Bed bug outbreak in a neonatal unit.

There has been a worldwide increase in bed bug infestations over the last 10-15 years. A major stigma is placed upon the institutions found to be infested. We report our experience with an outbreak of the tropical bed bug, Cimex hemipterus, in a neonatal unit. The outbreak not only affected the admitted newborns and mothers by causing a wide variety of rashes and inducing sleeplessness, but also impinged upon the health professionals and their families by producing similar symptomology. It is important for healthcare providers to be aware of, and for each healthcare facility to have, bed bug prevention and control policies.

A preliminary report on the genetic variation in pointed gourd (Trichosanthes dioica Roxb.) as assessed by random amplified polymorphic DNA.

Pointed gourd (Trichosanthes dioica Roxb.) is an economically important cucurbit and is extensively propagated through vegetative means, viz vine and root cuttings. As the accessions are poorly characterized it is important at the beginning of a breeding programme to discriminate among available genotypes to establish the level of genetic diversity. The genetic diversity of 10 pointed gourd races, referred to as accessions was evaluated. DNA profiling was generated using 10 sequence independent RAPD markers. A total of 58 scorable loci were observed out of which 18 (31.03%) loci were considered polymorphic. Genetic diversity parameters [average and effective number of alleles, Shannon's index, percent polymorphism, Nei's gene diversity, polymorphic information content (PIC)] for RAPD along with UPGMA clustering based on Jaccard's coefficient were estimated. The UPGMA dendogram constructed based on RAPD analysis in 10 pointed gourd accessions were found to be grouped in a single cluster and may represent members of one heterotic group. RAPD analysis showed promise as an effective tool in estimating genetic polymorphism in different accessions of pointed gourd.

Stevioside induced ROS-mediated apoptosis through mitochondrial pathway in human breast cancer cell line MCF-7.

Stevioside is a diterpene glycoside found in the leaf of Stevia rebaudiana, a traditional oriental medicinal herb, which has been shown to have various biological and ethno-medicinal activities including antitumor activity. In this study, we investigated the effects of stevioside on the cytotoxicity, induction of apoptosis, and the putative pathways of its action in human breast cancer cells (MCF-7). For the analysis of apoptotic pathway, measurement of reactive oxygen species (ROS) and assessment of mitochondrial transmembrane potential (MTP) were achieved. We showed that stevioside was a potent inducer of apoptosis and it conveyed the apoptotic signal via intracellular ROS generation; thereby inducing change in MTP and induction of mitochondrial mediated apoptotic pathway. Taken together, our data indicated that stevioside induces the ROS-mediated mitochondrial permeability transition and results in the increased expression of apoptotic proteins such as Bax, Bcl-2 and Caspase-9. Effect of stevioside on stress-related transcription factors like NF-E2-related factor-2 opens up a new vista for further studies. This is the first report on the mechanism of the antibreast cancer (in vitro) activity of stevioside.

Adjuvant therapy in neonatal sepsis to prevent mortality - A systematic review and network meta-analysis.

BACKGROUND: Despite appropriate antibiotic therapy, the risk of mortality in neonatal sepsis still remains high. We conducted a systematic review to comprehensively evaluate different adjuvant therapies in neonatal sepsis in a network meta-analysis. METHODS: We included randomized controlled trials (RCTs) and quasi-RCTs that evaluated adjuvant therapies in neonatal sepsis. Neonates of all gestational and postnatal ages, who were diagnosed with sepsis based on blood culture or sepsis screen were included. We searched MEDLINE, CENTRAL, EMBASE and CINAHL until 12th April 2021 and reference lists. Data extraction and risk of bias assessment were performed in duplicate. A network meta-analysis with bayesian random-effects model was used for data synthesis. Certainty of evidence (CoE) was assessed using GRADE. RESULTS: We included 45 studies involving 6,566 neonates. Moderate CoE showed IVIG [Relative Risk (RR); 95% Credible Interval (CrI): 1.00; (0.67-1.53)] as an adjunctive therapy probably does not reduce all-cause mortality before discharge, compared to standard care. Melatonin [0.12 (0-0.08)] and granulocyte transfusion [0.39 (0.19-0.76)] may reduce mortality before discharge, but CoE is very low. The evidence is also very uncertain regarding other adjunctive therapies to reduce mortality before discharge. Pentoxifylline may decrease the duration of hospital stay [Mean difference; 95% CrI: -7.48 days (-14.50-0.37)], but CoE is very low. CONCLUSION: Given the biological plausibility for possible efficacy of these adjuvant therapies and that the CoE from the available trials is very low to low except for IVIG, we need large adequately powered RCTs to evaluate these therapies in sepsis in neonates.

