Valorization of waste engine oil to mono- and di-rhamnolipid in a sustainable approach to circular bioeconomy.

This study aims to valorize waste engine oil (WEO) for synthesizing economically viable biosurfactants (rhamnolipids) to strengthen the circular bioeconomy concept. It specifically focuses on investigating the influence of key bioprocess parameters, viz. agitation and aeration rates, on enhancing rhamnolipid yield in a fed-batch fermentation mode. The methodology involves conducting experiments in a stirred tank bioreactor (3 L) using Pseudomonas aeruginosa gi |KP 163922| as the test organism. Central composite design and response surface methodology (CCD-RSM) are employed to design the experiments and analyze the effects of agitation and aeration rates on various parameters, including dry cell biomass (DCBM), surface tension, tensoactivity, and rhamnolipid yield. It is also essential to determine the mechanistic pathway of biosurfactant production followed by the strain using complex hydrophobic substrates such as WEO. The study reveals that optimal agitation and aeration rates of 200 rpm and 1 Lpm result in the highest biosurfactant yield of 29.76 g/L with minimal surface tension (28 mN/m). Biosurfactant characterization using FTIR, 1H NMR, and UPLC-MS/MS confirm the presence of dominant molecular ion peaks m/z 543.9 and 675.1. This suggests that the biosurfactant is a mixture of mono- and di-rhamnolipids (RhaC10C10, RhaRhaC10C12:1, RhaRhaC12:1C10). The findings present a sustainable approach for biosurfactant production in a fed-batch bioreactor. This research opens the possibility of exploring the use of pilot or large-scale bioreactors for biosurfactant production in future investigations.

A comprehensive review of flue gas bio-mitigation: chemolithotrophic interactions with flue gas in bio-reactors as a sustainable possibility for technological advancements.

Flue gas mitigation technologies aim to reduce the environmental impact of flue gas emissions, particularly from industrial processes and power plants. One approach to mitigate flue gas emissions involves bio-mitigation, which utilizes microorganisms to convert harmful gases into less harmful or inert substances. The review thus explores the bio-mitigation efficiency of chemolithotrophic interactions with flue gas and their potential application in bio-reactors. Chemolithotrophs are microorganisms that can derive energy from inorganic compounds, such as carbon dioxide (CO2), nitrogen oxides (NOx), and sulfur dioxide (SO2), present in the flue gas. These microorganisms utilize specialized enzymatic pathways to oxidize these compounds and produce energy. By harnessing the metabolic capabilities of chemolithotrophs, flue gas emissions can be transformed into value-added products. Bio-reactors provide controlled environments for the growth and activity of chemolithotrophic microorganisms. Depending on the specific application, these can be designed as suspended or immobilized reactor systems. The choice of bio-reactor configuration depends on process efficiency, scalability, and ease of operation. Factors influencing the bio-mitigation efficiency of chemolithotrophic interactions include the concentration and composition of the flue gas, operating conditions (such as temperature, pH, and nutrient availability), and reactor design. Chemolithotrophic interactions with flue gas in bio-reactors offer a potentially efficient approach to mitigating flue gas emissions. Continued research and development in this field are necessary to optimize reactor design, microbial consortia, and operating conditions. Advances in understanding the metabolism and physiology of chemolithotrophic microorganisms will contribute to developing robust and scalable bio-mitigation technologies for flue gas emissions.

Reforming CO2 bio-mitigation utilizing Bacillus cereus from hypersaline realms in pilot-scale bubble column bioreactor.

