Heavy Metals Scavenging Potential of Trichoderma asperellum and Hypocrea nigricans Isolated from Acid Soil of Jharkhand.

Trichoderma asperellum (NAIMCC-F-03167) and Hypocrea nigricans (NAIMCC-F-03168) were isolated from the acidic soil of the vicinity of Litchi orchard, Ranchi, Jharkhand and were characterized on the basis of morphological, molecular and biochemical features. Both strains are fast growing, light to dark green, highly sporulative and have ability to cover 90 mm Petri dish within 96 h of inoculation. Biochemcial estimation of both isolates indicated significant cellulase and phosphate solubilisation activity. Highest cellulase activity was observed in T. asperellum (5.63 cm) followed by H. nigricans (5.10 cm) and phosphate solubilisation index was observed maximum in T. asperellum (1.93) followed by H. nigricans (1.39). Moreover, these isolates were molecularly identified on the basis of ribosomal DNA based sequences database and phylogenetic analysis in NCBI GenBank as T. asperellum (NCBI-KM 438015) and H. nigricans (NCBI-KJ910335). Negetive effect on sporulation of Lead (Pb) and Cadmium (Cd) was observed while in heavy metal scavenging potential, T. asperellum (88.9% Cd) showed highest scavenging potential followed by H. nigricans (87.2% Cd) while in Pb scavenging potential, H. nigricans (88% Pb) followed highest scavenging potential followed by T. asperellum (81.30% Pb) after 21 days of inoculation from 30 µg/ml heavy metals concentrated broth medium. If both potential bioagents can apply in Cd and Pb affected soil/water will be helpful in scavenging of heavy metals as well as management of phosphorus deficiency and soilborne fungal diseases.

Enhancing soil health and fruit yield through Tephrosia biomass mulching in rainfed guava (Psidium guajava L.) orchards.

Leguminous crop Tephrosia candida has high biomass production and contains a substantial quantity of nutrients within its biomass. Starting in 2019, a long-term study was done to find the best Tephrosia candida dose for mulching in guava orchards. The study had four treatments: T1 = 3.0 kg dry biomass m-2 of the plant basin, T2 = 2.0 kg, T3 = 1.0 kg, and T4 = control (no mulch). Every year, the treatments imposed in the month of August. The third year (2021-2022) results indicated that mulching with 3 kg of biomass m-2 increased trunk diameter, fruit yield, fruit weight, specific leaf area, total leaf chlorophyll, and leaf macro- and micro-nutrients. At 3.0 kg m-2, mulching improved soil properties such as EC, available nitrogen, available phosphorus, exchangeable potassium, DTPA extractable micronutrients (Fe, Zn, Cu, and Mn), total organic carbon (Ctoc), soil organic carbon (Csoc), organic carbon fractions, and microbial biomass carbon between 0-0.15 m and 0.15-0.30 m. There was an increasing trend in dehydrogenase activity (DHA) and fluorescein diacetate (FDA). The Tephrosia leaf litter exhibited decay constants of 1.27 year-1, and the carbon content was 40.11%. Therefore, applying Tephrosia biomass mulching at a rate of 3.0 kg m-2 is a viable long-term solution for enhancing soil fertility and sequestering carbon.

Effect of lead on the transformation of urea-N in fly ash-contaminated soils under different moisture regimes.

Urea is applied to soil for plant growth and undergoes various changes while in the soil. The mobility of heavy metals changes with the transformation of urea applied to the soil that, in turn, affects the activity of microbial biomass. The objective of this study was to determine the interaction between lead (Pb) and urea under two moisture regimes (60% and saturated water contents). At 60% water content, the amount of NH4-N decreased with the incubation time, irrespective of Pb and urea applied, while the amount of NO3-N content in the soil gradually increased with the incubation period to 28 days, and such an increase was counteracted by application of Pb. The amount of NO3-N content was higher than that of NH4-N, however, under saturated moisture condition, the amount of NH4-N was increased with the incubation time regardless of the levels of Pb application. The amount of NO3-N content in the soil gradually decreased with the advance of incubation at saturated condition. Although application of urea increased the NO3-N content in the soil, such an increase was suppressed by the application of different levels of Pb at water saturated condition throughout the incubation period.

Exercise intolerance following heart transplantation: the role of pulmonary diffusing capacity impairment.

