Effect of different doses of dexmedetomidine as an adjuvant to lignocaine nebulization: A comparative study during awake flexible fiberoptic bronchoscopy.

Background and Aims: Mild to moderate sedation during bronchoscopy is essential for patient safety, comfort during and after the procedure, and to facilitate the performance of the bronchoscopist. Dexmedetomidine is a highly selective, centrally acting α-2 agonist used to provide conscious sedation during various procedures. The aim of this study was to compare the efficacy of three different doses of dexmedetomidine nebulization as an adjuvant to lignocaine during bronchoscopy. Material and Methods: Ninety American Society of Anesthesiologists physical status I/II patients, aged from 18 to 60 years, scheduled for an elective bronchoscopy, were recruited. They were divided into three groups: 30 patients in each group. Group I: The patient was nebulized with a mixture of 4 ml of 4% lignocaine and dexmedetomidine 0.5 µg/kg. Group II: The patient was nebulized with a mixture of 4% lignocaine, 4 ml, and dexmedetomidine, 1 µg/kg. Group III: The patient was nebulized with 4% lignocaine 4 ml and dexmedetomidine 1.5 µg/kg. Results: The mean cough score was (1.17 ± 0.37), (1.40 ± 0.49), and (1.70 ± 0.75) in group III, group II, and group I, respectively. A significant difference was found between the groups. Patients were more comfortable with a statistically significant difference in the comfort score in group III as compared to group II and group I. Conclusion: Dexmedetomidine nebulization in a dose of 1.5 µg/kg (compared to 1 µg/kg or 0.5 µg/kg) as an adjuvant to lignocaine, provides better bronchoscopy conditions and patient satisfaction.

Europium-based ß-hydroxyketone complexes: synthesis, optoelectronic, thermal and computational analyses.

Six red-light-emitting Eu(III) complexes having a ß-hydroxyketone as ligand and heterocyclic ring containing compounds as ancillary ligands were synthesized to explore their use in displays and optoelectronics. The coordinating behavior of complexes was determined by various techniques such as FTIR (Fourier transform infrared), 1H-NMR (Nuclear magnetic resonance), and 13C-NMR that establishes a bonding of ligand and ancillary ligand with the Eu(III) ion. Morphology and purity were investigated through XRD (X-ray diffraction), SEM (scanning electron microscopy) and EDS (energy-dispersive X-ray spectroscopy) analyses that suggest semicrystalline and pure complex formation. Thermal analysis of complexes by TGA/DTG (thermogravimetric/derivative thermogravimetric) indicates that complexes are stable upto 200 ºC temperature making them suitable for use in display devices. Analysis of the photophysical properties was carried out in both solid and solution states using PL (photoluminescence) studies, color parameters, J-O (Judd-Ofelt) analysis and bandgap. Most emissive transition (5D0 → 7F2) is responsible for the red emission in the complexes. The CIE (Commission International de I'Eclairage) coordinates of complexes also indicate the red emission on UV excitation. The bandgap which was obtained in the range of 2.54-3.02 eV reveals the semiconducting behavior of complexes. Values of J-O parameters and Ω2 in the complexes reflect asymmetric chemical environment around Eu (III) and less covalence and the Ω4 indicates that complexes are less rigid. Bandgap calculated through DFT (density function theory) for complexes is in range of 2.37-2.77 eV, and intensity parameters (J-O), energy transfer rates, and spherical coordinates were determined by LUMPAC software. The computational data are in good harmony with the experimental data. Further biological aspects of complexes were studied using antioxidant and antimicrobial studies.

Comparative evaluation of nebulised dexmedetomidine vs fentanyl for the treatment of post-dural puncture headache (PDPH) in parturients after caesarean section under spinal anaesthesia: A randomised controlled study.

