Evaluation of immunogenicity and protective efficacy of bacteriophage conjugated haemagglutinin based subunit vaccine against equine influenza virus in a murine model.

Equine influenza (EI) is a highly contagious acute respiratory disease of equines caused by the H3N8 subtype of Influenza A virus i.e. equine influenza virus (EIV). Vaccination is an important and effective tool for the control of EI in equines. Most of the commercial influenza vaccines are produced in embryonated hen's eggs which has several inherent disadvantages. Hence, subunit vaccine based on recombinant haemagglutinin (HA) antigen, being the most important envelope glycoprotein has been extensively exploited for generating protective immune responses, against influenza A and B viruses. We hypothesized that novel vaccine formulation using baculovirus expressed recombinant HA1 (rHA1) protein coupled with bacteriophage will generate strong protective immune response against EIV. In the present study, the recombinant HA1 protein was produced in insect cells using recombinant baculovirus having cloned HA gene of EIV (Florida clade 2 sublineage) and the purified rHA1 was chemically coupled with bacteriophage using a crosslinker to produce rHA1-phage vaccine candidate. The protective efficacy of vaccine preparations of rHA1-phage conjugate and only rHA1 proteins were evaluated in mouse model through assessing serology, cytokine profiling, clinical signs, gross and histopathological changes, immunohistochemistry, and virus quantification. Immunization of vaccine preparations have stimulated moderate antibody response (ELISA titres-5760 ± 640 and 11,520 ± 1280 for rHA1 and rHA1-phage, respectively at 42 dpi) and elicited strong interferon (IFN)-γ expression levels after three immunizations of vaccine candidates. The immunized BALB/c mice were protected against challenge with wild EIV and resulted in reduced clinical signs and body weight loss, reduced pathological changes, decreased EIV antigen distribution, and restricted EIV replication in lungs and nasopharynx. In conclusion, the immune responses with moderate antibody titer and significantly higher cytokine responses generated by the rHA1-phage vaccine preparation without any adjuvant could be a novel vaccine candidate for quick vaccine preparation through further trials of vaccine in the natural host.

Etiological prevalence and antifungal sensitivity patterns of dermatophytosis in India - A multicentric study.

BACKGROUND: The prevalence of dermatophytes varies with season, geographical area, socio-economic factors and effective management strategies. AIMS: The aim of the study was to assess the prevalence of pathogenic dermatophytes, clinical types of dermatophyte fungal infection, and in vitro antifungal drug susceptibility testing against dermatophytes. METHODS: Three hundred and ninety five patients with dermatophytosis were enrolled from five cities (Mumbai, Delhi, Lucknow, Kolkata and Hyderabad) across India. All patients were subjected to clinical examination and investigations, including potassium hydroxide microscopy, fungal culture and antifungal drug susceptibility testing. RESULTS: Trichophyton rubrum was the most common species identified (68.4%), followed by T. mentagrophytes (29.3%). Within species, T. mentagrophytes was prevalent in humid environmental conditions (Mumbai and Kolkata), whereas T. rubrum was prevalent in noncoastal areas (Delhi, Lucknow and Hyderabad). Tinea corporis (71.4%) and tinea cruris (62.0%) were the common clinical types observed. antifungal drug susceptibility testing data indicated that minimum inhibitory concentration required to inhibit the growth of 90% of organisms (MIC-90) was lowest for griseofulvin (0.25-3.0 µg/mL). Among oral antifungals, the mean MIC of itraconazole was within the range (0.84 [0.252] µg/ mL), whereas high mean MIC values were reported for terbinafine (0.05 [0.043] µg/mL). Among topical agents, lowest mean MIC values were reported for luliconazole (0.29 [0.286] µg/mL), eberconazole (0.32 [0.251]) µg/mL and amorolfine (0.60 [0.306]) µg/mL. LIMITATIONS: Lack of correlation between in vitro antifungal susceptibility and clinical outcome and absence of defined MIC breakpoints. CONCLUSION: T. rubrum was the most common, followed by T. mentagrophytes as an emerging/codominant fungal isolate in India. Tinea corporis was the most common clinical type of dermatophytosis. Mean MIC of terbinafine was above the reference range, while it was within the range for itraconazole; griseofulvin had the lowest mean MIC. Luliconazole presented the lowest mean MIC values across cities.

Pathological and immunological protection induced by inactivated reverse genetics-based H3N8 equine influenza vaccine candidate in murine model.

