Multi-response optimization of reinforcement parameters of aluminum alloy composites by Taguchi method and grey relational analysis.

The present work describes the optimization of reinforcement parameters for hardness, thermal conductivity, and coefficient of thermal expansion while developing LM6 alloy/soda-lime glass particulate composite through Taguchi-based Grey Relational Analysis (GRA). Soda-lime glass particle weight % (1.5, 3.0 and 4.5 %), particle size (100, 150 and 300 µm) and pre-heat temperature (260, 380 and 500oC) are varied accordingly to explore the effect of reinforcement parameters on LM6 alloy/soda-lime glass composite properties. Composites are developed through stir casting based on the L9 Taguchi orthogonal array approach. The properties such as hardness, thermal conductivity and coefficient of thermal expansion of developed composites are assessed. Signal to Noise Ratios (S/N ratios) are calculated and used for the optimization of parameters. GRA is employed for multi-response optimization to find the levels of parameters that affect the desirable properties of the composite. Thus, the reinforcement parameters are optimized for attaining the combined objectives of higher hardness, higher thermal conductivity and lower coefficient of thermal expansion values considered in this investigation. The analysis shows that 4.5 wt %, particle size of 200 µm and pre-heat temperature of 380oC are optimal parameter levels. A confirmation test is carried out with the optimal parameter levels and the GRG value of 0.7778 is obtained. The GRG with the initial parameter settings is 0.4711, and the improvement of GRG is found to be 65.1 %. ANOVA is performed on GRG to find out significant parameters and the contribution of each parameter is identified. The wt.% of soda-lime glass is the most significant parameter and its contribution is 92.6 %.

Envirotype-based delineation of environmental effects and genotype × environment interactions in Indian soybean (Glycine max, L.).

Soybean is a rainfed crop grown across a wide range of environments in India. Its grain yield is a complex trait governed by many minor genes and influenced by environmental effects and genotype × environment interactions. In the current investigation, grain yield data of different sets of 41, 30 and 48 soybean genotypes evaluated during 2019, 2020 and 2021, respectively across 19 locations and twenty years' data on 19 different climatic parameters at these locations was used to study the environmental effects on grain yield, to understand the genotype × environment interactions and to identify the mega-environments. Through analysis of variance (ANOVA), it was found that predominant portion of the variation was explained by environmental effects (E) (53.89, 54.86 and 60.56% during 2019, 2020 and 2021, respectively), followed by genotype × environment interactions (GEI) (31.29, 33.72 and 28.82% during 2019, 2020 and 2021, respectively). Principal Component Analysis (PCA) revealed that grain yield was positively associated with RH (Relative humidity at 2 m height), FRUE (Effect of temperature on radiation use efficiency), WSM (Wind speed at 2 m height) and RTA (Global solar radiation based on latitude and Julian day) and negatively associated with VPD (Deficit of vapour pressure), Trange (Daily temperature range), ETP (Evapotranspiration), SW (Insolation incident on a horizontal surface), n (Actual duration of sunshine) and N (Daylight hours). Identification of mega-environments is critical in enhancing the selection gain, productivity and varietal recommendation. Through envirotyping and genotype main effect plus genotype by environment interaction (GGE) biplot methods, nineteen locations across India were grouped into four mega-environments (MEs). ME1 included five locations viz., Bengaluru, Pune, Dharwad, Kasbe Digraj and Umiam. Eight locations-Anand, Amreli, Lokbharti, Bidar, Parbhani, Ranchi, Bhawanipatna and Raipur were included in ME2. Kota and Morena constitutes ME3, while Palampur, Imphal, Mojhera and Almora were included in ME4. Locations Imphal, Bidar and Raipur were found to be both discriminative and representative; these test locations can be utilized in developing wider adaptable soybean cultivars. Pune and Amreli were found to be high-yielding locations and can be used in large scale breeder seed production.

Efficacy of modified vacuum-assisted dressing versus conventional betadine dressing in wound healing of open fractures.

