Role of Plasma Fibrinogen in Diagnosis and Prediction of Short Term Outcome in Neonatal Sepsis

The study was carried out to determine the role of plasma fibrinogen in diagnosis of neonatal sepsis and to evaluate its role in predicting short term outcome. Sixty five neonates with clinical features suggestive of neonatal sepsis were included in this study. Seventy five neonates served as the control group. Plasma fibrinogen, prothrombin time, activated partial thromboplastin time and platelet counts were performed in all the neonates. Cut-off value of plasma fibrinogen for diagnosis of neonatal sepsis was determined with the help of receiver operating characteristic curve. Plasma fibrinogen level was found to be significantly higher among neonates with sepsis when compared to neonates in control group (p < 0.0001). It had sensitivity of 70.8 %, specificity of 82.7 %, positive predictive value (PPV) of 72.3 % and negative predictive value (NPV) of 81.6 % for diagnosis of neonatal sepsis at cut-off value of 301.90 mg/dL. When neonates with septic shock and/or disseminated intravascular coagulation (DIC) were excluded from study population, sensitivity and NPV rose to 91.9 % and 95.4 % at the same cut-off value while specificity and PPV remained the same. Lower level of plasma fibrinogen was detected in neonates with septic shock and/or DIC (p < 0.0001) and in neonates who died (p < 0.0001). Hence plasma fibrinogen can serve as an effective tool in diagnostic work up of neonatal sepsis as well as in assessing development of complications and outcome.     

Withania somnifera root extract ameliorates hypobaric hypoxia induced memory impairment in rats

Ethnopharmacological relevance

Withania somnifera (WS) root extract has been used traditionally in ayurvedic system of medicine as a memory enhancer and anti-stress agent.

Aim of the study

To evaluate the neuroprotective and prophylactic potential of WS root extract in ameliorating hypobaric hypoxia (HH) induced memory impairment and to explore the underlying molecular mechanism.

Materials and methods

WS root extract was administered to male Sprague Dawley rats during a period of 21 days pre-exposure and 07 days exposure to a simulated altitude of 25,000 ft. Spatial memory was assessed by Morris Water Maze. Neurodegeneration, corticosterone, acetylcholine (Ach) levels, acetylcholine esterase (AchE) activity, oxidative stress markers and nitric oxide (NO) concentration were assessed in the hippocampus. Synaptic and apoptotic markers were also investigated by immunoblotting. To study the role of NO in regulating corticosterone mediated signaling, the neuronal nitric oxide synthase (n-NOS) inhibitor, l-Nitro-arginine methyl ester (l-Name) and NO agonist sodium nitroprusside (SNP) were administered from 3^rd to 7^th day of hypoxic exposure.

Results

Administration of WS root extract prevented HH induced memory impairment and neurodegeneration along with decreased NO, corticosterone, oxidative stress and AchE activity in hippocampal region. Inhibition of NO synthesis by administration of l-Name reduced corticosterone levels in hippocampus during hypoxic exposure while co-administration of corticosterone increased neurodegeneration. Administration of sodium nitroprusside (SNP) along with WS root extract supplementation during hypoxic exposure increased corticosterone levels and increased the number of pyknotic cells.

Conclusion

WS root extract ameliorated HH induced memory impairment and neurodegeneration in hippocampus through NO mediated modulation of corticosterone levels.     

Spectroscopic and chromatographic evidences of NADPH in human placental extract used as wound healer

An aqueous extract of human placenta, which is used as wound healer, has been investigated in terms of fluorescence properties. When excited at 340 nm, it results in fluorescence emission having maxima around 436 nm, which is fairly specific for nicotinamide adenine dinucleotide, reduced form (NADH) and nicotinamide adenine dinucleotide phosphate, reduced form (NADPH). The excitation spectra, having emission at 440 nm, show patterns comparable to these nucleotides. Thin layer chromatography and reversed-phase (RP) HPLC confirm presence of only NADPH in the extract. The emission and excitation patterns of NADPH purified after HPLC resemble exactly with the reference compound. Its content has been estimated to be 0.018±0.003 mg/ml based on fluorescence emission with respect to a standard calibration curve (n=6). Biological functionality of NADPH in the extract has been confirmed by glutathione reductase assay (n=5).     

Daily skin cleansing with chlorhexidine did not reduce the rate of central-line associated bloodstream infection in a surgical intensive care unit

Purpose  

Cleansing the skin of intensive care unit (ICU) patients daily with chlorhexidine gluconate (CHG) has been associated with beneficial effects, including a reduction in central-line-associated bacteremias (CLABSIs). Most studies have been done in medical ICUs. In this study, we evaluated the effectiveness of daily chlorhexidine skin cleansing on CLABSI rates in a surgical ICU.     

Towards understanding of electrolyte degradation in lithium-mediated non-aqueous electrochemical ammonia synthesis with gas chromatography-mass spectrometry

Lithium-mediated electrochemical ammonia synthesis (LiMEAS) in non-aqueous media is a promising technique for efficient and green ammonia synthesis. Compared to the widely used Haber–Bosch process, the method reduces CO₂ emissions to zero due to the application of green hydrogen. However, the non-aqueous medium encounters the alkali metal lithium and organic components at high negative potentials of electrolysis, which leads to formation of byproducts. To assess the environmental risk of this synthesis method, standardized analytical methods towards understanding of the degradation level and consequences are needed. Here we report on the implementation of an approach to analyze the liquid electrolytes after electrochemical ammonia synthesis via high-resolution gas chromatography-mass spectrometry (GCMS). To characterize the molecular species formed after electrolysis, electron ionization high-resolution mass spectrometry (EI-MS) was applied. The fragmentation patterns enabled the elucidation of the mechanisms of byproduct formation. Several organic electrolytes were analyzed and compared both qualitatively and quantitatively to ascertain molecular composition and degradation products. It was found that the organic solvent in contact with metallic electrodeposited lithium induces solvent degradation, and the extent of this decomposition to different organic molecules depends on the organic solvent used. Our results show GCMS as a suitable technique for monitoring non-aqueous electrochemical ammonia synthesis in different organic electrolytes.