Equine influenza (EI) is an important viral respiratory disease of equines caused by influenza A virus (IAV). The antigenic drift in IAVs necessitates regular updating and harmonization of vaccine strain with the circulating virus. The reverse genetics-based recombinant viruses could be easy instrument in generating vaccine against circulating virus in a quick and effective manner. Present study has been envisaged to evaluate the immunogenicity and protective efficacy of inactivated recombinant equine influenza virus (rgEIV) vaccine candidate having six segments from H1N1 virus (A/WSN/33/H1N1) and HA (hemaglutinin) and NA (neuraminidase) segments from H3N8 equine influenza virus [(A/eq/Jammu-Katra/06/08) of clade 2 of Florida sublineage] generated through reverse genetic engineering. BALB/c mice were immunized with inactivated rgEIV adjuvanted with aluminium hydroxide gel and challenged with H3N8 virus (A/eq/Jammu-Katra/06/08). The protective efficacy was evaluated through serology, cytokine profiling, clinical signs, gross and histopathological changes, immunohistochemistry and residual virus quantification. Immunizations induced robust humoral immune response as estimated through hemagglutination inhibition assay (HAI). The antibodies were isotyped and the predominant subclass was IgG1. The vaccine candidate produced mixed Th1 and Th2 responses through stimulation of IFN-γ, IL-2, IL-4 and IL-6 expression. Immunization protected mice against challenge as reflected through reduction in clinical signs and body weight loss, early recovery, mild pathological changes (gross and histopathological lesions) as evident through scoring of lesions, low residual virus in nasopharynx and lungs quantified through egg titration and quantitative reverse transcriptase PCR (qRT-PCR). The study demonstrates that inactivated recombinant EIV generated through reverse genetic approach provides equivalent protection to that observed with inactivated whole H3N8 EIV vaccine. Keywords: equine influenza; reverse genetics; vaccine; pathology; murine model.

In vitro antibacterial effect of Withania somnifera root extract on Escherichia coli.

AIM: The aim was to investigate antibacterial activity of Withania somnifera (Ashwagandha), an Indian traditional medicinal plant against Escherichia coli O78, a pathogenic strain. MATERIALS AND METHODS: Two-fold serial dilutions of 20% aqueous W. somnifera root (WSR) extract were inoculated with E. coli O78 @ 1*10(7) colony forming units grown in nutrient broth. Following inoculation, turbidity optical density was measured by spectrophotometer at 600 nm in all the tubes at 0, 2, 4, 6 and 8 h of incubation at 37°C. RESULT: The results revealed that the maximum inhibition of bacterial growth was observed at 1:8 dilution of WSR extract. The highest dilution of the extract that showed inhibited growth of the test organism when compared with control was 1:16. Therefore, the minimum inhibitory concentration of aqueous extract of WSR is 1:16. CONCLUSION: It is concluded that WSR possessed good antibacterial activity, confirming the great potential of bioactive compounds and its rationalizing use in health care.

Summarising published results from spirometric surveys of COPD: the problem of inconsistent definitions.

SETTING: The use of different spirometric definitions for chronic obstructive pulmonary disease (COPD) has made an informative review of the available prevalence surveys impossible. OBJECTIVE: To derive adjustment factors that allow the comparison of studies using different spirometric criteria. METHODS: Pre- and post-bronchodilator one-second forced expiratory volume (FEV1) and forced vital capacity (FVC) values were taken from the Burden of Obstructive Lung Disease (BOLD) survey in 16 centres. Using a post-bronchodilator FEV1/FVC ratio less than the lower limit of normal (LLN) as our reference prevalence, we calculated simple multiplicative adjustments to transform other reported prevalence estimates to reference values. These adjustments were then tested on independent data sets from six further BOLD centres and five centres from the PLATINO study, a Latin American survey on obstructive lung disease. RESULTS: Prevalence estimates based on pre-bronchodilator fixed-ratio measurements were 5-25% higher than reference values, and were strongly positively biased with age and prevalence level. Applying simple adjustments provided prevalence estimates that were almost unbiased and within 5% of the reference values. CONCLUSIONS: Using the BOLD data, we have been able to estimate COPD prevalences based on post-bronchodilator FEV1/FVC < LLN by adjusting estimates based on other common definitions, enabling more meaningful comparisons of published findings.

Factors associated with the motivation and de-motivation of health workforce in Nepal.