The bubble column reactor of 10 and 20 L capacity was designed to bio-mitigate 10% CO2 (g) with 90% air utilizing thermophilic bacteria (Bacillus cereus SSLMC2). The maximum biomass yield during the growth phase was obtained as 9.14 and 10.78 g L-1 for 10 and 20 L capacity, respectively. The maximum removal efficiency for CO2 (g) was obtained as 56% and 85% for the 10 and 20 L reactors, respectively. The FT-IR and GC-MS examination of the extracellular and intracellular samples identified value-added products such as carboxylic acid, fatty alcohols, and hydrocarbons produced during the process. The total carbon balance for CO2 utilization in different forms confirmed that B. cereus SSLMC2 utilized 1646.54 g C in 10 L and 1587 g of C in 20 L reactor out of 1696.13 g of total carbon feed. The techno-economic assessment established that the capital investment required was $286.21 and $289.08 per reactor run of 11 days and $0.167 and $0.187 per gram of carbon treated for 10 and 20 L reactors, respectively. The possible mechanism pathways for bio-mitigating CO2 (g) by B. cereus SSLMC2 were also presented utilizing the energy reactions. Hence, the work presents the novelty of utilizing thermophilic bacteria and a bubble column bioreactor for CO2 (g) bio-mitigation.

Remediation of multifarious metal ions and molecular docking assessment for pathogenic microbe disinfection in aqueous solution by waste-derived Ca-MOF.

The present study demonstrates an eco-friendly and cost-effective synthesis of calcium terephthalate metal-organic frameworks (Ca-MOF). The Ca-MOF were composed of metal ions (Ca2+) and organic ligands (terephthalic acid; TPA); the former was obtained from egg shells, and the latter was obtained from processing waste plastic bottles. Detailed characterization using standard techniques confirmed the synthesis of Ca-MOF with an average particle size of 461.9 ± 15 nm. The synthesized Ca-MOF was screened for its ability to remove multiple metal ions from an aqueous solution. Based on the maximum sorption capacity, Pb2+, Cd2+, and Cu2+ ions were selected for individual parametric batch studies. The obtained results were interpreted using standard isotherms and kinetic models. The maximum sorption capacity (qm) obtained from the Langmuir model was found to be 644.07 ± 47, 391.4 ± 26, and 260.5 ± 14 mg g-1 for Pb2+, Cd2+, and Cu2+, respectively. Moreover, Ca-MOF also showed an excellent ability to remove all three metal ions simultaneously from a mixed solution. The metal nodes and bonded TPA from Ca-MOF were dissociated by the acid dissolution method, which protonated and isolated TPA for reuse. Further, the crystal structure of Ca-MOF was prepared and docked with protein targets of selected pathogenic water-borne microbes, which showed its disinfection potential. Overall, multiple metal sorption capability, regeneration studies, and broad-spectrum antimicrobial activity confirmed the versatility of synthesized Ca-MOF for industrial wastewater treatment.

Phylloplane fungus Curvularia dactyloctenicola VJP08 effectively degrades commercially available PS product.

Polystyrene (PS), a widely produced plastic with an extended carbon (C-C) backbone that resists microbial attack, is produced in enormous quantities throughout the World. Naturally occurring plasticizers such as plant cuticle and lignocelluloses share similar properties to synthetic plastics such as hydrophobicity, structural complexity, and higher recalcitrance to degradation. In due course of time, phytopathogenic fungi have evolved strategies to overcome these limitations and utilize lignocellulosic waste for their nutrition. The present investigation focuses on the utilization of phylloplane fungus, Curvularia dactyloctenicola VJP08 towards its ability to colonize and degrade commercially available PS lids. The fungus was observed to densely grow onto PS samples over an incubation period of 30 days. The morphological changes showcased extensive fungal growth with mycelial imbrication invading the PS surface for carbon extraction leading to the appearance of cracks and holes in the PS surface. It was further confirmed by EDS analysis which indicated that carbon was extracted from PS for the fungal growth. Further, 3.57% decrease in the weight, 8.8% decrease in the thickness and 2 °C decrease in the glass transition temperature (Tg) confirmed alterations in the structural integrity of PS samples by the fungal action. GC-MS/MS analysis of the treated PS samples also showed significant decrease in the concentration of benzene and associated aromatic derivatives confirming the degradation of PS samples and subsequent utilization of generated by-products by the fungus for growth. Overall, the present study confirmed the degradation and utilization of commercially available PS samples by phylloplane fungus C. dactyloctenicola VJP08. These findings establish a clear cross-assessment of the phylloplane fungi for their prospective use in the development of degradation strategies of synthetic plastics.

