Expert Consensus on Dipeptidyl Peptidase-4 Inhibitor-Based Therapies in the Modern Era of Type 2 Diabetes Mellitus Management in India.

India has a high prevalence of type 2 diabetes mellitus (T2DM) with unique clinical characteristics compared to other populations. Despite advancements in diabetes therapy, a significant number of patients in India still experience poor glycemic control and complications. Dipeptidyl peptidase-4 (DPP-4) inhibitors continue to be an important component of T2DM treatment due to their favorable efficacy and tolerability profile. Given the current scenario, there is a need to revisit the role of DPP-4 inhibitors in T2DM management in Indian patients. This consensus paper aims to provide guidance on the utilization of DPP-4 inhibitors in T2DM management from an Indian perspective. A consensus group of 100 experts developed recommendations based on an extensive literature review and discussions. The expert group emphasized the importance of timely glycemic control, combination therapy, and targeting the underlying pathophysiology of T2DM. The combinations of DPP-4 inhibitors with metformin and/or sodium-glucose transport protein-2 inhibitors are rationalized in this paper, considering their complementary mechanisms of action. This paper provides valuable insights for clinicians in optimizing the management of T2DM in the Indian population with the use of DPP-4 inhibitors and proposes an algorithm for selecting DPP-4 inhibitor-based therapies.

Comparing the posture and comfort of anaesthesiologists during laryngoscopy and tracheal intubation in the head-elevated laryngoscopy position in supine position and with a 25° backup: A randomised clinical crossover trial.

Background and Aims: The head-elevated laryngoscopy position (HELP) and a 25° backup have been proposed to enhance glottic visualisation, yet concerns about ergonomic discomfort hinder their widespread adoption. This study compares the comfort and posture adopted by anaesthesiologists while performing laryngoscopy and tracheal intubation with patients in HELP while in a supine position or with 25° backup. Methods: The study included 48 patients aged 18-60 years with normal airways and 12 experienced anaesthesiologists. Patients were randomised into two groups using permuted block randomisation. Anaesthesiologists performed laryngoscopy and intubation in supine HELP and 25° backup HELP positions. Anaesthesiologist's posture was determined by measuring the angles of neck, wrist, elbow, back and knee joints, which were compared using Student's t-test, and subjective comfort assessed on a Likert scale was compared using the Chi-square test. As mentioned by the anaesthesiologist, Cormack- Lehane grading was also noted and compared using a Chi-square test between groups, taking a P value <0.05 as significant. Results: Both positions demonstrated comparable anaesthesiologist posture (P = 0.919) and comfort (P = 0.644). However, the 25° backup HELP positions significantly improved Cormack-Lehane grades, with 68% achieving grade 1 compared to 31% in the supine HELP group (P = 0.012). Haemodynamic stability and tracheal intubation time showed no significant differences between the groups (P = 0.475 and 0.117, respectively), and no complications were reported in either group. Conclusion: Anaesthesiologists' posture and comfort during laryngoscopy and tracheal intubation are similar between supine and 25° backup in patients with easy airways.

Expert Consensus on Ivabradine-based Therapy for Heart Rate Management in Chronic Coronary Syndrome and Heart Failure with Reduced Ejection Fraction in India.

Heart rate is an important indicator of health and disease and the modulation of heart rate can help to improve cardiovascular outcomes. Besides ß-blockers, Ivabradine is a wellestablished heart rate modulating drug that reduces heart rate without any hemodynamic effects. This consensus document was developed with the help of expert opinions from cardiologists across India on effective heart rate management in routine clinical practice and choosing an appropriate Ivabradine-based therapy considering the available scientific data and guideline recommendations. Based on the discussion during the meetings, increased heart rate was recognized as a significant predictor of adverse cardiovascular outcomes among patients with chronic coronary syndromes and heart failure with reduced ejection fraction making heart rate modulation important in these subsets. Ivabradine is indicated in the management of chronic coronary syndromes and heart failure with reduced ejection fraction for patients in whom heart rate targets cannot be achieved despite guideline-directed ß-blocker dosing or having contraindication/intolerance to ß-blockers. A prolonged release once-daily dosage of Ivabradine can be considered in patients already stabilized on Ivabradine twice-daily. Ivabradine/ß-blocker fixed-dose combination can also be considered to reduce pill burden. Two consensus algorithms have been developed for further guidance on the appropriate usage of Ivabradine-based therapies. Ivabradine and ß-blockers can provide more pronounced clinical improvement in most chronic coronary syndromes and heart failure with reduced ejection fraction patients with a fixed-dose combination providing an opportunity to improve adherence.