BACKGROUND: Health workforce plays an important role in improving the health of people but its shortage is a major problem facing Nepal. This is further compounded by prolonged absence, low motivation, and improper distribution. The objective of the study is to find out the factors determining motivation of health workforce in the public sector. METHODS: A cross sectional study was conducted during September, 2012 to February, 2013. The health facilities were selected proportionately representing all the Illakas and then a simple random sampling was done to select individual facilities. Data was collected using questionnaire. The collected data was entered and analyzed in SPSS. Ethical approval was taken from the Nepal Health Research Council. RESULTS: More than a half (55%) of the health workers were satisfied with their current jobs and the financial benefits they acquired. The results revealed that higher age, higher education (OR:2.6; CI:1.414-4.660) and lower service duration (OR:2.567; CI:1.193-3.306) were significant factors for the motivation of health workers along with financial rewards (OR:4.706; CI:2.961-7.478), working environment (OR:2.344; CI:1.507-3.648) and opportunity for capacity development (OR:5.437; CI:3.344-8.840). The major de-motivational factors were: low remuneration (OR:3.215; CI:2.049-5.045), limited capacity development opportunity (OR:4.269; CI:2.672-6.821), poor working environment (OR:4.062; CI:2.528-6.526), non-recognition of performance (OR: 2.157; CI:1.389-3.350), and political interferences (OR:2.752; CI:1.754-4.320). CONCLUSIONS: Motivation of health workers is an important factor for smooth functioning of health intuitions and increased access to quality services. The good working environment, salary and other financial benefits matter greatly for enhanced performance of health workers along with additional factors.

Involving diaspora and expatriates as human resources in the health sector in Nepal.

BACKGROUND: Health professional mobility has increased in the recent years and is one of the public health concerns in the developing countries including Nepal. On the other hand, we can't ignore a positive shift of Nepali diaspora coming back to Nepal for some work related projects. The objective of this study was thus to estimate the number of Nepalese Diaspora and foreign expatriate those are coming to Nepal and explore the ways and process of their engagement in the health sector of Nepal. METHODS: Mixed method was used. In total, 13 Key Informant Interviews were conducted at the central level along with record review from professional councils. RESULTS: Nepalese Diasporas mainly come through Diaspora Volunteering Organizations, Non Resident Nepali Association and personal connections to the place of their origin. Nepalese Diasporas have supported as health specialists, health camps and project organizers, trainer and hospital promoters, supplier of equipment including ambulances etc. The Nepalese Diasporas are unrecorded with professional organizations such as NMC and NHPC. As such the real status and results of support from Nepalese Diaspora are not known. Overall, 5,120 foreign medical professionals have served to Nepal through NMC followed by 739 nursing professionals through NNC and 189 paramedical staff through NHPC as of 2012. CONCLUSIONS: Systematic information on number and characteristics of the Nepalese Diaspora and their role in the health sector of Nepal is limited. The health professional bodies have some record systems but they lack uniformity and systematic process.

Health governance at local level from human resource for health perspectives: the case of Nepal.

BACKGROUND: Evidence about effects of good governance in Human Resources for Health (HRH) is scant in Nepal. The study aimed to explore the situation of health governance at the local level and suggest measures to address the HRH challenges. METHODS: Ninety health facilities from Siraha, Bardiya and Doti districts were included in the study. Focus group discussions (N=36) with different groups and key informants interviews (33 VDC Secretaries, 76 Health Facility Management Committees and 9 central level policy makers and managers) were conducted. RESULTS: Only 49 (54%) of the health facilities have properly displayed signboard, 42 (47%) citizen charter, 36 (40%) free health services and Information on Aama program in 25 (28%) health facilities. In total 52 (58%) health facilities have not displayed names of women receiving Aama benefits. Seventy two out of 90 health facilities have not displayed social audit reports and 80 (89%) of the health facilities have not maintained complaint box. The initiative of decentralized human resource management, where implemented, has increased ownership at the local level. Staff retention has been reported well though it does not apply in case of the medical doctors. Rule of law in terms of human resource recruitment and transfer, promotion, and training were not fully implemented and were lenient in the upper level. Nepotism and power exercise was frequently reported as a hindrance in implementing the gender and social inclusion policy fully. CONCLUSIONS: Transparency, gender and social inclusion is yet to be implemented fully at the district and health facility level.

Human resource for health production capacity in Nepal: a glance.

