Prevalence and risk factors of soil-transmitted helminth infections in school age children (6-14 years) - A cross-sectional study in an urban resettlement colony of Delhi.

BACKGROUND: Soil-transmitted helminth (STH) infections have adverse physical and mental effect, especially in preschool (3-6 years) and school-age children (6-14 years). They are associated with socio-behavioral factors of poverty and poor personal and community hygiene. OBJECTIVES: To determine the prevalence, intensity, and the type of helminths infection harbored by the school age children (6-14 years) and to examine the relationship between STH infection and their potential risk factors and associated variables. METHODS: This cross-sectional study was conducted from January to December 2016 among 250 school age children residing in an urban resettlement colony of East Delhi. Data were collected using a semistructured interview schedule. Stool sample was tested using the Kato Katz technique. Data were analyzed in SPSS software version 16, and multivariable regression analysis was done to calculate the odds of various risk factors. RESULTS: The prevalence of STH was found to be 54.8%, and majority (85.3%) of Ascaris and all Trichuris infections were of light intensity. Multivariable logistic regression analysis confirmed that children having poor handwashing behavior in school, irregular handwashing before eating, having pica, and lack of de-worming had higher odds of having STH infection. CONCLUSION: The prevalence of STH in the study area is substantially high, and the findings suggest that besides mass de-worming strategy, behavior change, and improvement in hygiene are required to control STH.

A new approach to airway assessment-"Line of Sight" and more. Recommendations of the Task Force of Airway Management Foundation (AMF).

Assessment of airway is recommended by every airway guideline to ensure safe airway management. Numerous unifactorial and multifactorial tests have been used for airway assessment over the years. However, there is none that can identify all the difficult airways. The reasons for the inadequacy of these methods of airway assessment might be their dependence on difficult to remember and apply mnemonics and scores, inability to identify all the variations from the "normal", and their lack of stress on evaluating the non-patient factors. Airway Management Foundation (AMF) experts and members have been using a different approach, the AMF Approach, to overcome these problems inherent to most available models of airway assessment. This approach suggests a three-step model of airway assessment. The airway manager first makes the assessment of the patient through focused history, focused general examination, and focused airway assessment using the AMF "line of sight" method. The AMF "line of sight" method is a non-mnemonic, non-score-based method of airway assessment wherein the airway manager examines the airway along the line of sight as it moves over the airway and notes down all the variations from the normal. Assessment of non-patient factors follows next and finally there is assimilation of all the information to help identify the available, difficult, and impossible areas of the airway management. The AMF approach is not merely intubation centric but also focuses on all other methods of securing airway and maintaining oxygenation. Airway assessment in the presence of contagion like COVID-19 is also discussed.

Laryngoscope decontamination techniques: A survey.

BACKGROUND AND AIMS: India is a vast country with variable, nonuniform healthcare practices. A laryngoscope is an important tool during general anesthesia and resuscitation. The study aimed to determine the current practices of laryngoscope decontamination in India. MATERIAL AND METHODS: An online survey was conducted amongst 100 anesthesiologists to determine the common methods of laryngoscope decontamination adopted in their settings. The survey was done over 6 months after validating the questionnaire. RESULTS: A total of 73 responses were received out of 100. The result of the survey revealed that there is no uniform technique of laryngoscope decontamination. There is marked variability in techniques followed not only among different institutions, but also within the same institution. CONCLUSION: There are no fixed protocols adopted for laryngoscope decontamination. Thus, there is a need to develop definitive guidelines on this subject, which can be implemented in India.

Examining the Pre- and Post-percutaneous Coronary Intervention Blood Pressure Variability Using Ambulatory Blood Pressure Monitoring in Patients With Stable and Unstable Coronary Artery Disease.