Background and Aims: The incidence of post-dural puncture headache (PDPH) following spinal anaesthesia in the obstetric population is around 0.5%-2%. Hydration, bed rest, caffeine, paracetamol, non-steroid anti-inflammatory drugs, epidural blood patches, etc., are the various modalities used for its management. This study aims to compare nebulised dexmedetomidine versus fentanyl for the treatment of PDPH in parturients after caesarean section under spinal anaesthesia. Methods: Ninety obstetric patients aged 18-35 years with American Society of Anesthesiologists (ASA) physical status II/III and suffering from PDPH as per the criteria of the International Headache Society after caesarean section under spinal anaesthesia were recruited in this double-blinded randomised study. Patients were randomised to Group D (dexmedetomidine 1 µg/kg nebulisation), Group F (fentanyl 1 µg/kg nebulisation), and Group S (saline nebulisation 4mL). The nebulisation was done 12 hourly for 72 hours. Assessment parameters included pain score and the requirement of additional treatment such as paracetamol, caffeine, and epidural blood patch. Analysis of variance test was used for continuous quantitative variables, and the Kruskal-Wallis test was used for quantitative discrete data. Results: The pain scores at 1, 6, 12, 24, 48, and 72 hours following nebulisation were significantly lower in Group D in comparison to groups F and S (P < 0.001). The number of patients requiring additional analgesic therapy was lower in Group D in comparison to patients in other groups (P < 0.001). Conclusion: Dexmedetomidine nebulisation resulted in effective reduction in PDPH symptoms and pain scores. Nebulisation with fentanyl did not alleviate PDPH symptoms when compared to the control group.

Factors Associated with Nursing Professionalism: Insights from Tertiary Care Center in India.

BACKGROUND: Professionalism among nurses plays a critical role in ensuring patient safety and quality care and involves delivering competent, safe, and ethical care while also working with clients, families, communities, and healthcare teams. AIMS AND OBJECTIVES: To assess the level of nursing professionalism and the factors affecting professionalism among nurses working at a tertiary care center in India. METHODS: A descriptive cross-sectional study was conducted from October 2022 to March 2023 using a total enumeration sampling technique. Following institutional ethics committee approval, standardized tools were administered consisting of Nursing Professionalism Scale and socio-demographic, personal, and organizational characteristics. RESULTS: A total of 270 nurses participated, with a response rate of 93.7%. The mean age of the participants was 27.33 ± 2.75 years, with the majority being female (82.6%) and belonged to the age group of 23-27 years (59.6%). More than half of the nurses exhibited high professionalism (53%), with the highest and lowest median scores for professional responsibility (29.0) and valuing human beings (13.0) respectively. Multivariate regression analysis demonstrated that, compared with their counterparts, nurses with a graduate nursing qualification (AOR = 4.77, 95% CI = 1.16-19.68), up-to-date training (AOR = 4.13, 95% CI = 1.88-9.06), and adequate career opportunity (AOR = 33.91, 95% CI = 14.48-79.39) had significant associations with high nursing professionalism. CONCLUSION/IMPLICATIONS FOR PRACTICE: The majority of the nurses had high professionalism, particularly in the domains of professional responsibility and management. Hospitals and healthcare institutions can use these findings to develop policies and prioritize opportunities for nurses to attend conferences and workshops to enhance their professional values, ultimately leading to improved patient care outcomes. PATIENT AND PUBLIC CONTRIBUTION: No patient or public contribution.

SIRT7: a novel molecular target for personalized cancer treatment?

The Sirtuin family of NAD+-dependent enzymes assumes a pivotal role in orchestrating adaptive responses to environmental fluctuations and stress stimuli, operating at both genomic and metabolic levels. Within this family, SIRT7 emerges as a versatile player in tumorigenesis, displaying both pro-tumorigenic and tumor-suppressive functions in a context-dependent manner. While other sirtuins, such as SIRT1 and SIRT6, exhibit a similar dual role in cancer, SIRT7 stands out due to distinctive attributes that sharply distinguish it from other family members. Among these are a unique key role in regulation of nucleolar functions, a close functional relationship with RNA metabolism and processing -exceptional among sirtuins- and a complex multienzymatic nature, which provides a diverse range of molecular targets. This review offers a comprehensive overview of the current understanding of the role of SIRT7 in various malignancies, placing particular emphasis on the intricate molecular mechanisms employed by SIRT7 to either stimulate or counteract tumorigenesis. Additionally, it delves into the unique features of SIRT7, discussing their potential and specific implications in tumor initiation and progression, underscoring the promising avenue of targeting SIRT7 for the development of innovative anti-cancer therapies.