Resiliencies of soil phosphorus fractions after natural summer fire are governed by microbial activity and cation availability in a semi-arid Inceptisol.

The unintended impact of natural summer fire on soil is complicated and rather less studied than its above-ground impact. Recognising the impact of a fire on silvopastoral soils and their resilience can aid in improving the management of silvopastoral systems. We studied the immediate (after 1 week (W)) and short-term (after 3 months (M)) recovery of different soil biological and chemical properties after the natural fire, with specific emphasis on phosphorus (P) dynamics. Soil samples were collected from four different layers (0-15, 15-30, 30-45, and 45-60 cm) of Morus alba, Leucaena leucocephala, and Ficus infectoria based silvopastoral systems. In the 0-15 cm soil layer, soil organic carbon (SOC) declined by ∼37, 42, and 30% after the fire in Morus-, Leucaena-, and Ficus-based systems, respectively within 1W of fire. However, after 3M of fire, Morus and Leucaena regained ∼6 and 11.5% SOC as compared to their status after 1W in the 0-15 cm soil layer. After 1W of the fire, soil nitrogen (N), sulfur (S), and potassium availability declined significantly at 0-15 cm soil layer in all systems. Iron and manganese availability improved significantly after 1W of the fire. Saloid bound P and aluminium bound P declined significantly immediately after the fire, increasing availability in all systems. However, calcium bound P did not change significantly after the fire. Dehydrogenase and alkaline phosphatase activity declined significantly after the fire, however, phenol oxidase and peroxidase activity were unaltered. Resiliencies of these soil properties were significantly impacted by soil depth and time. Path analysis indicated microbial activity and cationic micronutrients majorly governed the resilience of soil P fractions and P availability. Pasture yield was not significantly improved after the fire, so natural summer fire must be prevented to avoid loss of SOC, N, and S.

On the performance of a hierarchically porous Ag2S-CuxS electrode in Li-ion batteries.

A new binder- and carbon-free electrode for lithium-ion batteries was prepared using a hierarchically porous Ag-based current collector. The latter was produced by applying the method of selective dissolution of the less noble metals from the Cu60Ag30Al10 master alloy tape. The current collector was reaction-coated with an electrochemically active Ag2S-CuxS coating. The metallic structure provided a mechanically stable conductive scaffold on the walls of which the Ag2S-CuxS skin material was directly deposited. The ordered porosity - hierarchical and directional - provided easy penetration of the liquid electrolyte as well as short Li+ ion diffusion paths. The as-prepared electrodes were tested in a half-cell configuration vs. Li/Li+ at various current rates to study the cycling and rate performances of the electrode. The first cycling capacity of ∼1250 mA h g-1 was measured at 0.4 A g-1 current rate. After a rapid decrease, a stable reversible capacity of ∼230 mA h g-1 was established at a current rate of 0.4 A g-1 (calculated vs. the weight of the incorporated sulphur). Excellent charge/discharge cycling and rate properties were observed for over 1000 cycles at higher rates of 1.0 and 2.0 A g-1, in the potential window of 0.15-2.8 V vs. Li/Li+. The observed cycling stability was ascribed to the mechanism of a "displacement" reaction with Li ions. Additional capacity is also available from alloying-dealloying with Ag (and Cu to some extent) and S redox reactions. These results open up a new opportunity for using a Cu-Ag alloy as the precursor for making electrodes for thin Li-ion and Li-S batteries with high cycling stability at relatively high current rates.

Influence of TCM 199B, α-MEM, Waymouth MB 752/1 culture media, VEGF, Estradiol-17ß, GDF-9 and FGF on in vitro development of preantral follicles in sheep.