Introduction The World Health Organization has drawn attention to the fact that coronary artery disease (CAD) is our modern "epidemic." Nowadays, sudden death during sleep has become prevalent due to a lack of oxygen supply to the heart. CAD causes more deaths and disabilities and incurs greater economic costs than any other illness in the developed world. The prevalence of cardiovascular disorders and heart disease is on the rise in India. Hypertension is one of the leading risk factors for all cardiovascular diseases. This study aims to compare blood pressure variability before and after percutaneous coronary intervention (PCI), using ambulatory blood pressure monitoring (ABPM) in patients with stable and unstable CAD. Materials and methods This prospective observational study was conducted among 52 patients with stable and unstable CAD, admitted to the medicine department, who required PCI at a tertiary care hospital. Before and after PCI, the same antihypertensive drugs were orally administered. ABPM was performed before PCI and one day after PCI. ABPM was conducted every 30 minutes during the day and every 60 minutes during the night over a 24-hour period using a mobil-o-graph (IEM, Germany). The results of the observed parameters were analyzed using the HMS Client-Server 4.0 system (Informer Technologies, Inc., Los Angeles, USA). The collected data were analyzed using SPSS Statistics version 21.0 software (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.). Results Out of 52 patients, 28 (53.8%) had stable CAD and 24 (46.2%) had unstable CAD. The mean age of patients with stable and unstable CAD was 56.64±9.44 and 57.04±12.36 years, respectively. The majority of patients with stable (67.9%) and unstable CAD (62.5%) were males. Various other variables were considered, such as lipid profile, blood sugar, cardiac troponin-I, and medical history, including hypertension and type 2 diabetes mellitus. Among stable CAD patients, a comparison between pre- and post-PCI systolic blood pressure (SBP) did not show a significant difference in all SBP measurements (p>0.05). However, the mean diurnal index was significantly lower following PCI compared to before PCI (p=0.019). Among unstable CAD patients, a comparison between pre- and post-PCI SBP showed a significant change in peak daytime, average daytime, and diurnal index (p<0.05). For all other SBP measurements, the difference between pre- and post-PCI measurements was not statistically significant (p>0.05). In patients with stable CAD, a statistically significant change in diastolic blood pressure (DBP) following PCI was observed for peak daytime, peak nighttime, and average nighttime values. In contrast, for patients with unstable CAD, a statistically significant change in DBP following PCI was observed for peak daytime, peak nighttime, and minimum daytime values (p<0.05). Statistically, post-PCI, there was no significant difference between the two groups for SBP and DBP measurements (p>0.05). Additionally, there was no significant difference between the two groups pre- and post-PCI in the pattern of dipping. Conclusion A comparison of the ABPM before and after PCI showed that, within 48 hours post-PCI, the ambulatory blood pressure indicators did not differ statistically from those before PCI.

Correlation of Serum Calcium with Severity and Outcomes in Patients of COVID-19 Pneumonia.

Background: Calcium is an essential electrolyte with critical physiological functions. Recently, it has been implicated in the pathogenesis and outcomes of COVID-19. This retrospective study was conducted to estimate serum ionic calcium and its correlation with clinical severity, inflammatory markers, and in-hospital outcomes in moderate to severe COVID-19 patients. Methods: We retrospectively analyzed data from 377 COVID-19 patients, aged between 23 and 79 years, with a mean age of 54.17±11.53 years. Severity of the disease was determined using ICMR criteria. Parameters including age, gender, inflammatory markers, calcium levels, and clinical outcomes were assessed. Results: The study showed a prevalence of moderate and severe COVID-19 in 58.1% and 41.9% patients, respectively. Severity was significantly associated with younger age, higher mean inflammatory markers, notably IL-6, procalcitonin, D-Dimer, and lower ionic and total calcium levels, as well as vitamin D levels. Mortality and referral rate were significantly higher in the severe group. Hypocalcemia was prevalent in 39% of the patients and was significantly associated with disease severity, ARDS, and mortality. On multivariate assessment, only age and ionic calcium were significantly associated with COVID-19 severity. Conclusion: Lower serum ionic calcium levels are associated with increased severity and poor outcomes, including higher mortality in COVID-19 patients, underscoring the potential role of calcium as a diagnostic and prognostic marker in COVID-19 pneumonia and may be an important factor in various other forms of pneumonia.

Distribution and risk assessment of pesticide pollution in small streams adjoining paddy fields.

