Feature-based multimodal registration framework for vertebral pose estimation.

PURPOSE: The reliable estimation of the vertebral body posture helps to aid a safe and effective spine surgery. The proposed work aims to present an MR to X-ray image registration to assess the 3D pose of the vertebral body during spine surgery. The 3D assessment of vertebral pose assists in analyzing the position and orientation of the vertebral body to provide information during various clinical diagnosis conditions such as curvature estimation and pedicle screw insertion surgery. METHODS: The proposed feature-based registration framework extracted vertebral end plates to avoid the mismatch between the intensities of MR and X-ray images. Using the projection matrix, the segmented MRI is forward projected and then registered to the X-ray image using binary image matching similarity and the CMA-ES optimizer. RESULTS: The proposed method estimated the vertebral pose by registering the simulated X-ray onto pre-operative MRI. To evaluate the efficacy of the proposed approach, a certain number of experiments are carried out on the simulated dataset. CONCLUSION: The proposed method is a fast and accurate registration method that can provide 3D information about the vertebral body. This 3D information is useful to improve accuracy during various clinical diagnoses.

Perioperative Anxiety and Stress in Children Undergoing Congenital Cardiac Surgery and Their Parents: Effect of Brief Intervention-A Randomized Control Trial.

OBJECTIVE: To know the effects of psychological preparation on perioperative stress, anxiety, and mood in children undergoing cardiac surgery and their parents. DESIGN: Prospective randomized control nonblinded trial. SETTING: Single-center tertiary teaching hospital. PARTICIPANTS: A total of 60 children aged 5 to 15 years undergoing cardiac surgery were included in the study. One of the parents, preferably the father, was selected from the respective children. INTERVENTIONS: Subjects were randomized into 2 groups: noninterventional (group 1) and interventional (group 2). Intervention was in the form of toys and video games in children, and counseling and information in parents. Preoperative and postoperative anxiety in parents was measured using the State-Trait Anxiety Inventory (STAI), stress using the Index of Clinical Stress (ICS) scale by Abell, and the Ottawa mood scale. In children, the STAI-C (child version of STAI), Ottawa mood and Ottawa stress scales, and Wong-Baker faces pain scale were applied and serum cortisol was measured. MEASUREMENTS AND MAIN RESULTS: Group 2 children had significantly less (p < 0.001) stress, anxiety, and pain and improved mood. Group 2 parents had a significant reduction in state anxiety (42 ± 4.4 v 54.5 ± 7.8; p < 0.001) and ICS score (68.1±9.6 v 84.2 ± 9.2; p < 0.001) and an improvement in mood (7.5 ± 0.7 v 5.9 ± 1; p < 0.001) compared with group 1. Postoperatively, cortisol levels in group 2 were lower than group 1 (571.3 nmol/L [123.3 -1247.14] v 718.9 nmol/L [53-1642.0]). CONCLUSION: Providing video games and toys preoperatively reduced postoperative stress and anxiety and improved mood in children undergoing congenital cardiac surgery. Parents were relieved of anxiety and stress with proper counseling and information.

Transcutaneous nerve stimulation for pain relief during chest tube removal following cardiac surgery.

BACKGROUND AND AIMS: In patients undergoing open heart surgery, chest tubes are removed postoperatively when patients are well awake and stable. Pain during chest tube removal can be moderate to severe and can be the worst experience of hospitalization. Various modalities of pain relief during chest tube removal have been tried with variable results. We sought to examine the effect of transcutaneous electrical nerve stimulation (TENS) as an intervention for pain relief during chest tube removal after cardiac surgery. MATERIAL AND METHODS: In a tertiary care center, fifty patients undergoing open heart surgery were randomized into two groups. Group TENS (n = 25) received TENS from 30 min before and continued up to 30 min after chest tube removal. Control Group (n = 25) did not receive TENS. In both the groups, additional analgesic medication was provided on demand, besides the standard analgesic regime which was injection ketorolac 30 mg intramuscularly every 8 h. Patients were studied for pain during chest drain removal and pain related nausea, vomiting, and sense of well-being. RESULTS: Mean visual analog pain score assessed for chest tube removal was significantly less 4.1 ± 1.2 (P < 0.05) in TENS Group as compared to 6.1 ± 0.8 in Control Group. Significantly greater number of patients (n = 14) (P < 0.05) in Control Group demanded additional analgesia as compared to TENS Group (n = 5). Feeling of well-being, improvement in appetite, and sleep was better in TENS Group as compared to Control Group. CONCLUSION: We conclude that TENS might not replace the conventional analgesics but has definite adjuvant role in decreasing pain scores and improves sense of well-being during chest tube removal after cardiac surgery.

