Comparative study of percutaneous dilatational tracheostomy and conventional tracheostomy in the intensive care unit

Objective: Tracheostomy is a one of the earliest described surgical procedure dating back to 2000 B.C. Percutaneous tracheostomy is becoming increasingly popular as an alternative method for conventional tracheostomy in the intensive care unit. In this study we compare the results of the use of these 2 techniques in 32 patients who underwent elective tracheostomy in the intensive care unit.Study Design: Prospective randomized comparative study.Setting: Tertiary care hospital.Patients: Adult intubated patients selected randomly in the intensive care unit with normal cervical soft tissue, laryngeal framework, palpable cricoid cartilage and normal coagulation parameters.Results: 17 patients underwent conventional tracheostomy and 15 patients underwent percutaneous dilatational tracheostomy. Demographic data and duration of intubation comparable between two groups. The mean operative time, blood loss and complications were lower in percutaneous than in conventional tracheostomy.Conclusions: PDT is quicker to perform and has lower blood loss and complication rates compared to conventional tracheostomy. However percutaneous tracheostomy is not indicated in emergencies and in children. The cost of the percutaneous kit and use of bronchoscopy adds to the cost. It is a good alternative to conventional tracheostomy in properly selected patients.     

Intermittent pneumatic compression as an adjuvant therapy in venous ulcer disease

Despite improvements in healing rates venous ulcer disease still carries significant morbidity and cost. Any therapy that further improves healing rates is worthy of consideration. The recognised effects of intermittent pneumatic compression (IPC) on both arterial and venous circulation suggest that its use may confer significant benefits to venous ulcer healing. This study investigates the potential additive effects of adjuvant IPC on the healing and subsequent prevention of venous ulcers. Some improvement in the rate of healing in venous ulcers is noted. These findings are set against a background of very high healing rates in both treatment and control groups. No benefit is seen to accrue if IPC is used as an adjuvant therapy to help prevent recurrence of ulcers although the study period is very short.     

Effect of Cassia auriculata leaf extract on lipids in rats with alcoholic liver injury

We studied the effect of administering Cassia auriculata leaf extract to rats with experimentally induced liver damage. Hepatotoxicity was induced by administering 9.875 g/kg bodyweight ethanol for 30 days by intragastric intubation. C. auriculata leaf extract was administered at a dose of 250 mg/kg bodyweight daily in one group and 500 mg/kg bodyweight daily in another group of alcohol-treated rats. All rats were fed with standard pellets. The control rats were also given isocaloric glucose solution. The average bodyweight gain was significantly lower in alcohol-treated rats, but improved on supplementation with C. auriculata leaf extract. Alcohol supplementation significantly elevated the cholesterol, phospholipid and triglyceride concentration in the liver, brain, kidney and intestine, as compared with those of the normal control rats. Treatment with C. auriculata leaf extract and alcohol significantly lowered the tissue lipid levels to almost normal levels. Microscopic examination of alcohol-treated rat liver showed inflammatory cell infiltrates and fatty changes, which were reversed on treatment with C. auriculata leaf extract. Similarly, alcohol-treated rat brain demonstrated spongiosis, which was markedly reduced on treatment with C. auriculata. In conclusion, this study shows that treatment with C. auriculata leaf extract has a lipid-lowering effect in rats with experimentally induced, alcohol-related liver damage. This is associated with a reversal of steatosis in the liver and of spongiosis in the brain. The mechanism of C. auriculata leaf extract lipid-lowering potential is unclear.     

Disseminated Intravascular Coagulation syndrome — ENT surgeon’s perspective

ENT surgeon is seldom confronted with a systemic disease severe enough to progress to Disseminated Intravascular Coagulation syndrome (DIC), where he has to undertake a definitive surgical procedure for malignancy or perform an emergency tracheostomy. This calls for a judicious calculation of the pros and cons with an element of risk that needs to be accepted. We report two such patients who have been treated in such a scenario where the outcome varied depending on the severity and time of onset of the underlying coagulation disorder.     

