Utility of Bedside Ultrasound Measurement of Optic Nerve Sheath Diameter as a Screening Tool for raised Intracranial Pressure in Neurocritical Care Prospective Observational Study.

Intracranial pressure (ICP) needs to be monitored in neurocritical patients. There is a need for portable bedside optic nerve ultrasound (ONUS) for early diagnosis to initiate the measures to reduce ICP Objective: To find the utility of bedside ONUS to diagnose raised ICP in neurocritical care. Materials and methods: After approval from the ethical committee, a prospective observational study was conducted. Optic nerve sheath diameter (ONSD) was measured in two groups: control group patients with neurological symptoms but computed tomography (CT)/magnetic resonance imaging (MRI) not suggestive of raised ICP, and second was study group patients with neurological symptoms and CT/MRI suggestive of elevated ICP Result: In patients with normal ICP, the mean ONSD in females was 4.47mm, and in males was 4.66mm. In patients with raised ICP, the mean ONSD in females was 6.45 ± 0.78 mm, and in males was 6.33 ± 0.70 mm. Regarding the correlation between Glasgow coma scale (GCS) and mean ONSD parameters, the coefficient of correlation (R) is 0.14; thus, there is a weak negative correlation. In our study, no difference was observed in raised mean ONSD in patients with different diagnoses. At a cut-off value of >4.8 mm, the sensitivity and specificity are 100% to diagnose raised ICP. Conclusion: Optic nerve sheath diameter (ONSD) is a reliable, rapid bedside screening tool in the Emergency Department/Critical Care/Operation Theatre to diagnose raised ICP. In order to keep a record of trends in ICP, we need to measure ONSD frequently. There was no correlation between GCS and ONSD measurement.

Incidence, Subtypes, Risk factors, and Outcome of Delirium: A Prospective Observational Study from Indian Intensive Care Unit.

Background: Delirium is a common, under-recognized, and often fatal condition in critically ill patients, characterized by acute disorder of attention and cognition. The global prevalence varies with a negative impact on outcomes. A paucity of Indian studies exists that have systematically assessed delirium. Objective: A prospective observational study designed to determine the incidence, subtypes, risk factors, complications, and outcome of delirium in Indian intensive care units (ICUs). Patients and methods: Among 1198 adult patients screened during the study period (December 2019-September 2021), 936 patients were included. The confusion assessment method score (CAM-ICU) and Richmond agitation sedation scale (RASS) were used, with additional confirmation of delirium by the psychiatrist/neurophysician. Risk factors and related complications were compared with a control group. Results: Delirium occurred in 22.11% of critically ill patients. The hypoactive subtype was the most common (44.9%). The risk factors recognized were higher age, increased acute physiology and chronic health evaluation (APACHE-II) score, hyperuricemia, raised creatinine, hypoalbuminemia, hyperbilirubinemia, alcoholism, and smoking. Precipitating factors included patients admitted on noncubicle beds, proximity to the nursing station, requiring ventilation, as well as the use of sedatives, steroids, anticonvulsants, and vasopressors. Complications observed in the delirium group were unintentional removal of catheters (35.7%), aspiration (19.8%), need for reintubation (10.6%), decubitus ulcer formation (18.4%), and high mortality (21.3% vs 5%). Conclusion: Delirium is common in Indian ICUs with a potential effect on length of stay and mortality. Identification of incidence, subtype, and risk factors is the first step toward prevention of this important cognitive dysfunction in the ICU. How to cite this article: Tiwari AM, Zirpe KG, Khan AZ, Gurav SK, Deshmukh AM, Suryawanshi PB, et al. Incidence, Subtypes, Risk factors, and Outcome of Delirium: A Prospective Observational Study from Indian Intensive Care Unit. Indian J Crit Care Med 2023;27(2):111-118.

Synthesis and antibacterial activity of nanoenhanced conjugate of Ag-doped ZnO nanorods with graphene oxide.