The present investigation was planned to bridge the knowledge gap on spatiotemporal variations of pesticide pollution in small streams adjacent to paddy fields, and to visualize the associated risks in the aquatic ecosystems. We screened 106 pesticides using GCMSMS and LCMSMS from 10 small streams (n = 212, surface water samples) adjacent to paddy fields over seven months. Fifty-five pesticides were detected across different streams and months. The highest mean concentration was detected for fenobucarb (272 ng L-1), followed by thiamethoxam (199 ng L-1). The highest maximum concentration was detected for thiamethoxam ( 13,264 ng L-1), followed by triflumezopyrim ( 11,505 ng L-1). The highest detection frequency was recorded for fenobucarb (80.00%), followed by pretilachlor (79.00%). Out of the ten streams, Attabira stream had the highest mean number of pesticides detected in each sample. Maximum number of pesticides were detected in October followed by September. Pesticides namely, hexaconazole, pretilachlor, tricyclazole, fenobucarb and thiamethoxam were consistently detected across all streams. The risk assessment against the fishes, micro-invertebrates and algae were measured by risk quotient index (RQ). Twenty-five pesticides out of the detected pesticides (n = 55) had risk quotient values greater than 1. The highest RQmax values were observed in case of fenpropathrin followed by cyfluthrin-3. The highest RQmean value was observed in case of cyfluthrin, indicating its higher toxicity to fishes. The present study reveals that small streams are polluted with pesticides and there is a need to develop strategies and policy interventions in regularizing the pesticide uses for reducing the pesticide pollution in aquatic systems.

DNA-Templated Silver Nanoclusters as Dual-Mode Sensitive Probes for Self-Powered Biosensor Fueled by Glucose.

Nanomaterials have been extensively explored in developing sensors due to their unique properties, contributing to the development of reliable sensor designs with improved sensitivity and specificity. Herein, we propose the construction of a fluorescent/electrochemical dual-mode self-powered biosensor for advanced biosensing using DNA-templated silver nanoclusters (AgNCs@DNA). AgNC@DNA, due to its small size, exhibits advantageous characteristics as an optical probe. We investigated the sensing efficacy of AgNCs@DNA as a fluorescent probe for glucose detection. Fluorescence emitted by AgNCs@DNA served as the readout signal as a response to more H2O2 being generated by glucose oxidase for increasing glucose levels. The second readout signal of this dual-mode biosensor was utilized via the electrochemical route, where AgNCs served as charge mediators between the glucose oxidase (GOx) enzyme and carbon working electrode during the oxidation process of glucose catalyzed by GOx. The developed biosensor features low-level limits of detection (LODs), ~23 µM for optical and ~29 µM for electrochemical readout, which are much lower than the typical glucose concentrations found in body fluids, including blood, urine, tears, and sweat. The low LODs, simultaneous utilization of different readout strategies, and self-powered design demonstrated in this study open new prospects for developing next-generation biosensor devices.

Small Volume Microrheology to Evaluate Viscoelastic Properties of Nucleic Acid-Based Supra-Assemblies.

Particle tracking (PT) microrheology is a passive microrheological approach that characterizes material properties of soft matter. Multicomponent materials with the ability to create extensive crosslinking, such as supra-assemblies, may exhibit a complex interplay of viscous and elastic properties with a substantial contribution of liquid phase still diffusing through the system. Microrheology analyzes the motion of microscopic beads immersed in a sample, making it possible to evaluate the rheological properties of biological supra-assemblies. This method requires only a small volume of the sample and a relatively simple, inexpensive experimental setup. The objective of this chapter is to describe the experimental procedures for the observation of particle motion, calibration of an optical setup for particle tracking, preparation of imaging chambers, and the use of image analysis software for particle tracking in viscoelastic nucleic acid-based supra-assemblies.

Optical, structural, and biological properties of silver nanoclusters formed within the loop of a C-12 hairpin sequence.

Silver nanoclusters (AgNCs) are the next-generation nanomaterials representing supra-atomic structures where silver atoms are organized in a particular geometry. DNA can effectively template and stabilize these novel fluorescent AgNCs. Only a few atoms in size - the properties of nanoclusters can be tuned using only single nucleobase replacement of C-rich templating DNA sequences. A high degree of control over the structure of AgNC could greatly contribute to the ability to fine-tune the properties of silver nanoclusters. In this study, we explore the properties of AgNCs formed on a short DNA sequence with a C12 hairpin loop structure (AgNC@hpC12). We identify three types of cytosines based on their involvement in the stabilization of AgNCs. Computational and experimental results suggest an elongated cluster shape with 10 silver atoms. We found that the properties of the AgNCs depend on the overall structure and relative position of the silver atoms. The emission pattern of the AgNCs depends strongly on the charge distribution, while all silver atoms and some DNA bases are involved in optical transitions based on molecular orbital (MO) visualization. We also characterize the antibacterial properties of silver nanoclusters and propose a possible mechanism of action based on the interactions of AgNCs with molecular oxygen.