Chikungunya epidemic-related mortality.

Port Blair, the capital city of the Union Territory of Andaman and Nicobar Islands in the republic of India, witnessed an outbreak of chikungunya (CHIK) fever in 2006. Although no deaths attributable to CHIK fever were registered, thousands of people were affected. In view of evidence from other parts of the world indicating that CHIK fever does cause death we studied the mortality trend in Port Blair from 2002 to 2008 in order to verify if there was increased mortality during the CHIK fever epidemic. The expected number of monthly deaths in 2006 was calculated by multiplying the average monthly mortality rate from 2002 to 2008 (with the exception of 2006) with the monthly population in 2006. The results indicated that there was a significant increase in expected deaths during some months of 2006, which coincided with the peak in the CHIK fever epidemic in Port Blair.

Immunomodulatory effect of leaf extract of Murraya koenigii in diabetic mice.

CONTEXT: Extracts of different parts of Murraya koenigii were traditionally used as medicine in many countries for the treatment of various diseases including diabetes. OBJECTIVE: To delineate whether aqueous (AEM) and 50% methanol (MEM) leaf extracts have immunomodulatory properties to regulate oxidative stress metabolism and fight against the adverse effect of diabetes in diabetic mice. MATERIALS AND METHODS: Alloxan-induced diabetic mice were received oral doses of extract (≥ 200 mg/kg body weight). Fasting blood glucose, total cholesterol (TC), triglycerides (TG), phospholipids (PL), and antioxidant enzymes activity were estimated by biochemical processes. Western blotting, flow cytometry study, cell count, and histology were performed to justify different aspects of diabetes-related pathology. RESULTS: Alloxanized mice showed higher blood glucose that was further reduced after treatment of extracts for 30 days. Extract-treated diabetic mice were found lower TC, TG, and PL than diabetic mice. Rising of glutathione (GSH) and superoxide dismutase (SOD) enzyme activities compared with diabetic mice showed antioxidant property of the extracts. We found anti-inflammatory response as it was evident by interleukin (IL)-2, 4, 10, and tumor necrosis factor alpha (TNF-α) expression. In addition, the reduction of apoptosis in pancreatic cells was found upon extract-treated diabetic mice. DISCUSSION: The leaf extracts of the plant not only have hypoglycemic property but also have certain effects to regulate mice immunology related to oxidative stress metabolism. Moreover, AEM gave better response than MEM. CONCLUSION: Thus, the work reveals about immunomodulatory property of the leaf extracts of M. koenigii on diabetes and diabetes-related pathology in mice.

Photodissociation dynamics of phosphorus trichloride (PCl3) at 235 nm using resonance enhanced multiphoton ionization (REMPI) with time-of-flight (TOF) mass spectrometry.