A total of 2792 preantral follicles (PFs') isolated from 750 ovaries of sheep were cultured in four different experiments. The efficacy of three commercially available culture media viz., TCM 199B, α-MEM and Waymouth MB 752/1 on the growth of sheep PFs' was tested in experiment I. Among the three media TCM 199B supported better development of PFs' in culture. The remaining experiments established the best concentrations of vascular endothelial growth factor (VEGF), Estradiol-17ß (E2), GDF-9, Fibroblast growth factor (FGF) and their best combinations for the in-vitro development of PFs'. Inclusion of VEGF at 10 ng/mL, Estradiol-17ß at 5 ng/mL, GDF-9 at 10 ng/mL or FGF at 10 ng/mL individually in a standard medium (SM) (containing FSH, IGF-I, GH and T4) supported better nuclear maturation of the oocytes to MII stage. Different combinations of VEGF, Estradiol-17ß, GDF-9 and FGF supplemented in the SM promoted similar overall follicular growth. However, (a) SM + VEGF(10 ng/mL) + E2(5 ng/mL) supported higher increase in the diameter, (b) SM without any supplements induced antrum formation in greater proportion of follicles, and (c) SM + VEGF(10 ng/mL) + GDF 9(10 ng/mL) or SM + E2 (5 ng/mL) + FGF(10 ng/mL) supported high proportion of oocytes to reach MII stage. To conclude, TCM 199B appeared to be a better medium for development of sheep PFs'. VEGF, Estradiol-17 ß, GDF-9 and FGF have beneficial influence on the development of sheep PFs' when supplemented in TCM 199B.

Long-term in situ moisture conservation in horti-pasture system improves biological health of degraded land.

In situ moisture conservation practices can conserve fertile topsoil and enhance available water in soil profile. We hypothesised that reclaiming degraded land ecologically through tree + pasture + in situ moisture conservation practices would significantly improve soil organic carbon (SOC) and health. Hence, the objectives were a) to identify changes in nutrient cycling enzymes and SOC status due to different in situ soil moisture conservation options in surface and subsurface soil layers, and b) to test the potentiality of soil enzymes to determine long-term nutrient availability. We conducted a long-term experiment involving aonla (Emblica officinalis) trees + pasture (Cenchrus ciliaris + Stylosanthes seabrana) + in situ soil moisture conservation measures viz. staggered contour trenches (T1), continuous contour trenches (T2), stone mulch (T3), vegetative barriers (T4), control (T5) and fallow land (T6) since 2007. Recommended dose of nitrogen (N), phosphorus (P) and potassium (K) were added to all treatments, except T6. SOC concentration increased by ~51 and 31% in T1 and T2, respectively, over T5 in surface (0-15 cm) soil. Culturable bacterial and fungal populations increased by ~20 and 95% in T1 over T5 in surface soil. Activities of all soil enzymes increased in T1 and T2 (ranging from 42 to 289%) over T5 and T6 in both surface and sub-surface (15-30 cm) layers. However, specific activity of phenol oxidase was ~25% lower for T1 than T6, suggesting more efficient SOC sequestration in T1. Moreover, geometric mean enzyme activity of T1 was ~65 and 33% higher than T5 and T3, respectively, in surface soil. Treated soil quality index (T-SQI) of T1 was ~184% higher than T5. Soil functional diversity was also ~1.24 and 1.22 times higher in T1 and T2 than T5, respectively. Peroxidase was the major C degrading enzyme in this ecosystem. Protease, urease and phosphatase significantly influenced N and P availability along with fruit and pasture yields. Importantly, ~96, 62 and 82% variability of SOC, N and P concentrations, respectively, could be attributed to their corresponding enzyme activities. Principal components analysis (PCA) revealed one-way operational role of soil enzymes. Thus, enzymes are potentially important for recycling nutrients from litters, root biomass of fruit trees and grasses to boost their availability in the long run. Adoption of horti-pasture system combined with moisture conservation practices and staggered contour trenches or continuous contour trenches ensured higher above ground biomass yield, SOC, nutrient availability and soil quality. Thus, long-term use of these practices could be recommended for reclamation and improving soil health and crop productivity of degraded lands of central India.

Dental caries experience in relation to body mass index and anthropometric measurements of rural children of Nellore district: A cross-sectional study.