In this paper, we report a successful synthesis of ZnO nanorods using the microwave-assisted technique, solid-state reaction method was utilized for the preparation of Zn1-xAgxO (x = 0.05, 0.1), Hummer's modified method for graphene oxide (GO) along with the sonication method to prepare GO-based Ag-doped ZnO (Zn1-xAgxO/GO: x  = 0.05, 0.1) nanocomposites. These nanorods and nanocomposites were characterized by X-ray diffraction (XRD), Fourier-transform infrared (FTIR), high-resolution transmission electron microscopy (HRTEM), and Raman spectroscopy for structural properties, scanning electron microscopy (SEM) along with energy dispersive X-ray (EDX) spectroscopy for morphological analysis, and UV-Vis spectroscopy for optical properties. XRD, FTIR, and Raman measurements substantiated that each sample is well crystallized in the single-phase polycrystalline wurtzite hexagonal structure of ZnO. The average crystallite size is found to be in decreasing order ranges 40 nm to 29 nm, respectively, along with a significant reduction in the optical bandgap. The SEM images showed a clear evidence of nanorods of ZnO, while the EDX spectra verified the presence of Zn, Ag, O, and C elements in the synthesized samples with their nominal percentage. Furthermore, the prepared nanocomposites effectively inhibited the growth ofStaphylococcus aureus and Escherichia coli. In comparison to pure ZnO nanorods, GO-based Ag-doped ZnO nanorods showed improved antibacterial activity against both S. aureus and E. coli.

Probing the interaction of zinc oxide nanorods with human serum albumin: A spectroscopic approach.

Bio-functionalized metal oxide nanoparticles (NPs) have been taken great importance in biomedical fields. The use of nanoparticles as delivery agents of therapeutic molecules led the researchers to emphasize the potential impact of these NPs on bio-macromolecules as protein-nanoparticle complexes, which also extended their importance as vehicles in targeted drug delivery systems due to increased ease of administration, firmness, reduced toxic side effects, and half-life of drugs. Since human serum albumin is the blood protein responsible for transporting materials in the blood system, the interaction of these particles with HSA is essential to be understood before considering the nanoparticles for any individual biomedical application. In the present study, we synthesized zinc-oxide nanorods (ZONRs) using a microwave-assisted synthesis technique, and characterized them by XRD, FTIR, Raman, SEM-EDX, UV-Vis spectroscopy, and photoluminescence (PL) spectroscopy methods. The interaction studies were carried out using fluorescence spectroscopy, and the change in secondary structure was analyzed using CD spectroscopy. The results of MTT cell viability assay demonstrated that the ZONRs has potential cytotoxic properties.

Nitrogenous Fertilizer Coated With Zinc Improves the Productivity and Grain Quality of Rice Grown Under Anaerobic Conditions.

An ample quantity of water and sufficient nutrients are required for economical rice production to meet the challenges of ever-increasing food demand. Currently, slow-release nitrogenous fertilizers for efficient inputs utilization and maximum economic yield of field crops are in the limelight for researchers and farmers. In this study, we evaluated the comparative efficacy of conventional urea and coated urea (zinc and neem) on rice grown under aerobic and anaerobic regimes in greenhouse conditions. For the aerobic regime, field capacity was maintained at 80-100% to keep the soil aerated. On the other hand, for the anaerobic regime, pots were covered with a polythene sheet throughout the experimentation to create flooded conditions. All forms of urea, conventional and coated (zinc and neem), improved plant growth, gas exchange, yield, yield contributing parameters, and quality characteristics of rice crop. However, better performance in all attributes was found in the case of zinc-coated urea. Gas exchange attributes (photosynthetic rate, 30%, and stomatal conductance 24%), yield parameters like plant height (29%), tillers per plant (38%), spikelets per spike (31%), grains per panicle (42%), total biomass (53%), and grain yield (45%) were recorded to be maximum in rice plants treated with zinc-coated urea. The highest grain and straw nitrogen contents, grain protein contents, and grain water absorption ratio were also found in plants with zinc-coated urea applications. In irrigation practices, the anaerobic regime was found to be more responsive compared to the aerobic regime regarding rice growth, productivity, and quality traits. Thus, to enhance the productivity and quality of rice grown in anaerobic conditions, zinc-coated urea is best suited as it is more responsive when compared to other forms of urea.

Despite Major Therapeutic Advances, Vena Caval Trauma Remains Associated with Significant Morbidity and Mortality.