Aim: This study aimed to compare the effectiveness of a customized vacuum-assisted dressing to traditional betadine dressings for wounds in open fractures. Materials and methods: In this prospective comparative study, 30 patients from two groups-group A receiving V.A.C. while group B receiving traditional dressing-were given data from sixty participants with open fractures. Wound was evaluated on days 0, 3, 7, 11, and 15 of the study. Results: In group A, there was a statistically significant decrease in the mean dimension of the wound overall (15.66 mm vs. 7.4 mm in group B), and it took an average of 9.83 days for healthy granulation tissue to emerge. In contrast to the 21 patients who had split skin grafting, five patients needed a flap as a final closure surgery. In group B, it took an average of 17 days for healthy granulation tissue to emerge. The authors used split skin grafting to close the wounds in 18 patients, and the wound was allowed to heal by secondary intention in 8 patients, while the flap was used in 4 patients. Conclusion: On comparing the modified Vacuum-assisted dressing to the standard dressing, there was considerable wound contraction and accelerated healing. Therefore, the authors observed that vacuum-assisted dressing treatment is superior to traditional betadine dressing in open fractures.

Laparoscopic Cholecystectomy in Acute Calculous Cholecystitis: A Secondary Center Experience.

Background Laparoscopic cholecystectomy (LC) has increasingly been accepted as the procedure of choice for the treatment of acute cholecystitis (AC). However, the timing of this procedure in the management of AC remains controversial. Hence this study was conducted to assess the feasibility of early laparoscopic cholecystectomy in acute cholecystitis. Materials and methods Patients who presented with symptoms of acute cholecystitis such as pain and tenderness in the right upper quadrant, systemic signs of inflammation, and positive ultrasound findings according to Tokyo guidelines were included for evaluation. Group 1 includes patients presented within 24 hours of the onset of symptoms whereas those presented between 25 and 72 hours of the onset of symptoms belonged to Group 2. All patients were taken up for early LC after assessment. Intraoperative and postoperative complications were analysed. Results Out of 120 patients, 37 belonged to Group 1 (30.83%) and 83 belonged to Group 2 (69.17%). There was a significant difference between the study groups in terms of certain demographic, laboratory findings and duration of surgery. None of the patients in Group 1 developed postoperative complications, whereas one patient in Group 2 had a bile leak on postoperative Day 2. Group 2 had a higher conversion rate to open procedure (p = 0.059). The mean duration of hospital stay for patients in Groups 1 and 2 were 3 and 3.3 days, respectively. Conclusion Laparoscopic cholecystectomy is safe and feasible with minimal conversion rates in patients presenting with early symptoms of AC. With the availability of good visualisation, optics, instruments and energy sources, good outcomes can be achieved.

Identification and genetic diversity analysis of high-yielding charcoal rot resistant soybean genotypes.

Charcoal rot disease caused by Macrophomina phaseolina (Tassi) Goid is one of the most devastating diseases in soybean in India. During 2018, 226 diverse soybean genotypes were evaluated for genetic resistance under hot-spot conditions. Out of them, a subset of 151 genotypes were selected based on Percent Disease Incidence (PDI) and better agronomic performance. Out of these 151 genotypes evaluated during 2019, 43 genotypes were selected based on PDI and superior agronomic performance for further field evaluation and molecular characterization. During 2020 and 2021, these forty-three genotypes, were evaluated for PDI, Area Under Disease Progress Curve (AUDPC), and grain yield. In 2020, genotype JS 20-20 showed least PDI (0.42) and AUDPC (9.37).Highest grain yield was recorded by the genotype JS 21-05 (515.00 g). In 2021, genotype JS 20-20 exhibited least PDI (0.00) and AUDPC (0.00).Highest grain yield was recorded in JS 20-98 (631.66 g). Across both years, JS 20-20 had the least PDI (0.21) and AUDPC (4.68), while grain yield was highest in JS 20-98 (571.67 g). Through MGIDI (multi-trait genotype-ideotype distance) analysis, JS 21-05 (G19), JS 22-01 (G43), JS 20-98 (G28) and JS 20-20 (G21) were identified as the ideotypes with respect to the traits that were evaluated. Two unique alleles, Satt588 (100 bp) on linkage group K (Chromosome no 9) and Sat_218 (200 bp) on linkage group H (Chromosome no 12), were specific for thetwo resistant genotypes JS 21-71and DS 1318, respectively. Through cluster analysis, it was observed that the genotypes bred at Jabalpur were more genetically related.

Pretreatment of mosquito larvae with ultraviolet-B and nitropolycyclic aromatic hydrocarbons induces increased sensitivity to permethrin toxicity.