Modified Thoracolumbar Interfascial Plane Block Versus Erector Spinae Plane Block in Patients Undergoing Spine Surgeries: A Randomized Controlled Trial.

BACKGROUND: Lumbar spine surgery is associated with significant postoperative pain. Interfascial plane blocks, such as erector spinae plane (ESP) and thoracolumbar interfascial plane (TLIP) blocks, can play a significant role in multimodal analgesic regimens. METHODS: Sixty patients aged 18 to 60 years undergoing elective single or double-level lumbar discectomy or primary lumbar laminoplasty were recruited into this randomized double­blind study. All patients received general anesthesia and were randomly allocated to either modified TLIP (mTLIP) block (group M) or ESP block (group E). Postoperative and intraoperative fentanyl consumption, and postoperative pain scores, were recorded. RESULTS: Total 48 h postoperative fentanyl consumption was higher in Group M (189.66±141.11 µg) than in Group E (124.16±80.83 µg; P =0.031). In the first 24 postoperative hours, fentanyl consumption was higher in Group M (150.3±120.9 µg) than in group E (89.9±65.3 µg; P =0.01) but was similar between groups in postoperative hours 24to 48 (39.0±20.2 µg versus 34.7±17.1 µg in group M and group E, respectively; P =0.37). Additional intraoperative fentanyl requirement was 57.66±21.76 µg in group M compared with 40.33±21.89 µg in group E ( P <0.01). Postoperative pain scores were higher in group M than in group E at 1, 2, 4, 6, 12, and 24 hours postoperatively ( P <0.001), but similar at 48 hours ( P =0.164). CONCLUSION: Compared with the mTLIP block, the ESP block was associated with lower pain scores and a small decrease in perioperative fentanyl consumption in patients undergoing lumbar spine surgeries. Both blocks could form a part of a multimodal analgesic regimen in spine surgery patients.

Plants and endophytes interaction: a "secret wedlock" for sustainable biosynthesis of pharmaceutically important secondary metabolites.

Many plants possess immense pharmacological properties because of the presence of various therapeutic bioactive secondary metabolites that are of great importance in many pharmaceutical industries. Therefore, to strike a balance between meeting industry demands and conserving natural habitats, medicinal plants are being cultivated on a large scale. However, to enhance the yield and simultaneously manage the various pest infestations, agrochemicals are being routinely used that have a detrimental impact on the whole ecosystem, ranging from biodiversity loss to water pollution, soil degradation, nutrient imbalance and enormous health hazards to both consumers and agricultural workers. To address the challenges, biological eco-friendly alternatives are being looked upon with high hopes where endophytes pitch in as key players due to their tight association with the host plants. The intricate interplay between plants and endophytic microorganisms has emerged as a captivating subject of scientific investigation, with profound implications for the sustainable biosynthesis of pharmaceutically important secondary metabolites. This review delves into the hidden world of the "secret wedlock" between plants and endophytes, elucidating their multifaceted interactions that underpin the synthesis of bioactive compounds with medicinal significance in their plant hosts. Here, we briefly review endophytic diversity association with medicinal plants and highlight the potential role of core endomicrobiome. We also propose that successful implementation of in situ microbiome manipulation through high-end techniques can pave the way towards a more sustainable and pharmaceutically enriched future.

New Highly Luminescent Red Emitting Complexes: Synthesis, Characterization, Judd-Ofelt Intensity Parameters and Pharmacological Investigations.

A series of new red luminescent Eu(III) complexes were integrated by ß-hydroxyketone ligand 2-(4-chlorophenyl)-1-(2-hydroxy-4,6-dimethoxyphenyl)ethan-1-one (CHDME) as main ligand and 1,10-phenanthroline (phen) or 5,6-dimethyl-1,10-phenanthroline (dmphen) or bathophenanthroline (bathophen) as ancillary ligand. The complexes were synthesised by solution precipitation method. The CHDME is taken as ligand and its analogous Eu(III) complexes were characterized by elemental analysis, FT-IR and 1H-NMR. The photoluminescent properties were also examined in solid state. The Judd-Ofelt intensity parameters (Ω2 and Ω4) and luminescence quantum efficiency (η) of Eu(III) complexes were additionally figured out as per luminescence spectra and decay cure. UV analysis and optical band was also calculated. Computational analysis were carried out and optical band and Judd-Ofelt intensity parameters were determined. Furthermore, the pharmacological activities such as antimicrobial and antioxidant activity of ligand CHDME and its analogous Europium complexes were also examined. The methods used were tube dilution method for calculating antimicrobial activity and DPPH free radical method for antioxidant activity.

