visiting a Tertiary Hospital in North India

Background: Congestive heart failure (CHF) is a serious clinical condition, with not many established treatment options. Eplerenone (Inspra) is the second aldosterone antagonist commonly used (in preference to Spironolactone) for treatment of hypertension and CHF in the US. Literature for its effectiveness in India is lacking, hence the need for the present study.Methodology: The present cross-sectional, observational study was done among 100 adult patients (>20 years) (50 patients in each study group: Eplerenone and Spironolactone), diagnosed with chronic CHF and poor left ventricle function (ejection fraction <40%) unknown of their blood pressure status. Sociodemographic profile, clinical and laboratory status was evaluated which included blood pressure measurements, lipid profile, kidney function tests, and other vitals. Assessment of parameters was done after 8 weeks of treatment.Results: Systolic blood pressure, diastolic blood pressure and CK levels showed a significant change over the study duration, with Eplerenone producing a better result than Spironolactone (p<0.05). Remaining parameters showed a non-significant difference.Conclusion: Eplerenone group proved to be associated with a better outcome in hypertension and cardiovascular parameters; however, due to limitations in sample selection, more research is warranted

Increasing incidence of multidrug resistant Pseudomonas aeruginosa in inpatients of a tertiary care hospital

Background:Pseudomonas aeruginosa is an important pathogen isolated from various clinical infections. The occurrence of multidrug-resistant (MDR) Pseudomonas aeruginosa strains is increasing worldwide and limiting our therapeutic options resulting in high mortality. We aim to study the incidence of multidrug resistant Pseudomonas aeruginosa in inpatients from various departments along with rate of nosocomial infections.Methods:A cross sectional study from January 1, 2013 to December 31, 2013. A total of 167 Pseudomonas aeruginosa were isolated from 764 clinical specimens. The isolates were identified by standard microbiological techniques. The antibiotic susceptibility was done by Kirby Bauer method.Results:The highest number of isolates were from pulmonary samples n=90 (53.89%) followed by pus n=48 (28.74%). Overall, 39 (23.36%) isolates were nosocomial. The nosocomial isolates were mainly isolated from department of surgery, orthopaedics, obstetrics & gynaecology followed by others. Among 167 isolates screened, 53 (31.73%) were found to be MDR (resistant to ≥3 classes of antipseudomonal agents). The resistance was most against cephalosporins [Cefepime (65.26%), cefotaxime (60.47%)], fluoroquinolones [Ciprofloxacin (46.1%), levofloxacin (31.87%)] aminoglycosides [Amikacin (37.72%), gentamicin (31.13%)] followed by ureidopenicillins and carbepenems. About 56.75% isolates were suspected Metallo β lactamases producers.Conclusion:The study suggests that the incidence of nosocomial infection by multidrug resistant Pseudomonas aeruginosa is increasing globally especially the Metallo Beta lactamases producing strains. So there is a continuous need of conduction of surveillance programmes to formulate rational treatment strategies to combat this emerging challenge.

Statistical optimization of alkaline protease from Bacillus amyloliquefaciens SP1

Alkaline protease has tremendous applications in different industries, and to fulfil industrial and commercial enzyme requirements, overproduction and optimization of production medium are prerequisites. Protease production by Bacillus amyloliquefaciens SP1, isolated from apple tree rhizosphere was studied. Plackett Burmann design and response surface methodology was used to optimize medium for alkaline protease production. Higher levels of protease activity were observed in presence of disaccharides owing to diauxic growth and inorganic nitrogen sources proved to be less favourable. After screening through one-factor-at-a time experiments and Plackett Burmann design, casein, yeast extract, maltose and KH2PO4 were identified as the most significant variables. Statistical design based three-dimensional (3-D) and contour plots were generated to understand the relationship between enzyme activity and medium variables. The protease production was found to increase from 1730 to 3630 µg/ml/min in optimized medium i.e. approx. 2.1 fold increased compared with original medium. The study assumes significance in the ability of bacterium to survive in wide variety of salts and agricultural wastes and yield optimum levels of extracellular protease

Intrinsic defect engineering of CVD grown monolayer MoS2_2 for tuneable functional nanodevices

