Colony phase variation switch modulates antimicrobial tolerance and biofilm formation in Acinetobacter baumannii.

Carbapenem-resistant Acinetobacter baumannii causes one of the most difficult-to-treat nosocomial infections. Polycationic drugs like polymyxin B or colistin and tetracycline drugs such as doxycycline or minocycline are commonly used to treat infections caused by carbapenem-resistant A. baumannii. Here, we show that a subpopulation of cells associated with the opaque/translucent colony phase variation by A. baumannii AB5075 displays differential tolerance to subinhibitory concentrations of colistin and tetracycline. Using a variety of microscopic techniques, we demonstrate that extracellular polysaccharide moieties mediate colistin tolerance to opaque A. baumannii at single-cell level and that mushroom-shaped biofilm structures protect opaque bacteria at the community level. The colony switch phenotype is found to alter several traits of A. baumannii, including long-term survival under desiccation, tolerance to ethanol, competition with Escherichia coli, and intracellular survival in the environmental model host Acanthamoeba castellanii. Additionally, our findings suggest that extracellular DNA associated with membrane vesicles can promote colony switching in a DNA recombinase-dependent manner.IMPORTANCEAs a WHO top-priority drug-resistant microbe, Acinetobacter baumannii significantly contributes to hospital-associated infections worldwide. One particularly intriguing aspect is its ability to reversibly switch its colony morphotype on agar plates, which has been remarkably underexplored. In this study, we employed various microscopic techniques and phenotypic assays to investigate the colony phase variation switch under different clinically and environmentally relevant conditions. Our findings reveal that the presence of a poly N-acetylglucosamine-positive extracellular matrix layer contributes to the protection of bacteria from the bactericidal effects of colistin. Furthermore, we provide intriguing insights into the multicellular lifestyle of A. baumannii, specifically in the context of colony switch variation within its predatory host, Acanthamoeba castellanii.

Insights into the genetic contexts of sulfonamide resistance among early clinical isolates of Acinetobacter baumannii.

Since the late 1930s, resistance to sulfonamides has been accumulating across bacterial species including Acinetobacter baumannii, an opportunistic pathogen increasingly implicated the spread of antimicrobial resistance worldwide. Our study aimed to explore events involved in the acquisition of sulfonamide resistance genes, particularly sul2, among the earliest available isolates of A. baumannii. The study utilized the genomic data of 19 strains of A. baumannii isolated before 1985. The whole genomes of 5 clinical isolates obtained from the Culture Collection University of Göteborg (CCUG), Sweden, were sequenced using the Illumina MiSeq system. Acquired resistance genes, insertion sequence elements and plasmids were detected using ResFinder, ISfinder and Plasmidseeker, respectively, while sequence types (STs) were assigned using the PubMLST Pasteur scheme. BLASTn was used to verify the occurrence of sul genes and to map their genetic surroundings. The sul1 and sul2 genes were detected in 4 and 9 isolates, respectively. Interestingly, sul2 appeared thirty years earlier than sul1. The sul2 gene was first located in the genomic island GIsul2 located on a plasmid, hereafter called NCTC7364p. With the emergence of international clone 1, the genetic context of sul2 evolved toward transposon Tn6172, which was also plasmid-mediated. Sulfonamide resistance in A. baumannii was efficiently acquired and transferred vertically, e.g., among the ST52 and ST1 isolates, as well as horizontally among non-related strains by means of a few efficient transposons and plasmids. Timely acquisition of the sul genes has probably contributed to the survival skill of A. baumannii under the high antimicrobial stress of hospital settings.

Biochemical properties of cellulolytic and xylanolytic enzymes from Sporotrichum thermophile and their utility in bioethanol production using rice straw.