Assessment of Changes in Hemodynamics and Intrathoracic Fluid Using Electrical Cardiometry During Autologous Blood Harvest.

OBJECTIVE: To evaluate the effect of autologous blood harvest (ABH)-induced volume shifts using electrical cardiometry (EC) in patients with pulmonary artery hypertension secondary to left heart disease. DESIGN: Prospective, randomized, controlled trial. SETTING: A tertiary care hospital. PARTICIPANTS: The study comprised 50 patients scheduled to undergo heart valve replacement. INTERVENTIONS: Patients were divided randomly into 2 experimental groups that were distinguished by whether ABH was performed. Blood volume extracted in the test group was replaced simultaneously with 1:1 colloid (Tetraspan; B Braun Melsungen, Melsungen, Germany). Hemodynamic, respiratory, and EC-derived parameters were recorded at predefined set points (T1 [post-induction/pre-ABH] and T2 [20 minutes post-ABH]). MEASUREMENTS AND MAIN RESULTS: Withdrawal of 15% of blood volume in the ABH group caused significant reductions in thoracic fluid content (TFC) (-10.1% [-15.0% to -6.1%]); right atrial pressure (-23% [-26.6% to -17.6%]); mean arterial pressure (-12.6% [-22.2% to -3.8%]); airway pressures: (peak -6.2% [-11.7% to -2.8%] and mean -15.4% [-25.0% to -8.3%]); and oxygenation index (-10.34% [-16.4% to -4.8%]). Linear regression analysis showed good correlation between the percentage change in TFC after ABH and the percentage of change in right atrial pressure, stroke volume variation, autologous blood extracted, peak and mean airway pressures, and oxygen index. CONCLUSIONS: In addition to its proven role in blood conservation, therapeutic benefits derived from ABH include decongestion of volume-loaded patients, decrease in TFC, and improved gas exchange. EC tracks beat-to-beat fluid and hemodynamic fluctuations during ABH and helps in the execution of an early patient-specific, goal-directed therapy, allowing for its safe implementation in patients with pulmonary hypertension secondary to left heart disease.

Echocardiographic Predictors of Immediate Postoperative Outcomes in Patients With Severe Left Ventricular Systolic Dysfunction Undergoing On-Pump Coronary Artery Bypass Grafting.

OBJECTIVES: The postoperative course following on-pump coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) systolic dysfunction is often unpredictable. Therefore, the aim of this study was to identify predictors of poor postoperative outcome in this subset of patients. DESIGN: Prospective observational study SETTING: Single university hospital PARTICIPANTS: Forty patients with severe LV systolic dysfunction undergoing isolated on-pump CABG INTERVENTIONS: None MEASUREMENTS AND MAIN RESULTS: Comprehensive transesophageal echocardiographic examination was performed to obtain the indices of systolic and diastolic LV function after induction of anesthesia. A poor postoperative outcome was defined as patient death or vasoactive inotropic score≥20 for at least 6 hours and/or requiring intra-aortic balloon counterpulsation and/or mechanical ventilation for≥24 hours. Poor postoperative outcome was observed in 40% (16/40) of patients. Patients with poor postoperative outcomes had a significantly higher systolic dyssynchrony index, septal-lateral delay with a significantly lower global longitudinal strain and isovolumic acceleration, end-diastolic volume, end-systolic volume, and lateral and medial mitral annulus systolic velocity. In a binary logistic regression model, global longitudinal strain (odds ratio, 1.5, confidence interval [CI] 95%, 1.19-1.88, p = 0.001), septal-lateral delay (odds ratio, 1.02, 95% CI, 1.01-1.03; p = 0.001) and systolic dyssychrony index (odds ratio, 1.3, 95% CI, 1.13-1.48; p = 0.000) were found to be predictors of poor postoperative outcome. CONCLUSION: Global longitudinal strain, systolic dyssynchrony index, and septal-lateral delay were reliable and accurate predictors of adverse outcomes in patients with severe LV systolic dysfunction undergoing on-pump CABG.