BACKGROUND: Penetrating inferior vena caval injuries remain a challenging operative entity. This study reviews our local experience with the injury over a nine-year period and attempts to contextualize it within the published literature that emanates from South Africa on the topic. METHODS: A single-centre retrospective review of prospectively collected data was performed of all patients who underwent a laparotomy for a penetrating IVC injury. Descriptive statistics were calculated for demographics, clinical and biochemical parameters, intraoperative data, ICU admission and outcomes. RESULTS: During the nine-year period, thirty-five patients sustained penetrating injuries to the IVC. Mechanism of injury included 25 low velocity gunshots (71%) and 10 stab wounds (29%). The anatomical location included two (6%) supra-renal, six (17%) juxta-renal and 27 (77%) infra-renal injuries. Venorrhaphy was performed in 22 cases (63%) and ligation in 13 (37%). Average ICU stay was 5.4 days. Thirteen patients died (37%), of which six (46%) died within 24 h of arrival. CONCLUSION: Despite dramatic improvements in surgical trauma care over the last four decades, penetrating injury to the IVC carries a high mortality rate ranging from 31 to 37%. It is unlikely that further improvements can be achieved by refining operative techniques and approaches to resuscitation. Future endeavours must focus on applying the burgeoning understanding of endovascular surgery to these injuries.

Timing of Invasive Mechanical Ventilation and Mortality among Patients with Severe COVID-19-associated Acute Respiratory Distress Syndrome.

BACKGROUND: Severe acute respiratory distress syndrome associated with coronavirus disease-2019 (COVID-19) (CARDS) pneumonitis presents a clinical challenge as regards to the timing of intubation and ambiguity of outcome. There is a lack of clear consensus on when to switch patients from trials of noninvasive therapies to invasive mechanical ventilation. We investigated the effect of the timing of intubation from the time of admission on the clinical outcome of CARDS. AIM AND OBJECTIVE: The aim and objective was to analyze the effect of timing of intubation early (within 48 hours of admission to critical care unit) versus delayed (after 48 hours of admission to critical care unit) on mortality in severe CARDS patients. MATERIALS AND METHODS: A retrospective observational study performed in a 28-bedded COVID-19 intensive care unit of a tertiary care hospital in Pune, India. All patients admitted between April 1, 2020, and October 15, 2020, with confirmed COVID-19 (RT-PCR positive) requiring mechanical ventilation were included in the study. RESULTS: The primary outcome was in-hospital mortality. Among 2,230 patients that were admitted to the hospital, 525 required critical care (23.5%), invasive mechanical ventilation was needed in 162 patients and 147 (28%) of critical care admission were included in the study cohort after exclusion. Seventy-five patients (51%) were intubated within 48 hours of critical care admission (early group) and 72 (48.9%) were intubated after 48 hours of critical care admission (delayed group). With regards to the total of 147 included patients; male patients were 74.1% with a median age of 59 years (interquartile range, 51-68 years). Diabetes (44.9%) and hypertension (43.5%) were the most common comorbidities. Higher admission acute physiology and chronic health evaluation II scores and lower absolute lymphocyte count were observed in patients intubated within 48 hours. The early intubated group had a mortality of 60% whereas the same was observed as 77.7% in delayed intubation group, and this difference was statistically significant (p = 0.02). CONCLUSION: Current study concludes that early intubation is associated with improved survival rates in severe CARDS patients. HOW TO CITE THIS ARTICLE: Zirpe KG, Tiwari AM, Gurav SK, Deshmukh AM, Suryawanshi PB, Wankhede PP, et al. Timing of Invasive Mechanical Ventilation and Mortality among Patients with Severe COVID-19-associated Acute Respiratory Distress Syndrome. Indian J Crit Care Med 2021;25(5):493-498.

Mechanistic insight into the binding of graphene oxide with human serum albumin: Multispectroscopic and molecular docking approach.

Increasing manufacturing and use of nanoparticles in industrial and biomedical applications creates the necessity to understand the impact of the interaction of nanoparticles with biomacromolecules. In the present study, graphene oxide nanosheets (GONS) were synthesized using modified Hummer's method and further characterized employing X-ray diffraction (XRD), UV, FTIR, and Raman spectroscopy. After characterization, the interaction of GONS with human serum albumin (HSA) was investigated to delineate the binding mechanism employing different kinds of spectroscopic techniques. Intrinsic fluorescence spectroscopy revealed that complex formation is taking place between HSA and GONS. Fluorescence-based binding studies suggested that GONS binds to HSA with a significant binding affinity, and the interaction is governed by dynamic quenching. The evaluation of enthalpy change (ΔH) and entropy change (ΔS) suggested that the HSA-GONS complex formation is driven by hydrogen bonding and van der Waals interaction and hence complexation process is seemingly specific. Structural transition in the microenvironment of HSA was monitored using synchronous fluorescence spectroscopy and three-dimensional fluorescence spectroscopy, which showed that GONS binding to HSA influences the microenvironment around tyrosine and tryptophan residues. Secondary structural alterations in HSA upon binding to GONS were measured using circular dichroism (CD) spectroscopy. Additionally, molecular docking provided an insight into the critical residues involved in HSA-GONS interaction and further validated our in vitro observations affirming interaction between GONS and HSA. The significance of this study is attributable to the fact that HSA and GONS can be used as nanocarriers in drug delivery systems.

