Modification of physicochemical properties of chitosan to improve its pharmaceutical and agrochemical potential applications.

Chitosan has received much more attention as a functional biopolymer with applications in pharmaceuticals, agricultural, drug delivery systems and cosmetics. The objectives of present investigation were to carry out modification of chitosan for enhancement of aqueous solubility, which will impart increased solubility and dissolution rate of poorly soluble drug itraconazole (ITZ) and also evaluate the modified chitosan for soyabean seed germination studies. The modification of chitosan was accomplished through the antisolvent precipitation method; employing five carboxylic acids. The resulting products were assessed for changes in molecular weight, degree of deacetylation, solubility and solid state characterization. Subsequently, the modified chitosan was complexed with itraconazole using the co-grinding technique. The prepared formulations were evaluated for solubility, FTIR (Fourier-transform infrared spectroscopy), PXRD (Powder X-ray diffraction), in-vitro dissolution studies. Furthermore the effect of modified chitosan has been evaluated on soybean seed germination. Results demonstrated that, modified chitosan improves self and solubility of itraconazole by six folds. As there was increased degree of deacetylation of chitosan leads to improvement in solubility. The results of FTIR showed the slight shifting of peaks in co-grind formulations of itraconazole. Formulations showed reduction in crystallinity of drug which leads to enhancement in dissolution rate as compared to pure itraconazole. Retention of property of seed germination was observed with modified chitosan at optimum concentration of 3 % w/v, with benefit of enhanced aqueous solubility of chitosan. This positive result paves the way for the advancement of pharmaceutical and agrochemical products employing derivatives of chitosan.

Accuracy of Femoral Tunnel Placement between Anteromedial and Anterolateral Visualisation Portals in Anterior Cruciate Ligament Reconstruction - Outcomes of a CT based Cross-Sectional Study.

Introduction: Anatomical femoral tunnel placement is critical for anterior cruciate ligament reconstruction (ACLR). Tunnel placement may vary with different surgical techniques. The aim of this study was to compare the accuracy of femoral tunnel placement between the Anteromedial (AM) and Anterolateral (AL) visualisation portals on post-operative CT scans among a cohort of ACLR patients. Materials and methods: This cross-sectional study was conducted from January 2018 to March 2020 after obtaining ethics clearance. Patients who went for arthroscopic ACLR in our institute were divided into an AM (group 1) and an AL (group 2) based on the visualisation portal for creating the femoral tunnel and a 3D CT scan was done. The femoral tunnel position was calculated in deep to shallow and high to low direction using the Bernard Hertel grid. Femoral tunnel angle was measured in the 2D coronal image. Statistical analysis was done with the data collected. Results: Fifty patients with an average age of 26.36 (18-55) years ±7.216 SD were enrolled in the study. In this study, the AM technique was significantly more accurate (p<0.01) than the AL technique in terms of femoral tunnel angle. Furthermore, the deep to the shallow position was significantly (p= 0.018) closer to normative values, as determined by the chi-square test. The chances of error in tunnel angle in femoral condyle are 2.6 times greater in the AL technique (minimal clinical difference). Conclusion: To conclude, in ACLR the anteromedial visualisation portal can facilitate accurate femoral tunnel placement compared to the anterolateral visualisation portal.

A comprehensive review on application of bioreactor for industrial wastewater treatment.

In the recent past, wastewater treatment processes performed a pivotal role in accordance with maintaining the sustainable environment and health of mankind at a proper hygiene level. It has been proved indispensable by government regulations throughout the world on account of the importance of preserving freshwater bodies. Human activities, predominantly from industrial sectors, generate an immeasurable amount of industrial wastewater loaded with toxic chemicals, which not only cause dreadful environmental problems, but also leave harmful impacts on public health. Hence, industrial wastewater effluent must be treated before being released into the environment to restrain the problems related to industrial wastewater discharged to the environment. Nowadays, biological wastewater treatment methods have been considered an excellent approach for industrial wastewater treatment process because of their cost-effectiveness in the treatment, high efficiency and their potential to counteract the drawbacks of conventional wastewater treatment methods. Recently, the treatment of industrial effluent through bioreactor has been proved as one of the best methods from the presently available methods. Reactors are the principal part of any biotechnology-based method for microbial or enzymatic biodegradation, biotransformation and bioremediation. This review aims to explore and compile the assessment of the most appropriate reactors such as packed bed reactor, membrane bioreactor, rotating biological contactor, up-flow anaerobic sludge blanket reactor, photobioreactor, biological fluidized bed reactor and continuous stirred tank bioreactor that are extensively used for distinct industrial wastewater treatment.

