Uncommon Bilateral Carotid Artery Dissection in a Farmer: The Perils of Heavy Weight Lifting.

Bilateral internal carotid artery (ICA) dissection on heavy weight lifting is a very rare cause of stroke in young patients. Arterial dissection is due to a tear in the intima and internal elastic lamina which leads to extravasation of blood into the media and subintimal plane. Clinical diagnosis of carotid artery dissection is difficult with common clinical presentations like headache and neck pain. Here we present a case of a 40-year-old young man who presented to us (tertiary referral center) with headache and quadriparesis. MRI brain showed multiple acute infarcts in bilateral centrum semiovale extending up to frontal periventricular white matter with few tiny foci in bilateral medial temporal and left gangliocapsular regions and CT cerebral angiography showed bilateral ICA dissection. He was treated with low molecular weight heparin and was discharged for follow-up with regular physiotherapy.

On Admission, Microcirculation Abnormality is an Independent Predictor of Sepsis and Sepsis-related Mortality: A Hospital-based Study.

Background: Microcirculatory derangement is the primary cause of organ dysfunction in patients with sepsis. Assessment of the microcirculation is usually done by means of indirect parameters (SvO2 transcutaneous PO2 serum lactate.) The aim of our study is to understand microcirculatory abnormalities in patients with sepsis by directly visualizing the tiny vessels using hand-held video microscopes (HVMs) and determining the role of this modality in the prediction of sepsis-related mortality. Methods: A longitudinal prospective hospital-based study was carried out in medical ward and ICU of a tertiary care hospital. Patients admitted with the presumed infectious disease were included. Evaluation of sublingual microcirculation was done in these patients from Day 1 to Day 5 Clinical and laboratory variables and microcirculation variables were compared between patients with or without sepsis and between survivors and non-survivors of sepsis. Chi-square test for categorical and Student's t-test or Wilcoxon rank-sum test for continuous variables were applied. Univariate and multivariate regression analyses were performed using the Cox-proportional hazard model. Results and discussion: On admission, microcirculation assessment measure, PPV (small), was significantly reduced in those with sepsis, as compared to those without sepsis. Multivariable models indicate the inverse relationship of PPV small with mortality. How to cite this article: Panda A, Revadi G, Sharma JP, Pakhare A, Singhai A, Joshi R, et al. On Admission, Microcirculation Abnormality is an Independent Predictor of Sepsis and Sepsis-related Mortality: A Hospital-based Study. Indian J Crit Care Med 2022;26(3):294-301.

Capsaicin production by Alternaria alternata, an endophytic fungus from Capsicum annum; LC-ESI-MS/MS analysis.

Alternaria alternata, an endophytic fungus capable of producing capsaicin (1) was isolated from Capsicum annum. The endophyte was found to produce capsaicin upto three generations. Upscaling of the fermentation broth led to the isolation of one known and one compound characterized as 2,4-di-tert-butyl phenol (2) and alternariol-10-methyl ether (3) respectively. Compound 1 and 3 were identified and quantified using liquid chromatography-electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS) system through multiple reaction monitoring (MRM). Furthermore, compound 3 displayed a range of cytotoxicity against a panel of human cancer cell lines and was found to induce apoptosis evidenced by Hoechst staining and loss of mitochondrial-membrane potential in HL-60 cells.

Bioreactor studies on the endophytic fungus Entrophospora infrequens for the production of an anticancer alkaloid camptothecin.

Twigs (young and old) from Nothapodytes foetida growing in the Jammu and Mahabaleshwar regions in India were used for the isolation of 52 strains of endophytic fungi and were tested for their ability to produce the anticancer alkaloid camptothecin. One of the isolates from the inner bark tissue of the N. foetida plant growing in the Jammu region of J&K state, India, was found to produce detectable quantities of camptothecin and its derivatives when grown in a semi-synthetic liquid medium. Camptothecin was identified by physicochemical analysis and further confirmed by spectroscopic studies. No camptothecin was detected in zero time cultures or in uninoculated culture broth. The maximum yield of camptothecin was 0.575 +/- 0.031 mg/100 g of dry cell mass in 96 h in shake flasks, whereas 4.96 +/- 0.73 mg/100 g of dry mass was recorded in 48 h in a bioreactor.