Reproductive outcome following hysteroscopic septal resection in patients with infertility and recurrent abortions.

OBJECTIVES: To evaluate the outcome of hysteroscopic septal resection in patients with infertility and recurrent abortions. MATERIALS AND METHODS: This was a retrospective clinical analysis of 170 patients who underwent hysteroscopic septal resection by monopolar electrode (Collin's) knife. A second-look office hysteroscopy was performed in all cases within 2 months. The mean follow-up period was 28.5 months. RESULTS: The mean age of the patients was 25.6 years. The presenting clinical complaint was recurrent abortions in 68.2% patients, infertility in 17.6% patients and preterm deliveries in 14.1% patients. Final reproductive outcome was assessed for 152 patients, after excluding patients with other confounding factors, interfering in pregnancy outcome. There was a significant difference in reduction of number of miscarriages (91.5% pre-surgery; 12.9% post-surgery: p = 0.02) and increase in term deliveries (2.5% pre-surgery; 79.5% post-surgery: p = 0.01), while the number of preterm deliveries remained almost the same (6.1% pre-surgery; 7.5% post-surgery). Thirteen out of 23 infertile patients (56.5%) conceived after septal resection. The take home baby rate was increased from 8.5 to 87.1%. Cumulative first live birth rate revealed that 51.2% women had their first live birth within 10-15 months. There was an increased incidence (43.2%) of cesarean section in mode of delivery. In 11/170 patients, repeat hysteroscopy suggested the presence of uterine adhesions which needed hysteroscopic adhesiolysis and three patients required repeat septal resection. CONCLUSIONS: Hysteroscopic septal resection for women with history of recurrent abortions, preterm deliveries and in women with infertility is a safe and effective method of choice for improving the obstetric outcome.

Acute Shortening and Re-Lengthening (ASRL) in Infected Non-union of Tibia - Advantages Revisited.

INTRODUCTION: A gap non-union in various conditions has been treated successfully by the Ilizarov method. The gap can be filled up either by an acute shortening and re-lengthening (ASRL) procedure or by an internal bone transport (IBT). We compared the functional and clinical outcome of ASRL and IBT in gap non-unions of the infected tibia. MATERIAL AND METHODS: A retrospective study was conducted in our department from the data collected in the period between 1997 and 2010. There were 86 cases of infected non-union of the tibia, in patients of the age group 18 to 65 years, with a minimum two-year follow-up. Group A consisted of cases treated by ASRL (n=46), and Group B, of cases by IBT (n=40). The non-union following both open and closed fractures had been treated by plate osteosynthesis, intra-medullary nails and primary Ilizarov fixators. Radical debridement was done and fragments stabilised with ring fixators. The actual bone gap and limb length discrepancy were measured on the operating table after debridement. In ASRL acute docking was done for defects up to 3cm, and subacute docking for bigger gaps. Corticotomy was done once there was no infection and distraction started after a latency of seven days. Dynamisation was followed by the application of a patellar tendon bearing cast for one month after removal of the ring with the clinico-radiological union. RESULTS: The bone loss was 3 to 8cm (4.77±1.43) in Group A and 3 to 9cm (5.31± 1.28) in Group B after thorough debridement. Bony union, eradication of infection and primary soft- tissue healing was 100%, 85% and 78% in Group A and 95%, 60%, 36% in Group B respectively. Nonunion at docking site, equinus deformity, false aneurysm, interposition of soft-tissue, transient nerve palsies were seen only in cases treated by IBT. CONCLUSION: IBT is an established method to manage gap non-union of the tibia. In our study, complications were significantly higher in cases where IBT was employed. We, therefore, recommend ASRL with an established protocol for better results in terms of significantly less lengthening index, eradication of infection, and primary soft tissue healing. ASRL is a useful method to bridge the bone gap by making soft tissue and bone reconstruction easier, eliminating the disadvantages of IBT.

Modelling and optimization of factors influencing adsorptive performance of agrowaste-derived Nanocellulose Iron Oxide Nanobiocomposites during remediation of Arsenic contaminated groundwater.

