Use of an anaesthesia workstation barrier device to decrease contamination in a simulated operating room.

BACKGROUND.: Strategies to achieve reductions in perioperative infections have focused on hand hygiene among anaesthestists but have been of limited efficacy. We performed a study in a simulated operating room to determine whether a barrier covering the anaesthesia workstation during induction and intubation might reduce the risk of contamination of the area and possibly, by extension, the patient. METHODS.: Forty-two attending and resident anaesthetists unaware of the study design were enrolled in individual simulation sessions in which they were asked to induce and intubate a human simulator that had been prepared with fluorescent marker in its oropharynx as a marker of potentially pathogenic bacteria. Twenty-one participants were assigned to a control group, whereas the other 21 performed the simulation with a barrier device covering the anaesthesia workstation. After the simulation, an investigator examined 14 target sites with an ultraviolet light to assess spread of the fluorescent marker of contamination to those sites. RESULTS.: The difference in rates of contamination between the control group and the barrier group was highly significant, with 44.8% (2.5%) of sites contaminated in the control group vs 19.4% (2.6%) of sites in the barrier group ( P <0.001). Several key clinical sites showed significant differences in addition to this overall decrement. CONCLUSIONS.: The results of this study suggest that application of a barrier device to the anaesthesia workstation during induction and intubation might reduce contamination of the intraoperative environment.

Sequential therapy (triple drug-based induction chemotherapy followed by concurrent chemoradiotherapy) in locally advanced inoperable head and neck cancer patients - Single institute experience.

CONTEXT: India has a high incidence of head and neck squamous cell carcinoma (HNSCC) mostly presenting in advanced stage. In the majority of inoperable patients a combination of chemotherapy and radiotherapy (CRT) is considered as the treatment of choice. Adding induction chemotherapy (ICT) before CRT has shown to decrease systemic relapse. Incorporation of taxanes to the cisplatin and 5-FU-based ICT has shown increase in response rates. AIMS: To evaluate the efficacy and toxicity of triple drug-based ICT followed by CCRT in locally advanced, inoperable HNSCC in the Indian context. SETTINGS AND DESIGN: Prospective, non-controlled, observational study, a single-institute experience. MATERIALS AND METHODS: Consecutive, locally advanced inoperable HNSCC patients were put on sequential therapy consisting of docetaxel, 5-FU and cisplatin for three cycles followed by concurrent weekly cisplatin and radiotherapy for responding or stable disease patients. RESULTS: Forty-four patients were enrolled with male,female ratio of 33/44(75%) and 11/44(25%). Hypopharynx 16/44(36.36%) was the most common site followed by oral cavity 12/44(27.27%) and oropharynx 12/44(27.27%); 38/44(86.36%) patients could complete the planned treatment. Seven patients required dose reduction in ICT. As per the RECIST criteria, 16 patients had Complete Response (CR) and 15 had partial response (PR), 10 had stable disease (SD) and three had progressive disease (PD) after ICT. Thirty-eight patients received concomitant chemo radiotherapy (CCRT); 28/44 (66.63%) patients achieved CR, 10/44 (22.72 %) had PR. The main toxicity was mucositis 18/44 (40.90%) secondary to ICT. Grade III and IV hematological toxicity was seen in 16/44(36.36%), of which 6/44 (13.63%) had febrile neutropenia. CONCLUSIONS: Triple drug-based sequential therapy is tolerable in our context. In this trial from a single institute the results are very encouraging.

Titania nanoparticles synthesis in mesoporous molecular sieve MCM-41.

Nanocrystalline titanium oxide (TiO(2)) is one of the most useful oxide material, because of its widespread applications in photocatalysis, solar energy conversion, sensors and optoelectronics. The control of particle size and monodispersity of TiO(2) nanoparticles is a challenging task. The use of MCM-41, an inorganic template of uniform pore size (2-10 nm), can overcome this difficulty and produce stable nanoparticles of uniform size and shape. Here, we demonstrate the synthesis of titania nanoparticles inside the pores of silica based MCM-41 forming a TiO(2)/Si-MCM composite. Composites are formed in the alcoholic medium by incipient wetness impregnation method. Titania particles of average 3 nm size are obtained. Effect of silica and titania precursors on the quality of nanoparticles has been investigated. The characterization of titania-MCM-41 composites has been carried out using a variety of techniques like UV-vis absorption spectroscopy, X-ray diffraction, FT-IR spectroscopy, X-ray photoelectron spectroscopy, transmission electron microscopy and photoluminescence spectroscopy. It has been found that the titania particles are co-ordinated with Si-MCM by SiOTi covalent bond.

Electrochemical organization of monolayer protected gold nanoclusters on single-walled carbon nanotubes: significantly enhanced double layer capacitance.