Echocardiographic Assessment of the Alterations in Pulmonary Blood Flow Associated with Ketamine and Etomidate Administration in Children with Tetralogy of Fallot.

BACKGROUND: Despite widespread uses of ketamine, the clinical studies determining its effect on pulmonary blood flow in children with tetralogy of Fallot (TOF) are lacking. Furthermore, the quantification of pulmonary blood flow is not possible in these patients, because pulmonary artery catheter is contraindicated. Therefore, the purpose of this study was to evaluate the changes in pulmonary blood flow by intra-operative transesophageal echocardiography after ketamine or etomidate administration in children with TOF. METHODS: Eleven children each in the two clinical variants of TOF (group A-moderate to severe cyanosis; group B-mild to minimal cyanosis) undergoing intracardiac repair were prospectively studied after endotracheal intubation. A single bolus dose of ketamine (2 mg/kg) and etomidate (0.3 mg/kg) was administered in a random order after 15 minute interval. Hemodynamic, arterial blood gas, and echocardiographic measurements were obtained at 7 consecutive times (T) points (baseline, 1, 2, 4, 6, 8, and 15 minutes after drug administration). RESULTS: Ketamine produced a significant reduction in VTI-T (velocity time integrals total of left upper pulmonary vein), RVOT-PG (right ventricular outflow tract peak gradient), and MG (mean gradient) in group A while those in group B had a significant increase in VTI-T, RVOT-PG, and RVOT-MG at time (T1, T2, T4, and T6; P = 0.00). This divergent behavior, however, was not observed with etomidate. CONCLUSION: Etomidate does not change pulmonary blood flow. However, ketamine produces divergent effects; it increases pulmonary blood flow in children with minimal cyanosis and decreases pulmonary blood flow in children with moderate to severe cyanosis.

Effect of Levosimendan on Diastolic Function in Patients Undergoing Coronary Artery Bypass Grafting: A Comparative Study.

PURPOSE: To compare the efficacy of levosimendan with nitroglycerin in patients with isolated diastolic dysfunction undergoing coronary artery bypass grafting. PROCEDURE: Thirty patients with isolated diastolic dysfunction undergoing on-pump coronary artery bypass grafting were randomized into 2 groups receiving levosimendan or nitroglycerin infusion. The infusion was started before sternotomy and continued in the postoperative period. Perioperatively, diastolic function was serially evaluated at 3 different time points using echocardiography. N-terminal fragment of pro-B-natriuretic peptide (NT-proBNP) levels were measured in both the groups. RESULTS: There was a significant improvement in diastolic function as measured by isovolumic relaxation time (P = 0.0001, P = 0.001) and deceleration time (P = 0.0001, P = 0.0001) in the levosimendan group from the baseline in patients with impaired relaxation. Similarly, tissue Doppler imaging also revealed an improvement from the baseline in patients with a pseudonormal pattern (P = 0.018, P = 0.001). Furthermore, there was a significant improvement in the above parameters when compared with the nitroglycerin group. The NT-proBNP levels also demonstrated a similar pattern between the 2 groups (P = 0.03, P = 0.02) when levosimendan was compared with nitroglycerin in patients with a pseudonormal pattern on echocardiography. CONCLUSIONS: Levosimendan is superior to nitroglycerin in improving diastolic function irrespective of coronary revascularization.

Comparison of a waxy maize and a potato starch-based balanced hydroxyethyl starch for priming in patients undergoing coronary artery bypass grafting.