Lithium-mediated non-aqueous electrochemical ammonia synthesis (LiMEAS) as an efficient and green ammonia production way was studied by GCMS in different organic electrolytes to evaluate the stability of electrochemical systems.     

Neoadjuvant chemotherapy in bladder cancer: Clinical benefit observed in prospective trials computed with restricted mean survival times

PurposeNeoadjuvant chemotherapy (NAC) is the standard of care for eligible patients with cT2-4a N0 M0 bladder cancer undergoing surgical resection. The extent to which (and if) NAC increases patient survival is not clear as clinical trials and meta-analyses have generated both negative and “borderline” positive results. The novel method of calculating restricted mean survival times (RMST) may provide a more meaningful way to quantify treatment efficacy due to inherent statistical limitations of conventional hazard ratios. In this study we analyzed the survival benefit attributable to NAC in bladder cancer by calculating RMST of previously published clinical trials.Materials and methodsAll published randomized controlled clinical trials of bladder cancer with available survival data comparing NAC plus radical cystectomy with cystectomy alone were included. RMSTs were calculated for each cohort at the 5-year and total follow-up time periods, comparing the NAC and radical cystectomy groups. Fixed effect meta-analysis of the 5-year RMSTs was then performed to calculate the net impact of NAC on overall survival.ResultsFor 2 among 7 included trails, RMST analysis changed the statistical significance. The SWOG 8,710 trial that had previously suggested a survival benefit associated with NAC (P = 0.06) was found to have a clearer beneficial association by 5-year RMST (6.5 month benefit; P = 0.01) and total follow-up RMST (13.6 month benefit over 168 months; P = 0.04). The International Collaboration of Trialists trial that had previously suggested a survival benefit with NAC (P = 0.04) was found to have a beneficial association by total follow-up RMST (6.7 months benefit over 120 months; P = 0.04) but not 5-year RMST (P = 0.10). The interpretation of other trials did not change.  Fixed effect meta-analysis suggested a clinically significant overall survival benefit associated with NAC (3.2 months benefit over 60 months; P < 0.01).ConclusionsEvaluation of published randomized controlled trials using RMSTs strengthens the association of neoadjuvant chemotherapy with survival benefit in bladder cancer. As RMST may enable improved detection of clinical benefit when compared to conventional statistical methods, consideration should be given to RMST-based endpoints in future clinical trial design.     

Sources and Variability of Petroleum Hydrocarbon Residues in Sediments of Chilika Lagoon,East Coast of India

The spatio-temporal distribution and the controlling factors of petroleum hydrocarbons (PHCs) in sediments of Chilika lagoon was investigated. Samples were collected during three seasons and quantified using UV-fluorescence spectroscopy. Concentrations of PHCs in surface sediments varies from 0.18 to 12.13 ppm (mean 3.71?±?3.94 ppm). Compared to the lagoon, the monitoring stations adjacent to jetties with high boating activities tend to have higher PHC concentrations, suggesting that the contribution is likely to be from fossil fuel combustion and accidental seepage. The sediment organic matter (OM) of Chilika ranges from 0.26% to 6.23%. PHC maintains a positive correlation with OM (p?<?0.05; f?=?0.334), indicating the long term deposition of PHC as sediment OM. However, there is no significant relation between PHC and sediment texture, indicating its negligible control over PHC. The recorded PHC concentrations are below the threshold limit (70 ppm) as classified by United States (US) National Academy of Sciences (NAS) and also lower than those reported from similar ecosystems in India and overseas. Since the long term deposition and the bioaccumulation of PHC cannot be avoided, it is essential to monitor these parameters periodically.     

Cancer during Corona Pandemic: Plight of cancer patients when two evils join hands

In the unprecedented times of Corona Pandemic (CP), each individual is facing uncertainty and stress. Presence of cancer during these times compounds the troubles. The changing scenario of consultation and treatment during pandemic, logistic issues, dwindling finances and fear are making a negative impact on the mental health of cancer patients. In a qualitative analysis conducted in a tertiary oncology hospital from 1st June to 6th July on the recently diagnosed or under treatment cancer patients. The face to face interview was conducted using a semi structured questionnaire specific to Cancer amid CP, General Anxiety Disorder Item Scale 7 and Physical Health Questionnaire 9 (PHQ-9). There were total 294 patients, mean age around 51 years with a male female ratio of 3:2, 40% were suffering from head and neck malignancy. There was a delay initiating cancer treatment in 22.4% of patients and three fourths of them attributed it to CP. Almost 80% of patients perceived that pandemic has adversely affected their treatment and 50% thought they would have had a better chance of cure. Half of our cohort stated that due to social distancing and usage of masks, there is a communication gap between them and the doctors. They also felt that now, with decreased nonverbal communication; they felt lack of empathy. 14.9% patients were more concerned about corona pandemic as compared to malignancy. This study is about the challenges and perspective of cancer patients during the CP. It indicates a need for more systematic and patient friendly approach by the regulatory authorities, hospital management and staff. Timely intervention of those under stress is recommended more frequently during CP.