Medium term results following heart transplantation for end stage heart failure: A single center experience of 257 patients.

OBJECTIVE: End stage heart failure is a lethal disease with a dismal 5 year survival. Heart transplantation has proven to be a highly effective modality of treatment in appropriately selected group of such patients. This is a retrospective analysis of medium term outcomes of heart transplantation in the setting of a private health facility in India. The objective of this study was two fold. METHODS: The outcome of 257 heart transplants done at a single centre from October 2012 to October 2019 was analyzed. Patients with combined Heart and lung transplants and those whose complete medical records were unavailable were excluded from the study. Survival was tracked at 60 days, 90 days, one year and beyond for a maximum of 7 years. Preoperative patient risk profiles were characterized on the basis of INTERMACS category. RESULTS: There were 176 male and 81 female patients. The age range was from 8 months to 78 years with a mean of 32.9 years. Survival at 2 months was 87%, at 90 days was 83%, at one year was 81%, 2 years was 75%, at 3 years was 72% and at 5 years and beyond was 62% for the whole series. Strong predictors of 90 day mortality included INTERMACS category (odd's ratio 0.289, p = 0.000) and creatinine more than 1.5 mg/dl (odd's ratio 2.48, p = 0.056). Recipient pulmonary vascular resistance and donor organ ischemic times were not found to be statistically significant factors affecting outcome. Medium term survival was influenced by INTERMACS category (Hazard ratio > 3 for INTERMACS category 1 compared to INTERMACS 4 or 5, p < 0.0001) and creatinine > 1.5 mg/dl (Hazard ratio 2.15, p = 0.003). This effect of creatinine was related to the age of the recipient. Hazard ratio 1.4, p = 0.524 if age <30 and Hazard ratio 4.78, p = 0.006, if age was >50. CONCLUSION: Satisfactory medium term outcome is possible after heart transplantation even in resource constrained environment of a developing country.

Demonstration of blood flow by color doppler in the femoral artery distal to arterial cannula during peripheral venoarterial-extracorporeal membrane oxygenation.

In spite of distal perfusion of the limb using a cannula, the limb can have ischemic events if there is an undetected kink or clot anywhere in the line or thrombus in the artery. There are several ways to monitor and assess the limb ischemia. Monitoring for clinical signs of limb ischemia like temperature change and pallor is reliable and mandatory. We report a method where we used color Doppler to document the blood flow. Curvilinear vascular probe of an echo machine is used to identify the flow in the distal femoral artery of the lower limb. . As we have demonstrated in the video attached, once flow to the distal limb perfusion system is shut off by closing the three way stop cock, we can appreciate the immediate cessation of flow in the artery by Doppler.

Molecular cloning and characterization of a tumor rejection antigen from rat histiocytoma, AK-5.

We have cloned and sequenced a tumor rejection antigen from a highly immunogenic rat histiocytoma, AK-5. Recombinant antigen induced an antibody response in syngeneic hosts, and the immunized animals showed significant resistance to AK-5 tumor challenge, where growth of the tumor was retarded. Autologous anti-AK-5 antibody, as well as the specific monoclonal antibodies raised against whole AK-5 cells, recognized the recombinant protein. Similarly, recombinant antigen was able to neutralize antitumor antibody in a complement-mediated lysis assay. Antibodies raised against the fusion protein recognized a 60-kDa protein from AK-5 cell extracts. A cDNA sequence analysis revealed significant homology with mouse thymus (81%), lymph node (83%), and human brain (71%) cDNAs; however, the function of these genes is not known. These observations suggest the recombinant protein to be a strong candidate for the tumor rejection antigen that is involved in the spontaneous regression of the AK-5 tumor in syngeneic hosts.

Insecticidal, antimicrobial and antioxidant activities of bulb extracts of Allium sativum.

OBJECTIVE: To evaluate the insecticidal, antimicrobial and antioxidant activities of bulb extracts of Allium sativum (A. sativum). METHODS: Dried bulbs of A. sativum were extracted with different solvents and evaluated for insecticidal, antimicrobial and antioxidant activities. METHODS: Aqueous and methanol extracts showed highest insecticidal activity (mortality rate of 81% and 64% respectively) against the larvae of Spodoptera litura (S. litura) at a concentration of 1 000 ppm. With regard to antimicrobial activity, aqueous extract exhibited antibacterial activity against gram positive (Bacillus subtilis, Staphylococcus aureu,) and gram negative (Escherichia coli and Klebsiella pneumonia) strains and antifungal activity against Candida albicans. While methanol extract showed antimicrobial activity against all the tested micro organisms except two (Staphylococcus aureus and Candida albicans), the extracts of hexane, chloroform and ethyl acetate did not show any anti microbial activity. Minimum inhibitory concentration of aqueous and methanol extracts against tested bacterial and fungal strains was 100-150 µg/mL. Antioxidant activity of the bulb extracts was evaluated in terms of inhibition of free radicals by 2, 2'-diphenly-1-picrylhydrazyl. Aqueous and methanol extracts exhibited strong antioxidant activity (80%-90% of the standard). CONCLUSIONS: Antioxidant and antimicrobial activity of A. sativum against the tested organisms therefore, provides scientific basis for its utilization in traditional and folk medicine. Also, our results demonstrated the insecticidal efficacy of A. sativum against S. litura, a polyphagous insect.