Unraveling the reaction mechanism of selective C9 monomeric phenols formation from lignin using Pd-Al2O3-activated biochar catalyst.

The conversion of biomass-derived lignin to valuable monomeric phenols at high selectivity is of paramount importance for sustainable biorefineries. In this study, a novel Pd-Al2O3 supported on activated biochar catalyst is developed for lignin hydrogenolysis. The catalyst characterization revealed that the (111) planes of both of Pd0 and Al2O3 were exposed to the surface. The maximum lignin conversion of 70.4% along with high liquid yield (∼57 wt%) was obtained at 240 °C, 3 h and 3 MPa H2 pressure. The total monomeric phenols yield in the liquid was 51.6 wt%, out of which C9 monomeric guaiacols constituted âˆ¼ 30.0 wt% with 38.0% selectivity to 4-propyl guaiacol. Using the reaction intermediate, coniferyl alcohol, chemoselective hydrogenation of Cα=Cß is proved to occur over the Pd site, while dehydroxylation of Cγ-OH is shown to occur over the alumina site. An impressive carbon atom economy of 60% was achieved for the production of monomeric phenols.

Withdrawal from Dialysis: Why and When?

Patients with end-stage kidney diseases may request for withdrawal of dialyses for many reasons. Healthcare practitioners frequently puzzled by ethical dilemma of respecting patient's wishes and beneficence of continuing dialysis. Shared decision-making and negotiating goal of care help in decision-making in patients' interests. Proactive identification guidelines that may be used for screening help in weighing options of dialysis and conservative care during progressive decline of clinical condition. Proactive identification guidelines may be used for screening. It helps in weighing options of dialysis versus conservative care during progressive decline of clinical condition. An individualized, patientcentred discussion, rather than disease-oriented, approach may be adapted.

Responding to Palliative Care Training Needs in the Coronavirus Disease 2019 Era: The Context and Process of Developing and Disseminating Training Resources and Guidance for Low- and Middle-Income Countries from Kerala, South India.

BACKGROUND: Palliative care has an important role to play in the global coronavirus disease 2019 (COVID-19) pandemic. It is integrated and is a key component in the governmental and community structures and services in Kerala, in India. Palliative care in the state has grown to be a viable model recognized in global palliative care and public health scene. The community network of palliative care, especially the volunteers linking with clinical teams, is a strong force for advocacy, relief support including provision of emergency medications, and clinical care. OBJECTIVE: To develop a palliative care resource tool kit for holistic care of patients affected with COVID-19 and to support the health-care workers looking after them to enable palliative care integration with COVID-I9 management. METHODS: The Kerala State government included senior palliative care advisors in the COVID-19 task force and 22 palliative care professionals formed a virtual task force named Palli COVID Kerala as an immediate response to develop recommendations. Results: Developed a palliative care in COVID-19 resource toolkit which includes an e-book with palliative care recommendations, online training opportunities, short webinars and voice over power point presentations. CONCLUSION: Integrated Palliative care should be an essential part of any response to a humanitarian crisis. The e resource tool kit can be adapted for use in other low- and middle-income countries.

Psychosocial Aspects of COVID-19 in the Context of Palliative Care - A Quick Review.

In a resource-poor country like India, where the health-care systems are difficult to access, overburdened, and unaffordable to many, the impact of the coronavirus disease 2019 (COVID-19) pandemic can be devastating. The increased burden of serious health-related suffering can impact the well-being of health-care workers, patients, and their families alike. The elderly, the frail, the vulnerable, and those with multiple comorbidities are disproportionately affected. Palliative care, with its comprehensive and inclusive approach, has much to offer in terms of alleviating the suffering, particularly those caused by the distressing physical and psycho-socio-spiritual symptoms, the complex medical decision-making, end-of-life care issues, and grief and bereavement, and needs to be integrated into the pathway of care provision in COVID-19. Psychosocial issues contribute to and amplify suffering and are often underestimated and undertreated and not accessible to many. Empowering frontline professionals in the core concepts of psychosocial support and palliative care thus becomes an absolute necessity. This quick review was done by a group of palliative care physicians and mental health experts from India to develop recommendations for physical and psychosocial care in the context of COVID-19. This review was done as part of that process and highlights the role and challenges of the psychosocial domain of palliative care in the context of COVID-19 situation in India.

Acute Pyelonephritis: A Single-center Experience.

