Comparative efficacy of quadratus lumborum type-II and erector spinae plane block in patients undergoing caesarean section under spinal anaesthesia: a randomised controlled trial.

BACKGROUND: Quadratus lumborum and erector spinae plane blocks have been used to provide analgesia in patients undergoing thoracic or abdominal surgeries. Our study compared the analgesic efficacy of the quadratus lumborum type-II block (QLB-II) and the erector spinae plane block (ESPB) in parturients who underwent caesarean section under spinal anaesthesia. METHODS: Fifty-two patients with comparable demographic profiles were randomised into two groups, QLB-II (n = 26) and ESPB (n = 26). After the surgery, patients received either ultrasound-guided QLB-II or ESPB using 0.25% bupivacaine 0.3 mL/kg. Comparison of analgesic efficacy was in terms of fentanyl consumption (primary outcome), pain scores, incidence of complications in the 24-h postoperative period, and quality of recovery (QoR-15) on postoperative days one and two, and day of discharge. RESULTS: There was no significant difference in cumulative number of fentanyl doses (W = 349.000, P = 0.840), numerical rating score at rest (P = 0.648) or with movement (P = 0.520), QoR-15 scores on postoperative day one (P = 0.549), day two (P = 0.927) or day of discharge (P = 0.676). CONCLUSION: We concluded that patients who underwent QLB-II or ESPB reported similar analgesic efficacy, complications, and quality of recovery in the postoperative period.

"There is more than what meets the eye" - Extensive spinal tuberculosis presenting as ocular tuberculosis.

Ocular tuberculosis (OTB) is a rare form of extrapulmonary Tuberculosis (EPTB) and a rare presenting feature of tuberculosis (TB) in children. We report such a case in a 3-year-old boy who presented with a painless swelling over left upper eyelid. Mycobacterium tuberculosis bacilli were isolated from the swelling by a Fine Needle Aspiration Cytology (FNAC) which confirmed the diagnosis. Investigating him for the extent of disease, we found him to have intracranial extension to involve the ethmoid sinus on contrast enhance Computed Tomography and Pott's disease causing a compression fracture of L3 with bilateral paravertebral collection, epidural extension and a left psoas abscess on Magnetic Resonance Imaging. After starting antitubercular therapy, the child is doing well and on regular follow up. We are presenting this case to highlight the fact that extensive spinal tuberculosis can present without any neurological deficit and may even present only as a benign looking orbital swelling.

Low energy electron and positron impact differential cross sections for the ionization of water molecules in the coplanar and perpendicular kinematics.

We report here triply differential cross sections (TDCSs) for 81 eV electron and positron-impact ionization of the combined (1b1 + 3a1) orbitals of the water molecule by using the second-order distorted wave Born approximation (DWBA2) for ejection electron and positron energies of 5 eV and 10 eV and different momentum transfer conditions. The electron-impact TDCS will be compared with the experimental data measured by Ren et al. [Phys. Rev. A 95, 022701 (2017)] and with the molecular 3-body distorted wave (M3DW) approximation results in the scattering plane as well as the perpendicular plane. The DWBA2 results are in better agreement with the experiment than the M3DW results for the scattering plane, and the M3DW results are somewhat better for the perpendicular plane. This observation is explained in terms of collision interactions. The electron and positron TDCSs are indistinguishable in the scattering plane. In the perpendicular plane, the positron results are similar in shape, but smaller in magnitude. However, the difference reduces with increasing projectile scattering angle and increasing ejected electron energy.

Dependence of electron impact differential cross sections on the ionic charge to radius ratio for the Al3+(2p) and Be2+(1s) ions.

The triple differential cross sections (TDCSs) have been obtained for the electron impact ionization of ionic targets, Al3+(2p) and Be2+(1s), having nearly the same ratio of ionic charge to radius. In the first of this kind of study, the trends of cross sections have been found to match to a greater extent despite ionization taking place from the ionic targets having considerable difference in nuclear charges as well as the ionization taking place from different types of orbitals, p-orbital and s-orbital. The trends of TDCSs have not been found to agree considerably for the neutral Al (3p) and Be (2s) targets.

