In vitro and in vivo anthelmintic response of the seeds of Amomum subulatum roxb and Vitex negundo.

The current study was designed to check the anthelmintic activities of some local plants. Seeds of Amomum (A.) subulatum and Vitex (V.) negundo in different solvents were subjected to in vitro (adult motility assay; AMA and egg hatch assay; EHA) and in vivo (faecal egg count reduction test; FECRT) anthelmintic activity testing protocols using Haemonchus (H.) contortus as an experimental model. The results of AMA, EHA, and FECRT were statistically analysed through linear regression and Duncan multiple range test. In AMA test, at 50 mg mL-1 concentration, the percent mortality of H. contortus was higher in A. subulatum than V. negundo, whereas, in EHA test, A. subulatum was proven better ovicidal (LC50=14.2 µg mL-1) than V. negundo (LC50= 65.7405 µg mL-1). The FECRT also indicated the better efficacy of A. subulatum than V. negundo against natural infection of gastrointestinal (GI) parasites. The crude powder of plants used in this study showed 29.6% to 57.7% anthelmintic. The reduction rate was found higher for A. subulatum (3 g kg-1) as compared to V. negundo (7 g kg-1). Reagrding efficacy analysis of solvents used for plants extract, ethyl acetate and chloroform were found better in increasing ovicidal activity in adult worms (in vitro testing), whereas, the crude aqueous methanol was found better than the crude powders in in vivo testing. It will be beneficial to document the indigenous knowledge to standard scientific procedures for their validation. This study will help to motivate the farmers to make a better choice of cultivation of the indigenous plants because of their varying efficacies as an alternative preventive approach against the GI parasitic infections.

Workplace mistreatment and mental health in female surgeons in Pakistan.

BACKGROUND: Despite workplace mistreatment, which includes harassment, bullying and gender discrimination(GD)/bias, being serious problems for female surgeons, there are limited data from lower-middle-income countries like Pakistan. This study explored harassment and GD/bias experienced by female surgeons in Pakistan, and the effects of these experiences on mental health and well-being. METHODS: A nationwide survey was conducted between July and September 2019 in collaboration with the Association of Women Surgeons of Pakistan, an organization consisting of female surgeons and trainees in Pakistan. An anonymous online survey was emailed directly, disseminated via social media platforms (such as Facebook, Twitter and Instagram), and sent to surgical programmes in Pakistan. RESULTS: A total of 146 women surgeons responded to the survey; 67.1 per cent were trainees and the rest attending surgeons. Overall, 57.5 per cent of surgeons reported experiencing harassment, most common being verbal (64.0 per cent) and mental (45.9 per cent), but this mostly went unreported (91.5 per cent). On multivariable analysis adjusted for age and specialty, workplace harassment (odds ratio 2.02 (95 per cent c.i. 1.09 to 4.45)) and bullying (odds ratio 5.14 (95 per cent c.i. 2.00-13.17)) were significantly associated with severe self-perceived burnout, while having a support system was protective against feelings of depression (odds ratio 0.35 (95 per cent c.i. 0.16 to 0.74)). The overwhelming majority (91.3 per cent) believed that more institutional support groups were needed to help surgeons with stress reduction (78.8 per cent), receiving mentorship (74.7 per cent) and work-life balance (67.8 per cent). CONCLUSION: Workplace mistreatment, in particular harassment and bullying, has a damaging impact on the mental well-being of female surgeons, particularly trainees. The absence of support groups in Pakistan should be urgently addressed so that surgeons, especially trainees, may cope better with potentially harmful workplace stressors.

Endoscopic Management of Vesicoureteral Reflux and Long-term Follow-up.

OBJECTIVE: To report our experience with endoscopic management of vesicoureteral reflux (VUR) by injection of a tissue bulking substance - Dextranomer/ hyaluronic acid co-polymer at vesicoureteric junction. DESIGN: Retrospective analyses of case records. SETTING: Pediatric Surgery department in a tertiary care government Institute. PARTICIPANTS: 500 children (767 renal units) consecutively referred to the out-patient department with vesicoureteral reflux noted on micturating cysto-urethrogram (MCU) over a period of 13 years (2004-2016). INTERVENTION: Preoperative VUR grading and renal scars on radionuclide scans were documented. Dextranomer hyaluronic acid copolymer was injected through a cystoscope at the vesicoureteral junction as a day care procedure under short anesthesia. Patients were followed (average duration 27.3 mo) with clinical assessment, periodic urine cultures and renal scans. MAIN OUTCOME MEASURE: Cessation of VUR and symptomatic relief / clinical success postoperatively at 3 months. RESULTS: Complete symptomatic relief was obtained in 482 (96.4%) patients. In 681 units where MCU was available, 614 (90%) units showed resolution of VUR. CONCLUSIONS: Endoscopic injection of tissue bulking substances at vesicoureteric junction to stop VUR seems to be an effective intervention.