Nitropolycyclic aromatic hydrocarbons (Nitro-PAH) are highly toxic PHA derivatives. Nitro-PHAs are emitted by carbonaceous materials and PHA post-emission transformation, which causes water and environmental pollution and also exists as carcinogenic and immunotoxic agents. UV light has been shown to cause DNA damage and improves the covalent binding of PAH to DNA significantly. Mosquito breeding grounds are pools of water that can be large open zones or encased ponds with varying levels of sunlight exposure. This research was performed to assess the combined effects of UV-B exposure and Nitro-PAH on the physiological function of Culex quinquefasciatus larvae. To assess the impact of UV-B irradiation and Nitro-PAH exposure on mosquito vectors, parameters were examined: (1) Nitro-PAH availability and its impact on cell fatalities; (2) the detoxifying abilities of cytochrome P450, glutathione-S-transferase, and esterase; (3) the reactions to Reactive Oxygen Species; and (4) The resistance of mosquito larvae to three synthetic pesticides (temephos, imidacloprid, and permethrin). UV-B and Nitro-PAH treatment caused cellular damage and increased major detoxification enzymes such as α & ß-esterase, cytoP450, CAT, GST, and POX. The levels of oxidative stress, ROS and protein carbonyl content, nitrite, ascorbic acid and thiobarbituric acid were decreased significantly. Toxicology bioassays revealed that UV-B + Nitro-PAH exposure significantly increased larval susceptibility. The current study concludes that prior exposure to Nitro-PAHs and UV-B may make mosquito larvae more vulnerable to chemical insecticides.

Assessment of Role of Platelet Indices in the Occurrence of Retinopathy of Prematurity.

PURPOSE: Platelets have a major role in the regulation of angiogenesis. Platelets have proangiogenic factors like vascular endothelial growth factor, which causes neovascularization of immature retina. However, there is no conclusive evidence to show that platelet indices have a role in retinopathy of prematurity (ROP). This study is aimed at assessing the role of platelet indices in the occurrence and need for treatment of ROP. METHODS: This prospective cohort study included the screening of preterm babies (<37 weeks of gestation with birth weight <2000 g). The samples of platelet indices (mean platelet volume [MPV], platelet count [PLT], plateletcrit [PCT], and platelet distribution width [PDW]) collected within 1st week of life were obtained from the electronic medical records and correlated to ROP status. Statistical analysis was done using SPSS version 22, and the Chi-square test and odds ratio were used for analysis. RESULTS: A total of 300 preterm babies were screened, of whom, 55 (18.3%) babies had ROP changes. The association of the presence of ROP changes and platelet indices was not statistically significant (P value being MPV [0.22], PLT [0.58], PCT [0.98], and PDW [0.17]). Similarly, the requirement of treatment for ROP (Type I ROP) could not be correlated with abnormal platelet indices (odds ratio at 95% confidence interval - MPV [6 (0.44-81.44)], PLT [1.7 (0.25-11.37)], PCT [3 (0.44-20.90)], and PDW [0.32 (0.33-3.05)]). CONCLUSION: Abnormal platelet indices did not show any significant risk with the occurrence or need for treatment of ROP.

Preparation and characterization of ancient recipe of organic Lime Putty-Evaluation for its suitability in restoration of Padmanabhapuram Palace, India.

The study aims at preparation and characterization of six organic lime putty (hydraulic Lime + fermented plant extract) using regionally available plants namely Terminalia Chebula (kadukkai), Rosa Sinensis (hibiscus), Palm jaggery (refined sugar), Xanthorrhoeaceae (aloe vera), and Indigofera Tinctoria (neelamari) as per the methods given in the ancient palm leaf of Padmanabhapuram Palace, India. Advanced analytical techniques like Gas chromatography-mass spectroscopy (GC-MS), UV-Spectrophotometer and carbon dioxide quantification were used to study the fermented plant extracts and Fourier transform-infrared spectroscopy (FT-IR), X-ray Diffraction (XRD), Field emission-scanning electron microscopy (FESEM) to study hydrated phases and microstructure of organic lime putty. GC-MS recorded the phytochemical compounds like fatty acids, traces of proteins, polysaccharides and carbohydrates. Fermented kadukkai and neelamari extracts reported as fatty acid, palm jaggery as carbohydrate, hibiscus as polysaccharide and aloevera rich in all the biomolecules. The detection limit of Quantification:0.013 and limit of detection:0.067 for polysaccharides, 0.026 and 0.088 for unsaturated fatty acids was reported through a U.V spectrophotometer for all the herbs. Aloevera and neelamari fermented extracts recorded the CO2 release around 96,000 and 90,000 ppm on 4th day of fermentation, whereas for other herbs it ranged below the recorded readings. Supply of CO2 has initiated the internal carbonation of the lime putty and precipitation of calcite in three different forms aragonite, calcite and vaterite minerals. The addition of organics resulted in high-intensity portlandite peaks and calcium carbonate polymorphs as reported in XRD graphs in agreement with FT-IR analysis. FESEM morphology validated the early formation of carbonate polymorphs, and EDX. has shown that kadukkai lime putty, jaggery lime putty and reference lime putty. mixes have calcium around 35-45%. From the overall results, 3% addition of eco-friendly biopolymers has altered the properties like setting time, water repellency and higher carbonation rate, which is the main reason behind longevity of the structure.