Real time PCR expression analysis of gene encoding p5cs enzyme and proline metabolism under NaCI salinity in rice.

Regulation of proline accumulation in seedlings of rice (Oryza sativa L. cv. Lunishree) was investigated. The increasing concentration of NaCl from 85 mM to 425 mM NaCl progressively increased proline content in rice. The maximum increase in proline content was recorded at 425 mM NaCl concentration as compared to control and other concentrations of NaCl. The highest significant activity of proline synthesizing enzymes, delta1-Pyrrolline-5-carboxylate synthetase, delta1-Pyrrolline-5-carboxylate reductase and Ornithine-δ- aminotransferase with lowest activity of proline hydrolysis enzymes;Proline dehydrogenase was also recorded at 425 mM NaCl salinity over control and other concentrations of NaCI with insignificant increase in the activity of delta1-Pyrrolline-5-carboxylate synthetase and Ornithine-δ-aminotransferase at 85 mM NaCI over control. It was found that the transcript of gene encoded with p5cs is up regulated about 1.35 folds under salinity stress. This gene synthesis an osmo protectant to help the plant resist the change in osmotic imbalances. Externally addition of MnCl2 at 300 mg/220 ml 1/2 strength Hoagland solution, having 1% NaCI, was also seen to increase 893.9% proline content of this variety as compared to control.

Prevalence of Obesity in Medical students and its correlation with cardiovascular risk factors: Emergency Alarm for Today?

Background It is predicted that the prevalence of overweight and obesity will rise significantly by 2015 in young population. Problem of overweight and obesity has been recognized as public health problem worldwide due to the fact that it increases the risk of chronic diseases such as Cardiovascular Diseases (CVD), stroke, diabetes, sleep apnoea, osteoarthritis etc. Objective To assess the body mass index in medical students and its association with various cardiovascular risk factors like blood pressure, dietary habits, and family history of cardiovascular diseases. Method A university based cross-sectional analytical study was conducted in Department of Physiology, Smt. B.K. Shah Medical Institute and Research Center, Vadodara, Gujarat. Data was collected through convenient sampling technique by using selfadministered questionnaire followed by anthropometric measurement. Body Mass Index (BMI) of 138 first year medical students was assessed. Systolic blood pressure, diastolic blood pressure, pulse pressure, mean blood pressure, pulse rate and arterial oxygen saturation were measured. Result Data was compiled in excel sheet, analyzed for percentage and proportion. Chi square and Pearson correlation test were also applied and alpha error was set at 5% level. In comparison to the students with normal BMI, students with BMI >25 kg/m2 (N=49) showed significantly high blood pressure indices. Dietary habits and family history of cardiovascular diseases were also noted. Highly significant association of high BMI was found with elevated blood pressure (X2=7.4042***, p<0.001) and presence of family history of cardiovascular diseases X2=9.8625***, p<0.001). BMI is negatively correlated with SpO2 (r= -0.0504, p<0.05) and pulse rate, while positively correlated with systolic blood pressure (r=0.2736) and diastolic blood pressure (r=0.0275). Conclusion In conclusion, majority (more than 35%) of medical students were overweight, high prevalence of cardiovascular risk factors like family history, elevated blood pressure and less SpO2.

Efficiency of hysteroscopic visualization of bubaline uterus.

Abattoir derived buffalo genitalia (n=98) were evaluated for uterine pathology employing palpable, ultrasonographic and hysteroscopic visualization. A high proportion (45.92%) of genitalia evidenced uterine pathology including endometritis (14.29%), pyometra (7.14%), hemorrhages in the endometrium (14.29%) and mucometra (6.12%). The sensitivity and specificity of hysteroscopy was 100% for endometritis and hemorrhages whereas for same conditions ultrasonography and palpation had low sensitivity and specificity. For pyometra and mucometra the sensitivity and specificity of ultrasonography and hysteroscopy was similar. It was concluded that for the diagnosis of minor pathological changes in the uterus such as endometritis and hemorrhages which can hamper fertility hysteroscopy is more efficient technique.