Effect of removal of phenolic compounds on structural and thermal properties of sunflower protein isolate.

The present study evaluated the effect of removal of polyphenols on the structural properties of protein isolates extracted from sunflower seed and kernel. The structural and thermal changes in protein upon phenolic interaction were studied using circular dichroism, differential scanning calorimetry, thermal gravimetric analysis, X-ray diffraction, sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE), and Fourier Transform Infrared (FT-IR) spectroscopy. Presence of phenolic compounds in proteins decreased the ordered structure content with parallel increase in unordered structure content. Denaturation temperature was higher for protein isolates with phenolic compounds while, enthalpy decreased upon phenolic interaction. In the presence of phenolic compounds, higher mass loss was observed upon heating. Crystalinity and crystal size got increased after removal of phenolic compounds. Protein isolates from kernels had higher percentage of crystalinity and crystal size as compared to seed protein isolates. Higher molecular weights were observed for protein isolates with phenolic compounds. Presence of polyphenols reduced the hydrophobicity as well the sulfhydryl content and increased the particle size of proteins.

Seroprevalence of human brucellosis in and around Jammu, India, using different serological tests.

AIM: Brucellosis is a disease of zoonotic importance as it affects both human as well as animal's health, and therefore, directly affects animal productivity and human efficiency. Therefore, a study was conducted to estimate the seroprevalence of brucellosis in humans in Jammu and surrounding areas. MATERIALS AND METHODS: A total of 121 sera samples from humans occupied with professional related to animals were collected and tested for anti-Brucella antibodies by Rose Bengal plate test (RBPT), modified RBPT (mRBPT), standard tube agglutination test (STAT), and indirect enzyme-linked immunosorbent assay (I-ELISA). Sampling was done keeping in view with the occupation, sex, and age. RESULTS: The overall seroprevalence of brucellosis recorded was 4.96%. The test-wise seroprevalence was 9.91% by RBPT, 9.91% by mRBPT, 9.09% by STAT, and 16.52% by I-ELISA. The prevalence of brucellosis was higher in >35-50 years age group compared to >20-35 years and >50-65 years. Sex-wise seroprevalence was higher in males than females. Taking I-ELISA as standard, the relative sensitivities of mRBPT, RBPT, and I-ELISA were in the order of mRBPT=RBPT>STAT. All the tests revealed high specificity values; however, among different serological tests, I-ELISA detected a maximum number of positive sera samples. CONCLUSIONS: The prevalence of brucellosis was found to be approximately 5%. The adult (>35-50 years) age male group was most vulnerable. The routine diagnosis of brucellosis involved the conventional serological tests, viz., RBPT and STAT, but each was associated with drawbacks which could give either false-positive or false-negative interpretation. Therefore, it is always recommended to use a battery of tests in the diagnosis of brucellosis.

Antibacterial efficacy of a novel plasma reactor without an applied gas flow against methicillin resistant Staphylococcus aureus on diverse surfaces.

The use of nonthermal plasma in the clinic has gained recent interest, as the need for alternative or supplementary strategies are necessary for preventing multi-drug resistant infections. The purpose of this study was to evaluate the antibacterial efficacy of a novel plasma reactor based on a high current version of sliding discharge and operated by nanosecond voltage pulses without an applied gas flow. This modification is advantageous for both portability and convenience. Bacterial inactivation was determined within a chamber by direct quantification of colony Jing units. Plasma exposure significantly inhibited the growth of Escherichia coli and Staphylococcus epidermidis following a 1-min application (p<0.001). S. epidermidis was more susceptible to the plasma after a 5-min exposure compared to E. coli. Temperature and pH measurements taken immediately before and after plasma exposure determined neither heat nor pH changes play a role in bacterial inactivation. Because of the notable effect on S. epidermidis, the effect of plasma exposure on several isolates and strains of the related opportunistic pathogen Staphylococcus aureus was quantified. While S. aureus isolates and strains were efficiently inactivated on an agar surface, subsequent testing on other clinically relevant surfaces demonstrated that the inactivation level, although significant, was reduced. This reduction appeared to depend on both the surface texture and the surface moisture content. These findings suggest this novel plasma source lacking an applied gas flow has potential application for surface bacterial decontamination.