Functional study of nasal mucosa in endoscopic sinus surgery and its correlation to electron microscopy of cilia

The effect of functional endoscopic sinus surgery (FESS) was evaluated in 20 patients with chronic sinusitis. The physiological function of sinus mucosa and its mucociliary transport mechanism was assessed pre and post operatively in patients undergoing FESS by performing Saccharin clearance test. The effect of functional sinus surgery on nasal mucosa was evaluated using scanning electron microscopy and study of the ultrastructure of cilia in pre and post operative patients and correlation with histopathological examination. The mucociliary transport mechanism of the sinus mucosa improved 6 weeks following surgery. Histopathologically there was evidence of improvement in the ciliary population and decrease in inflammation, ulceration, fibrosis, vascular congestion, edema, squamous cell metaplasia, basement membrane thickening and polyp formation in comparison to the diseased mucosa sampled preoperatively. Scanning electron microscopic examination revealed considerable increase in the ciliary area as well as the orientation of cilia. Subjective improvement 6 weeks following surgery was confirmed by decrease in saccharin test time. This study revealed that FESS is an effective surgical procedure in chronic sinusitis and improves the overall function of the sinuses     

Effect of visceral metastases on the efficacy and safety of everolimus in postmenopausal women with advanced breast cancer: Subgroup analysis from the BOLERO-2 study

BackgroundEverolimus (EVE; an inhibitor of mammalian target of rapamycin [mTOR]) enhances treatment options for postmenopausal women with hormone-receptor-positive (HR⁺), human epidermal growth factor receptor-2-negative (HER2^–) advanced breast cancer (ABC) who progress on a non-steroidal aromatase inhibitor (NSAI). This is especially true for patients with visceral disease, which is associated with poor prognosis. The BOLERO-2 (Breast cancer trial of OraL EveROlimus-2) trial showed that combination treatment with EVE and exemestane (EXE) versus placebo (PBO) + EXE prolonged progression-free survival (PFS) by both investigator (7.8 versus 3.2 months, respectively) and independent (11.0 versus 4.1 months, respectively) central assessment in postmenopausal women with HR⁺, HER2^– ABC recurring/progressing during/after NSAI therapy. The BOLERO-2 trial included a substantial proportion of patients with visceral metastases (56%).MethodsPrespecified exploratory subgroup analysis conducted to evaluate the efficacy and safety of EVE + EXE versus PBO + EXE in a prospectively defined subgroup of patients with visceral metastases.FindingsAt a median follow-up of 18 months, EVE + EXE significantly prolonged median PFS compared with PBO + EXE both in patients with visceral metastases (N = 406; 6.8 versus 2.8 months) and in those without visceral metastases (N = 318; 9.9 versus 4.2 months). Improvements in PFS with EVE + EXE versus PBO + EXE were also observed in patients with visceral metastases regardless of Eastern Cooperative Oncology Group performance status (ECOG PS). Patients with visceral metastases and ECOG PS 0 had a median PFS of 6.8 months with EVE + EXE versus 2.8 months with PBO + EXE. Among patients with visceral metastases and ECOG PS ?1, EVE + EXE treatment more than tripled median PFS compared with PBO + EXE (6.8 versus 1.5 months).InterpretationAdding EVE to EXE markedly extended PFS by ?4 months among patients with HR⁺ HER2^– ABC regardless of the presence of visceral metastases.FundingNovartis.     

Structural diversity and efficacy of culturable cellulose decomposing bacteria isolated from rice–pulse resource conservation practices