Wild Edible Flowers of Western Himalayas: Nutritional Characterization, UHPLC-QTOF-IMS-Based Phytochemical Profiling, Antioxidant Properties, and In Vitro Bioaccessibility of Polyphenols.

Four edible flowers commonly consumed in the Western Himalayan region, namely, Bauhinia variegata (Kachnar), Tropaeolum majus (Nasturtium), Matricaria chamomilla (Chamomile), and Tagetes erecta (Marigold), were characterized for their nutritional and phytochemical composition. Through the UHPLC-QTOF-IMS-based metabolomics approach, 131 compounds were tentatively identified consisting of phenolic acids, flavonoid glycosides, terpenoids, amino acids, and fatty acid derivatives. Kaempferol and quercetin glycosides for Kachnar, apigenin glycosides and caffeoylquinic acid derivatives for Chamomile, patulin and quercetin derivatives for Marigold, cyanidin and delphinidin glycosides for Nasturtium were the predicted marker metabolites identified through non-targeted metabolomics. Kachnar and Chamomile scored best in terms of macronutrients and essential micronutrients, respectively. Nasturtium contained high concentrations of α-linolenic acid, anthocyanins, and lutein. Kachnar contained the highest total phenolic acids (63.36 ± 0.38 mg GAE g-1), while Marigold contained the highest total flavonoids (118.90 ± 1.30 mg QUE g-1). Marigolds possessed excellent free radical scavenging and metal chelation activities. Chamomile exhibited strong α-glucosidase inhibition activity, followed by Nasturtium. The in vitro gastrointestinal digestibility of flower extracts indicated that the bioaccessibility of phenolic acids was higher than that of flavonoids. Polyphenols from Nasturtium and Chamomile showed the highest bioaccessibility. The study is an attempt to characterize traditionally consumed edible flowers and promote their wider utilization in gastronomy and nutraceuticals.

Harnessing the combined effect of antivirulence agent trans-chalcone with bactericidal curcumin against sortase A enzyme to tackle Gram-positive bacterial infections.

Gram-positive bacteria are responsible for a wide range of infections in humans. In most Gram-positive bacteria, sortase A plays a significant role in attaching virulence factors to the bacteria's cell wall. These cell surface proteins play a significant role in virulence and pathogenesis. Even though antibiotics are available to treat these infections, there is a continuous search for an alternative strategy due to an increase in antibiotic resistance. Thus, using anti-sortase drugs to combat these bacterial infections may be a promising approach. Here, we describe a method for targeting Gram-positive bacterial infection by combining curcumin and trans-chalcone as sortase A inhibitors. We have used curcumin and trans-chalcone alone and in combination as a sortase A inhibitor. We have seen ~78%, ~43%, and ~94% inhibition when treated with curcumin, trans-chalcone, and a combination of both compounds, respectively. The compounds have also shown a significant effect on biofilm formation, IgG binding, protein A recruitment, and IgG deposition. We discovered that combining curcumin and trans-chalcone is more effective against Gram-positive bacteria than either compound alone. The present work demonstrated that a combination of these natural compounds could be used as an antivirulence therapy against Gram-positive bacterial infection.

Assess perception, practice and lived experiences on use of corrective braces among parents of children diagnosed with clubfoot: A mixed method study.