Production of cellulolytic and xylanolytic enzymes by Sporotrichum thermophile was enhanced using response surface methodology in solid-state fermentation (SSF) using wheat straw and cotton oil cake. Cellulolytic and xylanolytic enzymes were partially purified by ammonium sulfate precipitation followed by ion exchange and gel filtration chromatographic techniques. Xylanase of S. thermophile is neutral xylanase displaying optimal activity at 60 °C with Km and Vmax values of 0.2 mg/mL and 238.05 µmole/min, respectively. All cellulases produced by the thermophilic mold showed optimal activity at pH 5.0 and 60 °C with Km values of 0.312 mg/mL, 0.113 mg/mL, and 0.285 mM for carboxymethyl cellulase (CMCase), filter paper cellulase (FPase), and ß-glucosidase, respectively and while Vmax values were 181.81, 138.88, and 66.67 µmole/min, respectively. The presence of various metal ions (Ca2+ and Co2+), chemical reagent (glutaraldehyde), and surfactants (Tween 80 and Triton X-100) significantly improved the activities of all enzymes. All the enzymes showed high storage stability under low temperature (-20 and 4 °C) conditions. Cellulolytic and xylanolytic enzymes resulted in enhanced liberation of reducing sugars (356.34 mg/g) by hydrolyzing both cellulosic and hemicellulosic fractions of ammonia-pretreated rice straw as compared to other pretreatment methods used in the study. Fermentation of enzymatic hydrolysate resulted in the formation of 28.88 and 27.18 g/L of bioethanol in separate hydrolysis and fermentation (SHF) process by Saccharomyces cerevisiae and Pichia stipitis, respectively. Therefore, cellulolytic and xylanolytic enzymes of S. thermophile exhibited ideal properties of biocatalysts useful in the saccharification of cellulosic and hemicellulosic fractions of rice straw for the production of bioethanol.

Impact of Synthesis Methods on Structural and Antifungal Properties of Metal Sulfide Nanoparticles.

Nanotechnology has the ability to produce novel nano-sized materials with excellent physical and chemical properties to act against phytopathogenic diseases, essential for revolution of agriculture and food industry. The development of facile, reliable and eco-friendly processes for the synthesis of biologically active nanomaterials is an important aspect of nanotechnology. In the present paper, we attempted to compare sonochemical and co-precipitation method for the synthesis of metal sulfide nanoparticles (MS-NPs) for their structural and antifungal properties against various phytopathogenic fungi of rice. The preparation of nanospheres (NSs) and nano rods (NRs) of CuS, FeS and MnS was monitored by UV-Visible spectroscopy complemented by transmission electron microscope (TEM), scanning electron microscope (SEM), atomic force microscopy (AFM), dynamic light scattering (DLS) and Zeta potential analyser. Sonochemical method resulted in formation of spherical shaped nanoparticles of size (7-120 nm), smaller than those of nanorods (50-200 nm) prepared by co-precipitation produced. It was observed that the metal sulfide nanospheres exhibited a better antifungal potential against D. oryzae, C. lunata and S. oryzae as compared to rod shaped metal sulfide nanoparticles. Smaller size and large surface area of spherical shaped particles opens up an important perspective of the prepared MS-NPs.

BipA exerts temperature-dependent translational control of biofilm-associated colony morphology in Vibrio cholerae.

Adaptation to shifting temperatures is crucial for the survival of the bacterial pathogen Vibrio cholerae. Here, we show that colony rugosity, a biofilm-associated phenotype, is regulated by temperature in V. cholerae strains that naturally lack the master biofilm transcriptional regulator HapR. Using transposon-insertion mutagenesis, we found the V. cholerae ortholog of BipA, a conserved ribosome-associated GTPase, is critical for this temperature-dependent phenomenon. Proteomic analyses revealed that loss of BipA alters the synthesis of >300 proteins in V. cholerae at 22°C, increasing the production of biofilm-related proteins including the key transcriptional activators VpsR and VpsT, as well as proteins important for diverse cellular processes. At low temperatures, BipA protein levels increase and are required for optimal ribosome assembly in V. cholerae, suggesting that control of BipA abundance is a mechanism by which bacteria can remodel their proteomes. Our study reveals a remarkable new facet of V. cholerae's complex biofilm regulatory network.

Development of MgO-sepoilite Nanocomposites against Phytopathogenic Fungi of Rice (Oryzae sativa): A Green Approach.