Occurrence and surgical repair of third degree perineal lacerations in adult female camels (Camelus dromedarius) by one-stage (Goetz) technique.

Retrospective analysis of third degree perineal lacerations in 7 female camels (6-17 yrs of age) that were surgically corrected by one stage repair (Goetz technique) is presented. Majority (3/7) of the camels was primiparous and all parturitions had a history of calving assistance. Six (6/7) camels recovered by first intention of healing. Dehiscence of perineal structure occurred in only one camel due to infection and healed by second intention. Subsequent matings resulted in pregnancy in four camels and one camel died due to unrelated causes. We conclude that perineal lacerations can occur in primiparous camels with difficult assisted deliveries and that one stage repair of perineal lacerations in camels improves the perineal conformation and such camels may easily regain normal fertility.

Sonographic monitoring of early follicle growth induced by melatonin implants in camels and the subsequent fertility.

The present study examined the effect of melatonin implants on follicle growth in dromedary camels two months ahead of their natural breeding season (December to March). Female camels (n = 6) were treated with melatonin implants at the dose rate of 1 implant per 28 kg body weight sc. Control camels (n = 6) were administered an SC placebo implant of 8 ml vitamin A. Ovarian ultrasonography was performed at weekly interval upto 7 weeks. Camels were mated with virile stud when a follicle (≥10 mm) was visible on either of the ovaries. Blood was collected on day 7, 9, 15, 20, 25 and 30 for assay of plasma progesterone and sonography performed at the same time. Small follicles (2-3 mm) appeared around the periphery of ovaries in 83.3% of camels by day 7 and in 100% camels by day 14. By the end of 7th week an ovulatory size follicle (≥1.0 cm) could be observed in 83.3% of treated camels, and these camels were mated with virile studs. In control group, small follicles appeared at the periphery of ovaries only in 66.6% camels but did not progress in growth except in one camel (16.6%) however, ovulating size (≥10 mm) follicle was not observed in any camel by the end of 7th week. All treated camels ovulated and one treated camel became pregnant while early embryonic death occurred in one camel. Non-pregnant camels of both groups were mated during the breeding season. All camels of treatment group and 33.33% camels of control group became pregnant by the end of breeding season (April 2010). It was concluded that melatonin implants can augment the follicle growth in lactating camels ahead of the breeding season and pregnancy can occur on mating. Fertility of treated camels during the breeding season is improved.

Ankyloglossia and its surgical correction by frenuloplasty in a she-camel calf (Camelus dromedarius).

A rare case of ankyloglossia in a one-humped camel and its successful surgical correction by horizontal to vertical frenuloplasty is reported. Seven-month-old she-camel calf, with a history of excessive salivation and inability to chew and swallow hay, was referred to Al Qattara veterinary hospital. Solid food was regurgitated, whereas milk and water could be swallowed. On examination; the animal could not protrude its tongue which was attached by a thin tissue band between the ventral surface of the tongue and the floor of the oral cavity. The tissue band was corrected by frenuloplasty and the incisions were sutured. The animal recovered well as the salivation and regurgitation stopped and the animal became able to chew and swallow solid food including hay. It was concluded that ankyloglossia can occur in one-humped camel in which a horizontal to vertical frenuloplasty may improve full function of tongue movement.

Rare congenital absence of tail (anury) and anus (atresia ani) in male camel (Camelus dromedarius) calf.

A one-day old male camel calf was presented to the Al-Qattara Veterinary Hospital with complaints of abdominal straining and lack of defecation. On examination it was found that the calf had no tail, the posterior sacral margin was blunt and the anal opening was absent. The case was diagnosed as congenital anury with atresia ani. The animal was sedated with 0.1 mg/kg of xylazine administered intramuscularly and under local infiltration with 2% lidocaine a circular incision was made at the anal area to create an anal opening. The animal passed plenty of meconium. The cut edges were sutured with horizontal mattress sutures. The animal was administered penicillin and streptomycin for 5 days and had an uneventful recovery. It is reported that congenital anury rarely occurs in one humped camel and accompanied atresia ani can be surgically treated.