Increased tracheostomy rates in head and neck cancer surgery during the COVID-19 pandemic.

Surgical practice during the coronavirus disease 2019 (COVID-19) pandemic has changed significantly, without supporting data. With increasing experience, a dichotomy of practice is emerging, challenging existing consensus guidelines. One such practice is elective tracheostomy. Here, we share our initial experience of head and neck cancer surgery in a COVID-19 tertiary care centre, emphasizing the evolved protocol of perioperative care when compared to pre-COVID-19 times. This was a prospective study of 21 patients with head and neck cancers undergoing surgery during the COVID-19 pandemic, compared to 193 historical controls. Changes in anaesthesia, surgery, and operating room practices were evaluated. A strict protocol was followed. One patient tested positive for COVID-19 preoperatively. There was a significant increase in pre-induction tracheostomies (28.6% vs 6.7%, P=0.005), median hospital stay (10 vs 7 days, P=0.001), and postponements of surgery (57.1% vs 27.5%, P=0.01), along with a significant decrease in flap reconstructions (33.3% vs 59.6%, P=0.03). There was no mortality and no difference in postoperative morbidity. No healthcare personnel became symptomatic for COVID-19 during this period. Tracheostomy is safe during the COVID-19 pandemic and rates have increased. Despite increased rescheduling of surgeries and longer hospital stays, definitive cancer care surgery has not been deferred and maximum patient and healthcare worker safety has been ensured.

Utility of a Single-Tube, Six-Color Flow Cytometry Panel for the Diagnosis of Myelodysplastic Syndrome: Experience of a Tertiary Care Centre in India.

Background: Diagnosis of myelodysplastic syndromes (MDS) is challenging in the presence of morphological mimickers. Flow cytometric immunophenotyping (FCI) has been added to the diagnostic armamentarium, but its use in clinical practice is variable. Materials and Methods: Bone marrow aspirate samples from 54 patients with a clinical and/or morphological suspicion of MDS were subjected to FCI using a single-tube, 6-colour panel comprising of monoclonal antibodies against CD13, CD11b, CD16, CD34, CD45 and CD56. Analysis was centered on the abnormal maturation pattern of granulocytes, blast percentage (≥3%) and ratio of side scatter peak channel value (SSC-PCV) of granulocytes and lymphocytes. Each of these parameters was assigned a score of 1. Overall sensitivity and specificity of this panel was ascertained to differentiate cytopenia/s of MDS from non-MDS cases. Results: Forty MDS and 14 non-MDS cases were diagnosed based on morphology and cytogenetic results. Twenty control samples were also processed simultaneously for FCI to assign the cutoff for various flow cytometric parameters. A score ≥2 was defined as positive for MDS. Hypogranularity was present in 62.5% cases of MDS. The median SSC-PCV of granulocytes and lymphocytes was 6.16 in the MDS group, 7.9 in the non-MDS group and 8.90 in the control group (p <0.05). This cut-off value of 6.16 had a specificity of 92.5% based on the ROC curve analysis. Abnormal granulocyte maturation patterns for CD13/16, CD13/11b and CD11b/16 dot plots were observed in 95.3, 69.8 and 74.4% cases, respectively. The overall sensitivity and specificity of the panel was found to be 87.5% and 64.2%, respectively. Conclusion: FCI is now an important tool for diagnostic workup in patients presenting with persistent cytopenia with or without morphological evidence of dyspoiesis. Inclusion of objective parameters like SSC-PCV would also reduce inter-lab variability in MDS diagnosis.

Fluorescent Aerolysin (FLAER)-based paroxysmal nocturnal hemoglobinuria (PNH) screening: a single center experience from India.