The photodissociation dynamics of phosphorus trichloride (PCl(3)) has been studied in a supersonic beam by resonance enhanced multiphoton ionization (REMPI), using time-of-flight (TOF) mass spectrometry. The study is focused on the nascent state of the primary chlorine atom, formed on excitation of the (n, sigma*) transition of the molecule around 235 nm. Dissociation of PCl(3) and the REMPI detection of chlorine atoms are performed, using the same laser around 235 nm. The photofragments, namely, Cl((2)P(3/2)) and Cl*((2)P(1/2)), are probed, using the 2+1 REMPI scheme in the 234-236 nm region. We have determined the photofragment speed distribution, the recoil anisotropy parameter beta, and the spin-orbit branching ratio for chlorine atom elimination channels. Polarization-dependent and state-specific TOF profiles are converted into kinetic energy distributions, using a least-squares fitting method, taking into account the fragment anisotropies. The anisotropy parameters for Cl and Cl* are characterized by values of 0.0 +/- 0.05 and 0.20 +/- 0.05, respectively. Two components, namely, the fast and the slow, are observed in the speed distribution (P(v)) of Cl and Cl* atoms, formed from different potential energy surfaces. The average translational energies for the Cl and Cl* channels for the fast component are 29.7 and 30.6 kcal/mol, respectively. Similarly, for the slow component, the average translational energies for the Cl and Cl* channels are 9.5 and 9.1 kcal/mol, respectively. The energy partitioning into the translational modes is interpreted with the help of an impulsive model, for the fast component, and a statistical model, for the slow component. Apart from the chlorine atom elimination channel, molecular chlorine (Cl(2)) elimination is also observed in the photodissociation of PCl(3). The observation of the molecular chlorine in the dissociation process and the bimodal translational energy distribution of the chlorine atom clearly indicate the existence of a crossover mechanism from the initially prepared state to the ground state.

Correlation of functional echocardiography and clinical parameters in term neonates with shock.

BACKGROUND: To evaluate the correlation between functional echocardiography and clinical parameters in term neonates with shock. METHOD: Cross sectional study of 30 full term newborns who were clinically detected to have shock compared to 30 full term hemodynamically stable neonates. For statistical analysis, cases were further sub classified into cardiogenic and septic shock. RESULT: Functional echocardiography revealed inferior vena cava collapsibility index (cIVC), fractional shortening (FS), ejection fraction (EF), cardiac output and superior vena cava (SVC) flow were significantly lower whereas myocardial performance index (MPI) was significantly higher in babies with cardiogenic and septic shock as compared to the controls. Left ventricular end diastolic area (LVEDA) was significantly higher in cardiogenic shock whereas it was significantly lower in septic shock as compared to the controls. Also, cIVC was significantly lower and LVEDA was significantly higher in cardiogenic as compared to the septic shock. In cardiogenic shock SVC flow correlated significantly with capillary filling time and systolic blood pressure. The correlation between functional echocardiographic parameters of cardiogenic and septic shock showed that EF, FS and MPI were positively and significantly correlated (r 0.742, p 0.022 for EF, r 0.766, p 0.016 for FS and r 0.478, p 0.05 for MPI) whereas SVC flow and cIVC were negatively and significantly correlated between cardiogenic and septic shock (r - 0.655, p 0.045 for SVC flow and - 0.578, p 0.05 for cIVC). CONCLUSION: In the complex environment of neonatal intensive care unit detection of shock continues to be a major challenge. Functional echocardiography provides an adjunct information to the clinical assessment of shock and helps in monitoring the response to treatment.

Retromandibular transparotid approach compared with transmasseteric anterior parotid approach for the management of fractures of the mandibular condylar process: a prospective randomised study.

Fractures of the mandibular condyle lead to displacement of the condyle and loss of the height of the ramus. A retromandibular approach is the most commonly used for open reduction and internal fixation (ORIF) of such fractures. We aimed to compare the complications associated with a retromandibular transparotid approach with a retromandibular transmasseteric anterior parotid (TMAP) approach for their management. Thirty patients were randomly selected into two groups (15 in each): Group A comprised the retromandibular transparotid approach and Group B the retromandibular TMAP. The variables evaluated were: operating time, facial nerve injury, occurrence of Frey syndrome, and sialocoele at one week, four weeks, three months, and six months. The mean (SD) age in group A and B was 33.93 (17.97) years and 33.53 (16.15) years, respectively, and there were 28 men and two women. Mean (SD) exposure time in the transparotid approach was 26.93 (5.19) minutes and 25.4 (8.35) minutes in the TMAP approach. The incidence of facial nerve injury was 2/15 patients in the transparotid group and 3/15 in the TMAP group, all of which resolved within six months. The incidence of sialocoele was 2/15 in the transparotid group. The results did not show any significant difference in complications between the two approaches, but the retromandibular transparotid approach provided straight-line access in fractures of the condylar neck, with fewer incidences of nerve injury. The anterior parotid approach, on the other hand, provided easier access for fractures that were medially dislocated or of the condylar base but had an increased incidence of facial nerve injuries.

