Genetic diversity assessment of Fusarium oxysporum f. sp ciceris isolates of Indian chickpea fields as revealed by the SRAP marker system.

An experiment was conducted to study the precise geographical distribution and racial complexity of Fusarium oxysporum f.sp ciceris (Foc) isolates representing 12 states of 4 agro-climatic zones of India at morphological, pathogenic and molecular level. The DNA based sequence related amplified polymorphism (SRAP) markers was employed to differentiate Foc isolates at genome level. The genotypic data output of the isolates was examined for diversity parameter as marker's Polymorphic percentage (PM %), Polymorphic Information Content (PIC), Marker Index (MI) and Gene Diversity Index (DI). As a result, 15 primers used in this study could generated total of 154 reproducible alleles ranging from 100-2100 bp (average allele per marker 10.26) in size, of that 149 (97%) were found to be polymorphic. The neighbor-joining analysis effectively classified the isolates of North East Plain Zone (NEPZ), Central Zone (CZ), North West Plain Zone (NWPZ) and South Zone (SZ) into four clusters. In summary, DNA based marker analysis could differentiate as per isolates geographical location, however pathogenic interaction of isolates from same geographical location could not match the genetic differentiation. Accordingly, considering the present complexity in racial profile, precise classification based on homologs virulence genes specific to races would give a more meaningful in correlating isolates with their native geographical distribution and helps in future resistance breeding programs for sustainable management of vascular wilt disease.

Hyperglycemia Risk Evaluation of Hydrocortisone Intermittent Boluses versus Continuous Infusion in Septic Shock: A Prospective Randomized Trial.

Background: Hydrocortisone showed an important role in reversal of shock when added to standard therapy in managing septic shock. Hyperglycemia is one of the most common side effects associated with corticosteroid treatment. Aims: This study aimed to evaluate the risk of hyperglycemia of intermittent hydrocortisone boluses versus continuous infusion in septic shock patients. Settings and Design: This was a prospective randomized controlled study conducted in a tertiary care teaching hospital. Materials and Methods: One hundred and forty patients with septic shock and who received noradrenaline were enrolled in this randomized study. Group 1 was intermittent bolus hydrocortisone group (n = 70) and Group 2 was continuous infusion group (n = 70). All patients who were admitted with septic shock and who received noradrenaline and hydrocortisone were included in the study. Those patients who had exceeded 200 mg per day of hydrocortisone were excluded from the study. The primary outcome of the study was mean blood glucose. Statistical Analysis Used: Qualitative variables were compared between the two groups with the Chi-square of the Fisher's exact test and continuous variables were compared using the Student's t-test or the Wilcoxon rank-sum test. Results: Out of 112 patients, 54 patients received hydrocortisone as intermittent boluses (48.2%), and 58 patients (51.8%) received continuous infusion. For the primary outcome, no statistically or clinically significant difference was found in the blood glucose estimated marginal mean: 154.44 mg.dL-1 (95% confidence interval [CI]: 144.18-166.88) in the bolus group and 160.2 mg.dL-1 (95% CI: 143.82-176.76) in the infusion group with a mean difference of 05.76 mg.dL-1 (95% CI: -13.86-25.38). For the secondary outcomes of the study, no difference was found between the two groups in hyperglycemic or hypoglycemic events, mortality, length of stay in intensive care unit, and reversal of shock. Conclusions: The risk of hyperglycemia is almost equal in both intermittent and continuous infusions of hydrocortisone in septic shock patients.

Dexmedetomidine and Ketamine as an Adjuvant to Levobupivacaine for Pediatric Caudal Analgesia: A Randomized, Controlled Study.

BACKGROUND: Ketamine and dexmedetomidine as an adjuvant to caudal block are used in the pediatric population. AIMS: We aimed to compare the analgesic and safety profile of dexmedetomidine with ketamine for single-shot caudal block. SETTINGS AND DESIGN: This was a randomized controlled study conducted in a tertiary care university hospital. MATERIALS AND METHODS: Ninety patients admitted for routine infraumbilical surgical procedures under general anesthesia were enrolled in this double-blind randomized study. Following caudal block under general anesthesia, patients were allocated to one of three groups; Group LS received 0.75 mL.kg - 1 levobupivacaine 0.25% diluted in saline 0.9%, Group LK received 0.75 mL.kg - 1 levobupivacaine 0.25% with ketamine 0.5 mg.kg - 1, and Group LD received 0.75 mL.kg - 1 levobupivacaine 0.25% with dexmedetomidine 1 µg.kg - 1. Postoperative pain was assessed by the Face, Legs, Activity, Cry, and Consolability (FLACC) score, and the duration of analgesia (time from caudal block to time at which FLACC score 4 or more) was recorded. Hemodynamic parameters and oxygen saturation were also monitored. STATISTICAL ANALYSIS USED: Categorical data were analyzed by Chi-squire test and numerical continuous data were analyzed by Student's t-test for comparison between two groups. Mann-Whitney test was used to compare score. One-way analysis of variance was used to compare the means between three groups. RESULTS: The addition of dexmedetomidine and ketamine to levobupivacaine resulted in significant prolongation of postoperative analgesia duration (467 min and 385 min, respectively) compared with 0.25% levobupivacaine alone (276 min). No significant side effects requiring intervention were observed in any group. CONCLUSIONS: Dexmedetomidine as an adjuvant to levobupivacaine provides a longer duration of analgesia as compared to ketamine without any significant side effect.

