Mosquito larvicidal properties of Orthosiphon thymiflorus (Roth) Sleesen. (Family: Labiatae) against mosquito vectors, Anopheles stephensi, Culex quinquefasciatus and Aedes aegypti (Diptera: Culicidae)

ObjectiveTo determine the mosquito larvicidal activities of hexane, chloroform, ethyl acetate, acetone and methanol leaf extract of Orthosiphon thymiflorus (O. thymiflorus) against Anopheles stephensi (An. stephensi), Culex quinquefasciatus (Cx. quinquefasciatus) and Aedes aegypti (Ae. aegypti).MethodsThe larvicidal activity was assayed against three mosquito species at various concentrations ranging from (50-450 ppm) under the laboratory conditions. The LC₅₀ and LC₉₀ value of the O. thymiflorus leaf extract was determined by Probit analysis.ResultsThe LC₅₀ values of hexane, chloroform, ethyl acetate, acetone and methanol extract of O. thymiflorus third instar larvae of An. stephensi were LC₅₀= 201.39, 178.76, 158.06, 139.22 and 118.74 ppm; Cx. quinquefasciatus were LC₅₀=228.13, 209.72, 183.35, 163.55 and 149.96 ppm and Ae. aegypti were LC₅₀=215.65, 197.91, 175.05, 154.80 and 137.26 ppm, respectively. Maximum larvicidal activity was observed in the methanolic extract followed by acetone, ethyl acetate chloroform and hexane extract. The larval mortality was observed after 24 h exposure. No mortality was observed in control.ConclusionsThe present results suggest that the effective plant crude extracts have potential to be used as an ideal eco-friendly approach for the control of mosquito vectors. This study provides the first report on the larvicidal activity of this plant crude solvent extract of against An. stephensi, Cx. quinquefasciatus and Ae. aegypti mosquitoes.     

Evaluation of larvicidal and pupicidal activity of Morinda citrifolia L. (Noni) (Family: Rubiaceae) against three mosquito vectors

ObjectiveTo evaluate the mosquito larvicidal and pupicidal activity against three important medically mosquito vector such as malarial vector, Anopheles stephensi (An. stephensi), dengue vector, Aedes aegypti (Ae. aegypti) and filarial vector Culex quinquefasciatus (Cx. quinquefasciatus).MethodsMorinda citrifolia (M. citrifolia) leaf was collected in and around Alleppy districts, Kerala, India. M. citrifolia leaf was washed with tap water and shade dried at room temperature. An electrical blender powdered the dried plant materials (leaves). From the leaf, 1 kg powdered was macerated with 3.0 L of methanol sequentially for a period 72 h and filtered. The crude plant extracts were evaporated to dryness in rotary vacuum evaporator. The larvicidal and pupicidal activity was assayed at various concentrations ranging from (100–500 ppm) under the laboratory as well as field conditions. The LC₅₀and LC₉₀value of the M. citrifolia leaf extract was determined by Probit analysis.ResultsThe plant extract showed larvicidal and pupicidal effects after 24 and 48 hrs of exposure; All larval instars and pupae have considerably moderate mortality; however, the highest larval and pupal mortality was methanolic extract of M. citrifolia observed in three mosquito vectors at 48 h. The LC₅₀and LC₉₀of M. citrifolia against the first to fourth instar larvae and pupae against mosquito vectors. An. stephensi had values of LC₅₀=146.08, 159.07, 172.16, 185.08 and 202.68 ppm and LC₉₀=322.12, 363.48, 388.56, 436.51 and 513.56 ppm, respectively. The Ae. aegypti had values of LC₅₀=181.27, 210.40, 229.80, 256.73 and 292.01 ppm and LC₉₀=407.99, 485.65, 534.14, 624.16 and 756.79 ppm, respectively. The Cx. quinquefasciatus had values of LC₅₀=226.70, 256.97, 290.05, 316.33 and 358.11 ppm and LC₉₀=560.35, 652.07, 733.03, 797.09 and 875.25 ppm, respectively at 24 h.ConclusionsThe results of the leaf extract of M. citrifolia are promising as good larvicidal and pupicidal activity against the mosquito vector, An. stephensi, Ae. aegypti, Cx. quinquefasciatus. This is a new eco-friendly approach for the control of vector control programs. Therefore, this study provides first report on the larvicidal and pupicidal activities against three species of mosquito vectors of this plant extract from India.     