Innovation in agriculture is a vital organ of research for sustainable food supply to the increasing global population. Organic compounds used as fungicidal agents against seed-borne pathogens are bracketed due to their toxic nature and residual effects, which are either already banned or may get banned in the near future. In this study, the surface and electric properties of nontoxic sepiolite have been blended with the antimicrobial properties of metabolizable MgO nanoforms (nMgO) as a greener alternative to prepare their nanocomposites. We compared a sepiolite-MgO (SE-MgO) nanocomposite with MgO nanoparticles in an aqua dispersed form (aqMgO-NPs) for their antifungal evaluation against various phytopathogenic fungi of rice. The SE-MgO nanocomposite was more potent in comparison to aqMgO-NPs with ED90 > 230 and 249 µg/mL, respectively, against the test fungi better than standard fungicides. Ultramicroscopic studies revealed hyphal distortion and spore collapse as the cause of antimycotic activity. The in vitro seed treatment revealed 100% hyphal reduction with SE-MgO at 250 µg/mL of MgO as an active ingredient (a.i.). MgO and sepiolite both have been regarded as safe materials by international agencies; therefore, using their nanocomposites can be an effective, sustainable, nontoxic, eco-friendly, and residue-free strategy for combating fungal menace against phytopathogens.

Early versus delayed amniotomy during labor induction with oxytocin in women with Bishop's score of ≥6: a randomized trial.

OBJECTIVE: To study the effect of "early amniotomy" {initiating induction of labor (IOL) with amniotomy followed by oxytocin} versus "late amniotomy" (initiating IOL with oxytocin followed by amniotomy 4-8 h later) in induced labor. METHODS AND MATERIALS: One hundred and fifty women with Bishop's score of ≥6 undergoing IOL were randomized into "early amniotomy" and "delayed amniotomy". RESULTS: Early amniotomy resulted in a reduced induction-delivery interval (IDI) (7.35 versus 11.66 h with delayed amniotomy, p = .000) but higher the caesarean section (CS) rate was observed (10.7 versus 2.7% with delayed amniotomy, p = .049). With early amniotomy, the proportion of women delivering within 12 h was higher (86.7 versus 60%, p = .000) and the maximum oxytocin concentration used was lower (30.05 versus 39.68 mU/min, p = .001) as compared to delayed amniotomy. The neonatal outcomes were similar in the two groups. Early amniotomy detected meconium prior to initiating uterine contractions with oxytocin in three women who underwent CS for meconium. CONCLUSION: Initiating IOL with amniotomy in women with a favorable cervix was efficacious in expediting delivery, but it resulted in a higher CS rate. The higher CS rate was partly due to CS for meconium detected as a result of early amniotomy. Clinical Trials Registry (CTRI), India: Registration number CTRI/2015/01/005418.

Concomitant production of cellulase and xylanase by thermophilic mould Sporotrichum thermophile in solid state fermentation and their applicability in bread making.

Sporotrichum thermophile BJAMDU5 secreted high titres of xylanolytic and cellulolytic enzymes in solid state fermentation using mixture of wheat straw and cotton oil cake (ratio 1:1) at 45 °C, pH 5.0 after 72 h inoculated with 2.9 × 107 CFU/mL conidiospores. Supplementation of solid medium with lactose and ammonium sulphate further enhanced the production of hydrolytic enzymes. Among different surfactants studied, Tween 80 enhanced the production of all enzymes [3455 U/g DMR (dry mouldy residue), 879.26 U/g DMR, 976.28 U/g DMR and 35.10 U/g DMR for xylanase, CMCase (Carboxymethylcellulase), FPase (Filter paper activity) and ß-glucosidase, respectively] as compared to other surfactants. Recycling of solid substrate reduced the production of all these enzymes after second cycle. End products analysis by TLC showed the ability of hydrolytic enzymes of S. thermophile to liberate monomeric (xylose and glucose) as well as oligomeric (xylobiose, cellobiose and higher ones) sugars. Supplementation of enzyme resulted in improved nutritional properties of the bread. Formation of oligomeric sugars by xylanase enzyme of S. thermophile BJAMDU5 make it a good candidate in food industry.

Impact of different intravenous fluids on blood glucose levels in nondiabetic patients undergoing elective major noncardiac surgeries.