Acute pyelonephritis (APN), although a common clinical entity, still not much is known about the clinical profile in the Indian scenario. We prospectively collected clinical, biochemical, and radiological data of patients hospitalized with a diagnosis of APN from March 2014 to June 2016. A total of 296 cases were included in the study. Mean age was 53.85 ± 9.78 years. Male to females ratio was 1.93:1. Among the risk factors recognized for complicated pyelonephritis (PN), diabetes mellitus (DM) (54.4%) was the most common factor followed by renal calculi (14.4%), benign prostatic hyperplasia (6.7%), immunocompromised state (3.3%), stricture urethra and meatal stenosis (3.3%), and neurogenic bladder (2%). Urinary culture was negative in 153 (51.7%) and positive in 143 patient (48.3%). Most common organism isolated was Escherichia coli (29.7%), followed by Klebsiella pneumoniae (5.4%), pseudomonas (5.4%), Enterococcus (4.4%), and Proteus in 10 (3.4%). Serum creatinine of more than 1.5 mg/dl at admission was seen in 96.3% patients; 40% of them had underlying chronic kidney disease with DM being the most common. Multiorgan dysfunction either at admission or during the course in hospital stay was seen in 31.8% patients. Twelve (2%) had emphysematous PN. Six patients had Class II, 4 had Class III, 1 with Class I, and another with Class IV. A total of 18 deaths were noted (6.1%). Hemoglobin <10 g/dl, serum creatinine at admission >1.5 mg/dl, HbA1c% >10%, and immunosuppression had statistically significant association with the development of multiorgan dysfunction on univariate analysis, but on multivariate analysis, only hemoglobin, HbA1c%, and immunosuppression reached statistical significance. Even with attributable risk of mortality, only hemoglobin, HbA1c%, and immunosuppression reached statistical significance on multivariate analysis. HbA1c% adds to the predictive parameters to recognize at-risk patients to intensify the treatment and avoid complications.

Synergistic activity of phenazines isolated from Pseudomonas aeruginosa in combination with azoles against Candida species.

Candidiasis infections are caused by yeasts from the genus Candida. The types of infection range from superficial to systemic. Treatment often requires antifungals such as the azoles; however, increased use of these drugs has led to the generation of yeasts with increased resistance to these drugs. Here, we describe the synergistic anticandidal activity of three phenazines-phenazine-1-ol, phenazine-1-carboxylic acid, and phenazine-1-carboxamide. These phenazines were purified from Pseudomonas aeruginosa in combination with three clinically used azoles-fluconazole, itraconazole, and clotrimazole. The synergistic anticandidal activities of phenazines and azoles were assessed using the checkerboard microdilution and time-kill methods. Study results show that the combined effects of phenazines and azoles were predominantly synergistic activity (fractional inhibitory concentration index <0.5). The time-kill study, which included a combination of the minimum inhibitory concentration of phenazines and azoles, showed growth of Candida species that was completely attenuated after 0-6 h of treatment. These results, which suggest that the activity of phenazines and azoles may be beneficial, have potential implications in delaying the development of resistance, as the anticandidal effect is achieved with lower concentrations of both agents (phenazines and azoles). The cytotoxicity of phenazines was also tested against a normal human cell line (foreskin normal fibroblast). No cytotoxicity was recorded at concentrations up to 200 µg/ml. The in vitro synergistic activity of phenazines and azoles against Candida species is reported here for the first time.

Purification and characterization of antifungal phenazines from a fluorescent Pseudomonas strain FPO4 against medically important fungi.

The strain FPO4 was isolated from the rhizoplane of rice plant root and identified as a fluorescent Pseudomonas aeruginosa on the basis of 16S rDNA sequences and BLAST analysis. The extracellular metabolites produced by this strain were purified by silica gel column chromatography and isolated four pure compounds. Based on the spectral data the four compounds were identified as phenazin-1-ol, phenazine-1-carboxylic acid (PCA), 2-heptyl-3-hydroxyl-4(1H)-quinolone (PQS), and phenazine-1-carboxamide (PCN), respectively. Phenazin-1-ol and PCA were active against all the eight fungi tested. The highest activity of 4 µg/mL by PCA was recorded against Trichophyton rubrum, a human pathogen responsible for causing athlete's foot, jock itch, ringworm and fingernail fungus infections, followed by Candida albicans and Candida tropicalis. The activity of phenazin-1-ol, PCA against Candida spp. was found to be better than the standard antifungal agent amphotericin B. Furthermore, the present study reports the antimicrobial activity of the purified phenazines on major human pathogen, T. rubrum for the first time.