Rhamnolipid production by Pseudomonas aeruginosa (SSL-4) on waste engine oil (WEO): Taguchi optimization, soil remediation, and phytotoxicity investigation.

ABSTRACTEnvironmental concerns and rising biosurfactant demand emphasize the need for this study. The objective is to maximize rhamnolipid-biosurfactant production by Pseudomonas aeruginosa (SSL-4) utilizing waste engine oil (WEO) as the sole substrate for use in soil bioremediation and commercial production. Using an L16 Taguchi orthogonal array, a signal-to-noise ratio, and an analysis of variance (ANOVA), the effects of environmental (pH, incubation temperature) and dietary parameters (carbon source concentration, carbon/nitrogen (C/N) and carbon/phosphorus (C/P) ratio) are examined. Variations of the following parameters were made within a carefully selected range: incubation temperature of 25-40℃, pH range of 5-11, WEO concentration of 1-7% (v/v), and C/N and C/P ratios of 10-40. Response variables in this batch study include surface tension reduction (mN/m), dry cell biomass (DCBM) (g/L), and rhamnolipids yield based on substrate consumption, YP/S (g/g). Rhamnolipid was synthesized under optimal conditions, providing a yield of 21.42 g/g. The oil recovery of 74.05 ± 1.481% was achieved from oil-contaminated soil at a CMC of ∼70 mg/L. FTIR, 1H NMR, and UPLC-MS techniques were utilized for the characterization of rhamnolipids, and AAS for determining heavy metals concentration in WEO and residual waste engine oil (RWEO). The Germination Index (GI) of ∼82.55% indicated no phytotoxicity associated with synthesized rhamnolipid.

Production, characterization, and kinetic modeling of biosurfactant synthesis by Pseudomonas aeruginosa gi |KP 163922|: a mechanism perspective.

Kinetic studies and modeling of production parameters are essential for developing economical biosurfactant production processes. This study will provide a perspective on mechanistic reaction pathways to metabolize Waste Engine Oil (WEO). The results will provide relevant information on (i) WEO concentration above which growth inhibition occurs, (ii) chemical changes in WEO during biodegradation, and (iii) understanding of growth kinetics for the strain utilizing complex substrates. Laboratory scale experiments were conducted to study the kinetics and biodegradation potential of the strain Pseudomonas aeruginosa gi |KP 163922| over a range (0.5-8% (v/v)) of initial WEO concentration for 168 h. The kinetic models, such as Monod, Powell, Edward, Luong, and Haldane, were evaluated by fitting the experimental results in respective model equations. An unprecedented characterization of the substrate before and after degradation is presented, along with biosurfactant characterization. The secretion of biosurfactant during the growth, validated by surface tension reduction (72.07 ± 1.14 to 29.32 ± 1.08 mN/m), facilitated the biodegradation of WEO to less harmful components. The strain showed an increase in maximum specific growth rate (µmax) from 0.0185 to 0.1415 h-1 upto 49.92 mg/L WEO concentration. Maximum WEO degradation was found to be ~ 94% gravimetrically. The Luong model (adj. R2 = 0.97) adapted the experimental data using a non-linear regression method. Biochemical, 1H NMR, and FTIR analysis of the produced biosurfactant revealed a mixture of mono- and di- rhamnolipid. The degradation compounds in WEO were identified using FTIR, 1H NMR, and GC-MS analysis to deduce the mechanism.

Flexible Fiberoptic Bronchoscopy in Non-ventilated Children in Pediatric Intensive Care Unit: Utility, Interventions and Safety.