BACKGROUND: Intravenous (IV) fluids are an integral part of perioperative management. Intraoperative hyperglycemia is associated with poor clinical outcomes in patients undergoing major surgeries even in nondiabetics. AIM: This study was conducted to observe the effect of different maintenance fluid regimens on intraoperative blood glucose levels in nondiabetic patients undergoing major surgeries under general anesthesia. SETTINGS AND DESIGN: Randomized double-blind study. MATERIALS AND METHODS: One hundred nondiabetic patients of either sex were divided randomly into two Groups I and II of 50 each undergoing elective major surgeries of more than 90 min duration under general anesthesia. Both groups were given calculated dosage of IV fluids accordingly 4-2-1 formula while Group I was given Ringer lactate (RL) and Group II was given 0.45% dextrose normal saline and potassium chloride 20 mmol/L. Changes in vital parameters, % oxygen saturation, and urine output were monitored at regular intervals. Capillary blood glucose (CBG) was measured half-hourly until end of surgery. If CBG level was more than 150 mg%, then calculated dose of human insulin (CBG/100) was given as IV bolus dose. STATISTICAL ANALYSIS: Statistical analysis was done using SPSS 22.0 software (IBM Corporation, Armonk, New York, USA), paired t-test and Chi-square test. RESULTS: A significant increase of CBG level and was observed during intraoperative and immediate postoperative period (P < 0.001) in Group II. CONCLUSION: RL solution is probably the alternative choice of IV fluid for perioperative maintenance and can be used as replacement fluid in nondiabetic patients undergoing major surgeries.

Efficacy and safety of propofol versus midazolam in fiberoptic endotracheal intubation.

BACKGROUND: Fiberoptic intubation is a technique commonly used for difficult airways. Conscious sedation is desirable to make this procedure tolerable, and it is essential that patients are cooperative, relaxed, and comfortable especially when difficult airway anatomy or pathology is encountered. OBJECTIVE: To compare the safety and efficacy of propofol versus midazolam in oral fiberoptic endotracheal intubation in terms of hemodynamic changes, level of sedation, ease of intubation, and patient comfort and complications. MATERIALS AND METHODS: In a prospective randomized study, 60 patients of age group 18-60 years and American Society of Anesthesiologists health classification of I and II with anticipated difficult intubation were randomly allocated into two groups. Both the groups were premedicated with injection glycopyrrolate 0.005 mg/kg and injection butorphanol 1 mg and nebulized with 4 ml of 4% lignocaine starting 20 min before the surgery. After that patients in Group I received intravenous propofol 1-2 mg/kg to a maximum of 2 mg/kg followed by 20 mg increments if needed and Group II received 0.05 mg/kg midazolam followed by 2 mg increments till the adequate level of sedation was reached. Patients were monitored for hemodynamic parameters, sedation according to observer's assessment of alertness score, intubation score, intubation time, patient comfort, satisfaction score, and complications, if any. Results were statistically analyzed. RESULTS: The mean sedation score, patient comfort score, and patient satisfaction were greater in propofol group (P < 0.05) but there were no significant differences in hemodynamics, intubating conditions, and complications. CONCLUSION: We conclude that compared with midazolam, propofol provides better sedation for fiberoptic endotracheal intubation and better patient comfort and satisfaction.

The efficacy of combined regional nerve blocks in awake orotracheal fiberoptic intubation.

AIMS OF STUDY: To evaluate the efficacy, hemodynamic changes, and patient comfort during awake fiberoptic intubation done under combined regional blocks. MATERIALS AND METHODS: In the present observational study, 50 patients of American Society of Anesthesiologists ( ASA) Grade I-II, Mallampati Grade I-IV were given nerve blocks - bilateral glossopharyngeal nerve block, bilateral superior laryngeal nerve block, and recurrent laryngeal nerve block before awake fiberoptic intubation using 2% lidocaine. RESULTS: Procedure was associated with minimal increases in hemodynamic parameters during the procedure and until 3 min after it. Most of the intubations were being carried out within 3 min. Patient comfort was satisfactory with 90% of patients having favorable grades. DISCUSSION: The most common cause of mortality and serious morbidity due to anesthesia is from airway problems. One-third of all anesthetic deaths are due to failure to intubate and ventilate. Awake flexible fiberoptic intubation under local anesthesia is now an accepted technique for managing such situations. In awake patient's anatomy, muscle tone, airway protection, and ventilation are preserved, but it is essential to sufficiently anesthetize the upper airway before the performance of awake fiberoptic bronchoscope-guided intubation to ensure patient comfort and cooperation for which in our study we used the nerve block technique. CONCLUSION: A properly performed technique of awake fiberoptic intubation done under combined regional nerve blocks provides good intubating conditions, patient comfort and safety and results in minimal hemodynamic changes.