Radiosensitivity of seedling traits to varying gamma doses, optimum dose determination and variation in determined doses due to different time of sowings after irradiation and methods of irradiation in faba bean genotypes.

PURPOSE: Three experiments were conducted to assess the effect of different doses of gamma radiation on various seedling traits; determine the optimum doses of gamma radiation for different faba bean genotypes; find out the variation in optimum doses with respect to the different times of sowings after irradiation and methods of irradiation. MATERIALS AND METHODS: Five faba bean genotypes viz., L-2013-060, L-2013-092, Anandnagar Local, Gazipur Local and Bangla Gangachar were used in these experiments. In Experiment I, seeds of five experimental genotypes were exposed to different doses (100 Gy 200 Gy, 300 Gy, 400 Gy, 500 Gy, 600 Gy, 700 Gy and 800 Gy) of gamma radiation and were sown immediately after irradiation. In Experiment II, seeds of Bangla Gangachar and L-2013-060 were exposed to varying doses (100-800 Gy) of gamma radiation and were sown at seven sowings starting from 0 h to 24 h at 4-h intervals after irradiation. In Experiment III, L-2013-092 genotypes was exposed to different doses (100 -800 Gy) of gamma radiation with two different methods of irradiation. RESULTS: In Experiment I, the lethal dose 50 (LD50) values have arrived at 140 Gy, 669 Gy, 575 Gy, 386 Gy and 158 Gy for L-2013-060, L-2013-092, Anandnagar Local, Gazipur Local and Bangla Gangachar, respectively. The growth reduction 50 (GR50) doses for different seedling traits ranged from 130 Gy to 320 Gy for L-2013-060, 250 Gy to 480 Gy for L-2013-092, 130 Gy to 370 Gy for Anandnagar Local, 200 Gy to 350 Gy for Gazipur Local and 250 Gy to 400 Gy for Bangla Gangachar. In Experiment II, the values for LD50 of the genotypes Bangla Gangachar and L-2013-060 were significantly singular for different time intervals of sowing. The values of GR50 for most of the seedling traits were found to increase with the delay in sowing after irradiation from 4 to 24 h when compared with the immediately sown seed lots. In Experiment III, LD50 for L-2013-092 was 337 Gy with Method 1 and 669 Gy with Method 2. In Method 1, most of the growth parameters attained GR50 doses lower than Method 2. The first method was found to increase the radiosensitivity of L-2013-092. CONCLUSION: Every experimental genotype used in these three experiments showed dose-dependent retardation of different seedling traits. These optimized doses may be employed to establish mutant populations for exploiting the novel traits of faba bean. The time of sowing after irradiation and method of irradiation was found to be essential for confirming optimum doses.

Exploring the Immunomodulatory Aspect of Mesenchymal Stem Cells for Treatment of Severe Coronavirus Disease 19.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is an enveloped, positive sense, single stranded RNA (+ssRNA) virus, belonging to the genus Betacoronavirus and family Coronaviridae. It is primarily transmitted from infected persons to healthy ones through inhalation of virus-laden respiratory droplets. After an average incubation period of 2-14 days, the majority of infected individuals remain asymptomatic and/or mildly symptomatic, whereas the remaining individuals manifest a myriad of clinical symptoms, including fever, sore throat, dry cough, fatigue, chest pain, and breathlessness. SARS-CoV-2 exploits the angiotensin converting enzyme 2 (ACE-2) receptor for cellular invasion, and lungs are amongst the most adversely affected organs in the body. Thereupon, immune responses are elicited, which may devolve into a cytokine storm characterized by enhanced secretion of multitude of inflammatory cytokines/chemokines and growth factors, such as interleukin (IL)-2, IL-6, IL-7, IL-8, IL-9, tumor necrosis factor alpha (TNF-α), granulocyte colony-stimulating factor (GCSF), basic fibroblast growth factor 2 (bFGF2), monocyte chemotactic protein-1 (MCP1), interferon-inducible protein 10 (IP10), macrophage inflammatory protein 1A (MIP1A), platelet-derived growth factor subunit B (PDGFB), and vascular endothelial factor (VEGF)-A. The systemic persistence of inflammatory molecules causes widespread histological injury, leading to functional deterioration of the infected organ(s). Although multiple treatment modalities with varying effectiveness are being employed, nevertheless, there is no curative COVID-19 therapy available to date. In this regard, one plausible supportive therapeutic modality may involve administration of mesenchymal stem cells (MSCs) and/or MSC-derived bioactive factors-based secretome to critically ill COVID-19 patients with the intention of accomplishing better clinical outcome owing to their empirically established beneficial effects. MSCs are well established adult stem cells (ASCs) with respect to their immunomodulatory, anti-inflammatory, anti-oxidative, anti-apoptotic, pro-angiogenic, and pro-regenerative properties. The immunomodulatory capabilities of MSCs are not constitutive but rather are highly dependent on a holistic niche. Following intravenous infusion, MSCs are known to undergo considerable histological trapping in the lungs and, therefore, become well positioned to directly engage with lung infiltrating immune cells, and thereby mitigate excessive inflammation and reverse/regenerate damaged alveolar epithelial cells and associated tissue post SARS-CoV-2 infection. Considering the myriad of abovementioned biologically beneficial properties and emerging translational insights, MSCs may be used as potential supportive therapy to counteract cytokine storms and reduce disease severity, thereby facilitating speedy recovery and health restoration.