STUDY OBJECTIVES: Although impairment of the diffusing capacity of the lung for carbon monoxide (DLCO) in heart transplant recipients is well-documented, there are limited data on its impact on exercise capacity in these patients. The aim of this study was to determine the effect of DLCO reduction on exercise capacity in heart transplant recipients. DESIGN: Descriptive cohort study. SETTING: A regional cardiopulmonary transplant center. PARTICIPANTS: Twenty-six heart transplant recipients who were studied before and after transplantation compared with 26 healthy volunteers. MEASUREMENTS: Spirometry and static lung volumes were measured using body plethysmography, DLCO was measured using the single-breath technique, and progressive cardiopulmonary exercise was performed using a bicycle ergometer, continuous transcutaneous blood gas monitoring, and on-line analysis of minute ventilation, oxygen uptake (VO(2)), and carbon dioxide production. RESULTS: Before transplantation, the mean percent predicted for hemoglobin-corrected DLCO was reduced in patients (73.2%) compared to healthy control subjects (98.8%; p < 0.001) and declined significantly after transplantation (60.1%; p < 0.05). Although the mean maximal symptom-limited VO(2) (VO(2)max) increased after transplantation (increase, 41.3 to 48.6% of predicted; p < 0.05), it remained substantially lower than normal (92.9%; p < 0.001). There was a significant correlation between DLCO and VO(2)max after transplantation (r = 0.61; p = 0.001), but not before transplantation (r = 0.09; p = 0.66). DLCO was also inversely correlated with other respiratory responses to exercise, including the following: the ventilatory response to exercise (r = -0.44; p < 0.05); dead space to tidal volume ratio (r = -43; p < 0.05); and the alveolar-arterial oxygen gradient (r = -0. 45; p < 0.05), but there was no correlation between any of these variables and DLCO before transplantation. CONCLUSION: DLCO reduction after heart transplantation appears to represent persistent gas exchange impairment and contributes to exercise limitation in heart transplant recipients.

Histologically diagnosed Helicobacter pylori in heart transplant recipients.

BACKGROUND: The role of Helicobacter pylori in the pathogenesis of nonautoimmune gastritis and peptic ulceration is well recognized. H. pylori is widely prevalent in the general population, but the incidence among heart transplant recipients has not been reported. Furthermore, the natural history of this infection may be modified by immunosuppression. METHODS: Gastric and duodenal biopsy specimens from 47 heart transplant recipients were examined over a period of 44 months. RESULTS: Twenty-three (49%) patients had H. pylori infection (15 men, 8 women; mean age 49 [range 35 to 59] years). Eight of the 23 (35%) had symptoms. These eight patients were treated for H. pylori with bismuth, metronidazole, and amoxicillin, followed by maintenance H2-receptor antagonists. Dyspepsia continued in six of these patients, with persistence or recurrence of H. pylori being demonstrated in four. CONCLUSIONS: This study shows that although histologically diagnosed H. pylori infection is widely prevalent among heart transplant recipients, this prevalence is very similar to the general population. Immunosuppression may play a role in the recurrence or persistence of this infection and may diminish the mucosal inflammatory response to the organism.

Acute adrenal insufficiency after coronary artery bypass grafting.

We report a case of acute adrenal insufficiency after elective coronary artery bypass grafting. This potentially fatal complication has been reported only once before in the cardiac surgical literature, more than 15 years ago. Unfortunately, adrenal insufficiency in this setting is easily confused with the clinical picture of septic shock or an acute abdominal pathology, and it is our belief that this condition could easily escape recognition and thus contribute to needless mortality.

Novel techniques of bidirectional Glenn shunt without cardiopulmonary bypass.

BACKGROUND: We report novel techniques of performing bidirectional Glenn shunt (BDG) without cardiopulmonary bypass (CPB). METHODS: Five cases of single ventricle and pulmonary stenosis (PS) complex were taken up for BDG without CPB. The criteria for case selection were an unrestrictive atrial septal defect (ASD), no atrioventricular (AV) valve regurgitation, and no other intracardiac defects requiring correction. A temporary shunt was established between the superior vena cava (SVC) and contralateral branch pulmonary artery (PA) for venous drainage during SVC clamping for BDG anastomosis in four cases. In case 5, a shunt was put between the SVC and right atrium (RA) for venous drainage, and modified Blalock Taussig shunt and patent ductus arteriosus (PDA) were left open until the completion of the BDG. RESULTS: Central venous pressure (CVP) increased to a mean of 22.4 mm Hg during SVC clamping, with improvement of oxygen (O2) saturation from 62.4% to 82.4%. After Glenn shunt, CVP and O2 saturation maintained at 13.2 mm Hg and 87.4%, respectively. Postoperatively, there were no neurological abnormalities and no hospital mortality. CONCLUSIONS: Our technique provides an excellent venous drainage with improvement of O2 saturation during SVC clamping. It avoids problems related to CPB and economy. It is easily reproducible, with excellent results in a selected group of patients without compromising the completeness of repair.

