Comparison of the time taken for subarachnoid block using ultrasound-guided method versus landmark technique for cesarean section - A randomized controlled study.

BACKGROUND AND AIMS: Spinal anesthesia is the regional technique preferred for cesarean section and is usually administered using the traditional landmark technique. Ultrasonography of the spine appears to be helpful in locating the puncture site and increasing the success rate. The primary objective of this study was to assess the use of ultrasonogram in locating the lumbar interspinous space for spinal anesthesia in laboring parturients brought for elective cesarean section. MATERIAL AND METHODS: Sixty parturients scheduled to undergo elective cesarean section under spinal anesthesia were included in this prospective randomized controlled trial, after obtaining the institutional ethical clearance. In Group I, 30 patients received spinal anesthesia by landmark technique and in Group II, 30 patients underwent ultrasound-guided spinal anesthesia. The statistical analysis was done using SPSS software version 17 (SPSS Inc., Chicago, Illinois, USA) for Microsoft windows. RESULTS: The time taken for spinal in Group I was longer than in Group II (62 ± 18s; 41 ± 11s; P = 0.0001). The number of attempts of needle insertion was significantly less in Group II (group I 1.86 ± 1.04: group II 1.06 ± 0.25). However, the total preparation time (28 8.30 ± 92 vs 804.73 ± 77; P = 0.0001) was more in the ultrasound-guided than in the landmark group. The patients had better satisfaction in group II. CONCLUSION: Preprocedural ultrasound is a useful tool for successful lumbar puncture in parturients as it minimizes the number of attempts of needle insertion and provides better patient satisfaction.

Systematic literature review of learning curves for colorectal polyp resection techniques in lower gastrointestinal endoscopy.

AIM: The performance of therapeutic procedures in lower gastrointestinal endoscopy (LGI) can be challenging and carries an increased risk of adverse events. There is increasing demand for the training of endoscopists in these procedures, but limited guidelines exist concerning procedural competency. The aim of this study was to assess the learning curves for LGI polypectomy, colorectal endoscopic mucosal resection (EMR) and colorectal endoscopic submucosal dissection (ESD). METHOD: A systematic review of electronic databases between 1946 and September 2019 was performed. Citations were included if they reported learning curve data. Outcome measures that defined the success of procedural competency were also recorded. RESULTS: A total of 34 out of 598 studies met the inclusion criteria of which 28 were related to ESD, three to polypectomy and three to EMR. Outcome measures for polypectomy competency (en bloc resection, delayed bleeding and independent polypectomy rate) were achieved after completion of between 250 and 400 polypectomies and after 300 colonoscopies. EMR outcome measures, including complete resection and recurrence, were achieved variably between 50 and 300 procedures. Outcome measures for ESD included efficiency (resection rates and procedural speed) and safety (adverse events). En bloc resection rates of over 80% and R0 resection rates of over 70% were achieved at 20-40 cases and procedural speed increased after 30 ESD cases. Competency in safety metrics was variably achieved at 20-200 cases. CONCLUSION: There is a paucity of data on learning curves in LGI polypectomy, EMR and ESD. Despite limited evidence, we have identified relevant outcome measures and threshold numbers for the most common LGI polyp resection techniques for potential inclusion in training programmes/credentialing guidelines.

Risk of metachronous colorectal cancer following colectomy in Lynch syndrome: a systematic review and meta-analysis.

AIM: Lynch syndrome (LS) accounts for 2-4% of all colorectal cancer (CRC) cases, and is associated with an increased risk of developing metachronous colorectal cancer (mCRC). The role of extended colectomy in LS CRC is controversial. There are limited studies comparing the risk of mCRC following segmental colectomy and extended colectomy. The objective of this systematic review is to evaluate the risk of developing mCRC following segmental and extended colectomy for LS CRC and endoscopic compliance. METHOD: A systematic review of major databases was performed using predefined terms. All original articles published in English comparing the risk of mCRC in LS patients after segmental and extended colectomy from 1950 to January 2016 were included. RESULTS: The search retrieved 324 studies. Six studies involving 871 patients met the inclusion criteria. Of these, 705 (80.9%) underwent segmental colectomy and 166 (19.1%) extended colectomy. Average follow-up was 91.2 months. The mCRC rate was 22.8% and 6% in the segmental and extended colectomy groups, respectively. The segmental group were over four times more likely to develop mCRC (OR 4.02, 95% CI: 2.01-8.04, P < 0.0001). mCRC occurred in patients after segmental colectomy despite 1-2-yearly postoperative endoscopic surveillance. CONCLUSION: This result suggests that extended colectomy reduces the risk of mCRC by over four-fold compared with segmental colectomy. mCRC occurred in the segmental group despite postoperative endoscopic surveillance. This needs to be borne in mind when deciding on the appropriate surgical management of LS patients with CRC. We recommend that extended colectomy should be considered for patients with confirmed LS CRC.

