An Atom-Economic Method for 1,2,3-Triazole Derivatives via Oxidative [3 + 2] Cycloaddition Harnessing the Power of Electrochemical Oxidation and Click Chemistry.

An electrochemical method was developed to accomplish the reagentless synthesis of 4,5-disubstituted triazole derivatives employing secondary propargyl alcohol as C-3 synthon and sodium azide as cycloaddition counterpart. The reaction was conducted at room temperature in an undivided cell with a constant current using a pencil graphite (C) anode and stainless-steel cathode in a MeCN solvent system. The proposed reaction mechanism was convincingly established by carrying out a series of control experiments and further supported by electrochemical and density functional theory (DFT) studies.

Ocular manifestation and visual outcomes in herpes zoster ophthalmicus: a prospective study from a tertiary hospital of Eastern India.

AIM: To estimate the magnitude of different ocular manifestation in clinically established herpes zoster ophthalmicus (HZO) patients and assessment of the visual outcome after two months of initial examination. METHODS: An observational prospective study was conducted on 42 clinically diagnosed Tzanck smear positive cases HZO to observe the occurrence and frequency of different ocular manifestation and their visual outcome in 10-month period with 2mo follow up. Full ophthalmological examination using slit lamp, non-contact tonometry, applanation tonometry, direct and indirect ophthalmoscope were performed. RESULTS: Out of 42 patients of HZO, 33 had one or more type of ocular manifestation staring from lid skin involvement to conjunctivitis, keratitis, uveitis, increased intraocular pressure (IOP) and optic neuritis but no retinal manifestation. More number of HZO cases and ocular manifestation were found with advancement of ages. Young HZO patients were more associated with human immunodeficiency virus (HIV) infection and HIV infected people with HZO infection had more ocular manifestation. Male to female ratio was 2:1 among HZO cases but ocular manifestation occurred more among males. Female with advanced age were involved more. Lid involvement (73.81%), conjunctivitis (69.05%), and keratitis (59.52%) were most common ocular manifestation followed by anterior uveitis (30.95%) and episcleritis (11.90%). Ocular hypertension (42.86%) was associated with almost every ocular manifestation. Among the cases of more than 45 years of age, 9.52% patients acquired 6/6 vision compared to 7.14% patients at and below 45 years of age after 8wk of follow up. CONCLUSION: The visual outcomes are poor in HZO with advanced age group. Visual outcome of the affected eyes is poor than unaffected eyes. The loss of vision is mainly due to keratitis, anterior uveitis, posterior uveitis, and optic neuritis.

Decreased Survival With Mastectomy Vis-à-Vis Breast-Conserving Surgery in Stage II and III Breast Cancers: A Comparative Treatment Effectiveness Study.

PURPOSE: The primary purpose of hospital-based cancer registries is assessing patient care. Clinical stage-based survival and treatment-based survival are some of the key parameters for such assessment. Because of the challenges in obtaining follow-up parameters, a separate study on patterns of care and survival was undertaken by the Indian National Cancer Registry Program. The results for cancer of the female breast are presented here. PATIENTS AND METHODS: Data abstracted in a standardized patient information form were transmitted online to a central repository. Treatment patterns were assessed for 9,903 patients diagnosed between January 1, 2006, and December 31, 2008, from 13 institutions. Survival analysis was restricted to 7,609 patients from nine institutions wherein follow-up details (as of December 31, 2012) were available for at least 60% of patients. RESULTS: The overall 5-year survival rates with breast-conserving surgery (BCS) and mastectomy (MS) were 94.0% and 85.8%, respectively, for stage II disease (adjusted hazard ratio, 2.40; 95% CI, 1.8 to 3.2) and 87.1% and 69.0%, respectively, for stage III disease (hazard ratio, 2.82; 95% CI, 2.2 to 3.7). Patients who had MS did better with systemic therapy (chemotherapy and/or hormone therapy), whereas patients with BCS required just local radiation therapy to achieve best survival. CONCLUSION: This observational study in the natural setting of care of patients with cancer in India showed significantly decreased survival with MS when compared with BCS. The reasons for lower survival with MS and the biologic or scientific rationale of the necessity of systemic therapy to achieve optimal survival in patients undergoing MS but not in those with BCS need further investigation.