Marfanoid aneurysm in donor aorta after transplantation.

A case is reported of dissecting aneurysm of the donor ascending aorta and root 4 years after orthotopic cardiac transplantation. The pathology raises the possibility of Marfan's syndrome in the donor.

Postinfarction ventricular free wall rupture: strategies for diagnosis and treatment.

Ventricular free wall rupture is a recognized complication of myocardial infarction. In recent years, the widespread availability of echocardiography has enabled prompt antemortem diagnosis. Consequently, an avenue for lifesaving surgical intervention has emerged for this hitherto fatal condition. We review the pathology and discuss strategies for diagnosis, resuscitation, and definitive surgical intervention. We illustrate this review using our experience with a patient whose condition was diagnosed by transthoracic echocardiography and who successfully underwent emergency operation.

Evolving surgical management for ventricular septal defect, pulmonary atresia, and major aortopulmonary collateral arteries.

BACKGROUND: The purpose of this study was to evaluate the results of various surgical modalities that have been evolving for the treatment of ventricular septal defect, pulmonary atresia, and major aortopulmonary collateral arteries. METHODS: From 1993 to May 1997, 14 patients (group 1) were treated with staged unifocalization through thoracotomies and final repair by midsternotomy. From June 1997 to February 1998, 10 patients (group 2) were treated with midsternotomy, single-stage complete unifocalization, and repair. RESULTS: In group 1, 14 patients had 21 procedures (1.5 procedures per patient), of which 3 patients (21%) had final correction. There were two deaths (14%). One patient died of blocked shunt. Another patient who had aneurysmal dilation of homograft tubes that were used for unifocalization died after final repair because of low cardiac output. In group 2, 10 patients had ten surgical procedures for complete unifocalization and 9 of 10 (90%) of them achieved final correction. One patient with low cardiac output in whom we did not close the ventricular septal defect died (10%) of suprasystemic right ventricular pressure. CONCLUSION: In single-stage complete unifocalization, more patients had final correction. It reduces the number of operations and hospitalization and hence is more cost effective than multistaged procedures.

The alveolar-capillary membrane diffusing capacity and the pulmonary capillary blood volume in heart transplant candidates.

OBJECTIVES: To determine the mechanism of impairment of pulmonary transfer factor for carbon monoxide (TL(CO)) in heart transplant candidates, as this is the most common lung function abnormality. SETTING: Regional cardiopulmonary transplant centre. METHODS: TL(CO) and its components (the diffusing capacity of the alveolar-capillary membrane (D(M)) and the pulmonary capillary blood volume (V(C))) were measured using the Roughton and Forster method and the single breath technique in 38 patients with severe chronic heart failure awaiting heart transplantation (mean age 51 years, range 19 to 61; mean left ventricular ejection fraction 12.8%). Results were compared with data from 26 normal subjects (mean age 47 years, range 27 to 62). RESULTS: Mean per cent predicted TL(CO), D(M), and V(C) were significantly reduced in patients (69.9%, 81.4%, and 80.2% of predicted, respectively) compared with controls (97.7%, 100.1%, and 102.3% of predicted, respectively, p < 0.001). The relative contribution of the two components of TL(CO) in patients was similar to that of normal subjects, with each component accounting for approximately 50% of the total resistance to diffusion (1/TL(CO)). CONCLUSIONS: TL(CO) impairment in patients with severe chronic heart failure awaiting heart transplantation results from a proportionate reduction in both D(M) and V(C), suggesting a significant disturbance of the pulmonary vascular bed.

Infective dyspepsia in a heart transplant recipient.

We report the coexistence of symptomatic viral, bacterial, and fungal infection of the upper gastrointestinal tract in a heart transplant recipient. Endoscopic findings were normal at all levels but, because of severe symptoms and recent conversion to positive serology for Cytomegalovirus, biopsies were taken. These showed esophageal candidiasis and gastric Helicobacter infection that has hitherto been unreported in cardiac transplant recipients.

The measurement of the single-breath transfer factor for carbon monoxide and its components using the Morgan Transflow system.