The Role of Salivary Lactate Levels in assessing the Severity of Septic Shock.

Background: Sepsis is a major worldwide cause of morbidity and mortality. Hence, rapid and reliable diagnosis is essential. Emergency departments use a standard measure of sepsis, based upon an elevated Lactate level in blood. Saliva is more readily available and easier to obtain than blood samples, and is increasingly being studied as a new source of diagnostic information. Aim: This study aimed to evaluate whether analysis of Lactate levels in saliva can substitute for that of Lactate levels in blood. Methods/Materials: We processed saliva samples and serum samples from septic shock and non-septic shock patients. We found out Lactate levels in both the group. We plotted the concentration of Lactate in non-septic and septic patients and compared lactate levels in saliva to its levels in blood.Statistical analysis: Results were statistically analyzed by independent sample t test and A Spearman rho correlation. Results: We found increased serum and salivary Lactate levels in all cases of sepsis compared to the control group. Notably, the increase in Lactate levels was higher in serum as compared to saliva in septic patients, suggesting saliva may not serve as a better indicator of sepsis compared to blood. Salivary lactate was more in septic shock patients compared to non-septic shock patients. Conclusions: To our knowledge, this is the first study to compare lactic acid levels in serum and saliva in cases of sepsis. The increase in serum lactate in patients with sepsis is evident when compared to increase in salivary lactate, so serum lactate level would be easier for physicians to differentiate septic patients from non-septic patients. Salivary lactate may not serve as better indicator in septic shock patients.

Vajra Bhasma, Ayurvedic medicine: a rare and unusual cause of Lyell's syndrome and its successful management.

Toxic epidermolysis necrosis (TEN) or Lyell syndrome is a potentially life-threatening immunological adverse skin disease, which mostly occurs secondary to the intake of an offending drug. It commonly manifests as a widespread exfoliating bullous lesion in skin and mucous membrane mimicking superficial burns and may result in hypovolemic and/or septic shock. Authors report an unusual case of Lyell's syndrome in a 42-year-old woman, secondary to the intake of Ayurveda medicine 'Vajra Bhasma' (Diamond Ash) prescribed by an Ayurveda physician for treatment of her trigeminal neuralgia. After 8th day of continuous medication intake, she had prodromal illness and rapidly developing exfoliative skin lesion extended over 80% of total body surface area, breathing difficulty, dizziness and anuria. The case was successfully managed by timely diagnosis, adequate hydration and administration of immunoglobulins. After 17 days, the skin epithelium regenerated, and she improved clinically with some depigmented lesions at discharge, which were normalised without any sequel during her further follow-up visits in hospital. Identification and withdrawal of the suspected drug, adequate resuscitation and early immunoglobulin administration are critical in management of TEN.

Isolation and identification of entomopathogenic fungus from Eastern Ghats of South Indian forest soil and their efficacy as biopesticide for mosquito control.