CONTEXT: The relationship between body mass index (BMI) and dental caries consists of multiple contributing factors. There have been no studies documented in the literature in this part of rural India assessing the prevalence of dental caries in relation to BMI. Hence, an attempt was made to study dental caries in relation to BMI and anthropometric measurements. AIMS: The aims were to study dental caries experience in relation to BMI and anthropometric measurements of rural children in Nellore district. SETTINGS AND DESIGN: A descriptive cross-sectional study was carried out in Nellore city. SUBJECTS AND METHODS: A total of 1500 6- and 12-year-old children were examined. Dental caries was examined using the WHO dentition status criteria (1997) and 1-day diet chart was collected from each child followed by collection of anthropometric data. STATISTICAL ANALYSIS USED: Statistical analysis was performed using Chi-square test, Fisher's exact test, and Spearman's correlation test. RESULTS: In the present study, out of all the participants, 59.2% of low weight children, 41.3% of normal weight children, and 25.7% of overweight-obese children were having dental caries. Dental caries was more among low weight children compared to normal weight and overweight-obese children and was statistically significant. CONCLUSIONS: All the anthropometric measurements were positively correlated with dental caries except height for age and BMI for age. There was an inverse graded association between the height for age and BMI for age with dental caries in 6- and 12-year-old children.

Mechanistic studies on the biosorption of Pb(II) by Pseudomonas aeruginosa.

The biosorption of Pb(II) ions from aqueous solution has been studied using both the intact and thermolyzed cells of Pseudomonas aeruginosa. Further, the role of the major cell wall components, namely DNA, protein, polysaccharide, and lipid, in Pb(II) binding has been assessed using an enzymatic treatment method. The Pb(II) bioremediation capability of P. aeruginosa cells has been investigated by varying the parameters of pH, time of interaction, amount of biomass, and concentration of Pb(II). The complete bioremoval of Pb(II) using intact cells has been achieved for an initial Pb(II) concentration of 12.4 mg L-1 at pH 6.2 and temperature 29 ± 1 °C. The biosorption isotherm follows Langmuirian behavior with a Gibbs free energy of -30.7 kJ mol-1, indicative of chemisorption. The biosorption kinetics is consistent with a pseudo-second-order model. The possible Pb(II) binding mechanisms of P. aeruginosa cells are discussed based on characterization using zeta potential measurements, Fourier transform infra-red spectroscopy, and energy dispersive X-ray spectroscopy. The results confirm that among the major cell wall components studied, polysaccharide shows the highest contribution towards Pb(II) binding, followed by DNA, lipid, and protein. Similar studies using thermolyzed cells show higher Pb(II) uptake compared to the intact cells both before and after enzymatic treatment.

Impact of Sense of Coherence on Oral Health among Bus Drivers: A Cross-Sectional Study.

AIM AND OBJECTIVES: To assess the sense of coherence (SOC) and the impact of SOC on oral hygiene behaviors and oral health status among bus drivers in Nellore district, Andhra Pradesh. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted during August-September 2017. Cluster random sampling methodology was used for the selection of drivers. Five depots were randomly selected from the list of various Andhra Pradesh State Road Transport Corporation depots in Nellore district. The estimated sample size was proportionately divided among these five depots of Nellore district (n = 120). The SOC-related data were obtained using short version of Antonovsky's SOC scale. Every item was scored on a Likert scale ranging from 1 to 7. The sum of the scores for SOC was 13-91. A high score indicates a strong SOC. Clinical examination was done for recording oral health status using Oral Hygiene Index-simplified (OHI-S), dental caries, periodontal status, and oral mucosal lesions were recorded according to the WHO criteria 1997. Data were entered and analyzed using SPSS ver. 22 (SPSS Inc., Chicago, IL, USA). RESULTS: Majority of the bus drivers who participated in the study had a low SOC (60%). A significant (P < 0.05) positive correlation was observed with age (r = 0.1420), socioeconomic status (r = 0.1467), and visit to dentist (r = 0.1912). A nonsignificant negative correlation was observed with habits (r = -0.0681), OHI-S (r = -0.0772), dental caries (r = -0.0874), Community Periodontal Index (r = -0.0642), loss of attachment (r = -0.0650), and oral mucosal lesions (r = -0.0542). CONCLUSION: Strong SOC was associated with increase in age, better socioeconomic status, good habits, increased frequency of dental visits, and a good oral health.