The diversity of cellulolytic bacteria from the rice–pulse system can be sourced for identification of efficient cellulose decomposing microbial strains. In the present study, the abundance, structural diversity, and cellulolytic potential of the culturable bacterial community were studied in 5‐year old rice–pulse system under different resource conservation technologies. Higher cellulose (68% more) and xylanase (35% more) activities were observed under zero tilled soil. The populations of cellulolytic bacteria were significantly higher (44%) in zero tillage (ZT) treatment than those of conventional practice. Results revealed that the cellulolytic bacterial diversity was found to be significantly higher under ZT practice, but the present population may not be sufficient for effective recycling of organic wastes in this system. Out of 290 bacterial isolates, 20 isolates had significantly higher cellulolytic activities, of which the top three superior isolates were received from ZT practice. The cellulolytic bacterial diversity based on 16S rDNA sequencing data revealed that the Firmicutes was the most dominant phyla and the Bacillus spp. were the common genus, the observation also showed that there were 17 different haplotypes were recorded among 20 isolates of cellulolytic bacteria. The present findings indicated that long‐term ZT in the rice–pulse system could be a unique source for efficient cellulose decomposing bacteria and further the efficient bacterial strains isolated from this system can be used as efficient bioinoculants for in situ as well as ex‐situ decomposition of rice straw particularly in conservation agriculture.     

Divergent memory responses driven by adenoviral vectors are impacted by epitope competition

Adenoviral vectors induce robust epitope‐specific CD8⁺ T cell responses. Within the repertoire of responses generated both conventional memory evolution and the phenomenon of memory inflation are seen. The rules governing which epitopes inflate are not fully known, but may include a role for both antigen processing and competition. To investigate this, we looked at memory generated from vectors targeting the Gp33‐41 (KAVYNFATC/K9C) epitope from the gp of lymphocytic choriomeningitis virus (LCMV) in mice. This well‐described epitope has both the Gp33‐41 and Gp34‐41 epitopes embedded within it. Vaccination with a full‐length gp or a minigene Ad‐Gp33/K9C vector‐induced conventional memory responses against the immunodominant Gp33/K9C epitope but a strong inflationary response against the Gp34/A8C epitope. These responses showed sustained in vivo function, with complete protection against LCMV infectious challenge. Given the unexpected competition between epitopes seen in the minigene model, we further tested epitope competition using the full‐length Ad‐LacZ (β‐galactosidase) model. Generation of an Ad‐LacZ vector with a single amino acid disruption of the inflationary β‐gal_96‐103/D8V epitope transformed the β‐gal_497‐504/I8V epitope from conventional to inflationary memory. This work collectively demonstrates the importance of epitope competition within adenoviral vector inserts and is of relevance to future studies using adenoviral vectored immunogens.     

Diversity and association of HLA/KIR receptors with type 2 diabetes in South India

The present study was undertaken to delineate the association(s) of KIR–HLA combination in South Indian Type 2 diabetes mellitus (T2DM) patients. The T2DM patients (n = 343) and healthy controls (n = 309) were genotyped for KIR/HLA ligands by PCR‐SSP method. The increased frequency of activatory KIR (aKIR) 2DS2 (OR = 1.91; p < 2.91 × 10^?4) was observed in patients suggesting a susceptible association. The frequencies of iKIR 2DL2 (OR = 0.38; p < 1.55 × 10^?5) and aKIRs 2DS1 (OR = 0.60; p < 0.001) and 3DS1 (OR = 0.52; p < 5.83 × 10^?5) were decreased in patients suggesting protective associations. The C1/C2 combinatorial analysis has revealed an increased frequency of C1⁺/C2^? in T2DM patients (OR = 1.62; p < 0.014). The KIR “AB” genotype (OR = 2.41; p < 3.87 × 10^?5) was observed to be higher in patients. However, the “BB” genotype (OR = 0.32; p < 4.71 × 10^?7) was increased in controls. The KIR motifs, “Tel‐B/B” (OR = 1.84; p < 0.007), were observed higher among patients. However, the frequency of “Tel‐A/B” motif genotype was decreased in patients (OR = 0.56; p < 3.13 × 10^?4). The iKIR/HLA combinations such as 2DL2/3 +C1 and 3DL2+A3/A11 were increased in patients (OR = 3.90; p < 7.5 × 10^?5) suggesting susceptible associations. On the contrary, the aKIR+HLA combinations such as 2DS2+C1, 2DS1+C2 and 3DS1+Bw4 were less frequent in patients (OR = 0.32; p < 4.2 × 10^?4) suggesting protective associations. Thus, the present study clearly establishes the positive and negative associations of different KIR–HLA receptor combinations with T2DM in South India.