Comparison of Proseal Laryngeal Mask Airway with the I-Gel Supraglottic Airway During the Bailey Manoeuvre in Adult Patients Undergoing Elective Surgery.

OBJECTIVE: Since the inception of Bailey manoeuvre, various authors have advocated for the substitution of endotracheal tube (ETT) with a supraglottic airway device (SAD) before the emergence from anaesthesia. There is scant information about the ideal supraglottic device in the literature. The present study compared the Proseal laryngeal mask airway (LMA) with the I-gel SAD during the Bailey manoeuvre. The primary objective was to compare these for ease of insertion and adequate placement of supraglottic airway, whereas the secondary objective was comparison of haemodynamics following the Bailey manoeuvre. METHODS: A total of 100 patients aged 18-60 years who were scheduled for elective surgery under general anaesthesia were randomised into 2 groups: group I (Bailey manoeuvre using Proseal LMA) and group II (Bailey manoeuvre using I-gel). The Bailey manoeuvre was performed 15 min before the end of surgery using the chosen supraglottic airway as per randomisation. We measured the ease of insertion (number of attempts required for insertion) and adequate placement (Brimacombe scoring) of SADs (fibre-optic bronchoscopy). Haemodynamic parameters were recorded until 10 min after the Bailey manoeuvre. RESULTS: The groups were comparable in terms of demographic parameters. Both the devices were comparable in terms of ease of insertion (p>0.05). Significantly higher (p<0.05) Brimacombe scores were seen with the I-gel. Significant (p<0.05) rise in systolic blood pressure, diastolic blood pressure, and mean arterial pressure was observed at the insertion of SAD, removal of ETT, and at 1 min after the Bailey manoeuvre in Proseal LMA in contrast to the I-gel. CONCLUSION: This study showed that the I-gel provides a better glottic visualisation and haemodynamically superior profile compared with the Proseal LMA during the Bailey manoeuvre.

Association between climate and infectious diseases among children in Varanasi city, India: A prospective cohort study.

The effects of climate on infectious diseases could influence the health impacts, particularly in children in countries with the unfair socioeconomic conditions. In a prospective cohort of 461 children under 16-years-of-age in Varanasi city, India, the association of maximum-temperature (Tmax), relative humidity (RH), absolute humidity (AH), rainfall (RF), wind-speed (WS), and solar radiation (SLR) with prevalent infectious diseases (Diarrhea, Common cold and flu, Pneumonia, Skin-disease and Malaria, and Dengue) was examined using binomial-regression, adjusting for confounders and effect modifiers (socioeconomic-status; SES and child anthropometry), from January 2017 to January 2020. Attributable-fraction (AFx) was calculated due to each climate variable for each infectious disease. The result showed that each unit (1 °C) rise in Tmax was associated with an increase in diarrhea and skin-disease cases by 3.97% (95% CI: 2.92, 5.02) and 3.94% (95% CI: 1.67, 6.22), respectively, whereas, a unit decline in Tmax was associated with an increase in cold and flu cases by 3.87% (95% CI: 2.97, 4.76). Rise in humidity (RH) was associated with increase in cases of cold and flu by 0.73% (95% CI: 0.38, 1.08) and malaria (AH) by 7.19% (95% CI: 1.51, 12.87) while each unit (1 g/m3) decrease in humidity (AH) observed increase in pneumonia cases by 3.02% (95% CI: 0.75, 5.3). WS was positively associated with diarrhea (14.16%; 95% CI: 6.52, 21.80) and negatively with dengue (17.40%; 12.32, 22.48) cases for each unit change (kmph). RF showed marginal association while SLR showed no association at all. The combined AFx due to climatic factors ranged from 9 to 18%. SES and anthropometric parameters modified the climate-morbidity association in children with a high proportion of children found suffering from stunting, wasting, and underweight conditions. Findings from this study draw the attention of government and policymakers to prioritize effective measures for child health as the present association may increase disease burden in the future under climate-change scenarios in already malnourished paediatric population through multiple pathways.