Defects in atomically thin materials can drive new functionalities and expand applications to multifunctional systems that are monolithically integrated. An ability to control formation of defects during the synthesis process is an important capability to create practical deployment opportunities. Molybdenum disulfide (MoS$_2$), a two-dimensional (2D) semiconducting material harbors intrinsic defects that can be harnessed to achieve tuneable electronic, optoelectronic, and electrochemical devices. However, achieving precise control over defect formation within monolayer MoS$_2$, while maintaining the structural integrity of the crystals remains a notable challenge. Here, we present a one-step, in-situ defect engineering approach for monolayer MoS$_2$ using a pressure dependent chemical vapour deposition (CVD) process. Monolayer MoS$_2$ grown in low-pressure CVD conditions (LP-MoS$_2$) produces sulfur vacancy (Vs) induced defect rich crystals primarily attributed to the kinetics of the growth conditions. Conversely, atmospheric pressure CVD grown MoS$_2$ (AP-MoS$_2$) passivates these Vs defects with oxygen. This disparity in defect profiles profoundly impacts crucial functional properties and device performance. AP-MoS$_2$ shows a drastically enhanced photoluminescence, which is significantly quenched in LP-MoS$_2$ attributed to in-gap electron donor states induced by the Vs defects. However, the n-doping induced by the Vs defects in LP-MoS$_2$ generates enhanced photoresponsivity and detectivity in our fabricated photodetectors compared to the AP-MoS$_2$ based devices. Defect-rich LP-MoS$_2$ outperforms AP-MoS$_2$ as channel layers of field-effect transistors (FETs), as well as electrocatalytic material for hydrogen evolution reaction (HER). This work presents a single-step CVD approach for in-situ defect engineering in monolayer MoS$_2$ and presents a pathway to control defects in other monolayer material systems.Comment: 29 pages, 5 figure

Impact of a package of diagnostic tools, clinical algorithm, and training and communication on outpatient acute fever case management in low- and middle-income countries: protocol for a randomized controlled trial.

BACKGROUND: The management of acute febrile illnesses places a heavy burden on clinical services in many low- and middle-income countries (LMICs). Bacterial and viral aetiologies of acute fevers are often clinically indistinguishable and, in the absence of diagnostic tests, the 'just-in-case' use of antibiotics by many health workers has become common practice, which has an impact on drug-resistant infections. Our study aims to answer the following question: in patients with undifferentiated febrile illness presenting to outpatient clinics/peripheral health centres in LMICs, can we demonstrate an improvement in clinical outcomes and reduce unnecessary antibiotic prescription over current practice by using a combination of simple, accurate diagnostic tests, clinical algorithms, and training and communication (intervention package)? METHODS: We designed a randomized, controlled clinical trial to evaluate the impact of our intervention package on clinical outcomes and antibiotic prescription rates in acute febrile illnesses. Available, point-of-care, pathogen-specific and non-pathogen specific (host markers), rapid diagnostic tests (RDTs) included in the intervention package were selected based on pre-defined criteria. Nine clinical study sites in six countries (Burkina Faso, Ghana, India, Myanmar, Nepal and Uganda), which represent heterogeneous outpatient care settings, were selected. We considered the expected seasonal variations in the incidence of acute febrile illnesses across all the sites by ensuring a recruitment period of 12 months. A master protocol was developed and adapted for country-specific ethical submissions. Diagnostic algorithms and choice of RDTs acknowledged current data on aetiologies of acute febrile illnesses in each country. We included a qualitative evaluation of drivers and/or deterrents of uptake of new diagnostics and antibiotic use for acute febrile illnesses. Sample size estimations were based on historical site data of antibiotic prescription practices for malarial and non-malarial acute fevers. Overall, 9 semi-independent studies will enrol a minimum of 21,876 patients and an aggregate data meta-analysis will be conducted on completion. DISCUSSION: This study is expected to generate vital evidence needed to inform policy decisions on the role of rapid diagnostic tests in the clinical management of acute febrile illnesses, with a view to controlling the rise of antimicrobial resistance in LMICs. TRIAL REGISTRATION: Clinicaltrials.gov NCT04081051 . Registered on 6 September 2019. Protocol version 1.4 dated 20 December 2019

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Not AvailableMaize (Zea mays L.) is one of the most versatile cereal crops and widely cultivated in more than 150 countries of the world including tropical and temperate regions. Though maize can be grown in the wide range of climatic conditions, its productivity is largely depending on the prevailing weather conditions throughout the life cycle of the crop. Different management practices as well as prevailing weather parameters affect growth and development of crop differently. Therefore, it was contemplated to have an insight on the effect of photosynthetically active radiation (PAR) interception and leaf area index of maize grown under different nutrient management practices in Punjab.Not Availabl