Synthesis and characterization of amorphous precipitated silica from alkaline dissolution of olivine.

The high worldwide demand for amorphous precipitated silica (APS) materials, millions of tons worth billions of dollars, makes it worthwhile to further expand the techniques for synthesizing new, cheap, and environmentally friendly resources. In this research, amorphous precipitated silica was synthesized from alkaline dissolution of olivine using a mixture of NaOH and KOH and characterized; this combination resulted in better kinetics than those of the separate components. Experimental parameters (concentration of alkali, liquid/solid ratio, reaction time, and temperature) were optimized to provide maximum recovery of APS from olivine dissolution, which was then characterized using X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM), Brunauer-Emmett-Teller (BET) N2 adsorption-desorption measurements, and thermogravimetric analysis (TGA). The APS possessed suitable morphology for use as an additive in polymers and in catalysis: a particle size below 10 nm, pore width of 5.59 nm, BJH adsorption cumulative pore volume of 0.96 cm3 g-1, BET surface area of 670.8 m2 g-1, and Langmuir surface area of 859.3 m2 g-1. The apparent activation energy of olivine dissolution with a mixture of NaOH/KOH was 43.6 kJ mol-1. The steps involved in creation of APS from olivine resulted in opportunities for carbon dioxide absorption, which could contribute to the production of valuable materials through decarbonation of exhaust gases.

Correction: Synthesis and characterization of amorphous precipitated silica from alkaline dissolution of olivine.

[This corrects the article DOI: 10.1039/C8RA06257A.].

Autogenous Bone Marrow Aspirate Coated Synthetic Hydroxyapatite for Reconstruction of Maxillo-Mandibular Osseous Defects: A Prospective Study.

PURPOSE: This prospective study was conducted to evaluate the bone regeneration capacity of synthetic hydroxyapatite mixed with autogenous bone marrow aspirate when used as a bone graft substitute in maxillo-mandibular osseous defects. METHODS: This study included nine patients with histopathalogically proven benign osteolytic lesions in maxilla and mandible that were treated with enucleation or marginal resection followed by bone marrow aspirate coated synthetic biphasic hydroxyapatite (hydroxyapatite and beta tricalcium phosphate) graft placement. Incorporation of graft was assessed based on Irwin's radiologic staging. The efficacy of graft to form new bone was radiologically evaluated by observing the sequential changes of density at grafted site using gray scale level histogram which was processed in adobe photoshop 7.0 elements. Clinical assessment of recipient and donor sites was done. RESULTS: Based on Irwin's radiologic staging, at 6 month follow up period, obvious incorporation of graft with new bone was observed. Sequential changes in bone density measured by gray scale histogram revealed initial resorption followed by replacement of BMA coated hydroxyapatite with new bone formation. None of the patients eventually had complications like infection, wound dehiscence, graft loss at recipient sites at 6 months follow up period. CONCLUSION: Autogenous bone marrow aspirate in combination with synthetic hydroxyapatite is an effective option for accelerating bone regeneration in small to moderate sized jaw bone defects. This mixture provides all the three critical elements needed for bone regeneration (osteogenesis, osteoinduction and osteoconduction) with an added advantage of obviating donor site morbidity.

Inkjet printing infiltration of Ni-Gd:CeO2 anodes for low temperature solid oxide fuel cells.

ABSTRACT: The effect of inkjet printing infiltration of Gd0.1Ce0.9O2-x in NiO-Gd0.1Ce0.9O2-x anodes on the performance of symmetrical and button cells was investigated. The anodes were fabricated by inkjet printing of suspension and sol inks. Symmetrical cells were produced from composite suspension inks on Gd0.1Ce0.9O2-x electrolyte. As-prepared scaffolds were infiltrated with Gd0.1Ce0.9O2 ink. Increasing the number of infiltration steps led to formation of "nano-decoration" on pre-sintered anodes. High resolution SEM analysis was employed for micro-structural characterization revealing formation of fine anode sub-structure with nanoparticle size varying in the range of 50-200 nm. EIS tests were conducted on symmetrical cells in 4% hydrogen/argon gas flow. The measurements showed substantial reduction of the activation polarization as a function of the number of infiltrations. The effect was assigned to the extension of the triple phase boundary. The i-V testing of a reference (NiO-8 mol% Y2O3 stabilized ZrO2/NiO-Gd0.1Ce0.9O2-x /Gd0.1Ce0.9O2-x /Gd0.1Ce0.9O2-x -La0.6Sr0.4Co0.2Fe0.8O3-δ ) cell and an identical cell with infiltrated anode revealed ~2.5 times improvement in the maximum output power at 600 °C which corresponded with the reduction of the polarization resistance of the symmetrical cells at the same temperature (2.8 times). This study demonstrated the potential of inkjet printing technology as an infiltration tool for cost effective commercial SOFC processing.