Airway obstruction, caesarean section and thyroidectomy.

Airway obstruction in pregnancy is rare. We report the case of a 39-year-old nulliparous woman with a body mass index of 47 kg/m(2) and a large multinodular goitre causing tracheal compression with airway symptoms who declined thyroid surgery until after delivery. However, worsening hypertension precipitated an urgent caesarean section and thyroidectomy at 32 weeks of gestation. As general anaesthesia was required, an awake fibreoptic intubation via the oral route was felt to be the safest option. Caesarean section was performed and a healthy baby delivered followed by a total thyroidectomy. She was extubated, monitored closely for tracheomalacia and cared for postoperatively in the surgical high-dependency unit. This case highlighted a number of challenges managed successfully with a multidisciplinary team.

Influence of cultivar and maturity at harvest on the essential oil composition, oleoresin and [6]-gingerol contents in fresh ginger from northeast India.

Severe flooding of the Brahmaputra River during the monsoon season and continuous rainfall in the northeast region (NER) of India cause an enormous loss of ginger crop every year. In this context, the present study investigates the variation in the essential oil composition and oleoresin and [6]-gingerol contents in 10 different fresh ginger cultivars harvested at 6- and 9-month maturity from five different states of NER. Monoterpenes, sesquiterpenes, and citral composition in the essential oil were evaluated to ascertain their dependence upon the maturity of ginger. Except Mizoram Thinglaidum, Mizoram Thingria, Nagaland Nadia, and Tripura I ginger cultivars, all other cultivars showed an increase in the citral content during the maturity that was observed for the first time. At 6-month maturity, a higher undecanone level was found in Nagaland Nadia (7.36 ± 0.61%), Tripura I (6.23 ± 0.61%), and Tripura III (9.17 ± 0.76%) cultivars, and these data can be used as a benchmark to identify those immature varieties. Interestingly, the Nagaland Nadia cultivar showed higher ar-curcumene (9.57 ± 0.58%) content than zingiberene (5.84 ± 0.24%), which was unique among all cultivars. Ginger harvested at 9-month maturity from the Tripura II cultivar had the highest citral content (22.03 ± 0.49%), and the Meghalaya Mahima cultivar had the highest zingiberene content (29.89 ± 2.92%). The oleoresin content was found to decrease with maturity in all cultivars, except Assam Fibreless and Manipur I. Moreover, the highest oleoresin (11.43 ± 0.58 and 9.42 ± 0.63%) and [6]-gingerol (1.67 ± 0.03 and 1.67 ± 0.05 g) contents were observed for Tripura II and Nagaland Nadia, respectively. This study suggests that Tripura and Nagaland are the most ideal locations in NER for ginger cultivation to obtain high yields of oleoresin and [6]-gingerol contents and harvesting at the 6-month maturation will compensate for the loss of ginger crop caused by the Brahmaputra River flooding in NER every year.

Assessment of panel slides prepared by phenol ammonium sulphate and NALC methods for proficiency testing.

BACKGROUND: Existing methods for the preparation of panel slides necessitate handling high-grade acid-fast bacilli positive sputum samples. OBJECTIVE: To compare panel slides prepared using the phenol ammonium sulphate sediment (PhAS) method with those prepared using the N-acetyl-L-cysteine (NALC) method in proficiency testing. METHODS: Pooled sputum specimens of known smear-positives and -negatives were divided into two parts: one part was used for preparing panel slides using the NALC method and the other using PhAS, a non-hazardous method. Respectively 413 and 384 smears of different grades were prepared in three batches using the PhAS and NALC methods. Smear grade and quality were recorded by 121 microscopists during proficiency testing in different states. Agreement between reference and reported results was analysed using the kappa test. RESULTS: The overall agreement was 96% for the PhAS method and 91% for the NALC method. There were 37 errors using the NALC method compared to 21 for the PhAS method (P < 0.223). Smear quality was equally good in both methods; however, the cell count was significantly higher in the PhAS than in the NALC method. CONCLUSION: The PhAS method, a non-hazardous procedure with good-quality smears, may be further explored for the preparation of panel slides.

Antimicrobial evaluation of novel substituted pyrimidinopyrazoles and pyrimidinotriazoles.