Non-alcoholic steatohepatitis and the risk of myocardial infarction: A population-based national study.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a systemic disease with bidirectional relationships with cardiovascular disease (CVD). Non-alcoholic steatohepatitis (NASH) is a more severe subtype of NAFLD. Patients with NASH exhibit more intra and extrahepatic inflammation, procoagulant imbalances and proatherogenic lipid profiles. Whether NASH increases the risk of ischemic heart disease is currently unclear. AIM: To investigate the relationship between acute myocardial infarction (MI) and NASH in a large cohort of subjects in the United States. METHODS: We reviewed data from a large commercial database (Explorys IBM) that aggregates electronic health records from 26 large nationwide healthcare systems. Using systemized nomenclature of clinical medical terms (SNOMED CT), we identified adult with the diagnosis of NASH from 1999-2019. We included patients with the diagnosis of acute MI from 2018-2019. Comorbidities known to be associated with NASH and MI such as obesity, diabetes mellitus, hyperlipidemia, smoking, male gender, and hypertension were collected. Univariable and multivariable analyses were performed to investigate whether NASH is independently associated with the risk of MI. RESULTS: Out of 55099280 patients, 43170 were diagnosed with NASH (0.08%) and 107000 (0.194%) had a MI within 2018-2019. After adjusting for traditional risk factors, NASH conferred greater odds of MI odds ratio (OR) 1.5 [95% confidence interval (CI): 1.40-1.62]. Hyperlipidemia had the strongest association with MI OR 8.39 (95%CI: 8.21-8.58) followed by hypertension OR 3.11 (95%CI: 3.05-3.17) and smoking OR 2.83 (95%CI: 2.79-2.87). NASH had a similar association with MI as the following traditional risk factors like age above 65 years OR 1.47 (95%CI: 1.45-1.49), male gender OR 1.53 (95%CI: 1.51-1.55) diabetes mellitus OR 1.89 (95%CI: 1.86-1.91). CONCLUSION: MI appears to be a prevalent disease in NASH. Patients with NASH may need early identification and aggressive cardiovascular risk modification.

To Compare the Efficacy of Postoperative Analgesia between Clonidine and Dexmedetomidine as Adjuvants with 0.5% Ropivacaine by Ultrasound-Guided Supraclavicular Brachial Plexus Block for Upper Limb Surgeries: A Prospective, Double-Blind, Randomized Study.

CONTEXT: The supraclavicular brachial plexus block is a very safe, useful and effective method for upper limb surgeries. Among local anesthetics, ropivacaine has special applications in neuraxial and peripheral nerve blocks due to its low cardiotoxicity and less toxicity to central nervous systems compared to bupivacaine and lignocaine. Dexmedetomidine is a newer and potent alpha-2 receptor agonist which has 10 times higher selectivity for alpha-2 receptors as compared to clonidine, So far, very few studies have been undertaken to compare the efficacy of clonidine and dexmedetomidine to provide and prolong postoperative analgesia, especially with the use of ultrasound for nerve localization. AIMS: To compare the efficacy of postoperative analgesia between clonidine and dexmedetomidine as adjuvants with 0.5% ropivacaine by ultrasound-guided supraclavicular brachial plexus block for upper limb surgeries. SETTINGS AND DESIGN: Prospective, randomised, double-blind interventional study. SUBJECTS AND METHODS: Eighty patients of ASA grade I or II undergoing elective upper limb surgery were randomly divided into two groups:- Group RC (n = 40) received 35 ml of 0.5% ropivacine with 1 µg.kg-1 of clonidine. Group RD (n = 40) received 35 ml of 0.5% ropivacaine with 1 µg.kg-1 of dexmedetomidine. STATISTICAL ANALYSIS USED: The statistical software SPSS version 20 has been used for the analysis. By using Pearson's Chi-Square test for Independence of Attributes/Fisher's Exact. Continuous variables were expressed as Mean, Median, and Standard Deviation and compared across the groups using unpaired t-test. RESULTS: In our comparative study, dexmedetomidine 1 µg.kg-1 with 35 ml of 0.5% ropivacaine provided significantly longer duration of postoperative analgesia and earlier sensory block as compared to clonidine 1 µg.kg-1 with same dose of ropivacaine in ultrasound-guided supraclavicular brachial plexus block. CONCLUSIONS: The ropivacaine-dexmedetomidine group in our study provided earlier sensory block and more prolonged postoperative analgesia as compared to ropivacaine-clonidine group. Thus ropivacaine-dexmedetomidine combination may be effectively used in all painful upper limb surgeries specially orthopaedic procedures.

Juvenile hyaline fibromatosis in siblings.

BACKGROUND: Juvenile Hyaline Fibromatosis is a rare autosomal recessive connective tissue disorder. CASE CHARACTERISTICS: Three year old girl with multiple facial nodules, gingival hypertrophy and multiple joint contractures. Her sibling, male child also had similar findings which was progressive and he died at 2 years. OUTCOME: Nodule biopsy showed extensively hyalinised dermis with PAS positivity. MESSAGE: Juvenile Hyaline Fibromatosis is a differential diagnosis for children presenting with multiple nodular lesions.

Blister fluid immunofluorescence in a case of pemphigus vulgaris.

Indirect immunofluorescence with serum is used in the diagnosis of pemphigus. We report a case in whom blister fluid was used as the specimen for indirect immunofluorecscence.