Evaluación comparativa de dexmedetomidina y labetalol para atenuar las respuestas de estrés hemodinámico durante la colecistectomía laparoscópica en pacientes con hipertensión limítrofe / Comparative evaluation of dexmedetomidine and labetalol for attenuating hemodynamic stress responses during laparoscopic cholecystectomy in borderline hypertensive patients

Objetivo: Diversos fármacos han tratado de atenuar la respuesta vasopresora en los pacientes de colecistectomía laparoscópica. Comparamos la inyección intravenosa preinducción única de dexmedetomidina y de labetalol para atenuar la respuesta de estrés hemodinámico. Métodos: Consideramos a un total de 160 pacientes para este estudio prospectivo, aleatorizado y doble ciego, realizado en un único centro de atención terciaria. Incluimos a los pacientes en el grupo D, quienes recibieron 1μg/kg iv de dexmedetomidina, o el grupo L, quienes recibieron 0,3 mg/kg iv de labetalol en 100ml de suero salino normal antes de la inducción de anestesia. Se anotaron preoperatoriamente los parámetros hemodinámicos de los pacientes, antes de iniciar la infusión, y a intervalos fijos, hasta la extubación. Resultados: Tras la intubación, la presión arterial sistólica (PAS) fue más alta en los pacientes del grupo L (128 +/- 13,866) en comparación con el grupo D (123,2 +/- 10,672). Posteriormente, la PAS fue comparable hasta la extubación. De igual modo, tras la intubación los pacientes del grupo D tendieron a tener una presión arterial diastólica más baja (73,1 +/- 9,683 vs. 79,2 +/- 14,153, valor p de 0,0017) en comparación con los pacientes del grupo L. También la incidencia relativa de bradicardia e hipotensión fue mayor en los pacientes que habían recibido labetalol. Conclusión: En los pacientes con predisposición a fluctuaciones significativas de la presión arterial, o de la frecuencia cardiaca, la administración de dexmedetomidina puede resultar más adecuada que labetalol, debido a una mejor conservación de la hemodinámica normal, especialmente durante el periodo de estrés, habiendo reflejado una menor incidencia relativa de efectos colaterales

Objective: Various pharmacological agents have been tried to attenuate the pressor response in laparoscopic cholecystectomy patients. We have compared single pre-induction intravenous injection of dexmedetomidine with labetalol for attenuation of haemodynamic stress response. Methods: A total of 160 patients were considered for this prospective, randomized, double blind clinical study done in a single tertiary care institution. Patients were either included in group D, to receive 1.0μg·kg−1 i.v. dexmedetomidine or group L, to receive 0.3 mg·kg−1 i.v. labetalol in 100ml of normal saline before induction of anaesthesia. Patient's hemodynamic parameters were noted pre-operatively before starting infusion and at fixed intervals afterwards till extrubation. Results: After intubation, mean systolic blood pressure (SBP) was higher in patients of group L (128.0 +/- 13.866) as compared to group D (123.2 +/- 10.672). Afterwards the SBP was comparable until extrubation. Similarly, after intubation patients in group D tended to have lower diastolic pressure (73.1 +/- 9.683 vs. 79.2+/- 14.153, P value .0017) compared to patients in group L. Also, the relative incidence of bradycardia and hypotension was higher in patients who had received inj. labetalol. Conclusion: In patients predisposed to significant fluctuations in blood pressure or heart rate dexmedetomidine may be more suitable than labetalol due to better preservation of normal haemodynamics especially during periods of stress showing a relatively lower incidence of side effects

Comparative evaluation of dexmedetomidine and labetalol for attenuating hemodynamic stress responses during laparoscopic cholecystectomy in borderline hypertensive patients. / Evaluación comparativa de dexmedetomidina y labetalol para atenuar las respuestas de estrés hemodinámico durante la colecistectomía laparoscópica en pacientes con hipertensión limítrofe.