Efficacy of Combination of Esmolol and Diltiazem for Attenuating Hemodynamic Response to Laryngoscopy and Intubation: A Prospective Randomized Study.

BACKGROUND: Laryngoscopy and tracheal intubation (LTI) are known to release catecholamines resulting in rise in heart rate (HR) and blood pressure. Various drugs have been studied till date to attenuate the sympathomimetic effects of laryngoscopy and intubation. AIMS: The aim is to study the effect and safety of esmolol, diltiazem, and their combination on pressor response of laryngoscopy and intubation. SETTING AND DESIGN: This prospective, randomized double-blind study was designed to assess the efficacy of the combination of esmolol and diltiazem and compare it with esmolol and diltiazem when used alone, for attenuating the pressor response to laryngoscopy and intubation. MATERIALS AND METHODS: One hundred twenty-four adult patients of physical status American Society of Anesthesiologists Classes I and II posted for elective surgery under general anesthesia requiring endotracheal intubation were randomly allocated (using computer-generated random numbers) into four groups of 31 each, in a double-blind fashion, to receive the test drug, i.e., saline (control), diltiazem (0.2 mg/kg), esmolol (1.5 mg/kg), or a combination (diltiazem [0.1 mg/kg] and esmolol [0.75 mg/kg]). The test drug was administered intravenously as a bolus after 1 min of injecting the muscle relaxant. LTI was performed after 2 min of the test drug. Hemodynamic data - HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) - were recorded at 1 min intervals after induction, until laryngoscopy and intubation, and at 1, 2, 3, 4, 5, and 10 min thereafter. STATISTICAL ANALYSIS: Statistical analysis was performed using one-way analysis of variance (ANOVA) for comparison among and between the groups. The Bonferroni's correction was applied when a significant difference was found between groups after applying ANOVA. Results were considered statistically significant at P ≤ 0.05. RESULTS: In the control and diltiazem groups, a significant increase in HR (P ≤ 0.05) was observed after laryngoscopy. Esmolol and combination groups were associated with a significant fall in HR after administration of the test drug, and no significant rise was noted after laryngoscopy. HR was significantly less in the combination and esmolol groups as compared to the control till 5 min after LTI. As compared with the control, all the other groups were associated with a fall in SBP after the test dose, and this lasted for 5 min (P < 0.001) after laryngoscopy in the esmolol and combination groups and for 1 min (P < 0.001) in the diltiazem group. All groups were associated with a significant rise in DBP and MAP for 1-2 min after LTI (P < 0.001), except the combination group in which no change was noted. DBP and MAP were significantly less in the combination group as compared to the control, from 1 min after giving the test dose till 5 min (P < 0.001) after LTI. CONCLUSION: Although esmolol and combination groups were both effective in controlling the increase in HR and SBP, only the combination group was effective in controlling the rise in DBP and MAP after LTI. HR, SBP, DBP, and MAP were significantly less in the combination group as compared to the control till 5 min after LTI. We recommend a combination of esmolol and diltiazem in appropriate doses for effectively attenuating the rise in HR and blood pressure responses during LTI.

Innovative Application of a Microlaryngeal Surgery Tube for difficult Airway Management in a Case of Down's Syndrome.

An 11-year-old male child, known case of down's syndrome with congenital oesophageal stricture was posted for oesophageal dilatation. Preoperative airway assessment revealed a high arched palate, receding mandible and Mallampati Score of 2. During surgery, after loss of consciousness which was described as loss of eyelash reflex and adequate jaw relaxation, direct laryngoscopy and endotracheal intubation was attempted with a cuffed endotracheal tube number 5.0mm ID (internal diameter). The endotracheal tube could not be negotiated smoothly, so 5.0mm ID uncuffed endotracheal tube was used which passed through easily, but on auscultation revealed a significant leak. Later, intubation via a Micro Laryngeal Surgery (MLS) cuffed tube 4.0mm ID was attempted. The MLS tube advanced smoothly and there was no associated leak on positive pressure ventilation. Thus by innovative thinking and avant-garde reasoning, a definitive airway device could be positioned with no other suitable alternative at hand.