Nanocellulose Iron Oxide Nanobiocomposites (NIONs) were synthesized from rice husk and sugarcane bagasse derived nanocelluloses for adsorptive removal of arsenic and associated contaminants present in groundwater samples. These NIONSs were superparamagnetic, hence magnetically recoverable and demonstrated promising recyclability. Synthesis of NIONs was confirmed by Transmission electron microscopy (TEM), X-Ray Diffraction (XRD), Fourier transform infrared spectroscopy (FTIR) and X-ray photoelectron spectroscopic (XPS). FTIR and XPS data together with adsorption kinetics provide insights into probable adsorption mechanism of Arsenic by NIONs. The experimental conditions for 10 different variants were modelled using response surface methodology (RSM) based on central composite design (CCD), considering the parameters; adsorbate dosage, adsorbent dosage, pH and contact time. The results identified the best performing variants and the optimal conditions for maximal absorption (~99%). These results were validated using a three-layer feed-forward Multilayer Perceptron (MLP) based Artificial Neural Network (ANN) model. Both RSM and ANN chemometric models were in close conformity for optimized conditions of highest adsorption by specific variants. The standardized conditions were used to expand the study to field-based arsenic contaminated groundwater samples and their performance to commercial adsorbents. NIONs show promising commercial potential for water remediation applications due to their high adsorptive performance, magnetic recoverability and recyclability.

The impact of point-of-care testing for influenza A and B on patient flow and management in a medical assessment unit of a general hospital.

OBJECTIVES: Timely implementation of influenza infection control and treatment can significantly reduce the impact on Hospital resources and patient management when demand is at peak. Turnaround times of Laboratory based screening tests for the diagnosis of influenza may have an impact on the implementation of infection control measures and treatment. In this study the objectives included determining the correlation between the Abbott ID NOW point-of-care testing (POCT) instrument using the Influenza A&B2 test and the laboratory based GeneXpert Flu+RSV kit. In addition the impact of the POCT instrument on the prescription of antivirals and antibiotics was evaluated by comparing with practice when the instrument was not in place. RESULTS: The results of the correlation study with a cohort of 54 patients revealed the Abbott ID NOW POCT has 92% sensitivity for the detection of Influenza A, while specificity was 100% for both Influenza A and B. The impact of the POCT instrument on the frequency of prescription of antivirals and amount of antibiotics consumed (33% reduction in antibiotic consumption in a cohort of 65 (2017) and 61 (2018)) was significant. In addition the average patient length of Hospital stay was significantly reduced from 5.26 days to 3.73 days.

Growth of a thermophilic bacterium on hydrocarbons: a new source of single-cell protein.

A species of the genus Bacillus, capable of growth on normal alkanes at 70 degrees C, was isolated by the method known as enrichment culture. Preliminary analyses of its amino acid composition indicate that it would be a good source of protein for human nutrition. Possible advantages of the use of such organisms for the production of single-cell protein include simplification of fermentor cooling and asepsis.

Incidence of dengue in a tertiary care centre--Kasturba Hospital, Manipal.

Dengue is the most important Arbovirus in the world in terms of occurrence and impact. It has been responsible for some devastating outbreaks and accounts for nearly 50-100 million cases of dengue fever and 2-5 lac cases of the dengue hemorrhagic fever worldwide. Dengue is caused by an arbovirus, which belongs to the Flaviviridae and is maintained in nature principally through biological transmission between susceptible vertebrate hosts by hematophagous arthropods. The incidence and global distribution of dengue has greatly increased in recent years and affects almost every country between the topics of Capricorn and Cancer. Although outbreaks of dengue fever has been occurring with regularity all over the country, and there have been 2 reported outbreaks in the neighboring district Mangalore in 1993 and 1996, there has been no reported outbreak in Manipal, which is what is responsible for the present study. In the study, out of the 100 clinically suspected cases of dengue, 44% tested positive for dengue IgM antibody, thus proving current dengue infection. Twenty six cases were from Shimoga district, which indicates increased dengue virus activity in this area and the possible endemicity in the region.

Correlation of electromyography with computed tomography in evaluation of lower back pain.

High-resolution computed tomography (CT) of the lumbar spine in 80 consecutive patients with lower back pain was correlated with electromyography (EMG) and with the clinical outcome at one-year follow-up. Forty-two patients had abnormal EMG findings that could be explained on the basis of anatomical defect(s) seen on CT. Nine had normal CT scans but abnormal EMGs, and five patients had normal EMGs but abnormal CT scans. Thirteen of the 80 patients were further investigated with myelography, 22 patients underwent surgical exploration, and the remainder received conservative therapy. In the majority of cases, surgery confirmed the abnormal CT and EMG findings; in some instances, however, myelography and/or surgery confirmed the abnormality only at the level demonstrated on EMG. The CT and EMG often agree. However, an abnormal EMG seems to correlate better with the demonstrated course of radiculopathy than CT.