Physico-chemical analysis of ground water samples of coastal areas of south Chennai in the post-Tsunami scenario.

The study of changes in ground water quality on the east coast of chennai due to the December 26, 2004 tsunami and other subsequent disturbances is a matter of great concern. The post-Tsunami has caused considerable plant, animal, material and ecological changes in the entire stretch of chennai coastal area. Being very close to sea and frequently subjected to coastal erosion, water quality has been a concern in this coastal strip, and especially after the recent tsunami this strip seems to be more vulnerable. In the present investigation, ten ground water samples were collected from various parts of south chennai coastal area. Physico-chemical parameters such as pH, temperature, Biochemical oxygen demand (BOD), Dissolved oxygen (DO), total solids; turbidity and fecal coliform were analyzed. The overall Water quality index (WQI) values for all the samples were found to be in the range of 68.81-74.38 which reveals a fact that the quality of all the samples is only medium to good and could be used for drinking and other domestic uses only after proper treatment. The long term adverse impacts of tsunami on ground water quality of coastal areas and the relationships that exist and among various parameters are carefully analyzed. Local residents and corporation authorities have been made aware of the quality of their drinking water and the methods to conserve the water bodies.

Neutrophil-lymphocyte ratio, pain perception, and disease activity score may serve as important predictive markers for sustained remission in rheumatoid arthritis.

The implementation of new treatment strategies based on current recommendations has enabled a greater number of patients with rheumatoid arthritis (RA) to achieve remission. However, there are no definite predictors of sustained remission. Moreover, the absence of clear consensus on the time of withdrawal or reduction of treatment further adds to the treatment burden. This pilot study was intended to evaluate the prognostic potential of various RA-related parameters. All the enrolled subjects (n=124) were clinically evaluated on the basis of various parameters including age, gender, duration of illness before the initiation of disease-modifying anti-rheumatic drugs, tender and swollen joints (28 joints), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), hemoglobin percentage, lymphocyte count, total white-blood cell counts, and neutrophil to lymphocyte ratio (NLR). Student's t-test and discriminant function analysis were performed. The specificity of all parameters and their best possible cut-off to predict relapse were calculated using the receiver operating characteristic (ROC) analysis. A significant difference in terms of pain perception, NLR, tendency to have a significant tender joint count and absolute lymphocyte counts was identified between the patients in sustained remission and those in relapse. The ROC analysis indicated that NLR was consistent in predicting remission. CRP, ESR, and/or disease activity score may not be very effective in differentiating patients with sustainable remission/low disease activity. NLR along with patient's perception of pain may assist in predicting sustained remission.

Persistent hexavalent chromium exposure impaired the pubertal development and ovarian histoarchitecture in wistar rat offspring.

Hexavalent chromium (CrVI) is a highly toxic metal and a major environmental pollutant. Several studies indicate that CrVI exposure adversely affects reproductive function. We reported that maternal Cr exposure resulted in Cr accumulation in the reproductive organs of female offsprings. CrVI can cross the placental barrier and also can be passed through breastfeeding. The present investigation aimed to determine the persistent (in utero through puberal period) CrVI exposure-induced toxic effects on the reproductive functions of mother and the offspring. Induction of oxidative stress is one of the plausible mechanisms behind Cr-induced cellular deteriorations. Mother rats exposed to CrVI showed reduced reproductive outcome, while the offsprings showed higher accumulation of Cr in ovary, altered steroid, and peptide hormones. Specific activities of antioxidant enzymes were decreased and associated with increased levels of H2 O2 , and lipid peroxidation. CrVI exposure also damaged the ovarian histoarchitecture in various age groups studied. CrVI exposure also delayed the sexual maturation. Results from the present investigation suggest that CrVI exposure from in utero through puberal period significantly damaged the pubertal development through altered antioxidants, anemia, and altered hormone levels. These changes were associated with damaged ovarian histoarchitecture and extended estrous cycle in developing Wistar rats.