Otitis Media with Effusion (OME) in Urban Pediatric Population in a Tertiary Care Centre: A Clinical Study.

Otitis media with effusion (OME) is a common condition affecting children. It is one of the most common causes for reduced hearing in pediatric age group leading to various learning disabilities including delayed speech development. The aim of this study was to find out various epidemiological characteristics and risk factors for developing OME and various treatment modalities depending on the clinical features and their outcomes in urban pediatric population. A prospective comparative study was done in 100 children taken 50 as cases and 50 as controls for a period of 2 years. The risk factors, common presenting features and the examination and investigational findings (tympanometry) of the study condition were compared among the cases and controls. Among the 50 cases, 28 children were treated medically and 22 underwent surgical treatment in the form of Myringotomy and Grommet insertion. The patients were followed up-to 6 months in both groups.

Distribution, antimicrobial resistance and predictors of mortality in neonatal sepsis.

OBJECTIVE: The aim of this study is to investigate etiological agents, patterns of antimicrobial resistance and predictors of mortality in culture proven neonatal sepsis. METHOD: This is a twenty-four month retrospective cohort study of infants with culture proven sepsis. Demographic data, type of isolates and its sensitivity pattern were recorded. Multidrug resistant gram-negative isolates were defined as resistance to any three of five antibiotic classes: extended-spectrum cephalosporins, carbapenems, aminoglycosides, fluoroquinolones and piperacillin-tazobactam. RESULT: A total of 183 case with culture positive sepsis were identified. Early onset sepsis occurred in 59% of cases. The majority of isolates (56.2%) were gram-positive but the most common individual isolates were klebsiella spp. (31.1%), Staphylococcus aureus (24.5%) and coagulase-negative staphylococci (CONS) (22.9%). The pathogen mix in early-onset did not differ from late-onset sepsis. High rates of multidrug resistance were observed in klebsiella spp. (49.1%), Escherichia coli (50%), citrobacter spp (50%), acinetobacter spp. (28.5%), pseudomonas spp. (100%) isolates. Methicillin resistance prevailed in 16.6% of coagulase-negative staphylococci, 24.4% of Staphylococcus aureus and 62.5% of enterococcus spp. Multivariate analysis revealed invasive ventilation and early onset sepsis to be independently associated with increased risk of mortality in contrast to breast milk feeding which is associated with decreased risk of mortality. CONCLUSION: A high degree of antimicrobial resistance underscores the need to understand the pathogenesis of resistance, curtail the irrational prescription of antibiotics in neonates and the requirement for measures to prevent it in low-income and middle-income countries.

Reconstruction of a Post Traumatic Anterior Maxillary Defect by Transport Distraction Osteogenesis.

Rehabilitation of segmental defects of maxilla presents a reconstructive challenge to obtain an ideal osseous form and height with adequate soft tissue investment. Though variety of prosthetic and surgical reconstructive options like the use of vascularized and non vascularized bone grafts are available they produce less than optimal results. Bone transport distraction is a reliable procedure in various maxillofacial bony defect reconstruction techniques. We describe herein a technique of maxillary bone transport distraction using an indigenously designed, custom made trifocal transport distractor performed in a post traumatic avulsive defect of the anterior maxilla. Transport distraction was successful for anterior maxillary alveolar bony regeneration, with excellent soft tissue cover and vestibular depth, which also helped close an oroantral/oronasal fistula.