BACKGROUND: Fluorescent aerolysin (FLAER) has been recommended as an important part of antibody panel used for flow cytometric detection of paroxysmal nocturnal hemoglobinuria (PNH) clone. This study was aimed to observe the frequency of PNH-positive clones and their sizes in patients screened for various indications. METHOD: A retrospective analysis of 624 patients screened over a period of 30 months. Frequency and size of clone sizes noted, and laboratory parameters were compared among different groups of patient being screened. RESULTS: There were 445 adults and 179 pediatric patients. Indications for screening included AA (n = 433), myelodysplastic syndrome (MDS) (n = 34), hemolytic anemia (n = 84), and thrombophilia workup group (n = 63). PNH clones were found in 39.03%, 5.88%, 26.19%, and 1.59% cases, respectively. No significant difference among adult or pediatric population was noted. The bone marrow failure (BMF) group [AA and MDS] with PNH clone had a significantly lower clone size (Median- 2.7%) as compared to classic PNH group (Median-77.2%). Most of the classic PNH cases (78.26%) and a small proportion of AA (9.9%) showed a large clone size (>50%). In spite of having large clone size, there was a significant difference between the median LDH values of these two groups (2511.5 vs 593 U/L). CONCLUSION: FLAER-based screening detects the presence of PNH clone in a high proportion of AA patients and some MDS patients. These patients usually have a small clone size. Even if they have a large clone, it does not get translated into a high LDH or severe clinical symptoms.

Role of light wavelengths in synchronization of circadian physiology in songbirds.

This study investigated whether at identical duration and equal energy level birds presented with short (450nm; blue, B) and long (640nm; red, R) light wavelengths would differentially interpret them and exhibit wavelength-dependent circadian behavioral and physiological responses, despite the difference in their breeding latitudes. Temperate migratory blackheaded buntings (Emberiza melanocephala) and subtropical non-migratory Indian weaverbirds (Ploceus philippinus) initially entrained to 12h light:12h darkness (12L:12D; L=0.33µM/m(2)/s, D=0µM/m(2)/s) in two groups of each, groups 1 and 2, were subjected to constant light (LL, 0.33µM/m(2)/s), which rendered them arrhythmic in the activity behavior. They were then exposed for about two weeks each to 12B:12R and 12R:12B (group 1) or 12R:12B and 12B:12R (group 2) at 0.33µM/m(2)/s light energy level. Blue and red light periods were interpreted as the day and night, respectively, with activity and no-activity in non-migratory weaverbirds or activity and intense activity (Zugunruhe, migratory night restlessness) in the migratory buntings. Consistent with this, plasma melatonin levels under B:R, not R:B, light cycle were low and high in blue and red light periods, respectively. A similar diurnal pattern was absent in the cortisol levels, however. These results show an important role of light wavelengths in synchronization of the circadian clock governed behavior and physiology to the photoperiodic environment, and suggest that photoperiodic timing might be a conserved physiological adaptation in many more birds, regardless of the difference in breeding latitudes, than has been generally envisaged.

Poland's syndrome with unusual hand and chest anomalies: a rare case report.

Poland's syndrome is a rare congenital anomaly consisting of a unilateral absence of the pectoralis major, ipsilateral muscle, hand anomaly and occasionally associated other malformations of the chest wall and breast. Many structural and functional abnormalities have been described in association with this syndrome. We report an incidentally diagnosed case in a 27-year-old male patient who presented to us with symbrachydactyly. In addition to this, anterior depression of 2nd, 3rd and 4th ribs and bifid (forked) 5th rib was present on radiological investigations. The body of sternum was short and deformed on the right side with absence of xiphoid process. All middle phalanges were absent on righthand. It is a rare variant of Poland's syndrome.

Accessory parotid gland with ectopic fistulous duct - Surgical view: A case report and review of current literature.

Accessory parotid glands are a common clinical occurrence and usually drain into the main Stenson's duct by small ductules and thereby, into the buccal cavity. Presence of an accessory parotid gland with an ectopic fistulous duct is a rare occurrence. Clinical findings, imaging studies, biochemical tests, histopathological examination are needed for appropriate surgical management. It is extremely rare case with ectopic fistulous duct in an accessory parotid gland managed surgically by internalization of the duct to open into the buccal mucosa and excision of pre-aural appendages. Further to this, we give a comprehensive review of literature on accessory parotid gland and duct anomalies.

SU-E-T-130: IMAT Patient Specific Quality Assurance Using ArcCHECK Diode Array Detector.

