Comparison of sedation efficacy of intravenous infusion of dexmedetomidine versus propofol in terms of opioid consumption in patients requiring postoperative mechanical ventilation after head and neck onco-surgeries - A randomized prospective study.

BACKGROUND: The conventional drug regimen of sedation for patients requiring mechanical ventilation in an intensive care unit (ICU) is propofol or midazolam. Dexmedetomidine is a newer drug for sedation with a better clinical profile. We conducted this study to compare the sedative efficacy of dexmedetomidine versus propofol in patients after head and neck cancer surgeries requiring mechanical ventilation. METHODS: After ethics committee approval and written informed consent, 80 patients undergoing head and neck onco-surgery were recruited. The patients were randomly allocated to group I [1 mg/kg of bolus propofol over 15 minutes followed by infusion of 1 mg/kg/hour titrated by increasing or decreasing the infusion dose to Ramsay Sedation Score (RSS) 2-4] or group II (a loading dose of dexmedetomidine 1 mcg/kg over 15 minutes followed by a maintenance dose of 0.4 µg/kg/hour titrated to desired sedation level). The RSS, behavioral pain scale (BPS), heart rate, blood pressure, fentanyl consumption, additional sedative agent, extubation time, length of ICU stays, mechanical ventilation duration, side effects, and patient's satisfaction were noted. RESULTS: Total fentanyl required was 0.56 ± 0.13 µg/kg/hour in group II and 0.58 ± 0.18 µg/kg/hour in group I (P = 0.75). Extubation time, RSS, BPS, patient satisfaction, and ICU duration were similar in both the groups. The incidence of hemodynamic-related adverse effects were 41.67% in group II and 11.11% in group I (P = 0.006). CONCLUSION: The fentanyl requirement was comparable in both the groups in the postoperative period. Dexmedetomidine was associated with an increased incidence of bradycardia and hypotension as compared to the propofol group. Propofol should be the preferred sedative for postoperative mechanical ventilation after head and neck onco-surgeries.

Does the Use of Probe-based Near-infrared Autofluorescence Parathyroid Detection Benefit Parathyroidectomy?: A Randomized Single-center Clinical Trial.

OBJECTIVE: To evaluate the benefits of probe-based near-infrared autofluorescence (NIRAF) parathyroid identification during parathyroidectomy. BACKGROUND: Intraoperative parathyroid gland identification during parathyroidectomy can be challenging, while additionally requiring costly frozen sections. Earlier studies have established NIRAF detection as a reliable intraoperative adjunct for parathyroid identification. METHODS: Patients undergoing parathyroidectomy for primary hyperparathyroidism were prospectively enrolled by a senior surgeon (>20 years experience) and a junior surgeon (<5 years experience), while being randomly allocated to the probe-based NIRAF or control group. Data collected included procedure type, number of parathyroids identified with high confidence by the surgeon and the resident, number of frozen sections performed, parathyroidectomy duration, and number of patients with persistent disease at the first postoperative visit. RESULTS: One hundred sixty patients were randomly enrolled under both surgeons to the probe group (n=80) versus control (n=80). In the probe group, parathyroid identification rate of the senior surgeon improved significantly from 3.2 to 3.6 parathyroids per patient ( P <0.001), while that of the junior surgeon also rose significantly from 2.2 to 2.5 parathyroids per patient ( P =0.001). Parathyroid identification was even more prominent for residents increasing significantly from 0.9 to 2.9 parathyroids per patient ( P <0.001). Furthermore, there was a significant reduction in frozen sections utilized in the probe group versus control (17 vs 47, P =0.005). CONCLUSION: Probe-based NIRAF detection can be a valuable intraoperative adjunct and educational tool for improving confidence in parathyroid gland identification, while potentially reducing the number of frozen sections required.

Modulation of salt stress in paddy field cyanobacteria with exogenous application of gibberellic acid: growth behavior and antioxidative status.