Retrospective study of antibiotic resistance among uropathogens from rural teaching hospital,Tamilnadu, India

ObjectiveTo determine the community associated urinary tract infection (UTI) causing uropathogen's prevalence, antibiotic resistance pattern and the risk factors predisposing infection in Indian rural settings.MethodsA pilot study was conducted between January and December 2010 among out patients attending rural teaching medical college hospital at Tamilnadu, India. The demographic details, culture, common antibiotic Kirby-Bauer disc diffusion assay susceptibility profiles of the isolates and the resistance analysis by WHONET 5.6 software were performed.ResultsDuring this surveillance study, a total number of 1 359 urinary samples were collected, among which 309 (22.78%) gave positive culture. The common uropathogens encountered were Escherichia coli (66.02%), Staphylococcus sp. (12.62%), Klebsiella sp. (5.83%), Streptococcus sp. (5.18%), Enterococcus sp. (2.59%) and Proteus sp., (2.26%). Antibiotic resistance analysis revealed the multiple drug resistance nature of the isolates to the commonly used antibiotics. It is also found that both genders at the specific age group of 40-50 were more prone to infection and seasonal variations also play an important role in their establishment.ConclusionsThe obtained results suggest that antibiotic selection for empirical treatment should be based on individual drug-sensitive test results. There is also an urgent need to develop a new combination of chemotherapeutic agents and awareness on antibiotic use for the effective UTI management in rural settings.     

MDCT Derived Left Ventricular Function in Relation to Echocardiography: Validation and Revising the Role with the Evolving Technology

Background:

Coronary computed tomography angiography (CCTA) is a frequently performed examination for coronary artery disease. When performed with retrospective gating, there is an opportunity to derive functional parameters of left ventricle utilizing automated software. Complementary information, if validated with established standards, will enhance the total value of study.

Objective:

Study evaluates the usefulness of fully automated software for the assessment of left ventricular ejection fraction (LVEF) using 64-slice CCTA data and to correlate CT results with echocardiography (ECHO). Role of CT derived LV function is reviewed in the light of emerging technologies and recent developments in multidetector CT (MDCT).

Materials and Methods:

A total of 113 patients referred for MDCT CCTA for evaluation of coronary artery disease. All patients were scanned on 64 slice GE-Helical CT scanner and had an ECHO done within 1 week of the CT scan. Retrospectively electrocardiogram (ECG)-correlated image reconstruction was performed with the reconstruction at 10% R-R interval increment. Axial image sets were analyzed with advanced workstation using a program-Auto ejection fraction, Circulation: GE Medical Solutions.

Results:

The mean LVEF calculated by clinical ECHO was 58.6 ± 4.5% and by fully automated software based on CTA data was 58.9 ± 5.4%. The Pearson''s regression analysis showed a large correlation, with a correlation coefficient of 0.503 (P < 0.001). Bland-Altman analysis showed a trend towards MDCT resulting in slightly higher values for LVEF when compared with ECHO.

Conclusion:

The fully automated software is simple, reliable, and user-friendly, and can provide rapid assessment of LV functional parameters with good reproducibility. Despite of good correlation, fewer patients are likely to benefit, in future, from this function due to smaller number of patients undergoing CCTA with retrospective gating.     

Modality of RRT and Recovery of Kidney Function after AKI in Patients Surviving to Hospital Discharge

Background and objectives

Observational evidence has suggested that RRT modality may affect recovery after AKI. It is unclear whether initial choice of intermittent hemodialysis or continuous RRT affects renal recovery, survival, or development of ESRD in critically ill patients when modality choice is made primarily on hemodynamics.

Design, setting, participants, & measurements

We performed a retrospective cohort study examining adults (≥18 years old) admitted to intensive care units from 2000 to 2008 who received RRT for AKI and survived to hospital discharge or 90 days. We analyzed renal recovery (alive and not requiring RRT) and reasons for nonrecovery (death or ESRD) at 90 and 365 days. Conditional multivariable logistic regression was used to assess differences in renal recovery at 90 and 365 days between continuous RRT and intermittent hemodialysis. Models were stratified by propensity for continuous RRT and adjusted for age and reference creatinine.