Objective: To study the utility of flexible fiberoptic bronchoscopy (FFB), and its effects on oxygenation and hemodynamics in children while on respiratory assist devices. Materials and methods: The data of non-ventilated patients who underwent FFB during their stay in the PICU from January 2012 to December 2019 was retrieved from medical, nurses, and bronchoscopy records. The study parameters, demography, diagnosis, indication, and findings of FFB and interventions done after FFB, were noted, and also the oxygenation and hemodynamic parameters before, during and 3 hours after FFB. Results: Data from the first FFB of 155 patients were analyzed retrospectively. About 54/155 (34.8%) children underwent FFB while on HFNC. About 75 (48.4%) patients were on conventional oxygen therapy (COT) before FFB. There were 51 (33%) patients who had received mechanical ventilation and were extubated successfully. The 98 (63.2%) children had primary respiratory diseases. Stridor and lung atelectasis were indications for FFB in 75 (48.4%) cases and the commonest bronchoscopic finding was retained secretions in the airways. Based on the FFB findings, 50 medical and 22 surgical interventions were done. The commonest medical and surgical interventions were changes in antibiotics (25/50) and tracheostomy (16/22) respectively. There was a significant fall in SpO2 and a rise in hemodynamic parameters during FFB. All these changes were reversed after the procedure with no consequences. Conclusion: Flexible fiberoptic bronchoscopy is a useful tool to diagnose and guide interventions in non-ventilated pediatric intensive care unit (PICU). There were significant but transient changes in oxygenation and hemodynamics with no serious consequences. How to cite this article: Sachdev A, Gupta N, Khatri A, Jha G, Gupta D, Gupta S, et al. Flexible Fiberoptic Bronchoscopy in Non-ventilated Children in Pediatric Intensive Care Unit: Utility, Interventions and Safety. Indian J Crit Care Med 2023;27(5):358-365.

Pathological Correlation of a Cardiac Mass with Multimodality Imaging.

Cardiac masses are rarely encountered in clinical practice and can lead to severe hemodynamic consequences. In addition to clinical cues, noninvasive modalities can play an important role in characterization of these masses and therefore their diagnosis and management planning. Here in this case report, we describe the use of various forms of noninvasive imaging techniques to narrow the differential diagnosis and form an operative plan for a cardiac mass later identified as a benign myxoma originating from the right ventricle on histological examination.

One-pot synthesis of metal oxide-clay composite for the evaluation of dye removal studies: Taguchi optimization of parameters and environmental toxicity studies.

The present study demonstrates the synthesis of eco-friendly metal oxide-clay composites (MgO-clay and CaO-clay) with phytochemical functionalization. The physical and chemical properties of prepared composites were characterized using standard techniques viz. scanning electron microscopy, Fourier transform infrared spectroscopy, and X-ray diffraction. The effect of pH on the dye adsorption capability of the synthesized composites was studied. The adsorption of an anionic dye methyl orange (MO) and a cationic due methylene blue (MB) was favored in the acidic and basic regions, respectively. The Taguchi design approach was adopted for the removal of MO and MB from wastewater using the synthesized composites. The obtained results suggest that initial dye concentration and composite dosage were the most influential parameters in dye removal among all the studied parameters. The adsorption experiments were carried out using MgO-clay and CaO-clay composites with the optimum conditions obtained from Taguchi optimization to validate the predicted response. The experimental parameters viz. the effect of contact time, initial dye concentration, and solution temperature were studied for screened composite (CaO-clay) with optimized conditions. The obtained results were interpreted using standard isotherms and kinetic models. A maximum adsorption capacity of 571 ± 10 and 859 ± 14 mg g-1 was obtained from the Langmuir adsorption isotherm for MO and MB, respectively. Regeneration studies suggested that the CaO-clay composite can be utilized up to 3 cycles with reduced adsorption capacity of the dyes over cycles due to the solid binding nature of dyes on the CaO-clay composite. The fresh and utilized CaO-clay composite were tested for their environmental toxicity analysis using ecologically important soil microorganisms. The obtained results suggested no detrimental effects on soil microbe's functionality, indicating their threat-free disposal in the soil environment.