The present study explores the possible function of gibberellic acid (GA: 20 µM) in reducing salt (NaCl) induced toxicity in two diazo-trophic cyanobacteria i.e. Nostoc muscorum and Phormidium foveolarum. The physiological and biochemical parameters viz. growth, photosynthetic pigments (chlorophyll a, carotenoids, and phycocyanin), photosynthetic and respiratory rates, oxidative stress biomarkers (superoxide radicle, hydrogen peroxide, and malondialdehyde contents) antioxidant activities (superoxide dismutase, peroxidase, catalase, and glutathione-S-transferase) and non-enzymatic antioxidants were studied under both the doses i.e. 40 mM (LC 10) and  mM (LC 30) of NaCl. The growth, photosynthetic pigments and photosynthetic rate were found to be declined under concentration-dependent manner of NaCl. Contrastingly, the respiratory rate, oxidative stress biomarkers, and the activity of antioxidant enzymes i.e. superoxide dismutase (SOD), peroxidases (POD), catalase (CAT), and glutathione-S-transferase (GST) together with contents of non-enzymatic antioxidants (proline and cysteine) were found to increase in the test cyanobacteria. PSII photochemistry in both the cyanobacteria was negatively affected showing an inhibitory effect of NaCl on JIP parameters, while an enhancement effect was noticed in the values related to energy flux parameters. Further, the addition of GA to the growth medium caused an alleviating effect as it completely mitigated NaCl toxicity induced by a lower dose i.e. 40 mM of NaCl, while it partially alleviated the growth and photosynthetic parameters of 80 mM NaCl stressed cyanobacteria. Supplementation of GA significantly reduced the contents of oxidative stress tested cyanobacteria due to an improved antioxidant system (increased activities of enzymatic and non-enzymatic antioxidants) as evident from the biochemical analysis. In brief, our findings reflect the possible role of GA as a potential modulator of salt toxicity. Supplementary Information: The online version contains supplementary material available at 10.1007/s12298-022-01266-5.

Review of Necrotizing Enterocolitis and Spontaneous Intestinal Perforation Clinical Presentation, Treatment, and Outcomes.

The Necrotizing Enterocolitis Surgery Trial (NEST) highlights the importance of distinguishing necrotizing enterocolitis (NEC) from spontaneous intestinal perforation (SIP) when developing surgical treatment plans. Further research is needed to increase the accuracy of this distinction, but even with our current abilities to do this initial laparotomy appears to be optimal for infants with presumed NEC. The preferred initial operation for those with SIP is more equivocal. Rates of NEC are likely decreasing slowly, whereas those with SIP are not. New imaging modalities, especially ultrasound, are becoming more useful but require more detailed investigation. Understanding the mechanisms causing these two conditions remains of paramount importance.

Differential response of copper nanoparticles and ionic copper on growth, chlorophyll fluorescence, oxidative stress, and antioxidant machinery of two paddy field cyanobacteria.

The current study explored the role of ionic copper (CuCl2; 0.2 µM and 1 µM) and synthesized copper nanoparticles (CuNPs; 0.2 mM and 1 mM) in the two paddy field cyanobacteria (Nostoc muscorum ATCC 27893 and Anabaena sp. PCC 7120) with respect to growth, photosynthetic pigments, photosynthetic efficiency (O2 evolution and photochemistry of photosystem II; PS II), oxidative stress biomarkers, and antioxidant system. The low doses of ionic Cu (0.2 µM) and CuNPs (0.2 mM) showed stimulating effects on growth, pigment content (chlorophyll a, phycobiliproteins, and carotenoids), oxygen evolution, and PS II photochemistry. High doses of Cu/CuNPs (1 µM Cu and 1 mM CuNPs) caused a decline in the above-mentioned parameters. The values of fluorescence kinetics parameters: ϕP0, FV/F0, ϕE0, Ψ0, and PIABS, except for F0/FV, associated with PS II photochemistry in tested cyanobacteria and subjected to the high doses of ionic Cu and CuNPs, were decreased, while energy fluxes, ABS/RC, TR0/RC, ET0/RC, and DI0/RC, were increased. Conversely, treatment with low doses of Cu and CuNPs caused a reverse trend, indicating normalization of PS II performance. Although the activity of enzymatic antioxidants (superoxide dismutase SOD; peroxidase POD; catalase CAT and glutathione-S-transferase GST) in both cyanobacteria exposed to high doses of ionic Cu and CuNPs was accelerated considerably, the oxidative stress remained high. Conversely, at low doses of ionic Cu and CuNPs, a significant enhancement in the activities of enzymatic antioxidants decreased the levels of oxidative stress biomarkers. Nevertheless, in Anabaena sp., the levels of biomarkers were greater than those of the control. The current study concluded that compared to synthesized CuNPs, ionic Cu at elevated concentration had a damaging effect on growth, photosynthetic pigments, and PS II photochemistry via increased oxidative stress, and this effect was enhanced in Anabaena sp. than N. muscorum.