Synthesis and biological evaluation of some 2-(3,5-dimethyl-1H-pyrazol-1-yl)-1-arylethanones: antibacterial, DNA photocleavage, and anticancer activities.

In continuation of our efforts to find new biologically active agents, regioselective synthesis of a series of 2-(3,5-dimethyl-1H-pyrazol-1-yl)-1-arylethanones 4a-k has been achieved under facile, extremely mild and greener reaction conditions with excellent yields. Moreover, one pot multicomponent reaction has also been reinvestigated under previously reported solvent conditions to prepare 4a-b and found that the reaction generates significant amount of side products. The chemical structures of 4a-k were established on the basis of a combined use of IR, NMR ((1)H, (13)C) spectroscopy, mass spectrometry and elemental analysis. All the compounds were evaluated for their antibacterial, DNA photocleavage and anticancer activities. Among all, 2-(3,5-dimethyl-1H-pyrazol-1-yl)-1-(naphth-2-yl)ethanone 4j displayed good inhibitory profile against Escherichia coli and Staphylococcus aureus which was about 50% and 25% of the Ampicillin (standard drug), respectively. The compounds, 4a and 4f showed relatively moderate inhibition against Psuedomonas aeruginosa and E. coli. In DNA photocleavage study, compounds 4c and 4d were found to be highly active and completely degraded both forms of DNA (SC and OC), even at a very low concentration of 1 µg (4c) under irradiation of UV light. However, 4h and 4f resulted in complete DNA degradation at 30 µg concentration. Moreover, 4h showed fluorescence at 15 µg concentration and increased the intensity of both bands of DNA (SC and OC) as compared to control. On the other hand, to valorize the biological potential, the compounds were screened for their cytotoxic activity on colon (HCT116 and HT29), prostate (DU145), ovarian (SKOV3) and lung (A549) cancer cell lines. The compound 4j was found to be cytotoxic to all the cancer cell lines, except SKOV3, with more selectivity towards the colon cancer cell lines (HCT116, HT29) and A549 lung cancer cell line. On A549 lung cancer cell line, 4j and 4k exhibited similar potency as carboplatin in inhibiting cell viability.

Developments in synthesis of the anti-inflammatory drug, celecoxib: a review.

Celecoxib, a tricyclic compound having pyrazole ring exhibits an excellent level of antiinflammatory action against COX-2 enzymes and some of its analogs act as anticancer and antibacterial agents. Various efficient routes and different improved processes for the synthesis of this drug have already been disclosed in the literature. However, there is a need for further developments in the present scenario of achieving cost effective synthetic technologies to celecoxib with high purity accompanied by excellent yield. Therefore, an effort has been made to summarize briefly the different methods of preparation of Celecoxib with their advantages or disadvantages that have been reported in various patents up to 2013. The present review would be beneficial for scientific community for further developments in the synthetic methodologies for Celecoxib and to explore some novel celecoxib based biologically active agents.

Management of swine-flu patients in the intensive care unit: Our experience.

BACKGROUND: H1N1 pandemic in 2009-2010 created a state of panic not only in India, but in the whole world. The clinical picture seen with H1N1 is different from the seasonal influenza involving healthy young adults. Critical care management of such patients imposes a challenge for anesthesiologist. MATERIALS AND METHODS: A retrospective analysis of hospitalized positive H1N1 patients was performed from July 2009-June 2010. Those requiring the ventilatory support were included in the study. RESULT: 54 patients were admitted in the swine-flu ward during the study period out of which 19 required ventilatory support. The average day of presentation to the health care facility was 6(th) day causing delay in initiation of antiviral therapy and increased severity of the disease. 65% of the ventilated patients were having associated comorbidities. Mortality was 74% among ventilated patients. CONCLUSION: Positive H1N1 with severe disease profile have a poor outcome. Early identification of high-risk factors and thus early intervention in the form of antiretroviral therapy and respiratory care will help in reducing the overall mortality.