Retrograde axonal transport of lead in rat sciatic nerve.

A wavelike pattern of retrograde axonal transport of lead was demonstrated in rat sciatic nerve after injection of 203Pb into the triceps surae muscle. The transport rate was about 10 mm per day, and the lead reached the spinal cord by 9 days after injection. The distribution of lead within the spinal cord indicated the possibility of retrograde axonal transport in the upper and lower motor neurons, which might explain how lead enters the central nervous system and could be related to the postulated role of lead in causing amyotrophic lateral sclerosis. Lead may be useful in investigating retrograde transport experimentally.

Sarcoidosis of the cervical spinal canal: case report.

A patient with sarcoidosis presenting as an intradural extramedullary space-occupying lesion in the cervical spinal canal is described.

Congenital hypoplasia of the depressor anguli oris muscle in the differential diagnosis of facial paralysis.

Facial paralysis presents an interesting diagnostic challenge. Etiologies ranging from facial nerve neuromas and CPA tumors to inflammatory disease and traumatic injuries need be considered and evaluated. However, an asymmetric facial appearance may result from abnormalities of facial musculature as well as facial innervation. Two cases of congenital hypoplasia of the depressor anguli oris muscle, a child and an adult, are reviewed to examine its presentation and diagnostic differentiation from other forms of facial paralysis. Photographs presenting the facial deformity and electrodiagnostic studies will be reviewed.

Plasmapheresis with acute inflammatory polyneuropathy.

Eleven children with acute inflammatory polyneuropathy were treated with a short course of intensive plasmapheresis. The 5 males and 6 females ranged in aged from 19 months to 16 years (mean: 7.8 years). The interval from disease onset to the initiation of plasmapheresis therapy was less than 7 days in 5 patients and less than 2 weeks in the others. At the time of the first plasmapheresis, 3 patients were on respirators (Grade 5 on the Guillain-Barré syndrome scale 0-6); 7 were bedridden (Grade 4); and 1 required assisted ambulation (Grade 3). One week after the last plasmapheresis, all but 1 patient had improved by 1 or more grades on the Guillain-Barré syndrome scale. At subsequent examination 6 months later, all patients were ambulatory and 9 of 11 had no significant neurologic findings. Electrophysiologic studies performed shortly before treatment initiation revealed predominant demyelinating neuropathy in 9 and axonal changes in 2. During the 76 plasmapheresis procedures, no severe complications were encountered. Although the number of patients treated is small, the clinical response observed would indicate plasmapheresis to be a safe and effective therapy in children with acute inflammatory polyneuropathy.

Effect of carbon and nitrogen sources on neutral proteinase production by Pseudomonas aeruginosa.

A strain of Pseudomonas aeruginosa from soil produced large quantities of extracellular neutral proteinase and could utilize several organic substances as carbon and nitrogen sources for enzyme production. The growth media required the presence of a high amount of phosphate when glucose was the carbon source. The intermediates of citric-acid cycle acids supported the proteinase production more than any other carbon sources. However, complex nitrogenous substances supported enzyme production more efficiently. Higher concentration of casamino acids suppressed the protinase synthesis.

Factors limiting the microbial conversion of sterols to 17-ketosteroids in the presence of metal chelate inhibitors.

Bioconversion of sterols to 17-ketosteroids by an Arthrobacter species occurred in the presence of hydrophobic metal-chelating agents but the production of 17-ketosteroids (17-KS) was seriously limited by the rapid loss of the viability of cells in the presence of these inhibitors. Besides, the conversion was inhibited by 17-KS at concentrations of 500 ppm or more. The 17-KS formed consisted exclusively of 1,4-androstadiene-3,17-dione (ADD) and 4-androstene-3,17-dione (AD) and these were found in the extracellular medium predominantly in bound form or as molecular aggregates which may limit their accumulation. It was concluded that enhanced production of 17-KS could be achieved by protecting the viability of cells and by removing the steroid metabolites from the site of inhibition.