Endoluminal Silicone-Covered Stenting in Children: Novel Applications and Lessons Learned.

BACKGROUND: Silicone-covered endoluminal stents have been applied to various hollow visceral disorders in adult patients with varying success. Efficacy of retrievable endoluminal stenting in children is less well-established. PURPOSE: The purpose of this study was to evaluate our experience with evolving applications of endoluminal silicone-covered stenting in children. RESEARCH DESIGN: Eight children 19 years and younger having silicone-covered stent placement for various indications at a single institution (2014-2021) were reviewed retrospectively. RESULTS: Eight patients received a total of 26 silicone-covered stents. Four stent placements (15.4%) were associated with a direct adverse event. To resolve the endoluminal disorder, four patients received multiple stents or further intervention. When evaluating novel applications, clinical benefit was noted for one patient with vaginal atresia, and another after ileal pouch anal anastomosis disruption. CONCLUSION: This experience highlights the broad and innovative applications for endoluminal silicone-covered natural orifice stenting in children. Acute processes respond well and rapidly to stenting, although chronic, established fistula may require additional manipulations or surgery.

Congenital Diaphragmatic Hernia Repair at the Bedside or Operating Theater.

BACKGROUND: For critically ill congenital diaphragmatic hernia (CDH) patients on high frequency oscillatory ventilation (HFOV), extracorporeal membrane oxygenation (ECMO), and/or inhaled nitric oxide (iNO), operative repair in the neonatal intensive care unit (NICU) has been proposed to avoid complications during transport to an operating room (OR). This study compared neonates with CDH who received herniorrhaphy in the NICU or OR, with a subgroup analysis considering only patients supported with ECMO. METHODS: Patients admitted to the NICU in the first 2 weeks of life at a free-standing children's hospital between July 2004 and September 2021 were examined. Patients were categorized according to location of CDH repair, and impact on operative complications and survival was compared. RESULTS: 185 patients were admitted to the NICU with posterolateral CDH and received operative repair. 48 cases were operated on at the bedside in the NICU and 137 in the OR. Patients repaired in the NICU had higher use of HFOV, pulmonary vasodilators, and ECMO (all P < .001). Children repaired in the NICU experienced significantly higher in-hospital death and overall mortality (P < .001). However, in multivariate analysis, repair location was not a significant predictor of survival to discharge in patients receiving ECMO. No significant difference in surgical site infection was detected for operative location (P = .773). DISCUSSION: Congenital diaphragmatic hernia repair in the NICU occurred more frequently among higher risk patients who experienced worse survival. The rate of surgical site infection appeared similar overall and across subgroups suggesting adequate sterility and technique for bedside procedures, when necessary, despite restricted access to advanced operative equipment.

Arsenate and arsenite-induced inhibition and recovery in two diazotrophic cyanobacteria Nostoc muscorum and Anabaena sp.: study on time-dependent toxicity regulation.