The repeated usage of chemical insecticides, responsible for insecticide resistance in mosquitoes and environmental toxicity. Currently effective and environmental-safe control strategies are needed for the control disease-vector mosquitoes. Entomopathogens can be an effective alternative to chemical insecticide. Herein we isolated and tested 46 soil-borne entomopathogenic fungi belonging to six genera, namely Beauveria sp., Metarhizium sp., Fusarium sp., Aspergillus sp., Trichoderma sp., and Verticillium sp., fungi conidia were tested on Aedes aegypti, Anopheles stephensi and Culex quinquefasciatus larvae. Bioassays results show that M. anisopliae fungal isolate causes a 100%, 98.6% and 92% mortality within six days, on Aedes aegypti, Anopheles stephensi and Culex quinquefasciatus, respectively. M. anisopliae treated three mosquito larvae have lower lifetime with LT50 values in A. stephensi, 2.931 days; A. aegypti, 2.676 days and C. quinquefasciatus, 3.254 days. 18 s rDNA sequence analysis confirmed that the isolated fungus are belonging to the genus of M. anisopliae-VKKH3, B. bassiana-VKBb03, and V. lecanii-VKPH1. Our results clearly show that M. anisopliae has good potential, as a low-cost, environmentally safe tool for the control of A. aegypti, A. stephensi, and C. quinquefasciatus mosquitoes.

Deacylation of Echinocandin B by Streptomyces species: a novel method for the production of Echinocandin B nucleus.

Anidulafungin, a new class of antifungal agent used for the treatment of chronic fungal infections, is derived from Echinocandin B nucleus, an intermediate metabolite of Echinocandin B produced by Aspergillus nidulans. The enzyme acylase plays a key role in the bioconversion of Echinocandin B to Echinocandin B nucleus. In the present study, a rapid screening method was used to select an actinomycete capable of producing Echinocandin B acylase. Out of 140 actinomycetes screened for the production of acylase by preliminary qualitative plate assay, 53 were selected. The selected isolates were subjected to quantitative assay under submerged fermentation for the bioconversion of Echinocandin B to Echinocandin B nucleus. Among 53 strains of actinomycetes, two strains (BICC-8848 and BICC-8547) exhibited higher degree of acylase activity. Various physico-chemical parameters were optimised for maximum bioconversion of ECB to ECB nucleus. It was found that the conditions viz. pH 7.0, temperature 26 °C and substrate concentration of about 4 g/L supported higher degree of bioconversion. It was also observed that, as the medium volume increased to 500 mL, the conversion rate was also increased by more than two-folds.

Salivary flow rate, pH and buffering capacity in patients undergoing fixed orthodontic treatment - A prospective study.

BACKGROUND: Human saliva has got many important functions like lubrication of the oral tissues, making oral functions like speech, mastication and deglutition possible and also protecting teeth and oral mucosal surfaces in different ways. Dental Caries is one of the common complications in patients undergoing orthodontic treatment. Subjects with impaired saliva flow rate often show high caries incidence. A low flow rate combined with a low or moderate buffer effect clearly indicates poor salivary resistance against microbial attack. AIM: To investigate the changes in stimulated and unstimulated salivary flow rate, pH and buffer capacity in patients undergoing therapy with fixed orthodontic appliances. MATERIALS AND METHODS: Salivary flow rate, pH and buffering capacity of 20 patients who underwent fixed orthodontic treatment at Department of Orthodontics, Ragas Dental College and Hospital, Chennai were examined using GC saliva check buffer kit. The procedure was carried out during the initiation of orthodontic treatment and subsequently, one month and six months after the placement of appliance. RESULTS: Results showed there was a significant increase in the salivary flow rate one month and six months after placement of fixed appliance while pH and buffering capacity showed no significant changes. CONCLUSION: Salivary flow rate increases significantly during fixed orthodontic treatment. Salivary pH and buffering capacity showed no significant changes suggesting that they are not sole factors for demineralization in orthodontic patients.

Genetic relationship, population structure analysis and allelic characterization of flowering and maturity genes E1, E2, E3 and E4 among 90 Indian soybean landraces.

A set of 90 Indian soybean landraces were analysed for polymorphism at 43 SSRs and five allele specific markers of four major genes involved in regulating flowering and photoperiod response. A total of 42 polymorphic SSRs had amplified 126 alleles which served as raw data for estimation of genetic relationship and population structure among 90 accessions. Rare alleles of four and three SSRs were detected in accessions IC18768 and IC15089, respectively. Gene diversity in the population ranges from 0.065 to 0.717 with a mean value of 0.411. The polymorphism information content of 42 SSRs varied from 0.063 to 0.668. Hierarchical clustering based on neighbour-joining method identified three major clusters among 90 soybean accessions. Model based population structure analysis divided the 90 soybean accessions into four populations (K = 4). Mean value of Fst for different populations ranged between 0.4143 and 0.7239. Genotyping of 90 accessions with allele specific markers had identified accession IC15089 as triple recessive mutant of flowering genes E1, E2 and photoperiod sensitivity gene E3. The triple mutant IC15089 (e1, e3, e3) had been characterized phenotypically and identified as early maturing (88 days) and photoperiod insensitive genotype under extended photoperiod. The present study characterized genetic relationship among 90 Indian soybean landraces and had identified a few diverse and unique genotypes for utilization in soybean breeding programmes targeting development of short duration and photoperiod insensitive varieties through marker assisted selection.