Infiltration of commercially available, anode supported SOFC's via inkjet printing.

Commercially available anode supported solid oxide fuel cells (NiO-8YSZ/8YSZ/LSCF- 20 mm in diameter) were anode infiltrated with gadolinium doped ceria (CGO) using a scalable drop-on-demand inkjet printing process. Cells were infiltrated with two different precursor solutions-water based or propionic acid based. The saturation limit of the 0.5 µm thick anode supports sintered at 1400 °C was found to be approximately 1wt%. No significant enhancement in power output was recorded at practical voltage levels. Microstructural characterisation was carried out after electrochemical performance testing using high resolution scanning electron microscopy. This work demonstrates that despite the feasibility of achieving CGO nanoparticle infiltration into thick, commercial SOFC anodes with a simple, low-cost and industrially scalable procedure other loss mechanisms were dominant. Infiltration of model symmetric anode cells with the propionic acid based ink demonstrated that significant reductions in polarisation resistance were possible.

Performance optimization of LSCF/Gd:CeO2 composite cathodes via single-step inkjet printing infiltration.

ABSTRACT: The effect of solid oxide fuel cell cathode microstructure modification on its electrochemical activity is investigated. Inkjet printing infiltration was used to develop a nano-decoration pattern on the composite cathode scaffolds. Two types of composite La0.6Sr0.4Co0.2Fe0.8O3-δ:Ce0.9Gd0.1O1.9 cathodes with different volume ratios (60:40 and 40:60 vol%) were fabricated using inkjet printing of suspension inks. The electrodes were altered by single-step inkjet printing infiltration of ethanol-based Ce0.9Gd0.1O1.9 ink. After heat treatments in air at 550 °C the cathodes' surfaces were shown to be nano-decorated with Ce0.9Gd0.1O1.9 particles (~20-120 nm in size) dispersed uniformly onto the electrode scaffold. The nano-engineered microstructure enhanced the active triple phase boundary of the electrode and promoted the surface exchange reaction of oxygen. Electrochemical impedance tests conducted on symmetrical cells showed a reduction in the polarization resistance of between 1.3 and 2.9 times. The effect was found to be more pronounced in the 60:40 vol% composite cathodes. Ageing of infiltrated electrodes up to 60 h in air revealed enhanced stability of gadolinium doped ceria nanoparticles decorated electrodes ascribed to the suppression of SrO surface segregation. This work demonstrated that single-step inkjet printing infiltration can produce reproducible performance enhancements and thus offers a cost-effective route for commercial solid oxide fuel cell infiltration processing.

A retrospective cohort study of perioperative prognostic factors associated with intra-abdominal sepsis.