Exposure time, metal bio-accumulation, and upregulation of ascorbate-glutathione (AsA-GSH) cycle are the key factor that provide tolerance against heavy metal stress. Thus, the current study is an endeavor to prove our hypothesis that regulation of arsenate (AsV: 50, 100, and 150 mM) and arsenite (AsIII: 50, 100, and 150 µM) toxicity is time dependent (48-96 h) due to modulation in bio-accumulation pattern, AsA-GSH cycle, and non-enzymatic antioxidants in two paddy field cyanobacteria Nostoc muscorum ATCC27893 and Anabaena sp. PCC7120. After 48 h, reduction in growth associated with increased sensitivity index, As bio-accumulation, and oxidative stress was observed which further intensified after 96 h but the degree of damage was lesser than 48 h. It denotes a significant recovery in growth after 96 h which is correlated with decreased As bio-accumulation and oxidative stress due to increased efficiency of AsA-GSH cycle and non-enzymatic antioxidants. Both the species of As caused significant rise in oxidative biomarkers as evident by in -vitro analysis of O2·-, H2O2, and MDA equivalent contents despite appreciable rise in the activity antioxidative enzymes APX, DHAR, and GR. The study concludes that among both forms of arsenic, AsIII induced more toxic effect on growth by over-accumulating the ROS as evident by weak induction of AsA-GSH cycle to overcome the stress as compared to AsV. Further, with increasing the time exposure, apparent recovery was noticed with the lower doses of AsV, i.e., 50 and 100 mM and AsIII, i.e., 50 and 100 µM; however, the toxicity further aggravated with higher dose of both AsV and AsIII. Study proposes the deleterious impact of AsV and AsIII on cyanobacteria N. muscorum and Anabaena sp. but the toxicity was overcome by time-dependent recovery.

Effect of Time Interval on Arsenic Toxicity to Paddy Field Cyanobacteria as Evident by Nitrogen Metabolism, Biochemical Constituent, and Exopolysaccharide Content.

Arsenic poisoning in aquatic ecosystem is a global concern that obstructs the productivity of agricultural lands (paddy fields) by targeting the growth of cyanobacteria. The cyanobacteria also tolerate and accumulate elevated concentration of arsenic (As) inside the cell and excrete out from cells in less toxic forms after the successive time interval. Thus to validate this, the study was carried out at two different time intervals, i.e., 48 h and 96 h. Two redox forms of As arsenate (AsV) and arsenite (AsIII) at different concentrations (50, 100, and 150 mM AsV; 50, 100, and 150 µM AsIII) caused substantial reduction in growth, pigments (Chl a/Car and phycobiliproteins: phycocyanin, allophycocyanin, and phycoerythrin), inorganic nitrogen ( nitrate (NO3-) and nitrite (NO2-)) uptake, activity of enzymes (NR, NiR, GS, and GOGAT) of nitrogen metabolism, biochemical constituents (protein, carbohydrate, and exopolysaccharide (EPS) contents of Nostoc muscorum, and Anabaena sp. PCC7120. The tested doses of AsV and AsIII after 48 h of exposure exhibited adverse impact on these parameters, but after 96 h with lower doses of AsV (50 mM and 100 mM) and AsIII (50 µM and 100 µM), significant recovery was recorded. Contrary to this, at higher dose of AsV (150 mM) and AsIII (150 µM), the adverse impact was further aggravated with increasing time exposure. Contrary to the activity of NR, NiR, GS, and GOGAT, GDH activity (alternative NH3+ assimilating enzyme) was found to increase, and after 96 h, the activity showed declining trend but still higher than the control. The biochemical constituent EPS (first protective barrier) under scanning electron microscope showed more accumulation of dry adsorbent in the case of AsIII stress hence displayed more toxic nature of AsIII than AsV. The study concludes that with increasing time exposure, the recovery in growth and related parameters mainly at lower doses of AsV and AsIII points toward adaptability of cyanobacteria which was more pronounced in Nostoc muscorum.

Phytohormone up-regulates the biochemical constituent, exopolysaccharide and nitrogen metabolism in paddy-field cyanobacteria exposed to chromium stress.