Concurrent Chemoradiation for Cancer of the Cervix: Results of a Multi-Institutional Study From the Setting of a Developing Country (India).

PURPOSE: The primary output of hospital-based cancer registries is data on cancer stage and treatment-based survival that can be used to evaluate patient care, but because there are many challenges in obtaining follow-up details, a separate study on patterns of care and patterns of survival for patients at selected sites was initiated under the National Cancer Registry Programme of India. This article presents the results for cervical cancer. PATIENTS AND METHODS: A standardized patient information form was used to record patient information, and data were entered into a central repository-the National Centre for Disease Informatics and Research. The study patients were from 12 institutions and were diagnosed between January 1, 2006, and December 31, 2008. Patterns of treatment were assessed for 7,336 patients, and patterns of survival were determined for 2,669 patients from six institutions, at least 70% of whom had data regarding follow-up as of December 31, 2012. RESULTS: Of 7,336 patients, 55.5% received optimal radiotherapy (RT). In all, 80.9% of patients had locally advanced cancers (stage IIB to IVA), 51.1% received RT alone, and 44.4% received concurrent chemoradiation (RTCT). In 1,753 patients with locally advanced cancers, significantly better survival was observed with RTCT than with RT alone (5-year cumulative survival, 70.2% v 47.3%; hazard ratio, 0.48; 95% CI, 0.41 to 0.56). CONCLUSION: A conservative estimate indicates that, on an annual basis, 38,771 patients with cervical cancers in India alone do not get the benefit of RTCT and thus they have poorer survival. There is a need to reiterate the National Cancer Institute's alert that advised supplementing chemotherapy to radiation for locally advanced cancer of the cervix in the context of the developing world, where 84.3% of cancers of the cervix occur.

Tigecycline activity against metallo-ß-lactamase-producing bacteria.

BACKGROUND: [corrected] Treatment of serious life-threatening multi-drug-resistant organisms poses a serious problem due to the limited therapeutic options. Tigecycline has been recently marketed as a broad-spectrum antibiotic with activity against both gram-positive and gram-negative bacteria. Even though many studies have demonstrated the activity of tigecycline against ESBL-producing Enterobacteriaceae, its activity is not well-defined against micro-organisms producing metallo-ß-lactamases (MBLs), as there are only a few reports and the number of isolates tested is limited. AIMS: The aim of the present study was to evaluate the activity of tigecycline against MBL-producing bacterial isolates. MATERIALS AND METHODS: The isolates were tested for MBL production by (i) combined-disk test, (ii) double disc synergy test (DDST), (iii) susceptibility to aztreonam (30 µg) disk. Minimum inhibitory concentration to tigecycline was determined according to agar dilution method as per Clinical Laboratory Standards Institute (CLSI) guidelines. Disc diffusion susceptibility testing was also performed for all these isolates using tigecycline (15 µg) discs. RESULTS: Among the total 308 isolates included in the study, 99 were found to be MBL producers. MBL production was observed mostly in isolates from pus samples (40.47%) followed by urine (27.4%) and blood (13.09%). MBL production was observed in E. coli (41.48%), K. pneumoniae (26.67%), Proteus mirabilis (27.78%), Citrobacter spp. (41.67%), Enterobacter spp. (25.08%), and Acinetobacter spp. (27.27%). The result showed that tigecycline activity was unaffected by MBL production and it was showed almost 100% activity against all MBL-producing isolates, with most of the isolates exhibiting an MIC ranging from 0.25-8 µg/ml, except 2 MBL-producing E. coli isolates who had an MIC of 8 µg/ml. CONCLUSION: To conclude, tigecycline was found to be highly effective against MBL-producing Enterobacteriaceae and acinetobacter isolates, but the presence of resistance among organisms, even before the mass usage of the drug, warrants the need of its usage as a reserve drug. The study also found that the interpretative criteria for the disc diffusion method, recommended by the FDA, correlates well with the MIC detection methods. So, the microbiology laboratories might use the relatively easier method of disc diffusion, as compared to the comparatively tedious method of MIC determination.