BACKGROUND: Shortage of human resources for health is apparent in Nepal. The current HRH strategy has tried to address the demand for skilled birth attendants, MDGPs, gynecologists, anesthetists, radiologists and other health workforce. Despite the increased number of institutions, there is still shortage of health workforce due to ineffective monitoring. This study was undertaken to find out the situation of HRH production in Nepal. METHODS: This cross sectional study was conducted from September 2012 to February 2013. The primary focus was on the quantitative method by using the format for the data collection. The main study samples were the academic institutions of Nepal. The finding was analyzed and tabulated in the summary form. RESULTS: There were a total of 294 institutions to produce different cadres of health workforce in Nepal. Staff nurses (101) and CMAs (76) have been produced by the maximum number of institutions. The result revealed that the institutions were not producing the graduates upon their capacity, only 1,451 staff nurse graduated annually against the capacity of producing 4,017 per annum. Although Nepal has a capacity to produce 1,760 MBBS, 267 MD and 116 MS doctors, only 1,074 Nepali MBBS, 222 MD and 95 MS doctors graduated per year. CONCLUSIONS: The health institutions performance is lower in producing HRH compared to their capacity in the country. A long-term effort is now required to match demand and supply of the HRH in the country.

Human resources for health in major national policies and plans of Nepal.

BACKGROUND: Nepal first began planning for human resources for health forty years back. Since then a number of long-term and short-term plans, policies and acts have been introduced. This study is conducted to analyse the HRH gap in relation to objectives, guidelines, and priorities of the Ministry of Health and Population. METHODS: A combination of desk review of the HRH related policies, strategies, and plans of the government and stakeholder consultation was used for the study from October 2012 to March 2013. Ethical approval was obtained from the NHRC. RESULTS: Almost all the plans and policies highlighted human resources as central to successful health systems in Nepal. Still there are several gaps at the implementation level. The expanding health programs with increasing demand for health services has demanded more robust evidence-based planning of HRH. There are many vacant positions due to complicated health act including the issue of social inclusions of workforce due to poor implementation of program policies. CONCLUSIONS: HRH needs to be recognized as dealing with more than just health personnel, but as assets necessary for the entire health system to function, plan, and manage it. There is the need to fill vacant positions in a timely manner, and increase the participation of excluded groups.

Immunotoxic effects of imidacloprid following 28 days of oral exposure in BALB/c mice.

Imidacloprid, a neonicotinoid insecticide has been in use worldwide for several years in agriculture and veterinary medicine. It is possible that residue of this compound may be recycled in the food chain and thus information regarding effects from potential exposure to it is warranted. The objective of the present study was to evaluate immunotoxic effects of imidacloprid in female BALB/c mice. Imidacloprid was administered orally daily at 10, 5, or 2.5mg/kg over 28 days. Specific parameters of humoral and cellular immune response including hemagglutinating antibody (HA) titer to sheep red blood cells (SRBC; T-dependent antigen), delayed type hypersensitivity (DTH) response to SRBC, and T-lymphocyte proliferation in response to phytohemagglutinin (PHA) were evaluated. The results showed that imidacloprid at high dose, specifically suppressed cell-mediated immune response as was evident from decreased DTH response and decreased stimulation index of T-lymphocytes to PHA. At this dose, there were also prominent histopathological alterations in spleen and liver. Histopathological analysis of footpad sections of mice revealed dose-related suppression of DTH response. Imidacloprid at low dose of 2.5mg/kg/day did not produce any significant alterations in cellular and humoral immune response and it seemed to be an appropriate dose for assessment of 'no observable adverse effects level' for immunotoxicity in BALB/c mice. The results also indicated that imidacloprid has immunosuppressive effects at doses >5mg/kg, which could potentially be attributed to direct cytotoxic effects of IMD against T cells (particularly TH cells) and that long-term exposure could be detrimental to the immune system.

The dynamics of two-species allelopathic competition with optimal harvesting.

This paper analyses a bionomic model of two competitive species in the presence of toxicity with different harvesting efforts. An interesting dynamics in the first quadrant is analysed and two saddle-node bifurcations are detected for different bifurcation parameters. It is noted that under certain parametric restrictions, the model has a unique positive equilibrium point that is globally asymptotically stable whenever it is locally stable. It is also noted that the model can have zero, one or two feasible equilibria appearing through saddle-node bifurcations. The non-existence of a limit cycle in the interior of the first quadrant is also discussed using the Poincare-Dulac criteria. The saddle-node bifurcations are studied using Sotomayor's theorem. Numerical simulations are carried out to validate the analytical findings. The conditions for the existence of bionomic equilibria are discussed and an optimal harvesting policy is derived using Pontryagin's maximum principle.