BACKGROUND: Cyanobacteria are well known for their inherent ability to serve as atmospheric nitrogen fixers and as bio-fertilizers; however, increased contaminants in aquatic ecosystem significantly decline the growth and function of these microbes in paddy fields. Plant growth regulators play beneficial role in combating the negative effects induced by heavy metals in photoautotroph. Current study evaluates the potential role of indole acetic acid (IAA; 290 nm) and kinetin (KN; 10 nm) on growth, nitrogen metabolism and biochemical constituents of two paddy field cyanobacteria Nostoc muscorum ATCC 27893 and Anabaena sp. PCC 7120 exposed to two concentrations of chromium (CrVI; 100 µM and 150 µM). RESULTS: Both the tested doses of CrVI declined the growth, ratio of chlorophyll a to carotenoids (Chl a/Car), contents of phycobiliproteins; phycocyanin (PC), allophycocyanin (APC), and phycoerythrin (PE), protein and carbohydrate associated with decrease in the inorganic nitrogen (nitrate; NO3- and nitrite; NO2-) uptake rate that results in the decrease in nitrate and ammonia assimilating enzymes; nitrate reductase (NR), nitrite reductase (NiR), glutamine synthetase (GS), glutamate synthase (GOGAT) except glutamate dehydrogenase (GDH). However, exogenous supplementation of IAA and KN exhibited alleviating effects on growth, nitrogen metabolism and exopolysaccharide (EPS) (first protective barrier against metal toxicity) contents in both the cyanobacteria, which probably occurred as a result of a substantial decrease in the Cr uptake that lowers the damaging effects. CONCLUSION: Overall result of the present study signifies affirmative role of the phytohormone in minimizing the toxic effects induced by chromium by stimulating the growth of cyanobacteria thereby enhancing its ability as bio-fertilizer that improved fertility and productivity of soil even in metal contaminated condition.

Comparison of analgesic efficacy of ultrasound-guided thoracic paravertebral block versus surgeon-guided serratus anterior plane block for acute postoperative pain in patients undergoing thoracotomy for lung surgery-A prospective randomized study.

CONTEXT: Inadequate pain relief after thoracotomy may lead to postoperative respiratory complications. AIMS: We have compared total morphine consumption in 24 hours following thoracotomy. SETTINGS AND DESIGN: This prospective randomized pilot study involved 50 patients undergoing elective thoracotomy for lung surgery at AIIMS, New Delhi. PATIENTS AND METHODS: Fifty patients undergoing elective thoracotomy were randomly allocated into two groups. In Group I patients, ultrasound (USG)-guided paravertebral catheter was inserted preoperatively and in Group II patients, serratus anterior plane (SAP) catheter was inserted by the surgeon before closure. Ropivacaine bolus (group I: 0.2% 0.1 ml/kg and group II: 0.375% 0.4 ml/kg) was given before extubation, followed by its continuous infusion for 24 hours. If the numerical rating scale (NRS) was >3, then patients were given intravenous (i.v.) morphine 3 mg. Total 24-hour morphine consumption, duration of effective analgesia, hemodynamic parameters, side effects, and overall patient satisfaction were recorded. STATISTICAL ANALYSIS USED: T-test was used to compare the parametric values in both the groups, whereas the Mann-Whitney U-test was performed to compare the nonparametric values. RESULTS: Postoperative morphine requirement in the ParaVertebral Block (PVB) group (8.65 ± 4.27 mg) was less as compared to the SAP group (11.87 ± 6.22 mg) but that was not statistically significant (p 0.052). Postoperative pain scores at rest and on movement, patient satisfaction, and incidence of chronic post-thoracotomy pain were comparable in both the groups. CONCLUSION: SAP block with continuous catheter technique seems to be a safe and effective modality for the management of acute postoperative pain after thoracotomy.

A Survey of Medical Professionals in an Apex Tertiary Care Hospital to Assess Awareness, Interest, Practices, and Knowledge in Palliative Care: A Descriptive Cross-sectional Study.

BACKGROUND: Medical discipline in India focuses on cure rather than comfort care. Palliative care is concerned with improving quality of life and relieving sufferings in patients with advanced incurable terminal diseases. Palliative care in India is still in infancy stage due to lack of knowledge, attitude and skills among health care providers. The reason being lack of training in under graduate as well as postgraduate teaching curriculum and lack of sensitization among policy makers. AIMS AND OBJECTIVES: To assess the awareness, interest, practices and knowledge in palliative care among medical professionals working in a tertiary care hospital. MATERIALS AND METHODS: All participants were mailed proforma to be filled in a fixed format including details of their qualification, demographic data, their field of work, their training in palliative care and multiple choice questions regarding awareness interest, practices and knowledge of palliative care. RESULTS: Out of 186 respondents, 56% had not received any basic training in palliative care. 81% wanted palliative care education to be included in undergraduate curriculum. Poor program was identified as the most common barrier in learning palliative care. 77% respondents had no idea about home based palliative care services. 50.8% patients dies in hospital in their terminal stage. 88% were interested in learning safe opioid practices. Although 89.8% were aware of the need of palliative care in metastatic cancer but less than 50% were aware of the fact that palliative care is also required in MDR-TB and mental illness. CONCLUSION: This study reflects data of an apex cancer institute of the country. The result of awareness is not very encouraging despite a dedicated palliative care department. So, we can assume what will be the palliative care status in other parts of India where there is no palliative care at all. RECOMMENDATION: We strongly recommends that palliative care teaching should be incorporated in undergraduate curriculum to sensitize the students from the beginning. Budding residents in their learning phase can play an important role by learning and providing palliative care as the first person to come into contact with the patients are residents. There is a strong need of spreading palliative care awareness all over the country.