Necrotizing fasciitis caused by Aeromonas caviae.

Aeromonads are rarely associated with human intestinal and extra-intestinal diseases and syndromes, ranging from relatively mild illnesses such as acute gastroenteritis to life-threatening conditions, including septicemia, necrotizing fasciitis, and myonecrosis. Among the aeromonas species known to cause human infection, Aeromonas caviae has been associated with septicemia and only one reported case of human soft tissue infection. Most of the infections due to aeromonas occur in immunocompromised patients. Herein we describe a successfully treated case of post-traumatic skin and soft-tissue infections due to A. caviae in an otherwise immunocompetent individual.

A Rare Case of Pancreatic Abscess due to Candida Tropicalis.

Candida albicans is found frequently as a commensal organism in the gastrointestinal tract. Despite this, it is rarely found in pancreatic abscesses, there being only a few cases in the literature and in most of these cases the significance of Candida spp. as a pathogen was not initially recognized at the time of diagnosis. In most of the earlier reported pancreatitis associated with candida, C. albicans was the commonest isolate. We report the case of a patient in whom computed tomography was used initially to diagnose a pancreatic abscess, aspiration of which showed growth of Candida tropicalis and Escherichia coli on culture. The patient was started on amphotericin B and imipenem, but the condition of the patient deteriorated, for which the patient underwent surgical necrosectomy and continued treatment with imipenem and amphotericin B led to the satisfactory recovery of the patient.

Evaluation of registered visually disabled individuals in a district of west bengal, India.

OBJECTIVE: To identify the sociodemographic characteristics, degree and cause of visual disability among certified visually disabled individuals in a rural district of West Bengal, India and to identify possible lacunae, if any, in the existing certification system. MATERIALS AND METHODS: A cross-sectional study by secondary data analysis of medical records of 155 visually disabled individuals and their 310 eyes. Demographical features, diagnosis, percentage of visual disability and work activity status of each individual were analyzed. RESULTS: One hundred and thirty one (84.52%) individuals had 100% disability. The number of males was significantly higher than that of females. Fifty eight (37.42%) individuals were below 21 years of age. Phthisis bulbi was the most common cause followed by microphthalmos. Further, 81.29% patients had the same lesion bilaterally. CONCLUSION: Patients with higher grades of disability have attended certification boards. A large number of disabled individuals comprised children and young adults. Male gender bias demands concern.

Assessing arsenic leachability from pulverized cement concrete produced from arsenic-laden solid CalSiCo-sludge.

Synthetically prepared arsenic-laden CalSiCo-sludge was converted to pulverized cement concrete (PCC) using solidification/stabilization technology with cement. Batch leaching experiments were conducted to estimate the leaching of As(III) and As(V) from the CalSiCo-sludge as well as from the PCC. The leaching of As(III) and As(V) was found to be the function of time, pH and concentration of anions such as Cl(-), NO(3)(-), and SO(4)(2-) present in the extraction fluid. It is observed that from the CalSiCo-sludge the leaching of As(III) is >0.05mg/l (which is above the permissible limit for arsenic in drinking water) at any pH. But in case of As(V) the leaching is >0.05mg/l only at pH>8 and at pH<4. It is noted that maximum leaching occurs when the extraction liquid contains Cl(-). In contrary, NO(3)(-) and SO(4)(2-) have negligible effect on arsenic leaching from the CalSiCo-sludge. Extraction tests were carried out to determine the maximum leachable concentration under the chosen conditions of leaching medium and leaching time. Leaching of As(III) and As(V) from exhausted arsenic-laden CalSiCo-sludge and from PCC was carried out in both tap water and rain water. It was noticed that tap water has no effect in leaching of arsenic from CalSiCo-sludge but rain water causes significant amount of leaching, which is mostly due to pH effect. However, in all cases the leaching of As(III) was more than that of As(V). When compared with CalSiCo-sludge PCC showed negligible leaching of arsenic. It was noticed further that the variation of 28 days compressive strength was within 15% of the original strength after replacing 35% cement with exhausted CalSiCo-sludge.