OBJECTIVE: Various pharmacological agents have been tried to attenuate the pressor response in laparoscopic cholecystectomy patients. We have compared single pre-induction intravenous injection of dexmedetomidine with labetalol for attenuation of haemodynamic stress response. METHODS: A total of 160 patients were considered for this prospective, randomized, double blind clinical study done in a single tertiary care institution. Patients were either included in group D, to receive 1.0µg·kg-1 i.v. dexmedetomidine or group L, to receive 0.3 mg·kg-1 i.v. labetalol in 100ml of normal saline before induction of anaesthesia. Patient's hemodynamic parameters were noted pre-operatively before starting infusion and at fixed intervals afterwards till extrubation. RESULTS: After intubation, mean systolic blood pressure (SBP) was higher in patients of group L (128.0 ± 13.866) as compared to group D (123.2 ± 10.672). Afterwards the SBP was comparable until extrubation. Similarly, after intubation patients in group D tended to have lower diastolic pressure (73.1 ± 9.683 vs. 79.2± 14.153, P value .0017) compared to patients in group L. Also, the relative incidence of bradycardia and hypotension was higher in patients who had received inj. labetalol. CONCLUSION: In patients predisposed to significant fluctuations in blood pressure or heart rate dexmedetomidine may be more suitable than labetalol due to better preservation of normal haemodynamics especially during periods of stress showing a relatively lower incidence of side effects.

The safety and efficacy of high dose ferric carboxymaltose in patients with chronic kidney disease: A single center study.

Ferric carboxymaltose (FCM) is a parenteral, dextran-free iron formulation designed to overcome the limitations of existing intravenous (IV) iron preparations. We investigated the safety and efficacy of high dose administration of FCM in our anemic chronic kidney disease (CKD) patients. It was a prospective observational study from June 2011 to August 2013. FCM was administered as IV infusion 1000 mg in 250 ml of normal saline over 15-30 min. Efficacy was evaluated by comparing the Hb and/or serum iron status at the first follow-up visit after the infusion with that at the baseline. A total of 500 infusions were administered to 450 patients. All patients had a successful administration of the FCM. None of the patients had any serious drug-related AE. AE of mild to moderate severity observed or reported after the infusion were: accelerated hypertension (0.2%), feeling abnormal (0.6%), headache and bodyaches (0.6% each), and infusion site reaction (0.8%). 261 patients had a follow up Hb, which showed an increase of 1.7 ± 1.5 g/dl after a period of 11 ± 7.2 weeks (P = 0.001); 188 (72%) patients had a rise in Hb of ≥1 g/dl. The increase in Hb was observed uniformly across all stages of CKD. Proportions of patients with an Hb of above 10 and 11 g/dl increased from 30.2% to 62.8% and 16.1% to 37.9%, respectively (P = 0.001). Iron status evaluation done in 44 patients after a follow up period of 15.1 ± 11.5 weeks showed increases in Hb of 1.6 ± 2.2 g/dl (P = 0.001), transferrin saturation of 9.1 ± 16.9% (P = 0.001), and ferritin of 406 ± 449 ng/ml (P = 0.001). We conclude high dose administration of FCM is safe and well-tolerated. It was effective in the treatment of iron deficiency in nondialysis and peritoneal dialysis CKD patients.

Neuroprotective activity of Matricaria recutita Linn against global model of ischemia in rats.

ETHNOPHARMACOLOGICAL RELEVANCE: Traditionally, the whole plant is used for various diseases, including neuronal disorders. AIM OF THE STUDY: To evaluate the neuroprotective effect of Matricaria recutita L. against global cerebral ischemia/reperfusion (I/R) injury-induced oxidative stress in rats. MATERIALS AND METHODS: Neuroprotective activity was carried out by global cerebral ischemia on Sprague-Dawley rats by bilateral carotid artery (BCA) occlusion for 30 min followed by 60 min reperfusion. The antioxidant enzymatic and non-enzymatic levels were estimated along with cerebral infarction area and histopathological studies. RESULTS: The Matricaria recutita L. methanolic extract showed dose-dependent neuroprotective activity by significant decrease in lipid peroxidation (LPO) and increase in the superoxide dismutase (SOD), catalase (CAT), glutathione (GSH) and total thiol levels in extract treated groups as compared to ischemia/reperfusion group. Cerebral infarction area was significantly reduced in extract treated groups as compared to ischemia/reperfusion group. CONCLUSION: The methanolic extract of Matricaria recutita L. showed potent neuroprotective activity against global cerebral ischemia/reperfusion injury-induced oxidative stress in rats.