PURPOSE: To evaluate the IMAT patient specific quality assurance (QA) performed using ArcCHECK detector array in reference with standard ion chamber for routine clinical use. METHODS: Twelve patient plans having different tumor sites chosen for this study. On Eclipse planning system,IMAT patient plans were calculated on ArcCHECK phantom inserted with Ion chamber using superposition algorithm. ArcCHECK is a cylindrical phantom with a three-dimensional array of 1386 diode detectors, arranged in a spiral pattern, with 10 mm diode spacing. These plans delivered from Clinac-iX linac equipped with 120 MLC. Point dose and Dose/fluence map were measured simultaneously with ion chamber (IC-15) and ArcCHECK diode array detector respectively. Point doses, dose/fluences map and dose at central axis (CAX) on ArcCHECK phantom were compared with their respective TPS calculated values. RESULTS: The ion chamber measurements are in good agreement with TPS calculated doses. Mean difference between them is 0.50% with standard deviation is 0.51%. Concordance correlation coefficient (CCC) obtained for ion chamber base absolute dose measurements is 0.9996. These results demonstrate a strong correlation between the absolute dose predicted by our TPS and the measured dose. The precision of the TPS software was 0.9999, and its accuracy was 0.9997.The agreement between ArcCHECK doses and TPS predictions on the CAX, shown CCC of 0.9978 (the mean difference in the central axis dose is 2.11%). The 95% Confidence Interval is from 0.9932 to 0.9995. In gamma analysis of dose/fluence map the mean passing rate was 98.53% for 3% dose difference and 3mm distance to agreement. CONCLUSIONS: The IMAT patient specific QA with Ion chamber and ArcCHECK phantom are consistent with the TPS calculated dose. Statistically good agreement observed between ArcCHECK measured and TPS calculated. Hence it can be used for routine IMAT QA.

Imaging characteristics of cavernous sinus cavernous hemangiomas.

Cavernous hemangiomas occur rarely in the cavernous sinus and are difficult to diagnose preoperatively. The imaging of these lesions resembles other benign paracavernous lesions such as schwannomas and meningiomas. Profuse intraoperative bleeding may be encountered during surgical resection of these lesions. A preoperative diagnosis is therefore important to alert the surgeon. We report on the imaging characteristics of two different histopathological types of cavernous sinus cavernous hemangiomas and the use of contrast-enhanced MRI, diffusion-weighted MRI and magnetic resonance spectroscopy in the differential diagnosis of these lesions.

Persistence of cypermethrin and decamethrin residues in/on brinjal fruits.

Residues of cypermethrin and decamethrin were estimated in brinjal fruits by gas liquid chromatography following single application of Cymbush 25 EC @ 43.75 and 87.50 g a.i./ha and of Decis 2.8 EC @ 11.20 and 22.40 g a.i./ha at fruiting stage. The average initial deposits of cypermethrin 0.600 and 1.095 mg kg(-1) and of decamethrin 0.430 and 0.900 mg kg(-1) were observed for single and double dose, respectively. Residues reached below maximum residue limit (MRL) value of 0.2 and 0.05 mg kg(-1) on third and seventh day for cypermethrin and decamethrin, respectively. The half-life values (t(1/2)) were worked out to be 1.16, 1.18 days for cypermethrin and 1.33, 1.42 days for decamethrin at single and double dose, respectively following first order kinetics. Washing and washing followed by boiling/cooking processes were found to be effective in reducing the residues of both the insecticides in brinjal fruits. Maximum reduction (31-42%) and (26-37%) was observed by washing followed by boiling/cooking for cypermethrin and decamethrin, respectively.

A Comparative Study of Propofol and Isoflurane Anaesthesia using Butorphanol in Neurosurgery.

SUMMARY: Propofol and isoflurane have well proven roles as intravenous and inhalational anaesthetics respectively in neurosurgery. We conducted this study to know the outcome using butorphanol as an intraoperative analgesic. Sixty craniotomy patients randomly divided into two groups of 30 each were included in this study. Group A patients were induced and maintained with propofol. Group B patients were induced with thiopentone and maintained with isoflurane. All patients were administered 30mug.kg(-1) butorphanol intravenously 10 minutes before induction of anaesthesia, followed by slow injection of 30mug.kg(-1) midazolam. All were assessed for sedation, respiratory insufficiency, postoperative nausea and vomiting (PONV) and other side effects in the recovery room. We found no difference in demographic parameters between the groups. The fall in HR was maintained in the post induction / intubation period and throughout the intraoperative period in Group A, unlike Group B patients in whom it rose significantly following intubation. Butorphanol was found to be a safe intraoperative analgesic in neurosurgical patients. In addition, it was associated with statistically better haemodynamics and earlier recovery when used with propofol as compared to thiopentone-isoflurane anaesthesia.