BACKGROUND: Congenital talipes equinovarus (CTEV) is a congenital musculoskeletal deformity, which further leads to abnormal alignment of the feet in children. The aim of the present study is to assess perception and practice and explore lived experiences on the use of corrective braces among parents of children diagnosed with clubfoot. MATERIAL AND METHODOLOGY: A mixed method study approach with convergent parallel research design was used on 100 parents of children with clubfoot. For the quantitative strand, a total enumerative sampling technique was used to collect the data using self-structured tools-a 5-point Likert scale on perception and a checklist on practice at the clubfoot clinic of a selected tertiary care hospital, Rishikesh. For the qualitative strand, a purposive sampling technique was used to conduct the in-depth interview until data saturation from 17 participants using a semi-structured questionnaire. Analysis was done using the SPSS 23.0 software, descriptive statistics with the use of frequency %, whereas for correlation, Pearson's correlation coefficient was used. RESULTS: The mean age of participants was 31 years with a mean score of 30.54 ± 4.97. Among parents, 93% showed positive perception with a mean score of 67.16 ± 6.23 and 64% followed appropriate practice with a mean score of 12.44 ± 1.45. Coefficient correlation showed a statistically weak positive correlation between perception and practice (P < 0.001). The lived experiences of parents were reflected under six main themes, i.e., "personal experiences with wearing braces for correction," "encounters and barriers," "effects on one's social and personal life," "perceived answers," "any other previous practice," and "awareness about clubfoot." CONCLUSION: Present study concluded that parents had a positive perception and appropriate practice on the use of corrective braces, but there were a few issues such as relapse due to non-adherence, financial burden, and traveling distance, and noticeably more, which need to be addressed. Parental information is a very essential component that should be addressed by all treating physicians and nursing officers before starting treatment for clubfoot.

Seasonal and diurnal measurement of ambient benzene at a high traffic inflation site in Delhi: Health risk assessment and its possible role in ozone formation pathways.

Benzene is the most toxic and hazardous pollutant among volatile organic compounds (VOCs), as it comes under group 1 carcinogens recognized by the International Agency for Research on Cancer (IARC). It also plays a significant role in forming secondary pollutants like ozone. The benzene concentration was measured using a charcoal sorbent tube by active sampling at a traffic junction and analysis was done using GC-FID. The maximum average concentration of benzene in ambient air was found to be 33 µg/m3. A diurnal study of benzene measurement shows higher benzene concentrations in the evening compared to the morning. Seasonal variation of benzene is found to be winter > spring > summer > autumn > monsoon and OFP was found to be 21, 19, 14, 13, and 10 respectively. Cancer (ILCR) and non-cancer (HQ) health risk assessment was done to determine the impact of ambient benzene on the residents of urban areas. The yearly average value of ILCR was found to be 2×10-6 ± 1×10-6 which ranges from acceptable value to three times the WHO acceptable value i.e 1×10-6. The correlation of ozone and its precursor, benzene with meteorological parameters is also evaluated. The correlation of benzene and ozone with solar radiation shows the influence of photochemical reactions on the levels of benzene and ozone at the study site, although it is low.

Molecular insights into intrinsic transducer-coupling bias in the CXCR4-CXCR7 system.

Chemokine receptors constitute an important subfamily of G protein-coupled receptors (GPCRs), and they are critically involved in a broad range of immune response mechanisms. Ligand promiscuity among these receptors makes them an interesting target to explore multiple aspects of biased agonism. Here, we comprehensively characterize two chemokine receptors namely, CXCR4 and CXCR7, in terms of their transducer-coupling and downstream signaling upon their stimulation by a common chemokine agonist, CXCL12, and a small molecule agonist, VUF11207. We observe that CXCR7 lacks G-protein-coupling while maintaining robust ßarr recruitment with a major contribution of GRK5/6. On the other hand, CXCR4 displays robust G-protein activation as expected but exhibits significantly reduced ßarr-coupling compared to CXCR7. These two receptors induce distinct ßarr conformations even when activated by the same agonist, and CXCR7, unlike CXCR4, fails to activate ERK1/2 MAP kinase. We also identify a key contribution of a single phosphorylation site in CXCR7 for ßarr recruitment and endosomal localization. Our study provides molecular insights into intrinsic-bias encoded in the CXCR4-CXCR7 system with broad implications for drug discovery.

Sulphonated poly(ethersulfone)/carbon nano-onions-based nanocomposite membranes with high ion-conducting channels for salt removal via electrodialysis.