Some novel substituted pyramidinopyrazoles and pyrimidinotriazoles have been synthesized by using 6-anisyl-5-cyan-2-hydrazine-3-N-methyl-3, 4-dihydropyrimidine-4-one as the starting material. Structures of these compounds have been established by IR, (1)H NMR, Mass and elemental analysis data and have been evaluated for their antimicrobial activity. Significant antimi.crobial activity was observed for some members of these series.

Quantitative analysis of organ tissue damage after septic shock.

The objective of this study was to quantify end-organ damage caused by bacteremic sepsis. Twelve adult swine were divided into two groups. The anesthesia control group (n = 6) received general anesthesia for 4 hours. The septic shock group (n = 6) received an infusion of Aeromonas hydrophila under general anesthesia for 4 hours. Swine were sacrificed at the end of the 4-hour procedure. Tissues from lungs, kidneys, livers, and hearts were stained with hematoxylin and eosin. Images of tissues were studied with digital image analysis. In lungs, cytoplasmic area (CA), nuclear area (NA), intra-alveolar hemorrhage (IAH), total airspace (TAS), and alveolar septum thickness (ST) were measured. Nuclear and cytoplasmic intensities (NI and CI) were measured in integrated optical density units (IOD). In kidneys, livers, and hearts, CA, CI, NA, and NI were measured similarly. Sinusoidal blood in the liver and vacuolization (VAC) in the kidney were also measured. In septic lungs, CI, NA, NI, ST, IAH, TAS, and ratios of NA/CA, NI/CI, and IAH/TAS were significantly increased compared with the control (P < 0.02). In septic kidneys, CI, NA, VAC, NA/CA, and NI/CI were significantly increased (P < 0.0005). In livers, CA, CI, and NI/CI were significantly increased (P < 0.005). In hearts, the ratios of NA/CA and NI/CI were statistically significant. End organs from septic swine, with exception of the heart, showed significantly higher levels of cellular damage. Digital image analysis provides an objective, precise, and accurate method of quantifying image characteristics. Automating these tasks is a high priority in the research and clinical community in providing a reproducible method for longitudinal analysis of various biological studies.

Neurocardiogenic syncope in the obstetric patient.

We report two patients who presented to our obstetric unit with a diagnosis of neurocardiogenic syncope. The first patient presented to the obstetricians in the second trimester having had two episodes of syncope during her pregnancy. The second patient had a pacemaker fitted prior to conceiving. We present the peri-partum management of both these patients.

A classical live attenuated vaccine for sheep pox.

A classical live attenuated sheep pox vaccine was prepared using the Ranipet strain of sheep pox virus (SPV) at the 50th passage in a secondary lamb testicular cell system. The TCID50 and RD50 were 10(9.63)/ml and 10(9.51)/ml. respectively. The SID50 of SPV challenge virus was 10(5)/ml. The vaccine was found to have no adverse effects in laboratory animals, and was safe and effective in SPV seronegative lambs. In the field, 660 sheep were vaccinated with an immunizing dose containing 1 x 10(2) TCID50. Randomly selected vaccinated sheep mounted good cell-mediated immunity and humoral responses as measured by glucose utilization test and serum neutralization test, respectively, for the study period of 6 months.

Combined spinal epidural anaesthesia for elective caesarean section in a patient with spondylometaphyseal dysplasia.

A patient with spondylometaphyseal dysplasia, an extremely rare form of dwarfism, presented for elective caesarean section. We report the successful management under regional anaesthesia, using a combined spinal epidural technique. There seem to be only two previous reports of spinal anaesthesia and there are no previous reports of the use of combined spinal epidural in a pregnant dwarf. Regional anaesthesia is thought to be complex in these dwarfs due to vertebral malformation and unpredictable anatomy of the spinal canal. They may present difficulties with intubation as well. Spondylometaphyseal dysplasia is reviewed and its anaesthetic implications discussed.

Cytoprotective role of Solanum nigrum against gentamicin-induced kidney cell (Vero cells) damage in vitro.

The 50% ethanol extract of the whole plant of Solanum nigrum was tested in vitro for its cytoprotection against gentamicin-induced toxicity on Vero cells. Cytotoxicity was significantly inhibited as assessed by the Trypan blue exclusion assay and mitochondrial dehydrogenase activity (MTT) assay. The test extract also exhibited significant hydroxyl radical scavenging potential, thus suggesting its probable mechanism of cytoprotection.