Comparing invasiveness of native and non-native species under changing climate in North-East India: ecological niche modelling with plant types differing in biogeographic origin.

We assess the invasive potential of Ageratum conyzoides, Hevea brasiliensis, Urena lobata and Imperata cylindrica differing in habit and biogeographic origin through ecological niche modelling in the context of the 2000 and 2050 climates of North-East (NE) India. Out of these four species, Ageratum conyzoides, Urena lobata and Imperata cylindrica are naturally occurring weed species and Hevea brasiliensis is a cultivated tree species. This study tries to address a basic question whether species with similarity in biogeographic origin may have some uniform strategy to succeed in invasion process. Ecological niche models predicted that Ageratum conyzoides (a shrub) and Hevea brasiliensis (a tree) of South American origin have greater potential to invade/distribute in NE region of India by 2050 than two other species, Urena lobata and Imperata cylindrica, of South-Asian origin. The latter two species show lower potential to invade in NE India in 2050 compared with their extent of distribution in 2000. A set of major contributing bioclimatic factors responsible for distribution of two South-Asian species (Urena and Imperata sp.) remain more or less constant between 2000 and 2050 climates. However, the distribution of Ageratum sp. and Hevea sp. with respect to two climate scenarios is attributed by two different sets of major bioclimatic factors. This indicates the robustness of the species to get adapted to different set of climatic variables over time.

Contemporary Trends in Clinical Outcomes among Dialysis Patients with Medicare Coverage.

BACKGROUND: The dialysis patient population in the United States continues to grow. Trends in rates of death and hospitalization among dialysis patients have important consequences for outpatient dialysis capacity and Medicare spending. OBJECTIVES: To estimate contemporary trends in rates of death and hospitalization among dialysis patients in the United States, overall and within subgroups. METHODS: We used Medicare Limited Data Sets (100% sample) in 2014-2017 to estimate trends in rates of death and hospitalization among dialysis patients with Medicare Parts A and B enrollment. We used seasonal autoregressive integrated moving average models to identify secular trends in the incidence of outcomes. RESULTS: There were 631,075 unique patients; 222,924 deaths; and 1,876,779 hospital admissions. Weekly risks of both death and hospitalization exhibited strong seasonality. However, overall weekly risks of death were 34.9, 35.4, 35.2, and 35.7 deaths per 10,000 patients in 2014-2017, respectively (p = 0.47, from a likelihood ratio test of secular trend). The overall weekly risk of hospitalization was 3.08, 3.05, 3.11, and 3.11% in 2014, 2015, 2016, and 2017, respectively (p = 0.30). There were significant secular trends in risk of death in subgroups defined by black race and residency in South Atlantic states (p < 0.05). There were also secular trends in risk of hospitalization in subgroups defined by age 20-44 years, concurrent enrollment in Medicaid, and residency in South Central states. CONCLUSION: For the first time since the beginning of this century, rates of both death and hospitalization among dialysis patients with Medicare fee-for-service coverage have stagnated. The reasons for this change are unknown and require detailed assessment. Persistent lack of change in clinical outcomes may alter the future expectations about dialysis patient population growth.

Perforation of Meckel's diverticulum by roundworm.

An 11-month-old girl child presented with distension of abdomen, constipation, vomiting and fever. X-ray of the abdomen suggested intestinal obstruction. Exploration revealed the distal ileum to be kinked around a band running from the tip of a congested Meckel's diverticulum to the lateral pelvic wall. A small perforation was noticed at the tip of the diverticulum and a live roundworm was found lying free in the peritoneal cavity. The diverticulum along with a segment of adjoining bowel was resected and end-to-end anastomosis done. The diverticulum had a wide lumen and showed no heterotopic tissue on subsequent examination.

Gigantic post-traumatic pseudocyst of sigmoid mesentery.

A 29-year-old man presented with dull abdominal pain and a lump occupying almost the entire abdomen, four months after a fall from a height. Ultrasonography revealed a cystic lesion with debris occupying almost the entire abdomen. Diagnostic tap revealed brownish fluid. Exploration revealed a huge thick-walled cyst of the sigmoid mesocolon, which could be enucleated out entirely. Histology suggested it to be a false cyst.