Liquid phase selective oxidation of veratryl alcohol to veratraldehyde using pure and Mg-doped copper chromite catalysts.

Mg-doped copper chromite (CuCr2O4) nanocomposites were synthesised through conventional technique. The pure and doped CuCr2-xMgx O4 (x = 0.00-0.1, 0.2 and 0.3%) nanocomposites were characterized in terms of their morphology, crystal structure, surface area and catalytic performance. The chemical composition of CuCr2-xMgx O4 was confirmed via FT-IR. The formation of pure and doped catalysts was validated by XRD results. TEM/SEM confirmed the formation of CuCr2-xMgxO4 nanoparticles. Mg-doped samples possess a high specific surface area compared to pure CuCr2O4. Thus, the effects of temperature, solvent, time, oxidant and the amount of catalyst on the oxidation of veratryl alcohol were reported. Furthermore, detailed mechanisms of the catalytic oxidation of veratryl alcohol as well as the reusability and stability of the nanomaterial were investigated. The resulting composites were shown to be effective heterogeneous catalysts for the oxidation of veratryl alcohol.

Ameliorative effect of vitamin C on hexavalent chromium-induced delay in sexual maturation and oxidative stress in developing Wistar rat ovary and uterus.

Hexavalent chromium (CrVI) is a highly toxic metal and major environmental pollutant and is extensively used in more than 50 industries. The major route of CrVI exposure for the general population is oral intake. Chromium is considered an important nutrient responsible for carbohydrate metabolism. However, excess CrVI exposure is associated with various pathological conditions including reproductive dysfunction. CrVI can traverse the placental barrier and cause wide range of abnormalities in fetal development. Cr is transported to offspring through mother's milk in lactating women exposed to CrVI. Therefore, the present study was carried out to determine the toxic effects of lactational CrVI exposure on ovary and uterus and the beneficial role of vitamin C in preventing/ameliorating the toxic effects of CrVI in developing female Wistar rats. Generation of oxidative stress is considered one of the plausible mechanisms behind Cr-induced cellular deteriorations. The present study evidenced a decrease in the specific activities of antioxidants, serum testosterone and progesterone and an increase in the levels of H2O2, lipid peroxidation (LPO) and follicle stimulating hormone in rats exposed to CrVI when compared to control. CrVI exposure also delayed the sexual maturation and extended the estrous cycle. Simultaneous administration of vitamin C significantly prevented the increase in LPO and enhanced the antioxidant status. These results suggest the protective effect of vitamin C against the CrVI exposure-induced toxicity and attest the significance of antioxidants in diet.

The Karyology of Uraeotyphlus gansi, and Its Implications for the Systematics and Evolution of Uraeotyphlidae (Amphibia: Gymnophiona).

The gross karyotype of the uraeotyphlid caecilian Uraeotyphlus gansi is described as comprising 2n = 42 and fundamental number = 58. These are the first karyotype data for any species of malabaricus-group Uraeotyphlus, and the diploid number is the same as those ichthyophiids thus far studied and differs from the oxyurus-group Uraeotyphlus (2n = 36). These data support the recognition of two species groups within Uraeotyphlus, the monophyly of the oxyurus group, and the understanding that the ancestral diatriatan was more ichthyophiid- than uraeotyphlid-like.

Coronary artery disease and mesenteric artery stenosis - Two sides of the same coin? - Long term prospective analysis.

Coronary artery disease (CAD) patients might have concomitant mesenteric artery stenosis (MAS). Identification of risk factors predicting mesenteric artery involvement might guide screening high risk individuals. A dilemma of intervention in radiologically severe MAS exists. This prospective study included CAD patients undergoing a coronary angiogram. A concomitant mesenteric angiogram was performed to diagnose MAS. Clinically relevant MAS (CR-MAS) was defined as i) presence of classical mesenteric angina with any degree of MAS or ii) severe stenosis (> 70%) involving two or more vessels. Risk factors for CR-MAS were studied and followed up prospectively. One hundred and three patients were included in the study. Left anterior descending artery was the most common involved coronary artery and was affected in 73% (n = 76). Mesenteric angiogram revealed 42.7% (n = 44) to have MAS. CR-MAS was present in 21 patients (20.4%). Involvement of celiac axis, superior mesenteric artery and inferior mesenteric artery was 22, 39 and 15 respectively. Multivariate analysis showed mesenteric angina (p < 0.01), diabetes mellitus (p < 0.01) and peripheral artery disease (p < 0.01) to be independent predictors of CR-MAS. At a median follow-up of 36 months (range 29-48 months), there was no acute mesenteric ischemia. In patients with CR-MAS, 16 (76.2%) had symptomatic improvement and 5 (23.8%) had stable symptoms. Three patients underwent angioplasty of superior mesenteric artery for persistent symptoms. Chronic CAD patients had a high prevalence of MAS. Mesenteric angina, diabetes mellitus and peripheral artery disease are independent predictors of CR-MAS. Intervention for MAS should be dictated by symptoms and not radiological severity. Lifestyle modification and medication for atherosclerotic ischemic heart disease probably prevents acute mesenteric ischemia in CAD patients.