Ureterosciatic Hernia in Focus: A Narrative Review of the Literature.

Pelvic herniation of the ureter through anatomical musculoskeletal foramina stands out as one of the rarest causes of ureteric obstruction. Historically, most cases have been documented as incidental intraoperative findings. The herniation of the ureter through the sciatic foramen presents as a particularly uncommon variant of this condition, distinguished by its potential to cause life-threatening sepsis or renal failure if not promptly recognized and treated. The diagnostic process remains challenging, attributed partly to the vague initial symptomatology and subtle radiological findings, and second, to the rarity of this condition. This challenge may be further compounded by the lack of a clear description of clinical features and pathways to raise clinician suspicion. In light of these considerations, we conducted this literature review to illuminate this unique cause of obstructive uropathy, aiming to delineate its clinical features and explore common diagnostic and treatment options.

Study of thermodynamics of a thermal electron in scattering.

This work presents the study of the thermodynamic properties of thermal electrons participating in scattering events. This is necessary because scattering with a thermal electron in presence of a laser field was not studied yet and it reduces the complexity of event measurement (differential cross-section). To study thermodynamic properties, the authors model the thermal Hamiltonian in presence of a laser field and used it to study the thermodynamic properties using the partition function. The study shows thermodynamic energy, around the target with distance at field amplitude 0.1 a.u. to 0.9 a.u. has destructive interference, above field amplitude 1 a.u. to 2.5 a.u. has superposition and at field amplitude 2.5 a.u. and 3 a.u. have coulomb potential like nature. Also, thermodynamic energy with temperature was found constant except at field amplitude 2.5 a.u. and at field amplitude 2.5 a.u. destructive interference at 10 °C and 21 °C. The thermodynamical potential at field amplitude 0.1 to 3.5 a.u. found constant and above field amplitude 3.5 a.u. increased linearly when studied with respect to temperature at 10 Å . The thermal Hamiltonian increase sharply when thermal electrons enter in 1-5 Å , slowly in 5-10 Å and beyond 10 Å constant, and the thermal Hamiltonian nature is like coulomb potential.

Uretero-Sciatic Hernia (Lindbom Hernia): A Case Report and Long-Term Follow-Up.

Ureteric herniation through the posterior pelvic wall is one of the rarest variants of hernias and causes of ureteric obstruction. The clinical features span from asymptomatic to a presentation with severe flank pain and life-threatening infection secondary to ureteric obstruction. The diagnosis needs a high index of suspicion and timely, appropriate radiological investigation. This article presents a case report of a patient who presented with a history of nonspecific abdominal pain and was diagnosed with a left-sided uretero-sciatic hernia (Lindblom hernia). This was managed with routine ureteral stent changes. Long-term follow-up and results from over 10 years of management are presented.

Indication-based timing of tracheostomy and its effects on outcome in the pediatric intensive care unit.