Optimization of beam dump shielding for K-130 cyclotron at VECC.

A compact and efficient beam dump shield has been designed using Monte Carlo simulation code FLUKA to facilitate low background measurement of neutron and gamma rays using K130 cyclotron at Variable Energy Cyclotron Centre, Kolkata (VECC). Iron, lead and high density Polyethylene (HDPE) were considered in the design of the beam dump shield. Representative FLUKA simulation results have been validated using in-beam experiment performed on the same beam dump constituents. Experimental neutron and gamma-rays energy spectra have been found to be in fair agreement with the simulation results. Activation of various beam dump shield components were also carried out.

Generation and application of LET calibration curve for neutron dosimetry using CR-39 detector and microwave induced chemical etching.

Microwave induced chemical etching (MICE) has been established as a faster and improved technique compared to other contemporary etching techniques for the development of tracks in a CR-39 detector. However, the methodology could not be applied for LET (linear energy transfer) spectrometry due to lack of a calibration curve using this method. For this purpose, a new LET calibration curve in the range of 12 keV/µm-799 keV/µm was generated considering different ions such as H, Li, C, O, and F on CR-39 having different LETs in water. An empirical relation was established from the obtained calibration curve for determining the value of LET (in water) from the value of V, the ratio of track etch rate to bulk etch rate. For application of this calibration curve in neutron dosimetry, CR-39 detectors were irradiated to neutrons generated from 120 and 142 MeV 16O+27Al systems followed by a similar MICE procedure. The absorbed dose (DLET) and the dose equivalent (HLET) were obtained from the LET spectra and were found to be 13% and 10% higher for 142 MeV 16O+27Al system than those for 120 MeV 16O+27Al system, respectively. The outcome of the study demonstrates the possibility of using the MICE technique for neutron dose estimation by CR-39 via LET spectrometry.

Diagnostic Features and Management Strategy of a Refractory Case of Osteoradionecrosis of the Mandible: Case Report and Review of Literature.

INTRODUCTION: Osteoradionecrosis of the jaws produces a considerable amount of esthetic as well as functional deficits seriously affecting quality of life of the patient. Cases are often notoriously difficult to treat and manage owing to associated comorbidities of the patient, post irradiation fibrosis and decreased vascularity at the site, which complicates free tissue flap and graft transfer, that subsequently succumb to failure. Hyperbaric oxygen therapy (HBOT), in which 100 % oxygen is administered by mask under 2.4 atm pressure, in a hyperbaric oxygen chamber, helps by increasing local vascularity. AIM AND METHODS: It was the aim of this study to show that a particularly refractory, compromised and challenging case of osteoradionecrosis can be managed successfully even without HBOT, by mandibular segmental resection followed by reconstruction using a titanium reconstruction plate enveloped within a pedicled Pectoralis Major Myocutaneous flap. RESULT: Post operative recovery of the patient was excellent with good functional and esthetic rehabilitation of the patient with and practically nil donor site morbidity. CONCLUSION: It is important to have a thorough knowledge of the clinical, radiographic, histopathologic, CT and MRI features of osteoradionecrosis of the jaws in order to make a quick and accurate confirmatory diagnosis and to overcome possible diagnostic dilemmas. The strategy of reconstruction of a large mandibular defect using a bridging titanium plate sandwiched by a healthy vascularized myocutaneous flap, following ablative surgery for ORN, has proved to be a safe and reliable option for composite mandibular defects, with gratifying long term functional and cosmetic results.

'Y' Modification of the Transconjunctival Approach for Management of Zygomatic Complex Fractures: A Prospective Analysis.