High pressure growth of nanocrystalline silicon films.

Nanocrystalline silicon thin films were grown using gaseous mixture of 5% silane (SiH4) diluted in hydrogen (H2) and argon (Ar) in a radio frequency (13.56 MHz) plasma enhanced chemical vapor deposition technique. These films were deposited as a function of pressure and were characterized using AFM, Laser Raman, UV-VIS transmission, photoluminescence and electrical conductivity techniques. AFM micrographs shows that these films contain nanocrystallites of 30-60 nm size. Laser Raman peaks at 520 cm(-1) and photoluminescence peaks at 2.75 and 2.85 eV have been observed. The crystalline fraction in these films was varied from 30% to 80% with the variation of deposition pressure from 2 Torr to 8 Torr. There is an optimum pressure of 4 Torr where the maximum growth of nanocrystalline phases was observed. It has been found that nanocrystallites in these film enhanced the optical band gap and electrical conductivity. Also a voltage-current (V-I) probe was used to evaluate the various electrical parameters of the plasma used to deposit the nc-Si:H films for the present investigation. Growth via a SiH3 precursor, diffusion of hydrogen in the sub-surface and argon etching of weak bonds are some of the processes that may be involved in the nano crystallization process.

Morphological observation of Y and T junctions in nanostructured boron nitride thin films.

Formations of Y and T nano junctions have been observed in boron nitride films deposited on silicon substrates by plasma chemical reaction of diborane (B2H6 diluted in hydrogen) and ammonia (NH3) gases using dual frequency (microwave/radio) plasma enhanced chemical vapor deposition technique without any intentional heating of the substrates. It has been observed that these nano junctions form at a critical feed gas ratio of ammonia and diborane. We have investigated the effect of gas feed ratio R (=NH3/B2H6) in the plasma reaction chamber, keeping all other deposition parameters constant, on the morphology of boron nitride films. The deposited films are characterized by SEM, AFM, TEM and Laser Raman. For gas feed ratio, R < 100, octahedron and cubic morphologies have been observed in BN films and on increasing R to >100, size of the crystallites reduces to nanometer level. In some of our BN samples deposited at a critical value of gas ratio (R = 400), uniform Y and T junctions having bamboo like morphologies, in nanometer level, have been observed, which we wish to emphasis here as an interesting and newer observation in boron nitride films deposited by the dual frequency PECVD technique. This change in morphology exhibited by varying gas feed ratio is mainly due to excess nitrogen ions in the plasma.

Extra-osseous Ewing's sarcoma of the thumb.

The hand is an uncommon location for Ewing's tumour of the bone. This paper details the presentation, pathology and management of an extra-osseous Ewing's sarcoma of the thumb in an adult woman. The management entailed a combination of neo-adjuvant chemotherapy and surgical excision, followed by reconstruction with an interposition bone graft from the subcutaneous surface of the ulna.

Condom-promotion programme among slum-dwellers in Chandigarh, India.

This study describes high-risk behaviour and condom usage in inhabitants of an urban slum in the Union Territory of Chandigarh, which has a population of about 20,000. A cohort of 375 participants was followed-up before and after an intervention. Half of the married but only one-eighth of the unmarried slum dwellers were using condoms regularly. One-quarter of the study subjects practised high-risk behaviour and this was higher among unmarried (44.88%) than married participants (18.7%). An intervention involving education on condom use and provision of free condoms increased the condom usage rate from 31.73% in the pre-intervention phase to 60% in the postintervention phase.

Kikuchi's disease mimicking lymphoma.