Do postoperative drain volumes correlate with intraoperative blood loss and postoperative transfusion requirements in posterior spinal fusion for adolescent idiopathic scoliosis?

Most studies have excluded postoperative drain volumes in analyzing blood loss associated with scoliosis surgery. We sought to analyze patient and surgical factors that influenced postoperative drain outputs. A retrospective review was conducted on 50 consecutive patients who had undergone posterior spinal fusion with pedicle screw instrumentation and subfascial drain placement over a 6-year period at a single institution for adolescent idiopathic scoliosis. Postoperative drain volumes were correlated to patient factors, surgical variables, and change in postoperative hemoglobin values. The association between drain output volumes and the need for allogeneic blood transfusion was also analyzed using univariate and multivariate analysis. Total postoperative drain volume positively correlated with Cell Saver volume (r=0.28, P=0.049), units of packed red blood cells transfused intraoperatively (r=0.31, P=0.03), and a number of Ponte osteotomies (r=0.43, P=0.002). On the basis of multiple linear regression analysis, only the number of osteotomies performed was associated with increasing total drain volume (R=0.25, P=0.003). Total drain output did not correlate with postoperative change in hemoglobin (P=0.85), the need for postoperative blood transfusion (P=0.22), or the total volume of blood transfused perioperatively (P=0.06). Patients with large intraoperative blood loss or multiple osteotomies are more likely to have higher postoperative drain volumes. Drain volume alone, however, should not be used as a trigger for recommending a postoperative blood transfusion.

Kinetin alleviates chromium toxicity on growth and PS II photochemistry in Nostoc muscorum by regulating antioxidant system.

The present study was undertaken to evaluate the metal toxicity alleviating effects of kinetin (KN, 10 nM) on growth, photosynthetic pigments and photochemistry of PS II in the cyanobacterium Nostoc muscorum exposed to chromium (CrVI) stress (100 and 150 µM). Chromium declined growth, photosynthetic pigments (chlorophyll a, phycocyanin and carotenoids), photosynthetic oxygen evolution rate and parameters of fluorescence kinetics (ϕP0, FV/F0, ϕE0, Ψ0 and PIABS except F0/FV) in concentration dependent manner, while stimulating effects on respiration, energy flux parameters (ABS/RC, TR0/RC, ET0/RC and DI0/RC), oxidative stress biomarkers i.e., superoxide radical (SOR), hydrogen peroxide (H2O2) and lipid peroxidation (TBARS contents) and antioxidative enzymes: superoxide dismutase (SOD), peroxidase (POD), catalase (CAT) and glutathione-S-transferase (GST), were observed. However, upon addition of KN in the growth medium an alleviating effect against chromium induced toxicity on growth, photosynthetic pigments and photochemistry of PS II was recorded. This had occurred due to substantial reduction in levels of oxidative stress biomarkers: SOR, H2O2 and TBARS contents with concomitant rise in activity of antioxidative enzymes: SOD, POD, CAT and GST and appreciable lowering in the cellular accumulation of chromium. The overall results demonstrate that KN application significantly alleviated chromium induced toxicity on growth performance of the cyanobacterium N. muscorum due to significant improvement in photosynthetic pigments and photochemistry of PS II by up-regulating the activity of antioxidative enzymes, and declining cellular accumulation of chromium. Furthermore, Cr induced toxicity at lower dose (100 µM) was found to be ameliorated more efficiently in N. muscorum following supplementation of KN.

Toxicity assessment of arsenate and arsenite on growth, chlorophyll a fluorescence and antioxidant machinery in Nostoc muscorum.