Sorption of cadmium from aqueous solution using pretreated rice husk.

The sorption of Cd(II) from aqueous solution by rice husk, a surplus agricultural byproduct was investigated. Some simple and low-cost chemical modifications resulted in increasing the sorption capacity of raw rice husk (RRH) from 8.58 mg/g to 11.12, 20.24, 16.18 mg/g and reducing the equilibrium time from 10 h of RRH to 2, 4 and 1 h for epichlorohydrin treated rice husk (ERH), NaOH treated rice husk (NRH), sodium bicarbonate treated rice husk (NCRH), respectively. The effect of pH, sorption kinetics and isotherms were studied in batch experiments. Good correlation coefficient was obtained for pseudo second-order kinetic model, which agreed with chemisorption as the rate-limiting mechanism. Sorption isotherm test showed that equilibrium sorption data were better represented by Langmuir model than the Freundlich model. The highly efficient low cost and the rapid uptake of Cd(II) by NCRH indicated that it could be an excellent alternative for the removal of heavy metal by sorption process.

Fixed bed column study for Cd(II) removal from wastewater using treated rice husk.

A fixed bed of sodium carbonate treated rice husk was used for the removal of Cd(II) from water environment. The material as adopted was found to be an efficient media for the removal of Cd(II) in continuous mode using fixed bed column. The column having a diameter of 2 cm, with different bed depths such as 10, 20 and 30 cm could treat 2.96, 5.70 and 8.55 l of Cd(II) bearing wastewater with Cd(II) concentration 10 mg/l and flow rate 9.5 ml/min. Different column design parameters like depth of exchange zone, adsorption rate, adsorption capacity, etc. was calculated. Effect of flow rate and initial concentration was studied. Theoretical breakthrough curve was drawn from the batch isotherm data and it was compared with experimental breakthrough curve. An amount of 0.01 mol/l HCl solution was used for desorption of adsorption column. Column regeneration and reuse studies were conducted for two cycles of adsorption-desorption.

Bilateral scleromalacia in a case of congenital erythropoietic porphyria.

A 25-year-old woman presented with gradual dimness of vision in the left eye with history of recurrent cutaneous bullae, photosensitivity and passage of red coloured urine. Examination revealed cataract and high intra-ocular pressure in left eye and symmetrical areas of scleral thinning in both eyes. Systemic features of the patient pointed towards congenital erythropoietic porphyria, which was established by laboratory investigations.

Adsorption of anionic surfactant on alumina and reuse of the surfactant-modified alumina for the removal of crystal violet from aquatic environment.