OBJECTIVE: Concerns have been raised about differences in the safety profile of potato- versus waxy maize-derived hydroxyethyl starch (HES). The objective of this study was to compare 2 HES solutions derived from 2 different source materials (potato versus waxy maize) for their dose-related effects on hemostasis and organ function when used to prime the cardiopulmonary bypass circuit (CPB). DESIGN: A prospective, randomized, controlled study. SETTING: Tertiary care center. PARTICIPANTS: Eighty patients undergoing coronary artery bypass grafting (CABG) on CPB. INTERVENTIONS: For priming the CPB circuit, the HESPRL group received 1000 mL of potato-derived balanced 6% HES 130/0.42 along with 500 mL of Ringer's lactate; the HESP group received 1,500 mL of potato-derived balanced 6% HES 130/0.42; the HESMRL group received 1000 mL of waxy maize-derived balanced 6% HES 130/0.4 along with 500 mL of Ringer's lactate, and the HESM group received 1500 mL of waxy maize-derived balanced 6% HES 130/0.4. MEASUREMENTS AND MAIN RESULTS: There were no significant differences in 24-hour mediastinal drainage, rate of re-exploration, blood product usage, coagulation parameters, and measures of pulmonary, renal, and hepatic function with respect to plant source of HES, when equivalent doses were used. Sonoclot activated clotting time (SonACT) was significantly higher and clot rate (CR) significantly lower at end of surgery (T1) and 24 hours after surgery (T2) in the HESP and HESM groups compared with the HESPRL and HESMRL groups. Compared with baseline, CR and platelet function were significantly lower at T1, PaO2/FIO2 ratio decreased significantly at T1 and T2, and serum bilirubin and transaminases increased significantly at T2 in all 4 groups. CONCLUSIONS: There was no significant difference in cumulative 24-hour mediastinal drainage when potato-derived balanced 6% HES 130/0.42 or waxy maize-derived balanced 6% HES 130/0.4 was used to prime the CPB circuit in patients undergoing CABG. In equal doses, both starches exerted the same effect on blood coagulation and pulmonary, renal, and hepatic function.

Visceral leishmaniasis in the hills of western Nepal: A transmission assessment.

In Nepal, visceral leishmaniasis (VL) has been targeted for elimination as a public health problem by 2026. Recently, increasing numbers of VL cases have been reported from districts of doubtful endemicity including hills and mountains, threatening the ongoing VL elimination program in Nepal. We conducted a multi-disciplinary, descriptive cross-sectional survey to assess the local transmission of Leishmania donovani in seven such districts situated at altitudes of up to 1,764 meters in western Nepal from March to December 2019. House-to-house surveys were performed for socio-demographic data and data on past and current VL cases. Venous blood was collected from all consenting individuals aged ≥2 years and tested with the rK39 RDT. Blood samples were also tested with direct agglutination test, and a titer of ≥1:1600 was taken as a marker of infection. A Leishmania donovani species-specific PCR (SSU-rDNA) was performed for parasite species confirmation. We also captured sand flies using CDC light traps and mouth aspirators. The house-to-house surveys documented 28 past and six new VL cases of which 82% (28/34) were without travel exposure. Overall, 4.1% (54/1320) of healthy participants tested positive for L. donovani on at least one serological or molecular test. Among asymptomatic individuals, 17% (9/54) were household contacts of past VL cases, compared to 0.5% (6/1266) among non-infected individuals. Phlebotomus argentipes, the vector of L. donovani, was found in all districts except in Bajura. L. donovani was confirmed in two asymptomatic individuals and one pool of sand flies of Phlebotomus (Adlerius) sp. We found epidemiological and entomological evidence for local transmission of L. donovani in areas previously considered as non-endemic for VL. The national VL elimination program should revise the endemicity status of these districts and extend surveillance and control activities to curb further transmission of the disease.

Comparison of different doses of ε-aminocaproic acid in children for tetralogy of Fallot surgery: clinical efficacy and safety.