A representative volume element based micromechanical analysis of a Bi-layered Ganoid Fish scale.

The Mississippi Alligator gar (Atractosteus spatula) possesses a flexible exoskeleton armor consisting of overlapping ganoid scales used for predatory protection. Each scale is a two-phase biomineralized composite containing bio-modified hydroxyapatite (hard) minerals and collagen (soft) fibers. The protective layer consists of a stiff outer ganoine layer, a characteristic "sawtooth" pattern at the interface with the compliant bone inner layer. The garfish scale exhibits a decreasing elastic modulus from the external to the internal layers. Scanning electron microscopy (SEM) images of the cross-section revealed a two-layered structure. Elastic moduli, measured from nanoindentation experiments, were correlated to structural changes across each layer. The "material" symmetry of this materially and geometrically nonlinear biomineralized composite is unknown. Therefore, to be able to determine the stiffness tensor requires the use of finite element analysis (FEA). The gar fish scale was computationally modeled using the representative volume element (RVE) based approach. As a result, the unknown symmetry induced by the architecture and material layering require the use of complex FEA boundary conditions. The simulation was conducted in the pure uniaxial strain regimes of tension and shear, which necessitated the mathematical determination so appropriate surface loading conditions could be applied. This paper provides the results from a highly-resolved mesoscale RVE model based on iso-strain boundary conditions (ISBC) to determine the elastic stiffness tensor for the composite system. By assuming isotropic behavior in individual elements, the results for the RVE reveal the fish scale has an "orthotropic symmetry" with slight local strain variations occurring at the sawtooth interface.

An international survey of polypectomy training and assessment.

Background and study aims Colonic polypectomy is acknowledged to be a technically challenging part of colonoscopy. Training in polypectomy is recognized to be often inconsistent. This study aimed to ascertain worldwide practice in polypectomy training. Patients and methods An electronic survey was distributed to endoscopic trainees and trainers in 19 countries asking about their experiences of receiving and delivering training. Participants were also asked about whether formal polypectomy training guidance existed in their country. Results Data were obtained from 610 colonoscopists. Of these responses, 348 (57.0 %) were from trainers and 262 (43.0 %) from trainees; 6.6 % of trainers assessed competency once per year or less often. Just over half (53.1 %) of trainees had ever had their polypectomy technique formally assessed by any trainer. Approximately half the trainees surveyed (51.1 %) stated that the principles of polypectomy had only ever been taught to them intermittently. Of those trainees with the most colonoscopy experience, who had performed over 500 procedures, 48.2 % had had training on removing large polyps of over 10 mm; 46.2 % (121 respondents) of trainees surveyed held no record of the polypectomies they had performed. Only four of the 19 countries surveyed had specific guidelines on polypectomy training. Conclusions A significant number of competent colonoscopists have never been taught how to perform polypectomy. Training guidelines worldwide generally give little direction as to how trainees should acquire polypectomy skills. The learning curve for polypectomy needs to be defined to provide reliable guidance on how to train colonoscopists in this skill.

High intensity exercise training programme following cardiac transplant.

A 26-year-old male patient who presented with symptoms of end stage cardiac failure as a result of dilated cardiomyopathy, had an orthotopic cardiac transplantation. A comprehensive cardiac rehabilitation programme was provided to him and he was introduced to a sport (tennis). The exercise training programme progressed from low intensity training to high intensity programme over a period of 15 months. A cardio-pulmonary exercise test done 22 months after surgery suggested that he was able to achieve the aerobic capacity comparable to that of a normal South Indian subject. He participated successfully in the World Transplant Games in Sydney and returned safely. This suggests that after a proper cardiac rehabilitation programme, patients undergoing heart transplantation can achieve normal physiological responses to lead a normal active life.