The adsorption characteristics of sodium dodecyl sulfate (SDS), an anionic surfactant on neutral alumina were studied in detail. Alumina was found to be an efficient adsorbent for SDS and could be used for the removal of SDS from its highly concentrated (several thousand ppm) solution. The equilibrium time found was 2 h. Though the removal efficiency was low (approximately 65%) at neutral pH, but in slightly acidic condition and in the presence of NaCl the efficiency could be increased dramatically (up to >98%). The adsorption isotherm study showed distinct four regions. The effects of various other parameters such as adsorbent dose, time, and the presence of different ions (Cl-, NO3-, SO4(2-), and Fe3+), and nonionic surfactant on the SDS adsorption were also studied. It was observed that the adsorption capacity was increased due to the presence of these ions in general. After the adsorption of SDS on alumina, the surfactant-modified alumina (SMA) was used for the removal of crystal violet (CV), a well-known cationic dye from aquatic environment. The kinetic studies showed that 1 h shaking time was sufficient to achieve the equilibrium. The removal of CV followed the second order kinetics. Studies were conducted to see the effects of adsorbent dose and initial CV concentration on the removal of CV using SMA. The pH was maintained at 6.7+/-0.1. SMA was found to be very efficient, and approximately 99% efficiency could be achieved under optimised conditions for the removal of CV when present even at a high concentration (200 ppm). To test whether the removal of CV was possible from real water using SMA, the adsorption study was conducted using CV spiked samples using distilled water, tap water, and synthetically prepared wastewater. It was interesting to note that the removal efficiency was even better for tap water and much better for wastewater when compared to that using distilled water. Desorption of both SDS and CV from the SMA surface was possible using 1 M sodium hydroxide solutions.

Performance of waste activated carbon as a low-cost adsorbent for the removal of anionic surfactant from aquatic environment.

In the present study, different low cost adsorbents were screened for their sodium dodecyl sulfate (SDS, an anionic surfactant) removal capacity. Waste activated carbon (WAC) from the aqua purifier has shown high efficiency for SDS removal. The performance evaluation in the presence of various ions (Ca2+, SO4(2-), NO3-, and Cl-) and at various pH was studied. Desorption studies were conducted using simple sonication and pH variation technique. Column adsorption studies were performed. SEM and EDS studies were done on the adsorbing material before adsorption, after adsorption and after desorption of SDS.

Adsorption of anionic surfactant by a low-cost adsorbent.

This study was undertaken to evaluate the efficiency of rubber granule, a low-cost adsorbent for the removal of sodium dodecyl sulfate (SDS) that is a representative member of anionic surfactant (AS). In the batch experiments conducted at an initial concentration range of 2-6 mg/l, it was found that the rubber granules selected could remove SDS from water up to 90%. Kinetic profiles were developed for various conditions. Effects of adsorbent size, initial adsorbate concentration and adsorbent dose, pH, Ca2+ ion concentration, Fe2+ ion concentration, Cl- ion concentration, and ionic strength on the adsorption of SDS on rubber granules were studied. The adsorption isotherm studies were also conducted.

Comparison of Goldmann applanation tonometry with the Tonopen for measuring intraocular pressure in a population-based glaucoma survey in rural West Bengal.

AIM: This study was undertaken to compare the measurement of intraocular pressure (IOP) in a population-based glaucoma survey by the Goldmann Applanation Tonometer (GAT) and the Tonopen with respect to IOP readings, the time required to measure IOP and subjects' preference for the two instruments. The purpose of the study was to see which of the two instruments could be more suitable in a rural survey, particularly house-to-house, in trying to find cases of advanced glaucoma. METHOD: The study was conducted on a total of 203 subjects as a part of a population-based glaucoma survey. The IOP of one randomly selected eye of each subject was measured, first with the GAT and subsequently with the Tonopen. The time taken for each procedure was noted and subjects' preference was ascertained. RESULTS: The mean of the paired differences between the readings of the two instruments (Tonopen minus GAT) was 1 mm Hg with a standard deviation of 2.28. The Tonopen readings were within +/-3 mm Hg of the GAT readings in 86.2% of eyes. In 7.4% of the eyes the paired differences were > or =+/-5 mm Hg. Measurement of IOP by the Tonopen was much quicker, the mean time difference being 38.7 sec. Subjects' preference for the Tonopen was higher. CONCLUSION: The overall agreement between the measurements of the two instruments was good but a small percentage of large difference (> or = +/-5 mm Hg in 7.4%) may be of concern in a population-based survey. The time to measure IOP and the subjects' preference were strongly in favour of the Tonopen.