Effect of entomopathogenic nematode of Heterorhabditis indica infection on immune and antioxidant system in lepidopteran pest Spodoptera litura (Lepidoptera: Noctuidae).

Entomopathogenic nematodes form excellent tools to study insect immunity in response to during infection. Insects activate as several defense mechanisms, namely Phenoloxidase, haemocytes, detoxification and antioxidant enzymes. However little mechanistic information is available about the sublethal effects of entomopathogenic nematodes infection on detoxification and immune mechanisms in lepidopteran insects. In the present study, the effects of infection on antioxidant, detoxification and immune systems of Spodoptera litura larvae were studied. Results show a significant reduction in Total Haemocyte Count observed after 3 h of infection. A significant increase Superoxide dismutase, Catalase, Glutathione S-transferase, Glutathione Peroxidase and Acid phosphatase were observed 6 h after infection and, progressive decrease in Peroxidase, Alkaline phosphatase and Lipid peroxidation was also observed. This study shows that increased detoxification enzyme levels in response to nematode infection are a protective mechanism in insects. Nematode infection suppresses insect immune response, which is evident from low haemocyte count and Phenoloxidase levels to ultimately cause larval mortality.

Mesenchymal Stem Cells of Different Origin-Seeded Bioceramic Construct in Regeneration of Bone Defect in Rabbit.

BACKGROUND: Stem cell is currently playing a major role in the treatment of number of incurable diseases via transplantation therapy. The objective of this study was to determine the osteogenic potential of allogenic and xenogenic bone-derived MSC seeded on a hydroxyapatite (HA/TCP) bioceramic construct in critical size bone defect (CSD) in rabbits. METHODS: A 15 mm long radial osteotomy was performed unilaterally in thirty-six rabbits divided equally in six groups. Bone defects were filled with bioscaffold seeded with autologous, allogenic, ovine, canine BMSCs and cell free bioscaffold block in groups A, B, C, D and E respectively. An empty defect served as the control group. RESULTS: The radiological, histological and SEM observations depicted better and early signs of new bone formation and bridging bone/implant interfaces in the animals of group A followed by B. Both xenogenous MSC-HA/TCP construct also accelerated the healing of critical sized bone defect. There was no sign of any inflammatory reaction in the xenogenic composite scaffold group of animals confirmed their well acceptance by the host body. CONCLUSION: In vivo experiments in rabbit CSD model confirmed that autogenous, allogenous and xenogenous BMSC seeded on bioscaffold promoted faster healing of critical size defects. Hence, we may suggest that BMSCs are suitable for bone formation in fracture healing and non-union.

Long-term neurodevelopment outcome of caffeine versus aminophylline therapy for apnea of prematurity.

OBJECTIVE: Methylxanthines are the most commonly prescribed drug in neonatal setups. However, Clinicians show indecision in choosing the right agent for Apnea of Prematurity in most of the developing countries. Present study aimed to compare rate of mortality and survival with normal neurodevelopment outcome at 18 to 24 months of corrected age, between Caffeine- and Aminophylline-treated infants for apnea of prematurity. METHODS: 240 infants were randomly allocated to caffeine and aminophylline for apnea of prematurity during February 2012 to January 2015. Long-term neurodevelopmental assessment was done only from children who had attained corrected age of 18 to 24 months during April 2014 to February 2016. Cognitive, language and motor deficits were assessed by Bayley Scale of infant and toddler development (BSID - III). Postnatal characteristics such as hearing and visual impairments during NICU stay were noted and same were followed up. RESULTS: Infants allocated to caffeine group showed 83% less risk of getting cognitive impairment (RR 0.16; CI 95% range 0.02 to 1.36), 50% less risk of developing motor deficits (RR 0.50; CI 95% range 0.12 to 1.95) and 24% less risk of developing language problems (RR 0.76; CI 95% range 0.36 to 1.58). However in all the neurodevelopment domains the difference between groups was not statistically significant. Risk of mortality in caffeine group was 9% less over aminophylline group which was statistically non-significant (RR - 0.92; CI 95% range - 0.45 to 1.84; p = 0.81). Physical growth parameters were found to be similar in both the groups. Risk of developing visual abnormality and hearing impairments was also statistically non-significant between the groups. CONCLUSION: Caffeine and aminophylline showed similar effects in reducing the rate of mortality and improving the survival without neurodevelopment delays; though the clinical significance of caffeine over aminophylline cannot be undermined.