CONTEXT: Intra-abdominal sepsis following laparotomy for acute abdomen remains still a challenging condition. The understanding of various perioperative risk factors by anesthesiologists are crucial in optimum management these patients. AIMS: The objective of this study is to assess the perioperative risk factors, which predicts the outcome of treatment. SETTINGS AND DESIGN: This retrospective observational study of 603 patients who underwent Laparotomies between March 2012 and March 2015 at our University Medical College. Of 603 patients, 52 consecutive patients with intra-abdomen sepsis who underwent surgical procedures and admitted in Intensive Care Unit (ICU) were selected and analyzed for prognostic risk factors in relation to severity of the disease. SUBJECTS AND METHODS: 52 consecutive patients who developed intra-abdominal sepsis following laparotomy was allocated one of two groups; Group Sepsis, patients with peritonitis without systemic hypotension (mean arterial pressure [MAP] >60 mm of Hg); and Group septic shock, patients with peritonitis with systemic hypotension (mean arterial pressure [MAP] <60 mm of Hg) and patients were analyzed for prognostic risk factors. STATISTICAL ANALYSIS USED: Categorical variables were analyzed by using Fisher's exact (two-tail) test and continuous variable were analyzed by using Mann-Whitney (two-tail) U-test. RESULTS: Out of 603 patients who underwent laparotomy 52 patients developed an intra-abdominal septic complication. Of these 52 cases studied 28 patients developed septic shock and required a longer duration of admission in ICU and more inotropic support. Preoperative albumin and hematocrit level were significantly low in septic shock patients as compared to the patients with sepsis without systemic hypotension. PaCO2: FiO2 was also significantly low in these patients. CONCLUSIONS: Preoperative low hematocrit, low albumin level, and delay in laparotomy more than 72 h were also associated with adverse outcome in the patients with intra-abdominal sepsis. Clinicians should maintain equipoise on this topic pending prospective randomized clinical trials.

Plasmablastic lymphoma of the gastrointestinal tract: A rare entity with a dismal prognosis.

INTRODUCTION: Plasmablastic lymphoma (PBL) is a rare and aggressive type of mature B-cell lymphoma, which is usually associated with HIV infection. The most common site of PBL is the oral cavity. Involvement of the gastrointestinal (GI) tract is rare, and literature is limited to few case reports and case series. AIMS: To retrospectively analyze the presentation, clinical findings, and outcome of patients presenting to our institute with a diagnosis of PBL involving the GI tract. MATERIALS AND METHODS: A retrospective observational study was conducted at our institute from February 2008 to January 2015 on consecutive patients presenting with PBL involving the GI tract. The data were compared to various case reports and series published in peer-reviewed journals. RESULTS: There were four patients diagnosed with PBL of the GI tract; three male and one female. The location of involvement was in the stomach, ileocecal junction, ascending colon, and rectum. Only one patient was HIV-positive and was on combination antiretroviral therapy since 2 years. Among the three immunocompetent patients, only one survived with therapy; however, the patient relapsed within 6 months of completion of treatment. CONCLUSION: PBL was seen to have a uniformly aggressive clinical course with poor outcomes even with optimal treatment. The prognosis of immunocompetent patients appears to be worse than that of HIV-AIDS patients. Although the most common histologies seen with GI lymphomas are mucosa-associated lymphoid tissue type lymphomas or diffuse large B-cell lymphoma, rarer and more aggressive histologies like PBL need to be kept in mind.

Faciomaxillary fractures in a Semi-urban South Indian Teaching Hospital: A retrospective analysis of 638 cases.

BACKGROUND AND OBJECTIVE: The incidence of maxillofacial trauma is increasing at a very fast pace in developing countries like India and poses a major health burden. Hence, the epidemiological data of maxillofacial trauma during a 6 year period, was analyzed to study the characteristics, factors predisposing, and aid in advocating strict guidelines to prevent the same. MATERIALS AND METHODS: Data related to 638 cases with maxillofacial trauma, from January 2008 to December 2014 were reviewed retrospectively and the data regarding gender, age, etiology, anatomic location of fracture, alcohol consumption, associated head and other injuries, modality of treatment rendered and associated complications were analyzed with descriptive statistics. RESULTS: A total of 638 patients presenting with 869 maxillofacial fractures were analyzed. Most of them [344 (53.9%)] were young adults aged 18-40, whereas, 123 (19.2%) were 11 to 17 years, and 97(15.2%) adults. Men (79.4%) were more affected than women. Road traffic accidents remain the main etiology causing fractures in 470 (73.6%), whereas 397 (62.2%) had history of consumption of alcohol. Those with alcohol intoxication had multiple injuries. Mandible was more frequently involved with 360 (41.4%) fractures, and condyle being the most common site. A total of 374 (58.6%) underwent open reduction with internal fixation under general anesthesia. Prevalence of other injuries was noted in 207 (32.4%) and complications of fracture treatment in 41(6.4%) cases. CONCLUSION: Road traffic accidents under alcohol influence were most commonly associated with comminuted facial fractures with head injuries, frequently leading to death. Mandible was the most commonly fractured facial bone followed by zygoma.