OBJECTIVES: The objective of study was to find an association between the timing of tracheostomy with duration of mechanical ventilation (MV) and length of stay (LOS) in pediatric intensive care unit (PICU) and hospital. METHODS: The data were collected prospectively from 2000 to 2018 and were analyzed retrospectively. Data included clinical diagnosis, indication, and duration (days) of MV, LOS in PICU and hospital before and after tracheostomy. Patients who did not receive MV or underwent MV for <24 h were excluded. According to the indication of tracheostomy enrolled patients were divided into four groups-airways anomalies (AA), central neurological impairment (CNI), cardiopulmonary insufficiency (CPI), and neuromuscular disorders (NMD). Patients in each group were divided into early (ET) and late tracheostomy (LT) category based on the median (interquartile range interquartile range [IQR]) days of pretracheostomy MV. RESULTS: Two hundred and fifty six patients were analyzed. The frequency and median [IQR] days of pretracheostomy MV were -AA 54 [7(3,16)], CNI 120 [12(9,16)], CPI 51 [25(16.5,30.5)], and NMD 31[12(8,16.5)]. In AA patients, median (IQR) durations of posttracheostomy MV [2(1,5.2) versus 3.5(2,12); p = 0.032], PICU [7(5,8.2) versus11(7,18); p = 0.004] and hospital [12(9.7,21) versus 21.5(12,28); p = 0.027] stays were lower in ET as compared with LT group. Posttracheostomy MV duration was significantly short in ET patients with CNI and NMD (p < 0.005). The total days of MV, PICU and hospital stay were significantly lower in ET as compared with LT patients in all four groups (p < 0.01). CONCLUSION: As compared with LT, ET patient had shorter durations of total MV and PICU and hospital stay.

Twitter sentiment analysis using ensemble based deep learning model towards COVID-19 in India and European countries.

As of November 2021, more than 24.80 crore people are diagnosed with the coronavirus in that around 50.20 lakhs people lost their lives, because of this infectious disease. By understanding the people's sentiment's expressed in their social media (Facebook, Twitter, Instagram etc.) helps their governments in controlling, monitoring, and eradicating the coronavirus. Compared to other social media's, the twitter data are indispensable in the extraction of useful awareness information related to any crisis. In this article, a sentiment analysis model is proposed to analyze the real time tweets, which are related to coronavirus. Initially, around 3100 Indian and European people's tweets are collected between the time period of 23.03.2020 to 01.11.2021. Next, the data pre-processing and exploratory investigation are accomplished for better understanding of the collected data. Further, the feature extraction is performed using Term Frequency-Inverse Document Frequency (TF-IDF), GloVe, pre-trained Word2Vec, and fast text embedding's. The obtained feature vectors are fed to the ensemble classifier (Gated Recurrent Unit (GRU) and Capsule Neural Network (CapsNet)) for classifying the user's sentiment's as anger, sad, joy, and fear. The obtained experimental outcomes showed that the proposed model achieved 97.28% and 95.20% of prediction accuracy in classifying the both Indian and European people's sentiments.

Functionalized Cu-based metal oxide nanoparticles with enhanced Cd+2 adsorption capacity and their ecotoxicity assessment by molecular docking.

In the present study, synthesis of eco-friendly Cu-based metal oxides nanoparticles [CuO, Cu2O, and CuO&Cu2O nanoparticles (NPs)] without and with functionalization with Diethylene glycol (DEG) has been demonstrated. The synthesized NPs were screened for their ability to adsorb multiple heavy metal ions from an aqueous solution. Based on the maximum Cadmium (Cd+2) ion adsorption capacity, functionalized Cu2O (fCu2O) NPs were selected for the detailed characterization and batch studies. The average size of fCu2O NPs was found to be 57.4 ± 6.14 nm in comparison to NPs without capping (72.6 ± 5.19 nm). The experimental parameters viz. contact time, initial pH, and initial concentration were optimized, and the obtained results were interpreted using standard isotherms and kinetic models. The maximum Cd+2 adsorption on fCu2O NPs was observed at initial solution pH 7. The adsorption of Cd+2 was found to be decreased at acidic pH due to the protonation of functional groups present on the NPs surface. A maximum Cd+2 adsorption capacity of 204 ± 6.2 mg g-1 was obtained from the Langmuir adsorption isotherm. The crystal structure of NPs was prepared and docked with the protein targets of selected soil microbes in order to determine their ecotoxicity. The obtained results showed that NPs exhibited low affinity towards protein targets in comparison to the standard used. It suggests that NPs have less impact on the functionality of soil microbes and are thus safe for their disposal into the soil micro-environment.