Cost-effective production of biotechnologically important hydrolytic enzymes by Sporotrichum thermophile.

Economical production of xylanase and three cellulases, endo-ß-1,4-glucanase (CMCase), exo-ß-1,4-glucanase (FPase), ß-glucosidase (BGL) was studied in submerged fermentation using cane molasses medium. A statistical optimization approach involving Plackett-Burman design and response surface methodology (RSM) resulted in the production of 72,410, 36,420, 32,420 and 5180 U/l of xylanase, CMCase, FPase and ß-glucosidase, respectively. Optimization resulted in more than fourfold improvements in production of xylanolytic and cellulolytic enzymes. Scale up of enzymes production in shake flasks of varied volumes was sustainable, suggesting a good scope for large scale enzyme production. Addition of microparticles engineered fungal morphology and enhanced enzymes production. Xylanase of S. thermophile is a neutral xylanase displaying its optimal activity at 60 °C while all the cellulases are optimally active at pH 5.0 and 60 °C. The efficacy of enzyme cocktail in waste tea cup paper and rice straw hydrolysis showed that maximum sugar yield of 578.12 and 421.79 mg/g substrate for waste tea cup and rice straw, respectively, were achieved after 24 h. Therefore, concomitant production of cellulolytic and xylanolytic enzymes will be beneficial for the saccharification of lignocellulosics in generating both monomeric and oligomeric sugars for biofuels and other biotechnological applications.

Anesthesiologist: The silent force behind the scene.

The Anesthesiologist provides continuous medical care before, during, and after operation to permit the surgeons to perform surgeries; sometimes quite challenging that could otherwise cause substantial threats to the patient's survival. Anesthesiologists, because of their combination of skills are uniquely qualified to care for dying patients suffering from end diseases like cancer. These skills include knowledge of analgesic and sedative pharmacology for the management of pain, awareness of perceptual alterations along with well-known skills in drug titration and experience with critically ill and highly anxious, often agitated patients under stressful circumstances. Anesthesiologists are physicians who provide medical care to patients in a wide variety of situations. This includes preoperative evaluation, consultation with the surgical team, creation of a plan for the anesthesia (which is different in each patient), airway management, intraoperative life support, pain control, intraoperative stabilization of all the vitals, postoperative pain management. Outside the operating room, Anesthesiologist's spectrum of action includes with general emergencies, trauma, intensive care units, acute and chronic pain management. In spite of providing these highly skilled services, Anesthesiologists are facing a lot of stress these days which predisposes them to burnout, fatigue, substance abuse, and suicide. The practice of anesthesia in Indian scenario is different as compared to the western countries. In India, the Anesthesiologists are dependent on surgeons for their work. The degree of stress faced is due to a number of factors like the type and quality of work, his/her relationship with surgeons and the support he/she receives from colleagues and family.

Epidural nalbuphine for postoperative analgesia in orthopedic surgery.