In contrast to the standard single-breath transfer factor for carbon monoxide (TLCO), there are no specific guidelines or recommendations for the measurement of its components, the pulmonary capillary blood volume (VC) and membrane component (DM), by the Roughton and Forster method. Ten randomly selected heart transplant patients (three life-long non-smokers, seven ex-smokers > 1 yr, age range 24-55 years) were assessed on two occasions using either the standard or high-oxygen mixture as the first inspired gas in random order. Ten normal subjects (all non-smokers, age range 23-54 years) were assessed on two occasions using either a long protocol (30 min waiting time between repeat measurements in an individual set) or a short protocol (5 min waiting time). Two technically acceptable results of TLCO were used to derive a mean value for DM and VC for each set of measurements (Transflow, P. K. Morgan, Kent, U.K.). The different sequences of gas mixtures produced no significant differences between the values obtained in ten heart transplant patients for mean TLCO (mmol min-1 kPa-1) (standard first 5.13 +/- 1.15, high-oxygen first 5.14 +/- 1.12; limits of agreement -0.57 to 0.59 for DM or for VC. The long or short protocol produced no significant differences between the means of TLCO (mmol min-1 kPa-1) (long 8.0 +/- 1.9, short 8.0 +/- 1.9; limits of agreement -0.5 to 0.5), DM or VC. This allows the development of a standard test protocol of short duration (about 40 min) making it practical for clinical use without compromising the precision or reproducibility of the results obtained.

Digoxin use in patients awaiting heart transplantation for systolic left ventricular failure.

We reviewed the drug therapy of 83 patients who underwent cardiac transplantation for chronic left ventricular cardiac failure in Scotland from 1992-1996. Digoxin had been prescribed to 52% of patients in sinus rhythm, and 82% of those in atrial fibrillation (P=NS). This audit confirms that, in line with the clinical practice in the period between 1992 and 1996, digoxin was not widely used in patients with advanced chronic heart failure who were in sinus rhythm. The publication of the withdrawal trials in 1993 might have been expected to increase the use of digoxin but this could not be demonstrated. The management of patients on the cardiac transplantation waiting list should include the best symptomatic treatment possible. In view of the clinical and experimental evidence of symptomatic improvement by cardiac glycosides, it is to be hoped that publication of the results of the Digitalis Investigation Group trial will improve this situation.

Ventricular remodelling and revascularization in severe left ventricular dysfunction.

OBJECTIVE: To evaluate the role of surgical revascularization in the presence of severe, global impairment of left ventricular function without discrete aneurysm formation or mitral regurgitation. The high mortality and morbidity associated with this group, together with the limited benefits tend to prompt referral for cardiac transplantation. METHODS: Fifty-three patients initially referred for transplantation, in addition to coronary revascularization, underwent mitral annuloplasty (group A = 23), free wall remodelling by endoaneurysmorrhaphy (group B = 17) or mitral annuloplasty and free wall reconstruction (group C = 13). The mean ages were 59, 56 and 57 years for groups A, B and C, respectively. Detailed assessment of pre- and post-operative physical and psychological status were carried out. RESULTS: Follow-up was for a mean period of 22-26 months. All patients reported substantial improvement in quality of life, both physical and psychological parameters and in NYHA functional class status. Objective evidence of improvement in ejection fraction was seen in all three groups but especially in group A. There were five early deaths, four were due to inadequate revascularization due to the poor quality of target vessels. There were three late deaths and one patient that required transplantation. CONCLUSION: We conclude that patients with severe left ventricular dysfunction can be candidates for surgical revascularization and optimization of ventricular geometry with acceptable mortality. The importance of achieving complete revascularization is emphasized in this series.

The time course of pulmonary transfer factor changes following heart transplantation.

OBJECTIVE: The pulmonary transfer factor for carbon monoxide (TLCO) has been reported to decline following heart transplantation, but the time course of this decline is not well documented. The aim of this study was to define the longitudinal changes in TLCO after heart transplantation. METHODS: Single breath TLCO, lung volumes and expiratory flow rates were prospectively measured in 57 patients (mean age 49 years, range 19-61) before and at least once after heart transplantation. Thirty seven of the 57 patients had four post-transplant assessment which were performed at 6 weeks, 3, 6 and 12 months in 26 patients and at 12, 18, 24 and 36 months in 11 patients. Results were compared with data from 28 normal subjects (mean age 40 years, range 19-61). RESULTS: Before transplantation there was a mild impairment of lung volumes and expiratory flow rates. At 6 weeks after transplantation, there was a further reduction in the forced expiratory volume in one second, forced vital capacity, residual volume and total lung capacity, but all of these increased in the subsequent measurements to exceed their pre-transplant values at about 1 year after transplantation. Haemoglobin-corrected TLCO was also reduced before transplantation compared to normal controls (74.3% and 98.6% of predicted respectively, P < 0.001). Although TLCO per unit alveolar volume (KCO) was relatively preserved in heart transplant candidates, it was still significantly lower than that of normal controls (92.6% and 105.3% of predicted respectively, P < 0.05). After transplantation, mean haemoglobin-corrected TLCO and KCO declined by 12% and 20% of predicted respectively) with the majority of patients having reductions greater than 10% of predicted. The decline in TLCO and KCO was evident at 6 weeks after transplantation with no further changes in the subsequent measurements. CONCLUSIONS: TLCO is reduced in heart transplant candidates and declines further after heart transplantation despite improvement in lung volumes and airway function. The early and non-progressive nature of TLCO decline suggests an aetiology exerting its effect on TLCO within the first 6 weeks after transplantation.