Impact of method of application and concentration of potassium on yield of wheat.

A field experiment was conducted to study the effect of different levels and methods of potassium application on yield, K uptake and forms of potassium in wheat crop at experimental field of Division of Soil Science, Sher-e-Kashmir University of Agricultural Sciences and Technology, Kashmir. The treatment consisted of 5 levels of potassium (0, 20, 40, 60 and 80 kg K2O ha(-1)) and two methods of application viz Single basal and split (1/2 basal+1/2 at tiller initiation stage). Out of various treatments, split application of potassium @ 80 kg K2O ha(-1) was found superior to single basal application in terms of grain yield (43.20 q ha(-1)) and K uptake (22.89 kg ha(-1)) by grains at harvest. However, it was at par with split application of 60 kg K2O ha(-1). All forms of potassium viz water-soluble, exchangeable, available, boiling HNO3 extractable and lattice increased with increasing levels of potassium and were found maximum (3.20, 62.80, 66.00 ppm 0.723 and 1.440% respectively) when potassium was applied @ 80 kg K2O ha(-1) in two equal splits except for lattice K which was maximum (1.440%) when potassium was applied @ 60 kg K2O ha(-1).

Clozapine-induced late leukopenia.

A patient with a 28-year history of schizophrenia was treated with a wide range of antipsychotic medications since diagnosis. She had experienced no clinically significant symptomatic relief until she commenced treatment on clozapine. Her psychotic symptoms, self care, and general sense of well-being improved significantly. After 6 years of successful treatment, she developed leukopenia and clozapine was discontinued. The following issues will be discussed in the article: rechallenge with clozapine following leukopenia during previous therapy and the choice of and haematological monitoring needs with other antipsychotic medications after clozapine-induced blood dyscrasia.

Facial tuberculoid leprosy: case report.

Leprosy is a chronic, infectious, systemic disease caused by Mycobacterium leprae and is classified as paucibacillary and multibacillary types. It is contagious and has an insidious onset. Clinical presentation is characterised by hypopigmented skin lesions with reduced sensation. Presence of acid-fast bacilli in tissue specimens is regarded as a gold standard for diagnosis. Treatment is based on multi-drug regimens. We report a case of borderline tuberculoid leprosy in a 31-year-old woman.

Lack of influence of DNA repair gene OGG1 codon 326 polymorphisms of gastric cancer risk in the Kashmir valley.

Damage to DNA may lead to carcinogenesis but is repaired through activation of pathways involving polymorphic enzymes, including human 8-oxoguanine glycosylase 1 (OGG1). The present study aimed to assess the role of genetic variants of DNA repair gene OGG1 Ser326Cys in susceptibility to gastric cancer in Kashmir valley. A case control study was performed in 303 subjects (108 gastric cancer and 195 healthy controls), all genotyped through the polymerase chain reaction (PCR). Data were statistically analyzed using the chi-square test and the logistic regression model. The distribution of OGG1 genotypes among controls and gastric cancer cases did not show any significant differences. Although smokers and high salted tea drinkers themselves were at higher risk for gastric cancer (OR=8.975, P=0.0001; OR=14.778, P=0.0001), interaction with OGG1 Ser326Cys did not further modulate the risk. In conclusion, our findings suggest that the OGG1 polymorphism does not influence either gastric cancer risk independently or by interaction with smoking or salted-tea consumption in the Kashmir valley.

Honey compared with silver sulphadiazine in the treatment of superficial partial-thickness burns.