Device Development for Biosimilars: Human Factor Engineering for a Teriparatide Pen.

BACKGROUND: A thorough Human Factors Engineering (HFE) process was implemented to develop a new Teriparatide Pen for the treatment of osteoporosis. The pen provides a cost-effective treatment alternative to branded teriparatide pens. The HFE process ensured that the pen was safe and effective to use and fulfilled the regulatory requirements. RESEARCH DESIGN AND METHODS: The HFE process utilized a risk-based approach that included understanding the users and other use characteristics, preliminary analyses including a thorough risk assessment, a formative and two validation studies. The studies were carried out with intended users - patients, caregivers and healthcare professionals (HCPs) - in the form of simulated use assessments. RESULTS: The preliminary analyses supported the design of the pen's user interface, including its Instructions for Use (IFU). The formative study helped to optimize the user interface. The validation study results were largely favorable but indicated a minor scope for improvement. The IFU was therefore further improved, and a bridging validation study assessed the revised IFU and found it to be effective in supporting the correct use of the pen. CONCLUSIONS: The HFE process ensured and demonstrated that the Teriparatide Pen was safe and effective for its intended use.

CRISPR/Cas9 mutants of tomato MICRORNA164 genes uncover their functional specialization in development.

Plant MICRORNA164 (miR164) plays diverse regulatory functions by post-transcriptional repression of certain NAM/ATAF/CUC-domain transcription factors. However, the involvement of miR164 in fleshy fruit development and ripening remains poorly understood. Here, de novo prediction of tomato (Solanum lycopersicum) MIR164 genes identified four genes (SlMIR164a-d), of which SlMIR164d has an atypically long pre-miRNA. The roles of the fruit expressed SlMIR164a, b, and d were studied by analysis of their Clustered Regularly Interspaced Short Palindromic Repeats mutants. The slmir164bCR mutant plants exhibited shoot and flower abnormalities characteristic of ectopic boundary specification, whereas the shoot and flower development of slmir164aCR and slmir164dCR mutants were indistinguishable from wild-type. Strikingly, the knockout of SlMIR164a practically eliminated sly-miR164 from the developing and ripening fruit pericarp. The sly-miR164-deficient slmir164aCR fruits were smaller than the wild-type, due to reduced pericarp cell division and expansion, and displayed intense red color and matte, instead of glossy appearance, upon ripening. We found that the fruit skin phenotypes were associated with morphologically abnormal outer epidermis and thicker cuticle. Quantitation of sly-miR164 target transcripts in slmir164aCR ripening fruits demonstrated the upregulation of SlNAM3 and SlNAM2. Specific expression of their miR164-resistant versions in the pericarp resulted in the formation of extremely small fruits with abnormal epidermis, highlighting the importance of their negative regulation by sly-miR164a. Taken together, our results demonstrate that SlMIR164a and SlMIR164b play specialized roles in development: SlMIR164b is required for shoot and flower boundary specification, and SlMIR164a is required for fruit growth including the expansion of its outer epidermis, which determines the properties of the fruit skin.

Tracheostomy in Pediatric Intensive Care Unit-A Two Decades of Experience.