Results

Of 4738 patients with Kidney Disease Improving Global Outcomes stage 3 AKI, 1338 (28.2%) received RRT, and 638 (47.7%) survived to hospital discharge (353 intermittent hemodialysis and 285 continuous RRT). Recovery from AKI was lower for intermittent hemodialysis versus continuous RRT at 90 days (66.6% intermittent hemodialysis versus 75.4% continuous RRT; P=0.02) but similar at 365 days (54.1% intermittent hemodialysis versus 59.6% continuous RRT; P=0.17). In multivariable analysis, there was no difference in odds of recovery at 90 or 365 days for patients initially treated with continuous RRT versus intermittent hemodialysis (90 days: odds ratio, 1.19; 95% confidence interval, 0.91 to 1.55; P=0.20; 365 days: odds ratio, 0.93; 95% confidence interval, 0.72 to 1.2; P=0.55).

Conclusions

We found no significant difference in hazards for nonrecovery or reasons for nonrecovery (mortality or ESRD) with intermittent hemodialysis versus continuous RRT. These results suggest that, when initial RRT modality is chosen primarily on hemodynamics, renal recovery and clinical outcomes in survivors are similar between intermittent hemodialysis and continuous RRT.     

Incidence and patterns of maxillofacial trauma—a retrospective analysis of 3611 patients—an update

Background

Maxillofacial fractures occur in a significant proportion worldwide and can occur as an isolated injury or in combination with other severe injuries including cranial, spinal, and upper and lower body injuries requiring prompt diagnosis with possible emergency interventions. The epidemiology of facial fractures varies with regard to injury type, severity, and cause and depends on the population studied. Hence, understanding of these factors can aid in establishing clinical and research priorities for effective treatment and prevention of these injuries.

Materials and methods

In this present retrospective study, we provide a comprehensive overview regarding cranio-maxillofacial trauma on 3611 patients to assist the clinician in assessment and management of this unique highly specialized area of traumatology. A preformed pro forma was used to analyze the medical records of patients treated for facial trauma in The Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Chennai. The distribution according to age, gender, etiology, type of injury, time interval between accident and treatment, loss of consciousness, facial bones involved, pattern of fracture lines, treatment offered, and postoperative complications were recorded and evaluated.

Results

We inferred male patients sustained more injuries mostly in the third decade of age. Road traffic accidents were the most common cause of injury. Mandible was the most commonly fractured bone in the facial skeleton. Soft tissue injuries occurred more in road traffic accidents and upper lip was the commonest site of injury.

Conclusion

Our study provides insights into the epidemiology of facial injuries and associated factors and can be useful not only in developing prevention strategies but also for grading the existing legal regulations and also for framing a more effective treatment protocol.

     

Hydroxyethyl starch in severe sepsis: end of starch era?

Expanded abstract

Citation

Perner A, Haase N, Guttormsen AB, Tenhunen J, Klemenzson G, Åneman A, Madsen KR, Møller MH, Elkjær JM, Poulsen LM, Bendtsen A, Winding R, Steensen M, Berezowicz P, Søe-Jensen P, Bestle M, Strand K, Wiis J, White JO, Thornberg KJ, Quist L, Nielsen J, Andersen LH, Holst LB, Thormar K, Kjældgaard AL, Fabritius ML, Mondrup F, Pott FC, Møller TP, Winkel P, Wetterslev J; 6S Trial Group; Scandinavian Critical Care Trials Group: Hydroxyethyl starch 130/0.42 versus Ringer''s acetate in severe sepsis. N Engl J Med 2012, 367:124-34.

Background

Hydroxyethyl starch (HES) is widely used for fluid resuscitation in ICUs, but its safety and efficacy have not been established in patients with severe sepsis.

Methods

Objective

To assess the effects of HES 130/0.4 compared with a balanced crystalloid solution on mortality and end-stage kidney failure in patients with severe sepsis.

Design

Multicenter, parallel-group, blinded, randomized clinical trial, in patients with severe sepsis.