Burn injury is associated with a high incidence of death and disability; yet, its management remains problematic and costly. We conducted this clinical study to evaluate the efficacy of honey in the treatment of superficial and partial-thickness burns covering less than 40% of body surface area and compared its results with those of silver sulphadiazine (SSD). In this randomised comparative clinical trial, carried out Burn Center of POF Hospital, Wah Cantt, Pakistan, from May 2007 to February 2008, 150 patients of all ages having similar types of superficial and partial-thickness burns at two sites on different parts of body were included. Each patient had one burn site treated with honey and one treated with topical SSD, randomly. The rate of re-epithelialization and healing of superficial and partial-thickness burns was significantly faster in the sites treated with honey than in the sites treated with SSD (13·47 ± 4·06 versus 15·62 ± 4·40 days, respectively: P < 0·0001). The site treated with honey healed completely in less than 21 days versus 24 days for the site treated with SSD. Six patients had positive culture for Pseudomonas aeroginsa in honey-treated site, whereas 27 patients had positive culture in SSD-treated site. The results clearly showed greater efficacy of honey over SSD cream for treating superficial and partial-thickness burns.

Determination of the optimal stylet strategy for the C-MAC videolaryngoscope.

The C-MAC videolaryngoscope is a novel intubation device that incorporates a camera system at the end of its blade, thereby facilitating obtaining a view of the glottis without alignment of the oral, pharyngeal and tracheal axes. It retains the traditional Macintosh blade shape and can be used as a direct or indirect laryngoscope. We wished to determine the optimal stylet strategy for use with the C-MAC. Ten anaesthetists were allowed up to three attempts to intubate the trachea in one easy and three progressively more difficult laryngoscopy scenarios in a SimMan manikin with four tracheal tube stylet strategies: no stylet; stylet; directional stylet (Parker Flex-It); and hockey-stick stylet. The use of a stylet conferred no advantage in the easy laryngoscopy scenario. In the difficult scenarios, the directional and hockey-stick stylets performed best. In the most difficult scenario, the median (IQR [range]) duration of the successful intubation attempt was lowest with the hockey-stick stylet; 18 s (15-22 [12-43]) s, highest with the unstyletted tracheal tube; 60 s (60-60 [60, 60]) s and styletted tracheal tube 60 s (29-60 [18-60]) s, and intermediate with the directional stylet 21 s (15-60 [8-60]) s. The use of a stylet alone does not confer benefit in the setting of easy laryngoscopy. However, in more difficult laryngoscopy scenarios, the C-MAC videolaryngoscope performs best when used with a stylet that angulates the distal tracheal tube. The hockey-stick stylet configuration performed best in the scenarios tested.

Comparison of the C-MAC videolaryngoscope with the Macintosh, Glidescope, and Airtraq laryngoscopes in easy and difficult laryngoscopy scenarios in manikins.

The C-MAC comprises a Macintosh blade connected to a video unit. The familiarity of the Macintosh blade, and the ability to use the C-MAC as a direct or indirect laryngoscope, may be advantageous. We wished to compare the C-MAC with Macintosh, Glidescope and Airtraq laryngoscopes in easy and simulated difficult laryngoscopy. Thirty-one experienced anaesthetists performed tracheal intubation in an easy and difficult laryngoscopy scenario. The duration of intubation attempts, success rates, number of intubation attempts and of optimisation manoeuvres, the severity of dental compression, and difficulty of device use were recorded. In easy laryngoscopy, the duration of tracheal intubation attempts were similar with the C-MAC, Macintosh and Airtraq laryngoscopes; the Glidescope performed less well. The C-MAC and Airtraq provided the best glottic views, but the C-MAC was rated as the easiest device to use. In difficult laryngo-scopy the C-MAC demonstrated the shortest tracheal intubation times. The Airtraq provided the best glottic view, with the Macintosh providing the worst view. The C-MAC was the easiest device to use.

Bilateral temporalis hypertrophy.

Temporalis muscle hypertrophy is rare and may present unilaterally or bilaterally. Variable combinations with masseteric hypertrophy are also reported. It may be associated with a parafunctional habit or occur as an idiopathic entity. A host of modalities including CT, MRI, ultrasonography and muscle biopsy may be utilized for diagnosis. While surgical reduction remains an option, medical therapy with boutlinum type A toxin is the treatment of choice. A case of bilateral temporalis hypertrophy in a 38-year-old female is reported.

Randomized controlled trial of the Pentax AWS, Glidescope, and Macintosh laryngoscopes in predicted difficult intubation.