Cutaneous horn following injury to pinna.

Cutaneous Horn of the pinna is a relatively uncommon entity. Most of the cases reported in literature have been caused due to prolonged exposure to sunlight but in this case the cutaneous horn has been caused due to injury to the pinna with wheat sheaf.

Leiomyoma arising from septum of nose.

Leiomyomas are benign tumours which are presumed to arise from vascular smooth muscle in the nasal cavity. They are rare in nasal cavity but are commonly encountered in GIT, female genital tract (uterus). The rarity of these tumours in nasal cavity is evident from the fact that less than 45 cases have been reported till date. We report a 45 years old male with Leiomyoma of the nasal cavity with brief review of literature.

Anterior abdominal wall reconstruction with a Permacol implant.

Laparostomy wound management is a difficult problem especially with a stoma and the potential risk of infection. A case describing the use of a permanent porcine dermal collagen implant in the repair of a massive ventral hernia, in a patient with a large post-laparostomy defect and colostomy is outlined. The implant was not rejected, and after 12 months, there was no evidence of residual or recurrent hernia. The search for the ultimate biomaterial for reconstructing abdominal wall defects is ongoing. Collagen based implants appear to have many of the requirements that an ideal material should possess.

Influence of epidermal growth factor and insulin-like growth factor 1 on nuclear maturation and fertilization of buffalo cumulus oocyte complexes in serum free media and their subsequent development in vitro.

The in vitro maturation, fertilization and development of Indian water buffalo (Bubalus sp.) cumulus oocyte complexes (COCs) to blastocysts were studied during culture, either in serum free tissue culture medium 199 (TCM 199) or Waymouth MB (WM). Based on different supplements added to these media, the experimental groups included: (a) no supplement (control); (b) hormones (FSH, LH and oestradiol) (c) Epidermal growth factor (EGF); (d) IGF-1; and (e) EGF + IGF-1. Experiments were conducted to note three end points: (1) nuclear maturation 24 h after culture (eight replicates); (2) fertilization 24 h after insemination (10 replicates); (3) development to blastocysts (nine replicates). The oocytes were cultured in groups of up to five per drop. Using a two-way (5 x 2) factorial model with interactions, the results were compared using generalized linear models with binomial errors and the logit link function. In experiment 1, the proportion of oocytes reaching metaphase II was higher for all the supplement treatments than the control treatment (t = 3.68, p < 0.0001). The proportion of oocytes reaching metaphase II was 74.7, 63.2, 64.7 and 81% with hormone (chi2 = 17.23, p < 0.0001), EGF (chi2 = 7.07, p = 0.007), IGF-1 (chi2 = 19.21, p = 0.002) and EGF + IGF-1 (chi2 = 33.04, p < 0.0001) supplementation, respectively, compared to 46.6% in the control (no supplement) group. Media did not have an effect on outcome. In experiment 2, the proportion of oocytes fertilized was significantly higher with hormones (31.0%, chi2 = 12.5, p = 0.0004), IGF-1 (35.7%, chi2 = 20.53, p < 0.0001), and the EGF + IGF-1 combination (49.7%, chi2 = 51.35, p < 0.0001) compared to control (16.2%). No significant effect of media was seen. In experiment 3, the proportion of oocytes that cleaved at 48 h after culturing was significantly higher for all supplement treatments compared to control. IGF-1 supplementation was the only treatment that did not produce a significantly higher rate of progression to blastocysts compared to the control. Once again, media had no effect on outcome. It was concluded that maturation, fertilization and development of buffalo oocytes were enhanced by all supplements tested. Enhancement was maximal with the combination of EGF+IGF-1. In contrast, no significant differences were found between the two types of media used.

Successful surgical removal of fibroma from the uterus of a cow: a case report.

A Holstein-Friesian cow aged 6 years aborted twice at 3-4 months of gestation. On rectal palpation a growth was palpable in the apex of one uterine horn. The growth was removed by right flank laparotomy under sedation and paravertebral nerve block. The growth was diagnosed to be a fibroma. The cow conceived and calved normally after the operation.