Hydrogen dependent surface morphology study of plasma deposited SiN(x):H films for two gas systems SiH4/NH3 and SiH4/N2.

Partially amorphous silicon nitride thin films were deposited using plasma enhanced chemical vapor deposition technique using the two gas systems: SiH4/NH3 and SiH4/N2. Fourier Transform infrared spectroscopy was employed to derive the relative changes in the bonded hydrogen content with increasing flow rates of NH3 and N2. Surface morphology was monitored using atomic force microscopy. Root mean square surface roughness was found to be dependent on the NH3 and N2 flow rates, unlike silicon nitride films deposited by rf magnetron sputtering with variation in (N2/Ar) (Li et al. Thin Solid Films 334 (1998) 140). The discrepancy has been explained in the light of bonded hydrogen content in these films. The X-ray diffraction technique has also been used to observe the phases of the nitride films which showed the presence of silicon nitride grains oriented in (200), (400) and (221) directions in the predominantly amorphous as-deposited SiN(x):H films.

Evaluation of Vitreous Substitutes in Managing Complicated Vitreo-retinal Surgeries.

BACKGROUND: Vitreous substitutes presently in use for intraoperative tamponade are perfluorocarbon liquids (PFCL) and for post operative tamponade are silicon oil (SO), sulphur hexafluoride (SF6) and perfluorocarbon gas (PFC). Several factors are important for a thorough understanding of each of these vitreous substitutes. The absorption or necessity for removal, indications for use (including clinical studies and special surgical methods), additives and complications of use have to be considered. METHODS: Three port standard pars plana vitrectomy was performed in 60 consecutive cases requiring intra-vitreal intervention. PFCL was used intra-operatively in 30 cases (PFCL group and X group). The eyes were implanted with SO (silicon oil subgroup), PFC (C3F8 sub-group) and SF6 (SF6 sub-group) in twenty cases each. Apart from best corrected visual acuity (BCVA), the retinal status and the longevity of gas when used, changes and reaction in both the anterior and posterior segments were noted. RESULT: The difference of postoperative BCVA in the PFCL and non-PFCL groups was statistically significant with p < 0.001. In both the PFCL and non-PFCL groups the difference between preoperative and postoperative BCVA was statistically significant with p < 0.0001. All three vitreous substitutes studied are effective given the case where they had been utilised. CONCLUSION: PFCL is invaluable in the management of complicated retinal detachment (RD). Where a vitreous microsurgery is indicated, the visual outcome is good. SF6 is useful for short-term tamponade. Silicon oil and C3F8 are useful for longer tamponade.

Semi-quantitative characterisation of ambient ultrafine aerosols resulting from emissions of coal fired power stations.

Emissions from coal fired power stations are known to be a significant anthropogenic source of fine atmospheric particles, both through direct primary emissions and secondary formation of sulfate and nitrate from emissions of gaseous precursors. However, there is relatively little information available in the literature regarding the contribution emissions make to the ambient aerosol, particularly in the ultrafine size range. In this study, the contribution of emissions to particles smaller than 0.3 mum in the ambient aerosol was examined at a sampling site 7 km from two large Australian coal fired power stations equipped with fabric filters. A novel approach was employed using conditional sampling based on sulfur dioxide (SO(2)) as an indicator species, and a relatively new sampler, the TSI Nanometer Aerosol Sampler. Samples were collected on transmission electron microscope (TEM) grids and examined using a combination of TEM imaging and energy dispersive X-ray (EDX) analysis for qualitative chemical analysis. The ultrafine aerosol in low SO(2) conditions was dominated by diesel soot from vehicle emissions, while significant quantities of particles, which were unstable under the electron beam, were observed in the high SO(2) samples. The behaviour of these particles was consistent with literature accounts of sulfate and nitrate species, believed to have been derived from precursor emissions from the power stations. A significant carbon peak was noted in the residues from the evaporated particles, suggesting that some secondary organic aerosol formation may also have been catalysed by these acid seed particles. No primary particulate material was observed in the minus 0.3 mum fraction. The results of this study indicate the contribution of species more commonly associated with gas to particle conversion may be more significant than expected, even close to source.

A rare cause of heart failure--primary hypoparathyroidism.