BACKGROUND: The purpose of this study was to determine the potential for the Pentax AWS and the Glidescope to reduce the difficulty of tracheal intubation in patients at increased risk for difficult tracheal intubation, in a randomized, controlled clinical trial. METHODS: Seventy-five consenting patients presenting for surgery requiring tracheal intubation, and who were deemed to possess characteristics indicating an increased risk for difficult tracheal intubation, were randomly assigned to undergo intubation using a Macintosh, AWS, or Glidescope laryngoscope (n=25 patients per group). All patients were intubated by one of three anaesthetists experienced in the use of each laryngoscope. RESULTS: Both the Glidescope and the AWS significantly reduced the intubation difficulty score compared with the Macintosh. The rate of successful tracheal intubation was lower with the Macintosh (84%) compared with the Glidescope (96%) or the AWS (100%). There were no differences in the duration of tracheal intubation attempts between the devices. Both the Glidescope and the AWS significantly reduced the need for additional manoeuvres and improved the Cormack and Lehane view obtained at laryngoscopy, compared with the Macintosh. Tracheal intubation with the AWS but not the Glidescope reduced the degree of haemodynamic stimulation compared with the Macintosh laryngoscope. CONCLUSIONS: The AWS and the Glidescope laryngoscopes reduced the difficulty of tracheal intubation to a similar extent compared with the Macintosh laryngoscope, in patients at increased risk for difficult tracheal intubation.

Tracheal intubation in patients with cervical spine immobilization: a comparison of the Airwayscope, LMA CTrach, and the Macintosh laryngoscopes.

BACKGROUND: The purpose of this study was to evaluate the effectiveness of the Pentax AWS, and the LMA CTrach, in comparison with the Macintosh laryngoscope, when performing tracheal intubation in patients with neck immobilization using manual in-line axial cervical spine stabilization. METHODS: Ninety patients undergoing anaesthesia who required tracheal intubation were randomly assigned to undergo intubation using a Macintosh (n=30), LMA CTrach (n=30), or AWS (n=30) laryngoscope. All patients were intubated by one of the three anaesthetists familiar with the use of each laryngoscope. RESULTS: The intubation difficulty scores were significantly higher with the Macintosh laryngoscope and were significantly lower with the AWS compared with the LMA CTrach. All 30 patients were successfully intubated with the Macintosh and the AWS device, compared with 27 patients with the LMA CTrach. The duration of both the first and the successful tracheal intubation attempts was significantly longer with the LMA CTrach compared with the AWS and Macintosh laryngoscopes. A greater number of optimization manoeuvres were required to facilitate tracheal intubation with the LMA CTrach compared with the AWS laryngoscope. The AWS group had a significantly better Cormack and Lehane glottic view obtained at laryngoscopy compared with both other devices. CONCLUSIONS: The AWS laryngoscope has several advantages over the Macintosh laryngoscope, or LMA CTrach, in patients undergoing cervical spine immobilization.

Comparison of the Glidescope, the Pentax AWS, and the Truview EVO2 with the Macintosh laryngoscope in experienced anaesthetists: a manikin study.

BACKGROUND: The Pentax Airwayscope, the Glidescope, and the Truview EVO2 constitute three novel laryngoscopes that facilitate visualization of the vocal cords without alignment of the oral, pharyngeal, and tracheal axes. We compared these devices with the Macintosh laryngoscope in a simulated easy and difficult laryngoscopy. METHODS: Thirty-five experienced anaesthetists were allowed up to three attempts to intubate in each of four laryngoscopy scenarios in a Laerdal SimMan manikin. The time required to perform tracheal intubation, the success rate, number of intubation attempts and of optimization manoeuvres, and the severity of dental compression were recorded. RESULTS: In the simulated easy laryngoscopy scenarios, there was no difference between the study devices and the Macintosh in success of tracheal intubation. In more difficult tracheal intubation scenarios, the Glidescope and Pentax AWS, and to a lesser extent the Truview EVO2 laryngoscope demonstrated advantages over the Macintosh laryngoscope including a better view of the glottis, greater success of tracheal intubation, and ease of device use. The Pentax AWS was more successful in achieving tracheal intubation, required less time to successfully perform tracheal intubation, caused less dental trauma, and was considered by the anaesthetists to be easier to use. CONCLUSIONS: The Pentax AWS laryngoscope demonstrated more advantages over the Macintosh laryngoscope than either the Truview EVO2 or the Glidescope laryngoscope, when used by experienced anaesthetists in difficult tracheal intubation scenarios.