'Flu' syndrome on once monthly rifampicin: a case report.

'Flu' syndrome as a complication of intermittent weekly administration of rifampicin is well documented. The rare occurrence of 'flu' syndrome on once monthly rifampicin is reported in this paper.

Pre-operative short-term pulmonary rehabilitation for patients of chronic obstructive pulmonary disease undergoing coronary artery bypass graft surgery.

The role of pre-operative short-term pulmonary rehabilitation in patients with chronic obstructive pulmonary disease who undergo coronary artery bypass graft surgery has been assessed for the first time prospectively. Forty-five patients posted for coronary artery bypass graft surgery were randomised to receive either short-term pulmonary rehabilitation (group I) or no such programme (group II). Patients of both the groups were evenly matched with respect to age, sex, body surface area, duration and severity of chronic obstructive pulmonary disease and coronary artery disease. Normal individuals who evenly matched with the study group were assessed for normal respiratory function parameters. Pre-operative and post-operative peak expiratory flow rate, inspiratory capacity, post-operative ventilation time, post-operative pulmonary complication and hospital stay were determined in both the groups. Peak expiratory flow rate (220.0 +/- 12.9 and 324.3 +/- 84.3 in group I, 218.0 +/- 16.4 and 260.5 +/- 35.2 in group II) and inspiratory capacity (844.0 +/- 147.4 and 1100.0 +/- 158.1 in group I, 830.0 +/- 117.4 and 1090 +/- 137 in group II) were significantly lower before and after surgery respectively in both groups compared to normal values. Even though both groups showed a significant rise in post-operative peak expiratory flow rate and inspiratory capacity after surgery, the post-operative peak expiratory flow rate and inspiratory capacity in group I was significantly higher than in group II. In group I, the post-operative ventilation time (24.5 +/- 6.00 hours), post-operative complications (n = 4) and hospital stay (12.4 +/- 3.6 days) were significantly lower than in group II (35.2 +/- 22.3 hours, n = 11, 18.8 +/- 6.6 days respectively). These data suggest that short-term pulmonary rehabilitation is feasible and effective in improving pulmonary functions before and after surgery and in reducing surgical morbidity and cost of medical care significantly.

An evaluation of the future role of non-governmental organizations currently engaged in leprosy control in India.

The mass implementation of short term multi-drug therapy in India, has led to dramatic falls in the prevalence of leprosy. This paper addresses the future role of non-governmental organizations currently involved in leprosy control. This evaluation is based on current trends in leprosy control, projected health needs in the future and the necessity to maximize health care outputs in the face of limited resources.

The use of topical phenytoin as an adjunct to immobilization in the treatment of trophic leprosy ulcers.

A total of 30 leprosy patients (controls n = 16; topical phenytoin n = 14) with trophic ulcers on the feet were investigated to ascertain the efficacy of topical phenytoin powder in the healing of ulcers. The ulcers in the two groups were matched for initial size. Healing patterns were assessed by determining changes in depth and planar (surface) dimensions at weekly intervals over a three week study period. Results indicate that while immobilization of the ulcer site is effective in promoting ulcer healing, additional use of topical phenytoin accelerates the healing process. There may however be non-responders to topical phenytoin.

Optical and spectroscopic studies of potassium p-nitrophenolate dihydrate crystal for frequency doubling applications.

Non centrosymmetric potassium p-nitrophenolate dihydrate single crystals have been grown by employing the technique of slow solvent evaporation from aqueous solution by slightly adjusting the pH and growth temperature. The grown crystals have been identified from single crystal XRD analysis, FTIR and FT Raman spectroscopic techniques. The high resolution X-ray diffraction experiments substantiate good quality of the title material. Between 510 and 2000 nm, the material is observed to be nearly transparent allowing it to be explored for potential use in device fabrication. In addition, the photoluminescence spectrum of the grown crystal at room temperature shows a stable broad violet-blue emission around the 383-550 nm wavelengths with the maximum centered at 436 nm. Owing to its excellent non linear figure of merit and strong PL emission, the title crystal can have technological applications in opto-electronic devices.

Delusional parasitosis: Worms of the mind.

Delusional parasitosis is an uncommon psychotic illness. Patients often report to dermatologists and physicians for treatment and are brought to psychiatric attention only for associated psychological distress. One such case is discussed in this report.