OBJECTIVE: The purpose of this study was to compare 2 different doses of ε-aminocaproic acid (EACA) and assess their relative efficacy and safety in children undergoing corrective surgery for tetralogy of Fallot (TOF). DESIGN: A prospective, randomized, controlled study. SETTING: A tertiary care center. PARTICIPANTS: One hundred twenty children undergoing corrective surgery for TOF using cardiopulmonary bypass (CPB). INTERVENTIONS: Group 1 received 100 mg/kg of EACA after induction, upon initiation of CPB, and after protamine. Group 2 received 75 mg/kg of EACA after induction, followed by a maintenance infusion of 75 mg/kg/h until chest closure, and an additional 75 mg/kg upon initiation of CPB. Group 3 did not receive any antifibrinolytic agent or placebo. MEASUREMENT AND MAIN RESULTS: Cumulative mean blood loss, total packed red blood cells, and fresh frozen plasma requirements were significantly less in group 2 (p ≤ 0.01). There were no significant differences in the total platelet concentrate transfused, re-exploration rate, incidence of renal failure, arrhythmias, neurologic complications, mortality, or length of intensive care unit stay among the 3 groups. The incidences of perioperative ST/T changes and chest closure time were significantly less in group 1 and group 2 (p ≤ 0.01). The duration of mechanical ventilation was significantly less in group 2 (p ≤ 0.01). CONCLUSIONS: EACA was effective in reducing the postoperative blood loss and transfusion requirements in children undergoing corrective cardiac surgery on CPB for TOF. The dose regimen of 75 mg/kg after induction, followed by a maintenance infusion of 75 mg/kg/h until chest closure, and an additional 75 mg/kg upon initiation of CPB were more effective.

Comparison of epsilon aminocaproic acid and tranexamic Acid in thoracic aortic surgery: clinical efficacy and safety.

OBJECTIVE: To evaluate the efficacy and safety of tranexamic acid (TXA) versus epsilon aminocaproic acid (EACA) in patients undergoing thoracic aortic surgery. DESIGN: A prospective randomized study. SETTING: A tertiary care center. PARTICIPANT: The study was conducted on 64 consecutive adult patients undergoing thoracic aortic surgery with cardiopulmonary bypass (CPB). INTERVENTIONS: Group EACA received a bolus of 50 mg/kg of EACA after induction of anesthesia over 20 minutes followed by maintenance infusion of 25 mg/kg/h until chest closure. Group TXA received a bolus of 10 mg/kg of TXA after induction of anesthesia over 20 minutes followed by maintenance infusion of 1 mg/kg/h until chest closure. MEASUREMENTS AND MAIN RESULTS: Cumulated mean blood loss, total packed red blood cells, and blood product requirement up to 24 h postoperatively were comparable between groups. A significant renal injury (EACA 40% v TXA 16%; p = 0.04) and increased tendency for renal failure (EACA 10% v TXA 0%, p = 0.11; relative risk 2.15) were observed with EACA compared to TXA. There was increased tendency of seizure with TXA (EACA v TXA: 3.3% v 10%; p>0.05, relative risk 1.53). There was significant increase in the D-dimer from preoperative to postoperative values in Group EACA. (p< 0.01). CONCLUSIONS: Both EACA and TXA were equally effective in reducing the perioperative blood loss and transfusion requirement in patients undergoing thoracic aortic surgery. While significant renal injury was observed with EACA, there was a tendency for higher incidence of seizure with TXA. Prospective placebo-controlled trials recruiting larger sample size using sensitive biomarkers are required before any recommendations.

Evaluating similarity measure for multimodal 3D to 2D registration.

The 3D to 2D registration technique in spine surgery is vital to aid surgeons in avoiding the wrong site surgery by estimating the vertebral pose. The vertebral poses are estimated by generating the spatial correspondence relationship between pre-operative MR with intra-operative x-ray images, then evaluated using a similarity measure. Different similarity measures are used in 3D to 2D registration techniques to assess the spatial correspondence between the pre-operative and intra-operative images. However, to evaluate the registration performance of the similarity measures, the proposed framework employs three different similarity measures: Binary Image Matching, Dice Coefficients, and Normalized Cross-correlation technique to compare the images based on pixel positions. The registration accuracy of the proposed similarity measures is compared based on the mean Target Registration Error, mean Iteration Times, and success rate. In the absence of simulated test images, the experiment is conducted on the simulated AP and Lateral test images. The experiment conducted on the simulated test images shows that all three similarity measures work well for the feature based 3D to 2D registration in that BIM gives better results. The experiment also indicates high registration accuracy when the initial displacements are varied up to ±20 mm and ±100of the translational and rotational parameters, respectively, for three similarity measures.