BACKGROUND: The challenging task of postoperative pain relief comes within the realm of the anesthesiologist. Combined spinal epidural (CSE) anesthesia can be used as the sole technique for carrying out surgical procedures and managing postoperative pain using various drug regimes. Epidural administration of opioids in combination with local anesthetic agents in low dose offers new dimensions in the management of postoperative pain. AIMS: Comparative evaluation of bupivacaine hydrochloride with nalbuphine versus bupivacaine with tramadol for postoperative analgesia in lower limb orthopedic surgeries under CSE anesthesia to know the quality of analgesia, incidence of side effects, surgical outcome and level of patient satisfaction. SETTINGS AND DESIGN: A prospective, randomized and double-blind study was conducted involving 80 patients of American Society of Anesthesiologists physical status I and II coming for elective lower limb orthopedic surgeries carried under spinal anesthesia. MATERIALS AND METHODS: Anesthesia was given with 0.5% of 2.5 ml bupivacaine intrathecally in both the groups. Epidurally 0.25% bupivacaine along with 10 mg nalbuphine (group A) or tramadol 100 mg (group B) diluted to 2 ml to make a total volume of 10 ml was administered at sensory regression to T10. STATISTICAL ANALYSIS: The data were collected, compiled and statistically analyzed with the help of MS Excel, EPI Info 6 and SPSS to draw the relative conclusions. RESULTS AND CONCLUSIONS: The mean duration of analgesia in group A was 380 ± 11.49 min and in group B was 380 ± 9.8 min. The mean sedation score was found to be more in group B than group A. The mean patient satisfaction score in group A was 4.40 ± 0.871 and in group B was 3.90 ± 1.150 which was found to be statistically significant (P < 0.05). We concluded that the addition of nalbuphine with bupivacaine was effective for postoperative analgesia in terms of quality of analgesia and patient satisfaction score as compared to tramadol.

Augmentation of virulence related traits of pqs mutants by Pseudomonas quinolone signal through membrane vesicles.

Pathogenicity of opportunistic Pseudomonas aeruginosa is mediated through expression of different virulence determinants, most of which are under the control of quorum sensing. Besides acylhomoserine lactones, P. aeruginosa produces Pseudomonas quinolone signal (PQS) molecules which co-regulate expression of overlapping subset of genes. In the present study, effect of mutations in the pqs genes on the production of virulence factors, biofilm, and membrane vesicles (MVs) was studied using standard strain and isogenic pqs mutants of P. aeruginosa. Mutations in pqs genes severely reduced elastase, pyocyanin, siderophores, biofilm formation, and production of MVs. Further, effect of synthetic PQS on virulence of P. aeruginosa and its correlation with MVs was investigated. Supplementation of PQS resulted in enhancement of phenotypic expression of virulence factors and biofilm forming capacity of these strains. Restoration of virulent phenotype of mutants in presence of PQS indicated that PQS system play an important role in the virulence of P. aeruginosa. In addition, PQS also induced substantial release of MVs in all strains. When vesicles containing natural PQS were added to the mutants, significant increase in production of virulence factors was observed. This augmentation of the virulence traits may be associated with the efficient delivery of PQS among bacterial cells, which could be one possible mechanism of pqs system contributing to the overall virulence of P. aeruginosa.

Pseudomonas quinolone signalling system: a component of quorum sensing cascade is a crucial player in the acute urinary tract infection caused by Pseudomonas aeruginosa.

Pseudomonas aeruginosa is an opportunistic pathogen which employs quorum sensing system to regulate several genes required for its survival and pathogenicity within the host. Besides acylhomoserine lactone (AHL) mediated las and rhl systems, this organism possesses Pseudomonas quinolone signalling (PQS) system based on alkyl quinolone signal molecules. The quinolone system represents another layer of sophistication in the complex quorum sensing cascade. Therefore, in the present study, we evaluated the contribution of the PQS system in the establishment of acute urinary tract infection (UTI) in the mouse model. For this, wild-type parent strain of P. aeruginosa MPAO1 and its isogenic single transposon mutant strains pqsH and pqsA were employed to induce UTI in mice. PQS molecules in the tissue homogenates of mice were detected by high performance thin layer chromatography (HP-TLC) method. Virulence of strains was assessed in terms of bacteriological count, histopathological lesions in the renal and bladder tissue and generation of pathological index markers like reactive nitrogen intermediates and malondialdehyde. HP-TLC analysis showed presence of PQS molecules in the renal and bladder tissue of mice infected with MPAO1 while no PQS was detected in case of pqsH and pqsA mutant strains. Results indicated that MPAO1 possessing fully functional PQS biosynthetic genes was highly virulent and caused acute pyelonephritis with severe inflammation and tissue destruction. On the contrary, significant reduction in the log count, mild tissue damage and declined levels of pathological markers were observed in mice infected with mutant strains as compared to MPAO1. Further among mutants, all these parameters were maximally impaired in the pqsA mutant in which synthesis of alkyl quinolones was completely abolished due to the transposon mutation in respective gene. Virulence of the pqsH mutant strain was lesser than that of the MPAO1 but higher than pqsA mutant. In addition, the levels of locally generated pro- and anti-inflammatory cytokines were also found to be low in the renal homogenates of mice infected with the mutant strains. Further, supplementation of strains with PQS resulted in significant enhancement in the virulence as indicated by increased bacterial load, severe histopathological damage and enhanced levels of pro-inflammatory cytokines. These findings provide a new insight into the relevant importance of the Pseudomonas quinolone signalling system in the acute UTI caused by P. aeruginosa. This system can be a potential target for futuristic anti-infective approach against this organism.