Ultrasonographic evaluation of uterine involution and postpartum follicular dynamics in French jennies (Equus asinus).

Uterine involution and follicular dynamics during postpartum period were studied ultrasonographically in French jennies. For the study of uterine involution in postpartum jennies (n = 6, Group S), sonographic measurements of different parts of the uterus and endometrium were made at three-day interval, starting from the day of foaling and continued up to 33 days postpartum. Uterine dimensions were also recorded in non-pregnant jennies (n = 3, Group C) throughout a cycle and compared with the dimensions of Group S jennies observed on the day of complete involution. Follicular dynamics of first and second postpartum ovulatory cycles were studied and compared with that of the single estrous cycle of Group C jennies. Jugular venous blood samples of Group S jennies were collected at weekly intervals for 49 days, commencing at the appearance of first preovulatory follicle, to support the sonographic findings. The average involution period was 22.5 +/- 1.7 days. However, it was significantly delayed (P < 0.05) in jennies which came into first postpartum ovulatory heat within Day 9 than those who came later (25.0 +/- 1.0 versus 20.0 +/- 1.0). The endometrial layer was not discernible beyond Day 15 postpartum and thus was found to be unreliable index of uterine involution. The follicular growth rate (mm per day) and diameter (mm) of preovulatory follicle in postpartum jennies were similar to that in normal cycling jennies (P > 0.05). The first and second ovulations occurred at 14.6 +/- 0.8 and 39.0 +/- 0.8 days postpartum in Group S jennies. All the corpora lutea, either echogenic or centrally non-echogenic were functionally similar and had similar life span (P > 0.05). In conclusion, the postpartum reproductive events related to uterine involution and ovarian cyclicity apparently resemble that of mares.

Use of vaginal electrical resistance (VER) to predict estrus and ovarian activity, its relationship with plasma progesterone and its use for insemination in buffaloes.

In three experiments we studied the baseline and changes in VER during different natural estrous cycle stages (n=146) in ovarian structures and in plasma progesterone during estrus induced by prostaglandin injection (n=16) and the VER at insemination (n=90) in an attempt to predict estrus, ovulation and the best VER range for inseminating buffaloes for optimum conception. The baseline VER was classified on the basis of ovarian findings and estrous cycle stages. The mean VER during estrus, metestrus, diestrus, proestrus and anestrus was 32.68 +/- 0.46, 41.26 +/- 1.17, 50.23 +/- 0.55, 43.20 +/- 0.64 and 55.86 +/- 0.57 ohms, respectively. There was a significant difference (P<0.01) between the VER except those between metestrus and proestrus. The ANOVA for VER over estrous cycle stages showed a highly significant (P<0.01) effect of stage of estrous cycle on VER in buffaloes. The percent decrease in VER was more pronounced from diestrus to estrus. In the second part of the study plasma progesterone profiles and the appearance of estrus in buffaloes induced to estrus using two dose schedules and routes of PGF2alpha administration showed that luteolysis and estrus induction was slower in the 10 mg i.v.s.m. route (Intra Vulvo Submucosal) (only 60% animals evinced estrus in 48 to 72 hours) as compared to the 25 mg i.m. route (83.33% evidenced estrus in 48 to 72 hrs). Fall in plasma progesterone was synchronous to a fall in VER, the correlation (0.65) between them being positive and significant (P<0.01). After ovulation the VER started rising, showing a distinct relationship between VER and ovulation. By using VER, an additional 36.6% of the buffaloes could be detected in estrus. In the third part of the study, insemination of buffaloes induced to estrus (n=11) and normal-estrus buffaloes (n=79) showed that the overall conception rates to single insemination when the buffaloes were inseminated at the VER range of 26 to 30, 31 to 35 and 36 to 40 ohms were 81.48, 58.97 and 16.66%, respectively. Buffaloes showing VER from 31 to 35 ohms and 36 to 40 ohms also evidenced atypical and Null fern pattern in the cervicovaginal mucus. The study proved that VER can be used successfully to predict the stage of estrous cycle, ovarian status and ovulation; and insemination at a low VER distinctly improves the conception rates in buffaloes.