Interventions

Patients with severe sepsis admitted to the ICU received fluid resuscitation with either 6% HES 130/0.42 (Tetraspan) or Ringer''s acetate at a dose of up to 33 ml per kilogram of ideal body weight per day.

Results

Of the 804 patients who underwent randomization, 798 were included in the modified intention-to-treat population. The two intervention groups had similar baseline characteristics. At 90 days after randomization, 201 of 398 patients (51%) assigned to HES 130/0.42 had died, as compared with 172 of 400 patients (43%) assigned to Ringer''s acetate (relative risk, 1.17; 95% confidence interval (CI), 1.01 to 1.36; P = 0.03); 1 patient in each group had end-stage kidney failure. In the 90-day period, 87 patients (22%) assigned to HES 130/0.42 were treated with renal replacement therapy versus 65 patients (16%) assigned to Ringer''s acetate (relative risk, 1.35; 95% CI, 1.01 to 1.80; P = 0.04), and 38 patients (10%) and 25 patients (6%), respectively, had severe bleeding (relative risk, 1.52; 95% CI, 0.94 to 2.48; P = 0.09). The results were supported by multivariate analyses, with adjustment for known risk factors for death or acute kidney injury at baseline.

Conclusions

Patients with severe sepsis assigned to fluid resuscitation with HES 130/0.42 had an increased risk of death at day 90 and were more likely to require renal replacement therapy compared with those receiving Ringer''s acetate.     

Effect of A. lanata leaf extract and Vediuppu chunnam on the urinary risk factors of calcium oxalate urolithiasis during experimental hyperoxaluria.

Urolithiasis is one of the third most common afflictions found in humans. The efficacy of the two Siddha drugs, Aerva lanata and Vediuppu chunnam as antilithic agents using a urolithic rat model were tested in this study. Hyperoxaluria was induced in rats using 0.75% ethylene glycol in drinking water. Aerva lanata(3.0 mg kg(-1)body weight) and Vediuppu chunnam (3.5 mg kg(-1)body weight) were given orally for 28 days. Urinary risk factors of urolithiasis were monitored at the end of 7th, 14th, 21st and 28th days. Urinary volume was increased in hyperoxaluric as well as drug-treated rats. Increased urinary excretion of calcium, oxalate, uric acid, phosphorus and protein in hyperoxaluric rats was brought down significantly by the administration of A. lanata or Vediuppu chunnam. Decreased magnesium excretion in hyperoxaluric rats was normalized by drug treatment. The drug increases the urine volume, thereby reducing the solubility product with respect to calcium oxalate and other crystallizing salts such as uric acid, which may induce epitaxial deposition of calcium oxalate. Drug alone treated rats did not show any adverse effects. Combination therapy was found to be more effective and this indigenous medicine can be used successfully as an antilithic agent.     

Larvicidal efficacy of Catharanthus roseus Linn. (Family: Apocynaceae) leaf extract and bacterial insecticide Bacillus thuringiensis against Anopheles stephensi Liston.

ObjectiveTo explore the larvicidal activity of Catharanthus roseus (C. roseus) leaf extract and Bacillus thuringiensis (B. thuringiensis) against the malarial vector Anopheles stephensi (An. stephensi), when being used alone or together.MethodsThe larvicidal activity was assayed at various concentrations under the laboratory and field conditions. The LC₅₀ and LC₉₀ values of the C. roseus leaf extract were determined by probit analysis.ResultsThe plant extract showed larvicidal effects after 24 h of exposure; however, the highest larval mortality was found in the petroleum ether extract of C. roseus against the first to fourth instars larvae with LC₅₀=3.34, 4.48, 5.90 and 8.17 g/L, respectively; B. thuringiensis against the first to fourth instars larvae with LC₅₀=1.72, 1.93, 2.17 and 2.42 g/L, respectively; and the combined treatment with LC₅₀=2.18, 2.41, 2.76 and 3.22 g/L, respectively. No mortality was observed in the control.ConclusionsThe petroleum ether extract of C. roseus extract and B. thuringiensis have potential to be used as ideal eco–friendly agents for the control of An. stephensi in vector control programs. The combined treatment with this plant crude extract and bacterial toxin has better larvicidal efficacy against An. stephensi.