Comparative Efficacy and Safety of Caffeine and Aminophylline for Apnea of Prematurity in Preterm (≤34 weeks) Neonates: A Randomized Controlled Trial.

OBJECTIVE: To compare the efficacy and safety of standard doses of Caffeine and Aminophylline for Apnea of prematurity. STUDY DESIGN: Randomized controlled trial. SETTING: Tertiary-care referral centre and a teaching institution in Southern India. Trial was conducted from February 2012 to January 2015. PARTICIPANTS: 240 preterm (≤34 wk) neonates with apnea of prematurity. INTERVENTIONS: Neonates randomized into two groups: Caffeine group received loading dose of caffeine citrate (20 mg/kg) followed by 5 mg/kg/day maintenance dose every 24 hour. Aminophylline group received loading dose of Aminophylline - 5 mg/kg and maintenance dose of 1.5 mg/kg 8-hourly. OUTCOME MEASURES: Difference in apneic spells, associated respiratory morbidity, and acute adverse events were assessed. Association of efficacy with therapeutic drug levels was also evaluated. RESULTS: Infants on aminophylline experienced less apnea spells in 4-7 days of therapy (P=0.03). Mean apnea rate and isolated desaturations were similar in 1-3, 4-7 and 8-14 days of therapy. No difference was noted in duration of Neonatal Intensive Care Unit stay and hospital stay. Mean heart rate was significantly high in Aminophylline group (P<0.001). Risk of developing tachycardia was less (RR 0.30; 95% CI range 0.15 to 0.60; P<0.001) in Caffeine- over Aminophylline-treated infants. CONCLUSION: Aminophylline is as effective as caffeine for prevention of apneic spells in preterm neonates; however, dosage optimization needs to be done to reduce toxicity.

Spatial molecular epidemiology of carbapenem-resistant and New Delhi metallo beta-lactamase (blaNDM)-producing Escherichia coli in the piglets of organized farms in India.

AIM: A cross-sectional study was conducted in 10 government-organized pig farms between 2014 and 2016 representing seven states of India to understand the epidemiology of carbapenem resistance in the Escherichia coli. METHODS AND RESULTS: In this study, fecal sample (n = 673) from non-diarrheic (n = 501) and diarrheic (n = 172) piglets were processed for isolation of carbapenem resistant E. coli. Of 673, E. coli isolate (n = 112) was genotyped for confirming the carbapenem resistance and associated virulence factors. Of the 112 isolates, 23 were phenotypically resistant to carbapenem and 8 were carrying the New Delhi metallo beta-lactamase (blaNDM) gene. The carbapenem-resistant isolates also produced extended spectrum beta-lactamases and were multidrug resistant. The PCR-based pathotyping revealed the presence of stx1, stx2, eae and hlyA genes. The enterobacterial repetitive intergenic consensus PCR dendrogram analysis of the isolates yielded three distinct clusters. The statistical analysis revealed no association between carriages of carbapenem-resistant E. coli in different breed of piglets however, location, sex, health status of piglets and age showed significant difference. The spatial analysis with SaTScan helped in identification of carbapenem-resistant clusters. CONCLUSIONS: The presence of carbapenem resistant E. coli isolates with virulence genes in the piglet poses a potential public health risk through possible access and spread via the food chain and environment. Efflux pump may also play an important role in carbapenem resistance in piglet E. coli isolates. Furthermore, identification of risk factors in relation to spatial clusters will help in designing preventive strategies for reducing the risk of spread of carbapenem resistant bacteria. SIGNIFICANCE AND IMPACT OF THE STUDY: 1. Piglets harbor carbapenem resistant E. coli and have great public health significance. 2. Apart from carbapenemase, efflux pump is also important for carbapenem resistance. 3. This is the first report of blaNDM in the piglets from India.