Kikuehi's disease or histiocytic necrotizing lymphadenitis is an uncommon cause of cervical lymphadenopathy. Clinically it resembles tuberculosis or lymphoma. Although, this condition is well known to the pathologists, few ENT surgeons are aware of this entity.

Mercuric chloride induces increases in both cytoplasmic and nuclear free calcium ions through a protein phosphorylation-linked mechanism.

The mechanism of the lymphocyte stimulatory action of sulfhydryl group-reactive mercuric ions was studied with respect to its potential ability to induce a protein tyrosine phosphorylation-linked signal for mobilization of free Ca2+ into cytoplasm and nucleus of the cell. Exposure of human leukamic T cell line (Jurkat) cells to high (1 mM) and low (0.01 mM) concentrations of HgCl2 induced tyrosine phosphorylation of multiple proteins in a concentration-dependent manner. Confocal microscopy directly visualized the time course localization of Ca2+ inside the cells after exposure to HgCl2. The onset and level of Ca2+ mobilization following HgCl2 exposure were in parallel to those of protein tyrosine phosphorylation. Interestingly, by either concentration of HgCl2, Ca2+ was mobilized in both cytoplasm and nucleus almost simultaneously, and the level of Ca2+ mobilization in the nucleus was more than that in the cytoplasm. All the HgCl2-mediated Ca2+ mobilization was prevented by addition of protein kinase inhibitor staurosporin prior to HgCl2. These results suggest that heavy metal stress triggers a protein tyrosine phosphorylation-linked signal that leads to a nuclear event-dominant Ca2+ mobilization.

Family law as a means of ensuring gender justice for Indian women.

PIP: This analysis of the use of family law to ensure gender justice for women in India is based on the assumption that law plays an important role in the struggle for gender justice despite problems in accessibility and focuses on how family law can help end the oppression that the compulsion to marry perpetrates on Indian women. It is argued that the colonial construct of the religious nature of personal laws must give way to development of a Uniform Civil Code for India that will seek gender justice. After an introduction, the article uses Australian family law as a model for suggested reforms in Indian family law. The first main section provides the details of Australian family law. The next section explores the suitability of Australian family law as a model for Indian family law through a consideration of the following: 1) whether Australian family law is a flawed model; 2) the difference between Indian society and industrialized societies; 3) economic independence and family law; 4) whether it is possible for family law to reconceptualize marriage as a partnership and whether this concept is desirable for Indian women; 5) whether progressive laws create a disadvantage for most women; 6) whether secular law embodying individualism is suitable for community-oriented Indian society; and 7) whether Indian society should become individualistic. The third section of the article considers the developments in feminist legal theory that raise doubts about the worthiness of legal reform as a feminist strategy and concludes that legal reform is a necessary part of a larger strategy.^ieng

Oncogene-linked in situ immunotherapy of pre-B lymphoma arising in E mu/ret transgenic mice.

We attempted to induce anti-tumour immunity for rejecting pre-B lymphoma derived from E mu/ret transgenic mice (TGM). We established pre-B-lymphoma cell lines of C57BL/6 x Balb/c background (H-2b/d) into which H-2k alloantigen and C3H background were introduced (retL1-6 and retL6-6), and we inoculated BCF1 mice with these immunising tumour cells. After these tumours were rejected by alloantigen (H-2k/C3H background)-specific effector cells, the mice were challenged with the pre-B-lymphoma cell line derived from the original E mu/ret TGM (ret0-2). All non-immunised control mice died within 80 days, whereas half the immunised mice survived for over 300 days. The immunity was also effective against primary pre-B-lymphoma cells from E mu/ret TGM and the ret-driven melanoma cell line (MEL-ret), but not against the pre-B-lymphoma cell line from E mu/myc TGM. This immunity was at least in part mediated by cell-mediated cytotoxicity that was specific to the ret oncogene product or ret-regulated antigen. Next we immunised E mu/ret TGM by inoculating them with retL6-6 cells once every 2 weeks beginning at the age of 1 month. Interestingly, this immunisation enabled the TGM to survive longer than the non-immunised control group (P < 0.05). Moreover, 2 of 11 transgenic mice receiving such immunisation were free from both macroscopic and microscopic tumours at the time when all of the 12 non-immunised control TGM had died from their tumour. This provides a new model for oncogene-linked immunotherapy research.