Parasternal intercostal block with ropivacaine for postoperative analgesia in pediatric patients undergoing cardiac surgery: a double-blind, randomized, controlled study.

OBJECTIVE: The objective of this study was to assess the effectiveness of 0.5% ropivacaine used for parasternal intercostal blocks for postoperative analgesia in pediatric patients undergoing cardiac surgery. DESIGN: A randomized, controlled, prospective, double-blind study. SETTING: A tertiary care teaching hospital. PARTICIPANTS: Thirty children scheduled for cardiac surgery with a median sternotomy. INTERVENTIONS: A 0.5% ropivacaine injection with 5 doses of 0.5 to 2.0 mL on each side in the 2nd to 6th parasternal intercostal space with a total dose of ropivacaine below 5 mg/kg or the same volume of saline before sternal wound closure. MEASUREMENTS AND MAIN RESULTS: The time to extubation was significantly lower in patients administered the parasternal blocks with ropivacaine than in the control group; the mean values were 2.66 hours and 5.31 hours, respectively (p < 0.001). The pain scores were lower in the ropivacaine group compared with the saline group; mean values were 2.20 for the ropivacaine group and 4.83 for the saline group on a scale of 10. The cumulative fentanyl dose requirement over a 24-hour period was higher in the saline group than the ropivacaine group (p < 0.001). CONCLUSIONS: Parasternal blocks with ropivacaine appear to be a simple, safe, and useful technique of supplementation of postoperative analgesia in pediatric patients undergoing cardiac surgery with a median sternotomy.

Arterial pressure waveform derived cardiac output FloTrac/Vigileo system (third generation software): comparison of two monitoring sites with the thermodilution cardiac output.

The present study was conducted to study the effect of monitoring site, radial or femoral, for arterial pressure waveform derived cardiac output using FloTrac/Vigileo system with third generation software version 3.02 during cardiac surgery. The cardiac output derived from the two sites was also compared to the pulmonary artery catheter (PAC) derived cardiac output to reevaluate the relation between them using the newer software. The effect of cardiopulmonary bypass (CPB) was also studied by doing the sub analysis before and after bypass. Forty patients undergoing coronary artery bypass surgery with cardiopulmonary bypass were enrolled in the study. Cardiac output derived from radial artery (RADCO), femoral artery (FEMCO) using FloTrac/Vigileo system with third generation software version 3.02 and cardiac output using pulmonary artery catheter (PACCO) at predefined nine time points were recorded. Three hundred and forty two cardiac output data triplets were analysed. The Bland-Altman analysis of RADCO and FEMCO revealed a mean bias of -0.28 with percentage error of 20%. The pre CPB precision of both RADCO and FEMCO was 1.25 times as that of PACCO. The post CPB precision of FEMCO was 1.2 times of PACCO while that of RADCO was 1.7 times of PACCO. The third generation of FloTrac/Vigileo system shows good correlation between the radial and femoral derived cardiac outputs in both pre and post bypass periods. The newer software correlates better to PAC derived cardiac output in the post bypass period for femoral artery than radial artery.

A Study on the Willingness to Use Meditation for Maintaining Psychological Well-Being During the COVID-19 Pandemic.