Rupture of the sinus of valsalva into the pulmonary artery.

Congenital aneurysms of the sinus of Valsalva are rare lesions that can rupture into any cardiac chamber, due to the central position of the aortic root. Rupture into the pulmonary artery, however, is very rare. We encountered an 18-year-old girl with rupture of the right coronary sinus into the pulmonary artery. During surgical correction, the girl was also found to have a small outlet ventricular septal defect, which was obscured by multiple hypertrophied septal trabeculae in the right ventricular outflow tract.

A study of the bacteriological profile of chronic suppurative otitis media in agartala.

Chronic suppurative otitis media (CSOM) is one of the most commonly encountered diseases in otolaryngology practice. Even in this era of powerful antibiotics, CSOM still consumes considerable medical expenditure, especially in the poorer sections of the society. The present prospective study was conducted at the IGM Hospital, Agartala, in North East India towards clinico-microbiologic evaluation of chronic suppurative otitis media. The focus was mainly on aerobic bacteria, involved in active CSOM in adults as well as children. An attempt was made, despite resource and man power constraints, to have a glimpse of the current antibiotic sensitivity pattern, with special reference to ciprofloxacin. However, the main aim of this study is to see the types of aerobic bacteria involved in CSOM, in our region. Aural swabs were collected from 100 ears, from 97 patients complaining of ear discharge, continuous or intermittent, with a non- intact tympanic membrane for at least 12 weeks. Swabs were sent to the hospitals microbiology laboratory for culture and sensitivity tests. Bacteria could be isolated in 53 cases and 47 swabs were culture negative. The commonest bacteria isolated was pseudomonas (20) followed by Staphylococcus aureus (11), E. coli (11), proteus (9) and klebseilla (2). Three patients had bilateral ear discharge of which one had proteus in both ear swabs, one grew proteus in one ear and no growth in the other, and one patient showed no aerobic bacteria in any of his ear swabs. Among the culture positive cases (n = 53) gram negative bacteria were isolated in 79.24% (n = 42) and S. aureus in 11(20.75%) cases. Among 97 patients number of male and female patients was 50 and 47, respectively. Pseudomonas, E. coli, Bacilli proteus and S. aureus were the predominant bacteria involved in CSOM. Out of the 53 positive isolates ciprofloxacin could be tested against 35 i.e., 66%. Ciprofloxacin was sensitive in 26 isolates, intermediately sensitive in 4 and resistant in only five isolates. It is concluded that, gram negative bacteria especially pseudomonas is the commonest bacteria involved in CSOM in this part of north east India. Ciprofloxacin is an important tool in the management of active CSOM as it is cheap, less ototoxic and widely available as topical preparations.

Perforation of Meckel's diverticulum by roundworm.

An 11-month-old girl child presented with distension of abdomen, constipation, vomiting and fever. X-ray of the abdomen suggested intestinal obstruction. Exploration revealed the distal ileum to be kinked around a band running from the tip of a congested Meckel's diverticulum to the lateral pelvic wall. A small perforation was noticed at the tip of the diverticulum and a live roundworm was found lying free in the peritoneal cavity. The diverticulum along with a segment of adjoining bowel was resected and end-to-end anastomosis done. The diverticulum had a wide lumen and showed no heterotopic tissue on subsequent examination.

Gigantic post-traumatic pseudocyst of sigmoid mesentery.

A 29-year-old man presented with dull abdominal pain and a lump occupying almost the entire abdomen, four months after a fall from a height. Ultrasonography revealed a cystic lesion with debris occupying almost the entire abdomen. Diagnostic tap revealed brownish fluid. Exploration revealed a huge thick-walled cyst of the sigmoid mesocolon, which could be enucleated out entirely. Histology suggested it to be a false cyst.

Rupture of the sinus of valsalva into the pulmonary artery.

Congenital aneurysms of the sinus of Valsalva are rare lesions that can rupture into any cardiac chamber, due to the central position of the aortic root. Rupture into the pulmonary artery, however, is very rare. We encountered an 18-year-old girl with rupture of the right coronary sinus into the pulmonary artery. During surgical correction, the girl was also found to have a small outlet ventricular septal defect, which was obscured by multiple hypertrophied septal trabeculae in the right ventricular outflow tract.