Study of aortic- common iliac bifurcation and its clinical significance.

OBJECTIVE: To determine the position of the aortic bifurcation, angle of aortic-common iliac bifurcation in relation to the lumbar vertebra, diameter of distal aorta, length of common iliac, diameter of iliac at bifurcation in cadavers. MATERIALS AND METHODS: The present study was done on 25 cadavers (16 males, 9 females) used for the dissection by 1st year MBBS students. The dissections were performed by anterior approach to the lumbar vertebra. The position of the aortic bifurcation, aortic bifurcation angle were measured in relation to lumbar vertebra. The remaining parameters were measured with the help of digital vernier caliper. RESULTS: The aortic bifurcation was seen in between L3 and L5 vertebra in all the cases. In majority of cases, 16 (64%), the bifurcation was observed at the level of L4 vertebra. During statistical analysis, significant differences were observed in the mean values of aortic-iliac take off angles and in mean diameter of distal aorta. CONCLUSION: The exact location of aortic bifurcation is useful when invasive procedures are performed in the pelvis, laproscopic lumbar discectomy and lumbosacral total disc arthroplasty. The aortic bifurcation mostly found at the level of L4 vertebra in the present study similar to previous studies. The aortic bifurcation can be a reliable landmark for determining the lumbar vertebral segments on MRI or CT.

Anatomical variation: median nerve formation - a case vignette.

Variations in the arrangement and distribution of brachial plexus and its branches in the infraclavicular part are common and have been reported by several investigators since the 19th century. These variations are significant for the neurologists, surgeons, anesthetists and the anatomists. During routine anatomical dissection of the right axilla and infraclavicular region of a 45-year-old male cadaver, the medial root of the median nerve was found to receive a supplementary branch from the medial aspect of the terminal portion of the lateral cord of brachial plexus and the branch was passing infront of the axillary artery from lateral to medial side. The median nerve was formed by joining of the lateral and medial roots from the lateral and medial cords of brachial plexus, infront of brachial artery, lower down, at the junction of upper one-third and lower two-third of the arm, instead in the axilla. This variation could be one of the cause of pressure symptom which occurs on the axillary artery and also the injury which occurs on the lateral cord or upstream to the lateral cord, which may sometimes lead to an unexpected presentation of weakness of forearm flexors and thenar muscles.

Leaf extract of Azadirachta indica (neem): a potential antibiofilm agent for Pseudomonas aeruginosa.

Pseudomonas aeruginosa is well known for its ability to form biofilm on indwelling medical devices. These biofilms are difficult to remove because of their high tolerance to conventional antibiotics. Therefore, there is a need to look for alternative agents such as medicinal plants, which can eradicate or inhibit biofilm effectively. This study evaluated the role of neem in inhibiting biofilm formation by P aeruginosa Factors contributing to adherence and biofilm formation were also studied. Results demonstrated that neem leaves extract was quite effective in disrupting formation and structure of biofilms. Moreover, the level of exopolysaccharide, alginate, hydrophobic interactions and uroepithelial cell attachment, which contributes to biofilm formation, was also affected significantly. Results confirm the effectiveness of neem extract in inhibiting biofilm formation. Such studies can lead to the discovery of safe antimicrobial drugs from natural sources without the risk of resistance.