Synthesis of gallotannin capped iron oxide nanoparticles and their broad spectrum biological applications.

Green synthesized nanoparticles (NPs) have attracted enormous attention for their clinical and non-clinical applications. A natural polyphenol, gallo-tannin (GT) was used to reduce and cap the Fe2O3-NPs. GT-Fe2O3-NPs were synthesized following co-precipitation of FeCl3 and FeSO4·7H2O with GT. Fe2O3-NPs absorbed light at 380 nm. Physicochemically, Fe2O3-NPs were spherical with slight aggregation and average diameter of 12.85 nm. X-ray diffraction confirmed crystallinity and EDX revealed the elemental percentage of iron and oxygen as 21.7% and 42.11%, respectively. FT-IR data confirmed the adsorption of gallo-tannin functional groups. Multiple drug-resistant (MDR) Escherichia coli (ESßL), Pseudomonas aeruginosa (ESßL), and Staphylococcus aureus were found susceptible to 500-1000 µg GT-Fe2O3-NPs per ml. In synergy, Fe2O3-NPs enhanced the efficiency of some antibiotics. GT-Fe2O3 NPs showed significant (P ≤ 0.05) inhibition of growth and biofilm against MDR E. coli, P. aeruginosa, and S. aureus causing morphological and biofilm destruction. Violacein production (quorum sensing mediated) by C. violaceum was inhibited by GT-Fe2O3-NPs in a concentration-dependent manner with a maximum decrease of 3.1-fold. A decrease of 11-fold and 2.32-fold in fungal mycelial growth and human breast cancer (MCF-7) cell viability, respectively was evident. This study suggests a plausible role of gallo-tannin capped Fe2O3-NPs as an alternative antibacterial, antiquorum sensing, antibiofilm, antifungal, and anti-proliferative agent.

Do the existing systemic diseases overstate anaesthetic intervention during cataract surgery under local anaesthesia? An observational study to correlate the association.

CONTEXT: The objective was to study the extent of anaesthetic intervention and its association with systemic comorbidities. The secondary objectives were to estimate the prevalence of systemic comorbidities in age-related cataracts. AIMS: To determine the prevalence of systemic comorbidities in cataract surgery patients and association with anaesthesiologists' intervention. SETTINGS AND DESIGN: Prospective observational study. METHODS AND MATERIALS: The study was done inatertiary care hospital over a period of 3 months. Adult and consenting patients were included and those having sensitivity or toxic reaction to local anaesthetics, uncooperative, and paediatric patients were excluded. STATISTICAL ANALYSIS: The sample size (717) was calculated according to the formula for the finite population. The total number of patients suffering from comorbidities, adverse events during surgery, and events attended by an anesthesiologist with percentages were calculated. RESULTS: Of the 717 patients studied, comorbidities were associated with 385 (53.69%) patients; among which hypertension was most frequent and found in 174 (20.30%). As much as 113 (15.72%) patients had adverse events during surgery and required intervention by the attending anaesthesiologist in which 26 (15.72%) patients required drug administration for stabilization of condition of the patient. CONCLUSIONS: From this study, we conclude that there is a correlation between prevalent comorbidities and active intervention by the attending anaesthesiologist in patients undergoing cataract surgery.

Giant Extra-Articular Synovial Chondromatosis of the Ankle Joint - A Rare Case Report.

INTRODUCTION: Synovial chondromatosis (SC) commonly involves large joints such as the knee and hip with smaller joints being less frequently involved. Extra-articular involvement is very rare, and here, we are presenting the first case of giant extra-articular SC originating from the ankle joint. CASE REPORT: A 42-year-old male presented to the outpatient department with painless swelling over the lateral malleolus for 2 years. Diagnostic imaging suggested the involvement of the synovial lining with the swelling. The mass was excised and histopathology proved the diagnosis of SC. CONCLUSION: Extra-articular involvement in SC has been mainly reported in the synovial sheath or bursae of the hand and foot, but they can involve ankle joint also. In recent times, there have been concerns about potential malignant transformation of these lesion to chondrosarcoma, diagnosing these lesions have become important.