Herein, we are reporting the carbon nano onions (CNO)-based sulphonated poly(ethersulfone) (SPES) composite membranes by varying CNO content in SPES matrix for water desalination applications. CNOs were cost-effectively synthesized using flaxseed oil as a carbon source in an energy efficient flame pyrolysis process. The physico- and electrochemical properties of nanocomposite membranes were evaluated and compared to pristine SPES. Moreover, the chemical characterisation of composite membranes and CNOs were illustrated using techniques such as nuclear magnetic resonance (NMR), Fourier transform infrared spectroscopy (FT-IR), field emission scanning electron microscope (FE-SEM), thermogravimetric analysis (TGA) and universal tensile machine (UTM). In the series of nanocomposite membranes, SPES-0.25 composite membrane displayed the highest water uptake (WU), ion exchange membrane (IEC) and ionic conductivity (IC) values that were enhanced by 9.25%, ~ 44.78% and ~ 6.10%, respectively, compared to pristine SPES membrane. The electrodialytic performance can be achieved maximum when membranes possess low power consumption (PC) and high energy efficiency (Ee). Therefore, the value of Ee and Pc for SPES-0.25 membrane has been determined to be 99.01 ± 0.97% and 0.92 ± 0.01 kWh kg-1, which are 1.12 and 1.11 times higher than the pristine SPES membrane. Hence, integrating CNO nanoparticles into the SPES matrix enhanced the ion-conducting channels.

Comparison of the efficacy of pericapsular nerve group block (PENG) block versus suprainguinal fascia iliaca block (SFIB) in total hip arthroplasty: A randomized control trial.

Background and Aims: Hip replacement surgery is a commonly performed surgery with the aim of improving mobility in patients suffering from hip conditions. Though the modified suprainguinal approach of fascia iliaca block (SFIB) is commonly used, the analgesic efficacy is moderate and is associated with quadriceps weakness. The pericapsular nerve group (PENG) block has been used to block the sensory articular branches of the hip joint in various hip surgeries. This study aimed to compare SFIB with PENG block in terms of pain relief, opioid consumption and their adverse effects in patients undergoing primary total hip arthroplasties. (THA). Methods: Seventy ASA I/II patients undergoing primary THA were enrolled in this double-blinded, randomized trial. Patients were randomly allocated to one of the two groups: Group P: ultrasound (US)-guided PENG block and Group S: patients received the US-guided SFIB. Results: Postoperatively, there was statistically significant difference in numerical rating scale (NRS) scores at all-time intervals. Total morphine consumption in 24 hours and 48 hours was statistically more in SFIB group. Five patients had quadriceps weakness in the SFIB group. There was no difference in any other adverse effects. Conclusion: US-guided PENG block significantly reduces perioperative morphine consumption and pain scores in THA patients when compared to SFI block. It is not associated with quadriceps weakness as seen in SFIB.

Biomass-derived carbon nano-onions for the effective elimination of organic pollutants and oils from water.

Oil spillage and leakage of organic solvents have caused severe environmental and ecological damages. It is of great significance to develop a cost-efficient and green adsorbent material with high uptake efficiency to separate the oil-water mixture. In this work, biomass-derived CNOs were first time explored in the adsorption of organic pollutants and oils from water. Carbon nano-onions (CNOs) with hydrophobicity and oleophilicity were cost-effectively synthesized in an energy efficient flame pyrolysis process using flaxseed oil as a carbon source. The as-synthesized CNOs without any further surface modification have shown high adsorption efficiency in removing organic solvents and oils from the oil-water mixture. The CNOs could adsorb diverse organic solvents such as pyridine (36.81 mg g-1), dichloromethane (90.95 mg mg-1), aniline (76 mg mg-1), toluene (64 mg mg-1), chloroform (36.25 mg mg-1), methanol (49.25 mg mg-1), and ethanol (42.25 mg mg-1). The uptake capacity for petrol and diesel over CNOs was observed at 36.68 mg mg-1 and 58.1 mg mg-1, respectively. The adsorption of pyridine followed pseudo-second-order kinetics and Langmuir's isotherm model. Moreover, the adsorption efficiency of CNOs towards the remediation of pyridine was almost similar in real-water samples when tested in tap water, dam water, groundwater, and lake water. Similarly, the practical applicability for the separation of petrol and diesel was also verified in the real sample (sea water) and has been proven to be excellent. By simple evaporation, the recovered CNOs can be reused for more than 5 cycles. CNOs exhibit the promising potential to be used in practical applications for oil-polluted water treatment.