We report a patient who presented with congestive heart failure (ejection fraction 24.4%) and who had previous history of convulsions. Our investigations found him to be a case of primary hypoparathyroidism. He showed a dramatic response with the addition of calcium infusion therapy with almost full recovery of left ventricular function (67% ejection fraction after 16 days of the initial echo). We conclude that in a young patient a thorough investigation for heart failure is never complete without looking for endocrine and metabolic causes. The prognosis in these cases is much better, identification and treatment of the same will yield dramatic results.

Comparison of Phaconit Rollable IOL with Acrylic Foldable IOL.

BACKGROUND: Phaconit or ultra micro incision phacoemulsification cataract surgery involves phacoemulsification through a 0.9 millimetre sleeveless phaco tip and irrigating chopper followed by implantation of a rollable intraocular lens. The procedure leads to negligible astigmatism and faster visual recovery as compared to phacoemulsification with a foldable intraocular lens. METHODS: This prospective study analysed 80 cases of sub millimetre phaconit surgery with implantation of rollable intraocular lenses(IOL) in 40 cases and acrylic foldable IOL in the remaining 40 cases. Evaluation of efficacy and adaptability of procedure, equipment settings, operative constraints, postoperative complications, keratometric and topographic evaluation of induced astigmatism with visual outcome and patient's rehabilitation were studied. RESULTS: The intraoperative complications were surge/ chamber collapse in 16 (20%), iris chaffing in one and corneal burns in two cases. All cases had an induced astigmatism of less than or equal to ± 0.25 D in four to six weeks after rollable IOL and ± 0.5 D to ± 0.75 D after acrylic IOL implantation. All patients had best-corrected visual acuity of 6/6 by third post operative day. CONCLUSION: Phaconit with rollable IOL is a perfect blend of surgical skill, application of technology and ultra thin IOL.

The changing spectrum of severe falciparum malaria: a clinical study from Bikaner (northwest India).

BACKGROUND & OBJECTIVES: Recently there were reports from all over India about changing spectrum of clinical presentation of severe malaria. The present study was planned to study the same in the northwest India. METHODS: This prospective study was conducted on patients of severe malaria admitted in a classified malaria ward of a tertiary care hospital in Bikaner, Rajasthan (northwest India) during 1994 and 2001. It included adult patients of both sexes belonging to all age groups. The diagnosis of Plasmodium falciparum was confirmed by demonstrating asexual form of parasites in peripheral blood smear. All patients were treated with i.v./oral quinine. The specific complications were treated by standard WHO protocol. The data for individual complications for both the years were analysed by applying chi-square test. RESULTS: In a prospective study in 1994 the spectrum of complication was dominated by cerebral malaria (25.75%) followed by jaundice (11.47%), bleeding tendencies (9.59%), severe anaemia (5.83%), shock (5.26%), Acute respiratory distress syndrome-ARDS (3.01%), renal failure (2.07%) and hypoglycemia (2.07%) whereas in 2001 it was dominated by jaundice (58.85%) followed by severe anaemia (26.04%), bleeding tendencies (25.52%), shock (10.94%), cerebral malaria (10.94%), renal failure (6.25%), ARDS (2.08%) and hypoglycemia (1.56%). The sharp difference for presence of jaundice and severe anaemia in 2001 and cerebral malaria in 1994 was statistically significant. Similarly, the important cause of mortality in 2001 was multiple organ dysfunction syndrome (71.10%) with predominant presentation of jaundice and renal failure, whereas in 1994, it was cerebral malaria (77.96%). INTERPRETATION & CONCLUSION: The observation of changing spectrum of severe malaria in this study and a significant increase in presentation with jaundice as an important manifestation is highly essential for primary, secondary and tertiary level health care providers for proper diagnosis and management.

Safety and Efficacy of Sodium Bicarbonate versus Hyaluronidase in Peribulbar Anaesthesia.

BACKGROUND: 400 cases undergoing surgery for cataract under local anaesthesia were studied. Peribulbar anaesthesia involves injecting a mixture of 2% lignocaine, bupivicaine 0.5% and hyaluronidase into the peripheral space of the orbit through a single infero-lateral point. Sodium bicarbonate has been shown to reduce the time of onset of anaesthesia and pain perception when mixed with local anaesthetics. METHODS: This study compared two groups of patients (200 each), one receiving hyaluronidase mixed anaesthetic and the other sodium bicarbonate buffered anaesthetic. The groups were compared for effectiveness of the anaesthesia, its onset, duration and the final visual outcome. RESULTS AND CONCLUSION: Sodium bicarbonate was shown to reduce the time of onset and increase the successful block rate without any adverse affects.