The present study deals with impact of varied doses of arsenite (AsIII; 50, 100 and 150 µM) and arsenate (AsV; 50, 100 and 150 mM) on growth, photosynthetic pigments, photochemistry of photosystem II, oxidative biomarkers, (O2•¯, H2O2 and MDA equivalents contents) and activity of antioxidant enzymes in diazotrophic cyanobacterium Nostoc muscorum after 48 and 96 h of the treatments. The reduction in growth, pigment contents (Chl a, Phy and Car) and PS II photochemistry was found to increase with enhanced accumulation of test metal in cells, and the damaging effect on photosynthetic pigments showed the order (Phy > chl a> Car). The negative effect on PS II photochemistry was due to significant decrease in the value of JIP kinetics ϕP0, FV/F0, ϕE0,Ψ0 and PIABS except F0/FV and significant rise in values of energy flux parameters such as ABS/RC, TR0/RC, ET0/RC and DI0/RC. Both the species of arsenic caused significant rise in oxidative biomarkers as evident by in vitro and in vivo analysis of (O2•¯, H2O2 and MDA equivalents contents) despite of appreciable rise in the activity antioxidative enzymes such as SOD, POD, CAT and GST. The study concludes that in among both forms of arsenic, arsenite effect was more dominant on growth, photosynthetic pigments; oxidative stress biomarkers as evident by weak induction of anti-oxidative defense system to overcome the stress as compared to arsenate.

Pretilachlor toxicity is decided by discrete photo-acclimatizing conditions: Physiological and biochemical evidence from Anabaena sp. and Nostoc muscorum.

The current study was undertaken to elucidate the impact of the herbicide pretilachlor (3 µg ml-1 and 6 µg ml-1) on cyanobacteria, Nostoc muscorum ATCC 27893 and Anabaena sp. PCC 7120 under three levels of photoacclimatization (suboptimum, 25 µmol photon m-2 s-1; optimum, 75 µmol photon m-2 s-1; and supra-optimum, 225 µmol photon m-2 s-1) by analyzing certain physiological (biomass accumulation, photosynthesis, Chl a fluorescence and respiration) and biochemical parameters (photosynthetic pigments‒ chlorophyll a, carotenoids and phycocyanin; reactive oxygen species‒ O2•¯, H2O2, lipid peroxidation; antioxidant system‒ superoxide dismutase, peroxidise, catalase and glutathione-S-transferase). The light conditioning played the most prominent role in deciding the extent of herbicide toxicity on both the tested cyanobacteria as the maximum toxicity was observed in suboptimum light acclimatized cyanobacterial cells corroborated by the least growth in the same cells. The impact of pretilachlor treatment on photosystem II photochemistry viz. φP0, Ñ°0, φE0, PIABS, ABS/RC, TR0/RC, ET0/RC and DI0/RC was also altered by light acclimatization. The percent rise in oxidative stress markers (SOR and H2O2) and consequent lipid peroxidation (MDA equivalents) were also highest in suboptimum light acclimatized cells exposed to pretilachlor which could not be prospered with compatible antioxidant performance. Conversely, supra-optimum light acclimatized cells of both the cyanobacteria was found to accelerate the activities of all the studied enzymes and thus able to counterbalance the pretilachlor toxicity and supported the healthier growth.

Aspiring Pain Practitioners in India: Assessing Challenges and Building Opportunities.

BACKGROUND: Pain medicine is a developing specialty, aimed at relieving pain and suffering, enhancing function, and improving the quality of life of patients. Pain is often ignored, under-reported and mismanaged by health-care providers. Aspiring pain physicians in India face many challenges and barriers in advancing their specialty. OBJECTIVES: The objective of this study is to determine the challenges in establishing a pain practice in India and to discuss the opportunities and strategies to overcome these barriers. SUBJECTS AND METHODS: Face-to-face interactive sessions were held with 60 aspiring pain physicians of India who were chosen as registrants to an International Association for the Study of Pain-Indian Society for Study of Pain multidisciplinary evidence-based pain management program conducted at Delhi and Mumbai. The available opportunities, practical issues and the hurdles in becoming a pain specialist were analyzed and summarized in this commentary. RESULTS: The major barriers identified were: (1) Inadequate knowledge and absence of structured, educational and training courses, (2) bureaucratic hurdles, and (3) concerns of opioid misuse and addiction. The opportunities for personal growth and that of the specialty that could be utilized include the creation of a pain resource team, increasing community awareness, changing attitudes of other physicians toward pain specialty, and research and evidence building of the effectiveness of pain management strategies. CONCLUSION: India needs a structured teaching and training program in the area of pain medicine that is affiliated by the Medical Council of India or other reputed boards of medical education and certification. There is an urgent need to include pain management in the undergraduate and postgraduate medical curriculum. Enhancing community level awareness by public health education campaigns, developing networks of pain physicians, and appropriate marketing of the specialty is needed to make pain medicine recognized and utilized as a valuable specialty.