Evaluation of intra-operative tramadol for prevention of catheter-related bladder discomfort: a prospective, randomized, double-blind study.

BACKGROUND: Catheter-related bladder discomfort (CRBD) is defined as an urge to void or discomfort in the supra-pubic region; reported postoperatively in patients who have had urinary catheterization intra-operatively. We have evaluated tramadol, a centrally acting opioid analgesic with muscarinic receptor antagonist properties for prevention of CRBD. METHODS: Fifty-four adults (18-60 yr), ASA physical status I and II of either sex, undergoing elective percutaneous nephro-lithomy were randomly divided into two groups of 27 each. Control (C) group received normal saline (NS; 2 ml), whereas Tramadol (T) group received tramadol 1.5 mg kg(-1). All medications were diluted in 2 ml NS and administered 30 min before extubation. Intra-operatively, urinary catherization was performed with a 16 Fr Foley's catheter, and the balloon was inflated with 10 ml distilled water. The CRBD was assessed at 0, 1, 2, and 6 h after patient's arrival in the post-anaesthesia care unit along with total postoperative fentanyl requirement. Severity of CRBD was graded as none, mild, moderate and severe. Data were analysed by one-way ANOVA, Z-test, and Fisher's exact test. P<0.05 was considered significant. RESULTS: Incidence and severity of CRBD was reduced in T group compared with C group at all time points (P<0.05). Postoperative pain as assessed by visual analogue scale and total postoperative fentanyl requirement (microg kg(-1)) was also reduced in the T group [176 (SD 26.5)] compared with C group [210 (34.6)] (P<0.05). CONCLUSIONS: Tramadol 1.5 mg kg(-1) administered i.v. 30 min before extubation decreases the incidence and severity of CRBD and postoperative fentanyl requirement.

Synthesis of 2-sulfanyl-6-methyl-1,4-dihydropyrimidines as a new class of antifilarial agents.

A series of 2-sulfanyl-6-methyl-1,4-dihydropyrimidines (8-21) were synthesized in good yields by alkylation of 5-methyl-6-phenyl-2-thioxo-1,2,3,6-tetrahydropyrimidine-4-carboxylic acid ethyl esters (2-7) with different alkyl or aralkyl halides in the presence of a combination of anhydrous K(2)CO(3) and catalytic amount of tetrabutyl ammonium bromide. The title compounds were evaluated for their antifilarial activity against adult parasites of human lymphatic filarial parasite Brugia malayi (sub-periodic strain) in vitro and in vivo at various concentrations. One of the compounds (18) showed promising antifilarial activity.

Accessory sulcus of the liver - an incidental laparotomy finding.

The diaphragmatic surface of the liver is normally smooth but may be grooved occasionally. Such grooves could be 'cough furrows' or due to a 'corset liver'. Accessory sulci have also been described and may confuse the inexperienced surgeon. We describe one such case of an accessory sulcus found incidentally at laparotomy.

Comparative evaluation of myolaxin and EMLA cream for attenuation of venous cannulation pain: a prospective, randomised, double blind study.

We evaluated the efficacy of topical Myolaxin (capsaican ointment, Geno, Mumbai) ointment over EMLA (eutectic mixture of lignocaine, prilocaine; Neon, Goa) cream for attenuating venous cannulation pain in this prospective, randomised, double blind study. Sixty adult patients undergoing elective laparoscopic cholecystectomy were randomly assigned into two equal groups. Group I (EMLA) received EMLA cream, whereas Group II (Myolaxin) received Myolaxin ointment. For both groups the cream was applied at the venous cannulation site (dorsum of the non-dominant hand) one hour prior to venous cannulation and was covered with an occlusive dressing. Following venous cannulation patients were asked if they felt pain during venous cannulation. If the answer was yes, they were asked to rate the severity of venous cannulation pain using a VisualAnalogue Scale (VAS) of 0-10. The incidence of venous cannulation pain was similar between groups: in the EMLA group 65% (18/28) compared to 67% (20/30) in the Myolaxin group (P=0.19). The severity of pain (median VAS with inter quartile range) was also similar between the groups: in the EMLA group 1.5 (3) compared to 1.5 (2) in the Myolaxin group (P=0.46). As the topical application of Myolaxin ointment is cheaper than EMLA and has similar efficacy, it may be a suitable alternative for reducing the incidence and severity of venous cannulation pain.