Mechanisms of pulmonary transfer factor decline following heart transplantation.

OBJECTIVE: Although the decline in the pulmonary transfer factor (TL(CO)) following heart transplantation is well documented, the causes and mechanisms of this decline remain unknown. The aim of this study was to determine the relative contribution of each of TL(CO) components (the diffusing capacity of the alveolar-capillary membrane (D(M)), the pulmonary capillary blood volume (V(C)) and haemoglobin concentration) to TL(CO) reduction in heart transplant recipients. METHODS: TL(CO) and its components were measured in 75 heart transplant recipients (mean age 48 years, range 19-61) between 6 weeks and 36 months after transplantation using the Roughton and Forster method and the single-breath technique. Results were compared with data from 38 heart transplant candidates (mean age 51 years, range 34-61) and 26 normal subjects (mean age 47 years, range 27-62). RESULTS: The mean percentage predicted TL(CO) was reduced in recipients compared to candidates (56.9 and 69.9%, respectively, P<0. 001) and both were lower than normal controls (97.7%, P<0.001). The mean percent predicted V(C) was also reduced in recipients compared to candidates (52.8% vs. 80.2 (4.2)%, P<0.001) which was also lower than normal subjects (102%, P<0.001). D(M) was equally reduced in recipients and candidates (77.7 and 81.4%, respectively, P=0.48) compared to normal subjects (100.0%, P<0.001). Correction for haemoglobin concentration increased TL(CO) in recipients to 63.5% (P<0.001), but it remained lower than haemoglobin-corrected TL(CO) in candidates (71.1%, P<0.001). In recipients, the intra-capillary resistance (1/thetaV(C)) formed 60% of the total resistance to CO transfer (1/TL(CO)) compared to 50% in candidates and normal subjects. CONCLUSIONS: TL(CO) decline following heart transplantation is due to an increase in the intra-capillary resistance, and this appears to be due to a combination of anaemia and reduced pulmonary capillary blood volume, with the diffusing capacity of the alveolar-capillary membrane remaining unchanged.

Heart transplantation: initial results in Scotland.

Between 1st Jan 1992 and 1st Sept 1993 164 patients were referred as candidates for heart transplantation in Scotland. 79 were accepted for transplantation and 39 of these received orthotopic heart transplants. 30 day mortality was zero. Mean time on intensive care post operatively was 46.35 hrs and mean time to hospital discharge was 17.03 days. Cumulative actuarial survival (survival at 18 months post operatively) was 87%. There were three deaths, two from infection at six and 19 weeks and one from neoplasia at 37 weeks. Mean time to rejection was 38.54 days. Linear rejection rates at 0-3, 3-6, 6-9, 9-12, 12-15 and 15-18 months were 1.86, 0.94, 0.6, 0.04, 0 and 0 events per 100 pt-days respectively. Linear infection rates at 0-3, 3-6, 6-9, 9-12, 12-15 and 15-18 months were 1.81, 0.17, 0.1, 0, 0.05 and 0.18 events per 100 pt-days respectively. The heart transplant programme in Scotland has been successful in terms of operative mortality and short to medium term survival.

Blast lung: experience at CIMS.

Blast lung is a clinical condition which is characterised by respiratory difficulty and hypoxia without obvious external injury to the chest in bomb blast cases. Two patients of the bomb blast episode were brought at emergency department at Chhattisgarh Institute of Medical Sciences, Bilaspur in a state of shock. After proper wound care, resuscitation and investigation both the cases proved to be that of blast lung. In bomb blast cases although there might not be any external injury over chest wall, it will be sensible to rule out blast lung in all cases with the help of computerised tomography.