High insertion of cystic duct at the gallbladder fundus: An undescribed anomaly!

The anatomy of the biliary tree is complex, and its variations of both intra- and extra-hepatic bile ducts can be found in approximately 30% of the general population. These variations are not picked up on routine pre-operative investigations of patients planned for a laparoscopic cholecystectomy (LC) and often present as an unusual 'surprise' and a challenge that can make dissection in the Calot's triangle difficult leading to iatrogenic injury. We present a case of a 53-year-old female with an undescribed anomaly encountered during an LC. There was a high insertion of the cystic duct into the fundus of the gallbladder. No such anomaly has been described in literature till date.

Success rate of probing for congenital nasolacrimal duct obstruction at various ages.

PURPOSE: To determine the success rate of probing for congenital nasolacrimal duct obstruction (CNLDO) in various age groups. METHODS: One hundred children (118 eyes) aged 4 to 48 months diagnosed with CNLDO were included and divided into 6 groups; group 1: infants 4-6 months of age, group 2: infants from 7 to 12 months, group 3: toddlers 13-18 months of age, group 4: older toddlers 19-24 months old, group 5: children from 25 to 36 months, and group 6: children 37-48 months of age. Probing was performed under general anesthesia in all subjects. All patients were followed at regular intervals up to 6 months postoperatively. Successful probing was documented as complete remission of symptoms 2 weeks following the procedure. RESULTS: The success rate of probing was 100% (2 eyes) in group 1, 94% (47 eyes) in group 2, 84.4% (27 eyes) in group 3, 83.3% (15 eyes) in group 4, 61.5% (8 eyes) in group 5 and 33.3% (1 eye) in group 6; the overall success rate was 84.7% (100 eyes). The majority of eyes, 87.3% (103 eyes), had membranous obstruction while 12.7% (15 eyes) had firm obstruction. The success rate was 92.2% (95 eyes) in eyes with membranous obstruction and 33.3% (5 eyes) in those with firm obstruction. CONCLUSION: Probing of the nasolacrimal duct under general anesthesia is a safe and viable option as a primary treatment modality for CNLDO. The success rate decreases with increasing age; membranous obstruction resolves in the majority of cases whereas firm obstruction has a poorer outcome.

Partially folded intermediate state of concanavalin A retains its carbohydrate specificity.

A systematic investigation of the effect of polyethylene glycol (PEG) 200 and 400 on the solution conformation of concanavalin A (con A) was made using circular dichroism (CD), tryptophan fluorescence, 1-anilino-8-naphthalenesulfonic acid (ANS) binding, and size-exclusion chromatography. Far-UV CD spectra of con A at 30%(v/v) PEGs show the retention of ordered secondary structure as compared to 70%(v/v) PEGs. Near-UV CD spectra showed the retention of native-like spectral features in the presence of 30%(v/v) PEGs. Intrinsic tryptophan fluorescence studies indicate a change in the environment of tryptophan residues on the addition of PEG. ANS binding was maximum at 30%(v/v) PEGs suggesting the compact "molten-globule"-like state with enhanced exposure of hydrophobic surface area. Size-exclusion chromatography indicates an intermediate hydrodynamic size at 30%(v/v) PEGs. GdnHCl denaturation of these states was a single-step, two-state transition. To study the possible minimum structural requirement in the specific binding, the effect of PEGs on the interaction of con A with ligand was investigated by turbidity measurements. The C50 value was less in PEG 400 suggesting the more inhibitory ability of PEG 400. The C50 value of PEGs was highest for dextran followed by glycogen, ovalbumin, and ovomucoid. From percentage inhibition of con A-ligands at 30%(v/v) PEG, maximum inhibition was in ovalbumin followed by ovomucoid, glycogen, and dextran. To summarize: con A at 30%(v/v) PEGs exists as compact intermediate with molten-globule-like characteristics, viz., enhanced hydrophobic surface area, retention of compact secondary as well as tertiary structure, and a considerable degree of carbohydrate binding specificity and activity. This result has significant implications on the molten globule state during the folding pathway(s) of proteins in general and quaternary association in the legume lectin in particular, where precise topology is required for their biological activities.