Effectiveness of the Certificate Course in Essentials of Palliative Care Program on the Knowledge in Palliative Care among the Participants: A Cross-sectional Interventional Study.

BACKGROUND: Palliative medicine is an upcoming new specialty aimed at relieving suffering, improving quality of life and comfort care. There are many challenges and barriers in providing palliative care to our patients. The major challenge is lack of knowledge, attitude and skills among health-care providers. OBJECTIVES: Evaluate the effectiveness of the certificate course in essentials of palliative care (CCEPC) program on the knowledge in palliative care among the participants. SUBJECTS AND METHODS: All participants (n = 29) of the CCEPC at All India Institute of Medical Sciences, Delhi, giving consent for pretest and posttest were recruited in the study. This educational lecture of 15 h was presented to all the participants following pretest and participants were given same set of questionnaire to be filled as postintervention test. RESULTS: In pretest, 7/29 (24.1%) had good knowledge which improved to 24/29 (82.8%) after the program. In pretest, 62.1% had average knowledge and only 13.8% had poor knowledge. There was also improvement in communication skills, symptom management, breaking bad news, and pain assessment after completion of the program. CONCLUSION: The CCEPC is an effective program and improving the knowledge level about palliative care among the participants. The participants should implement this knowledge and the skills in their day-to-day practice to improve the quality of life of patients.

Phase II Study of BGJ398 in Patients With FGFR-Altered Advanced Cholangiocarcinoma.

Purpose No standard treatment exists for patients with cholangiocarcinoma for whom first-line gemcitabine-based therapy fails. Fibroblast growth factor receptor 2 ( FGFR2) fusions/translocations are present in 13% to 17% of intrahepatic cholangiocarcinomas. BGJ398, an orally bioavailable, selective pan-FGFR kinase inhibitor, has shown preliminary clinical activity against tumors with FGFR alterations. Methods A multicenter, open-label, phase II study ( ClinicalTrials.gov identifier: NCT02150967) evaluated BGJ398 antitumor activity in patients age ≥ 18 years with advanced or metastatic cholangiocarcinoma containing FGFR2 fusions or other FGFR alterations whose disease had progressed while receiving prior therapy. Patients received BGJ398 125 mg once daily for 21 days, then 7 days off (28-day cycles). The primary end point was investigator-assessed overall response rate. Results Sixty-one patients (35 women; median age, 57 years) with FGFR2 fusion (n = 48), mutation (n = 8), or amplification (n = 3) participated. At the prespecified data cutoff (June 30, 2016), 50 patients had discontinued treatment. All responsive tumors contained FGFR2 fusions. The overall response rate was 14.8% (18.8% FGFR2 fusions only), disease control rate was 75.4% (83.3% FGFR2 fusions only), and estimated median progression-free survival was 5.8 months (95% CI, 4.3 to 7.6 months). Adverse events included hyperphosphatemia (72.1% all grade), fatigue (36.1%), stomatitis (29.5%), and alopecia (26.2%). Grade 3 or 4 treatment-related adverse events occurred in 25 patients (41%) and included hyperphosphatemia (16.4%), stomatitis (6.6%), and palmar-plantar erythrodysesthesia (4.9%). Conclusion BGJ398 is a first-in-class FGFR kinase inhibitor with manageable toxicities that shows meaningful clinical activity against chemotherapy-refractory cholangiocarcinoma containing FGFR2 fusions. This promising antitumor activity supports continued development of BGJ398 in this highly selected patient population.