AIM AND OBJECTIVE: To study the profile, indications, related complications, and predictors of decannulation and mortality in patients who underwent tracheostomy in the pediatric intensive care unit (PICU). MATERIALS AND METHODS: Retrospective analysis of prospectively collected data of tracheostomies was done on patients admitted at PICU. Demographics, primary diagnosis, indication of tracheostomy, and durations of endotracheal intubation, mechanical ventilation, and tracheostomy cannulation were recorded. The indication was recorded in one of the four categories-upper airway obstruction (UAO), central neurological impairment (CNI), prolonged mechanical ventilation, and peripheral neuromuscular disorders). RESULTS: Two hundred ninety cases were analyzed. UAO (42%) and CNI (48.2%) were main indications in the halves of the study period, respectively. Decannulation was successful in 188 (64.8%) patients. Seventy-seven percentage UAO patients were decannulated successfully [OR (odds ratio); 95% CI (confidence interval), 2.647; 1.182-5.924, p = 0.018]. Age <1 year (0.378; 0.187-0.764; p = 0.007), nontraumatic, noninfectious central neurological diseases (0.398; 0.186-0.855; p = 0.018), and malignancy (0.078; 0.021-0.298; p <0.001), durations of posttracheostomy ventilation (0.937; 0.893-0.983; p = 0.008), and stay in the PICU (0.989; 0.979-0.999; p = 0.029) were predictors of unsuccessful decannulation. There were 91 (31.4%) deaths. Age <1 year (2.39 (1.13-5.05; p = 0.02), malignancy (17.55; 4.10-75.11; p <0.001), durations of posttracheostomy ventilation (1.06; 1.006-1.10; p = 0.028), and hospital stay (1.007; 1.0-1.013; p = 0.043) were independent predictors of mortality. Indication of UAO favored survivor (0.24; 0.09-0.57; p <0.001). CONCLUSION: The indications for tracheostomy in children had changed over the years. Infancy, primary diagnosis, length of posttracheostomy ventilation, and stay in the PICU and hospital were independent predictors of decannulation and mortality. WHAT THIS ADDS: Similar to developed countries, the age at the time of tracheostomy and indication are changing. Inability to decannulate and mortality were associated with the age of a child at the time of tracheostomy, indication, medical diagnosis, and duration of postprocedure mechanical ventilation and stay in the hospital. HOW TO CITE THIS ARTICLE: Sachdev A, Chaudhari ND, Singh BP, Sharma N, Gupta D, Gupta N, et al. Tracheostomy in Pediatric Intensive Care Unit-A Two Decades of Experience. Indian J Crit Care Med 2021;25(7):803-811.

Early Predictors of Mortality in Children with Severe Dengue Fever: A Prospective Study.

OBJECTIVE: The aim of the study was to identify early predictors of mortality in children with severe dengue fever admitted to pediatric intensive care unit (PICU). MATERIALS AND METHODS: All consecutive children with laboratory-confirmed severe dengue fever were enrolled in this prospective observational study. Besides demographic data, disease severity and organ dysfunction scores, laboratory investigations and interventions are done in PICU were recorded and analyzed. RESULTS: During the study period of 42 months, 172 patients with dengue fever were admitted to PICU. A total of 78 (45.3%) patients with severe dengue fever were included and analyzed. There were 20 (25.6%) deaths. There were significant differences in disease severity and organ dysfunction scores, transaminases, blood lactate level and serum creatinine between survivors and nonsurvivors. A significantly higher number of nonsurvivors required interventions in first 24 hours of admission. Platelet counts (P value 0.22) and hematocrit (P value 0.47) were not statistically different in 2 groups. There was a significantly high vasopressor-inotrope score (VIS) (<0.001) and positive fluid balance >10% (0.002) in nonsurvivors. Multivariate stepwise logistic regression analysis identified serum glutamic pyruvic transaminases (≥ 284 IU/L; odds ratio [OR] 1.002, 95% confidence interval [CI]: 1.001-1.003), blood lactate level (≥2.73 mmol/L; OR 2.08, 95% CI: 1.354-3.202), Pediatric Risk of Mortality score at 12 hours (≥14.5; OR 1.35, 95% CI: 1.077-1.693), VIS (≥22.5, OR 1.129, 95% CI: 1.059-1.204) and positive fluid balance >10% (OR 22.937, 95% CI: 2.393-219.84) at 24 hours of admission as independent predictors of mortality. CONCLUSION: Disease severity, hyperlactatemia at admission, need for multiple vasoactive drugs and positive fluid balance are predictors of mortality in severe dengue infection in children admitted to PICU.