PURPOSE: The purpose of this study was to clinically and radiologically evaluate reduction and fixation of isolated zygomatic complex (ZMC) fractures treated by Y modification of the transconjunctival approach. PATIENTS AND METHODS: A prospective evaluation of ten patients was undertaken for a period of 6 months using this modified approach from Jan 2012 to Jun 2013. Patients were examined preoperatively and post operatively at the end of 6 months for symmetry discrepancies involving A-P globe projection, lateral canthal level, malar projection and diplopia in direct and extreme gazes. Cosmetic outcomes were assessed by clinical assessment and examination of photographs. Quality of reduction and stability of fixation was assessed by examination of postoperative images. RESULTS: All patients underwent a three point fixation of ZMC with reconstruction of the orbital floor using titanium mesh. Patients were post surgically followed up at regular intervals of 1, 3 and 6 months. Immediate complications noted were chemosis, lid edema and lower lid retraction. Late complications included minor scleral show in two cases. All patients experienced significant improvement with excellent esthetic appearance and function. CONCLUSIONS: Y modification of transconjunctival approach provides excellent surgical exposure for ZMC fractures potentially avoiding the use of a second incision in the area of ZF suture. Although this technique provides good exposure and excellent esthetics, it requires more operating time and detailed knowledge of the anatomy of the lateral canthal region.

Reconstruction of Cranial Defects in Armed Forces Personnel - Our Experience.

BACKGROUND: The aim of this study was to evaluate the efficacy of heat cured 'poly methyl methacrylate resin prosthesis and to assess the acceptability of the indigenously manufactured titanium mini bone plate and screws in patients treated for repair of cranial defects. METHODS: 17 patients with cranial defect were treated for reconstruction of the skull defect with two types of implants i.e. Acrylic resin plate prosthesis and titanium minibone plates, either in combination or singularly. In these cases, the skull defects resulted from trauma (88.23%) or due to ablative tumour surgery (11.96%). Acrylic implant was used in 12 cases (70.85%), titanium plates and screws in 2 cases (11.76%) and a combination of both of the above in 3 cases (17.64). RESULTS: The primary reconstruction was carried out in 2 cases (11.96%) and secondary reconstruction was done in 15 cases (88.23%). Majority of the cases underwent secondary reconstruction because of the initial surgical emergency requiring quick debulking and closure. In 2 cases where primary reconstruction was done, the second surgery could be avoided with gratifying results. CONCLUSION: 70.85% underwent reconstruction with polymethyl methacrylate resin prosthesis and in the rest either titanium plates were used singly or in combination. Only in one patient, there was rejection of the implant due to infection. In 94% cases the graft was well taken up with excellent results.

Value of immunohistochemistry in diagnosing a rare case of maxillofacial plasma cell granuloma masquerading as a gingival epulis.

BACKGROUND: Plasma cell granuloma is a non-neoplastic lesion rather uncommonly seen in the maxillofacial region. Its etiology, biological behavior, ideal treatment and prognosis are still unclear and rather controversial. STUDY: A detailed histopathological examination and immunohistochemical study of the excised specimen was carried out, both for making a confirmatory diagnosis as well as to determine the etiopathology, biological behavior and prognosis of the lesion. RESULTS: Light microscopy revealed a hyperplastic stratified squamous epithelial lining, overlying a densely fibrocellular granulation tissue containing a rich proliferation of mononuclear inflammatory cells, among which there was a predominance of plasma cells with their typical eccentric, cartwheel shaped, "clock-faced" nuclei. Strong immunohistochemical positivity was observed for CD-138 by numerous cells of the connective tissue of the lesion, thus confirming them to indeed be plasma cells. Further, immunohistochemistry (IH) analysis also demonstrated the expression of both, the lambda and kappa light chain immunoglobulins by the plasma cell population, thus confirming them to be polyclonal and of an inflammatory, non-neoplastic origin. SUMMARY AND CONCLUSION: As a plasma cell granuloma is rarely encountered in the oral and maxillofacial region, its diagnosis could have been very easily missed, had it not been for the detection of the large numbers of plasma cells by light microscopy, which was further confirmed by IH. IH also helped in establishing the likely etiopathology of the lesion and confirmed it to be of a non-neoplastic reactive/inflammatory origin.