Multiple venous thromboses and membranous obstruction of inferior vena cava in association with hereditary protein C deficiency: a case report.

A forty year old male presented with multiple dilated venous channels over the whole body involving both inferior and superior vena caval territories, along with features of chronic liver disease and portal hypertension. On investigation, he was found to have membranous obstruction of the inferior vena cava (MOIVC) as well as obstruction of both brachiocephalic and right subclavian veins and 'hereditary protein C deficiency'. He was managed successfully by percutaneous transluminal balloon angioplasty for the inferior vena cava (IVC) obstruction and was doing well on follow-up.

Comparative evaluation of the protective effect of immune spleen cells and immune RNA against Plasmodium berghei.

Earlier studies from this laboratory indicated that passive transfer of viable or frozen-thawed cells from spleens and lymph nodes of immune mice resulted in a significant protective immunity against Plasmodium berghei in syngeneic recipients. To assess whether immune RNA played a role in conferring such protection, experiments were designed wherein immune RNA was isolated from immune monkeys, rats and mice and transferred to normal mice. The effect of transfer was assessed by challenging RNA-primed animals with Plasmodium berghei. Results indicated that immune RNA failed to confer resistance against P. berghei both in syngeneic and in heterologous systems.

Perturbation of red cell membrane structure during intracellular maturation of Plasmodium falciparum.

An experimental approach, which in this study was applied to the malarial system, can be used to analyze the molecular structure and organization of individual phospholipids in a wide variety of biological membranes. Electron spin resonance spectroscopy was used to investigate the structural modifications of the major red cell phospholipids that occur in erythrocyte membranes infected with the human malarial parasite, Plasmodium falciparum. These modifications were correlated with the intracellular developmental stage of the parasite. Phosphatidylcholine, phosphatidylethanolamine, and phosphatidylserine were increasingly disordered (fluidized) as infection progressed. This disordering occurred at different rates and to varying extents.

Role of macrophage-processed antigen in a Plasmodium berghei model.

The present study demonstrates that malarial parasite could be processed by macrophages in vitro to release 'super antigens'. These super antigens obtained from the peritoneal macrophages were more protective than those processed by the splenic adherent cells. BCG-stimulated macrophages were also able to process the antigens efficiently and these antigens were even superior to those obtained from the unstimulated macrophages. These modified antigens were potent inducers of DFPS to malarial antigens. It is thus concluded that parasite antigens, processed in vitro, carry specific immunogenic potential and are able to protect the recipients to parasite challenge.

Cell mediated and humoral immunity in experimental Plasmodium berghei infection.

Adoptive passive transfer of immunity to Plasmodium berghei infection has been investigated in an inbred strain of Swiss mice. The mice were made hyperimmune by repeated passage of 10(3) parasites and subsequent therapy with an antimalarial drug. Immune sera and cells obtained from thymus, spleen and peritoneal exudate were transferred to normal animals which were subsequently challenged with standard doses of P. berghei. It was observed that: (a) immune serum in high doses (0.5 ml/mouse) enhanced parasitaemia; when used in smaller doses (0.1 ml/mouse), it afforded a considerable degree of protection; (b) viable immune lymphocytes obtained from thymus and lymph node afforded protection; (c) the mixed population of cells obtained from spleens of immunized mice, as well as peritoneal exudate, protected mice against challenge inoculum; (d) glutaraldehyde-treated spleen cells and material obtained after freezing and thawing the same number of spleen cells, macrophages and lymph node also afforded protection. These findings confirm that, under these experimental conditions, immunity against P. berghei is mediated through (i) specific antibody which is dose-dependent, (ii) cell-mediated immunity and (iii) effective response to processed antigen.