Background and objective Several studies have indicated an escalation in the stress and anxiety levels among all sections of the population at large during the ongoing coronavirus disease 2019 (COVID-19) pandemic. In this challenging environment, meditation or yoga can help in maintaining the quality of life. This pilot study aimed to assess the willingness to practice meditation as a tool to manage anxiety, perceived stress levels, and psychological well-being (quality of life) during the COVID-19 pandemic in India. Materials and methods Bivariate and multivariate logistic regression models were employed to characterize the attitude of healthy Indian adults toward meditation as a stress management tool and its impact on psychological well-being. Primary data of 241 participants were collected using Google Forms circulated via email and social media platforms through the snowball sampling technique. The self-reported data on four different psychosocial scales, viz., for anxiety measurement [the Seven-Item Generalized Anxiety Disorder Scale (GAD-7) and Coronavirus Anxiety Scale (CAS)], for stress measurement [Perceived Stress Scale (PSS)], and to quantify well-being levels [the Five-Item World Health Organization Well-Being Index (WHO-5)], along with those on their perception toward meditation were obtained. Results Our findings suggest that the anxiety and perceived stress scores are lower among those practicing some form of relaxation or meditation than those not practicing it, along with those who already report better psychological well-being and perceived stress. The bivariate results indicated that willingness to meditate among those who were practicing some form of meditation and those not mediating significantly differed based on their age, presence of comorbidities, and GAD and PSS levels. The multivariate logistic regression showed that only those individuals aged 35 years and above and those who have some comorbidity symptoms showed a significant level of willingness to opt for meditation. Conclusions In order to attain proper relief from psychological issues during a pandemic situation such as the current one, a more specific remedial module for meditation procedure needs to be devised as an intervention, and it should be kept in mind that age and comorbidity status also play a significant role with respect to individuals' attitude toward meditation as a tool for psychological relief.

Susceptibility status of the wild-caught Phlebotomus argentipes (Diptera: Psychodidae: Phlebotominae), the sand fly vector of visceral leishmaniasis, to different insecticides in Nepal.

BACKGROUND: Visceral leishmaniasis (VL) is targeted for elimination as a public health problem in Nepal by 2023. For nearly three decades, the core vector control intervention in Nepal has been indoor residual spraying (IRS) with pyrethroids. Considering the long-term use of pyrethroids and the possible development of resistance in the vector Phlebotomus argentipes sand flies, we monitored the susceptibility status of their field populations to the insecticides of different classes, in villages with and without IRS activities in recent years. METHODOLOGY/PRINCIPAL FINDINGS: Sand flies were collected from villages with and without IRS in five VL endemic districts from August 2019 to November 2020. The WHO susceptibility test procedure was adopted using filter papers impregnated at the discriminating concentrations of insecticides of the following classes: pyrethroids (alpha-cypermethrin 0.05%, deltamethrin 0.05%, and lambda-cyhalothrin 0.05%), carbamates (bendiocarb 0.1%) and organophosphates (malathion 5%). Pyrethroid resistance intensity bioassays with papers impregnated with 5× of the discriminating concentrations, piperonyl butoxide (PBO) synergist-pyrethroid bioassays, and DDT cross-resistance bioassays were also performed. In the IRS villages, the vector sand flies were resistant (mortality rate <90%) to alpha-cypermethrin and possibly resistant (mortality rate 90-97%) to deltamethrin and lambda-cyhalothrin, while susceptibility to these insecticides was variable in the non-IRS villages. The vector was fully susceptible to bendiocarb and malathion in all villages. A delayed knockdown time (KDT50) with pyrethroids was observed in all villages. The pyrethroid resistance intensity was low, and the susceptibility improved at 5× of the discriminating concentrations. Enhanced pyrethroid susceptibility after pre-exposure to PBO and the DDT-pyrethroid cross-resistance were evident. CONCLUSIONS/SIGNIFICANCE: Our investigation showed that P. argentipes sand flies have emerged with pyrethroid resistance, suggesting the need to switch to alternative classes of insecticides such as organophosphates for IRS. We strongly recommend the regular and systematic monitoring of insecticide resistance in sand flies to optimize the efficiency of vector control interventions to sustain VL elimination efforts in Nepal.

Screening and detection of biomarkers in chickpea plants exposed to chromium and cadmium.

A broad screening protocol, covering the most general phytochemical groups of compounds, was developed on the basis of high performance thin layer chromatography (HPTLC). A total of six TLC systems, comprising three derivatization reagents, two stationary phases and two mobile phases, were included. The screening method was applied for the identification of biomarkers in the chickpea plant exposed to cadmium and chromium. The biomarkers were selected on the basis of significant changes (0.26-4.6 fold) in concentration levels of phytochemicals. Totally, five different amino acids, three organic acids, one sulphur containing compound and one sugar were identified as biomarkers in chickpea exposed heavy metal.