This paper reports a novel electrochemical route for anchoring monolayer protected gold nanoclusters (size 8 +/- 0.2 nm) on single-walled carbon nanotube bundles, resulting in the formation of hybrid materials. Monolayer protected gold nanoclusters prepared by modified Brust synthesis route were organized on SWNT bundles by cycling the potential in dichloromethane between -1 to +1 V at a scan rate of 50 mV/s. Monolayer protected nanoclusters in electrolyte solutions possess ionic space charge around them (double layer charging), making them suitable for organization on nanotube bundles, by tuning the electrostatic interactions. More significantly, analysis of the double layer capacitance of these hybrid materials shows almost ten times increase in capacitance compared to that of bare SWNT bundles. We believe that these hybrid materials are potentially useful in nanoelectronics.

Postoperative residual tumour imaged by contrast-enhanced computed tomography and 201Tl single photon emission tomography: can they predict progression-free survival in high-grade gliomas?

AIMS: To evaluate if postoperative residual tumour imaged by either computed tomography or 201Tl single photon emission tomography (SPECT) carried out postoperatively could predict progression-free survival (PFS) in high-grade malignant gliomas. MATERIALS AND METHODS: Thirty-three patients with high-grade malignant gliomas underwent both contrast-enhanced CT scan and 201Tl-SPECT postoperatively before receiving radiotherapy. The PFS was evaluated against the individual reports of the above two imaging studies by univariate analysis. RESULTS: CT and 201Tl-SPECT were carried out within a median interval of 17 days after surgery. Of the 33 patients, CT and 201Tl-SPECT were reported as positive for residual tumours in 23 (69.7%) and 30 (91%) patients, respectively. Sensitivity, specificity and overall accuracy were 71.4%, 40% and 66.6% for CT, and 96.4%, 40% and 87.8% for 201Tl-SPECT, respectively, and were based on their last follow-up status (P = 0.627 for CT; P = 0.053 for 201Tl-SPECT). The median PFS for patients reported to be positive or negative on CT scan was 4 and 5 months, respectively (P = 0.202). With 201Tl-SPECT, although the median PFS for patients with a positive 201Tl uptake was also 4 months, it had not even reached for those reported having a negative 201Tl uptake (cumulative survival 66.7% at last follow-up) (P = 0.198). However, Karnofsky performance status (KPS) was the only significant predictor on univariate analysis (KPS: < 80 vs. > or = 80; P < 0.001) for PFS. CONCLUSIONS: Although both the imaging modalities have a poor specificity, postoperative 201Tl-SPECT had a significantly better accuracy to predict the status at last follow-up than contrast-enhanced CT. Nevertheless, KPS remained the most significant outcome predictor for PFS in high-grade malignant gliomas.

Predictors of survival end points in patients with cancer of the cervix on long-term follow-up: inferences and implications from an audit of patients treated with a specific radiotherapy protocol.

AIMS: An audit of patients with cancer of the cervix treated with a specified protocol of external beam radiotherapy (EXRT) followed by intracavitary brachytherapy (ICBT) was carried out to determine the prognosticators for major survival end points. MATERIALS AND METHODS: Patients treated between 1991 and 2003 with a uniform protocol of EXRT (50 Gy/25 fractions/5 weeks) followed by high-dose-rate ICBT (18 Gy/3 fractions/3 weeks) were selected from the database. Various clinical and treatment parameters were evaluated for extent of locoregional response at completion of EXRT, namely absence or presence of gross residual tumour (AGRT and PGRT, respectively) and survival end points. These included locoregional disease-free survival (LDFS), disease-free survival (DFS) and overall survival (OS). RESULTS: Of the 157 evaluable patients, 145 (92%) belonged to FIGO stages II and III. Eighty-three (53%) at completion of EXRT had AGRT, which was influenced by age and gross tumour features. The estimated 10-year LDFS, DFS and OS were 38.6%, 33.1% and 38.5%, respectively. Factors significant on univariate analysis for these survival end points were EXRT duration, ICBT time, overall treatment time (OTT) and EXRT response. On multivariate analysis, AGRT to EXRT, an OTT of < or = 67 days, and patients older than 50 years were the significant favourable determinants for all the above survival end points. CONCLUSION: The audit highlights that younger people, especially those with bulky tumours that determine response to EXRT, are poor prognosticators for survival end points. They could perhaps benefit from treatment intensification regimens using chemoradiotherapy, provided that OTT is not unduly prolonged.

Medically treated neurocysticercosis in a blind child. A case report.

A 5-year-old child presented with headache and blindness. Clinically she had blindness and bilateral optic atrophy. Computed tomography scanning of the head revealed multiple enhancing cysticercus cysts in the brain. She recovered from her blindness completely and lesions on the computed tomography scan either disappeared or diminished in size after 3 months of praziquantel therapy.